Syrians began arriving in the United States as immigrants in the late 1800s (right after the American Civil War).

The first wave of immigration from the Middle East & North Africa continued through the 1920s. This initial wave of immigrants consisted of Arab Christians from the Ottoman Empire & the Province of Syria, now modern-day Lebanon, Israel, Palestine, & Syria.

The second wave of Syrian immigration to the U.S began in 1948 (at the beginning of the Cold War) and continued through 1965 (when America was in the middle of the Vietnam war).

In 1973, Sadat of Egypt won the Israeli-Arab war, and promptly made peace with Israel. This awarded him the Nobel Peace Prize.

The war also involved the Golan Heights (part of Syria) and this was still a conflict zone. Many Syrians immigrated to Egypt during that time.

During the 1980s and up until early 2000s, Syria was a relatively stable political state, and the immigration rate to the U.S significantly dropped during that time (albeit many came to the U.S as non-immigrant workers e.g doctors, engineers, lawyers, students, athletes).

After the so-called “Arab Spring” of 2011, many Middle-Eastern countries (including Syria) began demanding social & economical reform from their governments. This resulted in toppling of dictators like Ben Ali of Tunisia & Mubarak of Egypt.

But Assad of Syria remained in power.

Emboldened by Putin & the Russian intelligence, Assad embarked on a massacre spree, killing his own people to remain in power.

This divided the country & provided ISIS (already gaining control of Iraq after Saddam Hussein’s death) an ample opportunity to infiltrate Syria.

The Syrian people started suffering colossally & were forced to flee Syria & seek asylum elsewhere. Here is a chart of neighboring countries in which the displaced Syrians were able to seek refuge. Notice how the rich Arab countries like Saudi, Qatar, & UAE are curiously missing.

Also notice how Turkey, the non-Arab country disliked by the Arab countries that did not take Syrian refugees (eg Saudi, UAE) took in the MOST Syrian refugees.

Between the beginning of the Syrian conflict in 2011 until 2014, the rate of immigration and asylum application in the U.S was minimal. In 2016, things significantly changed.

Here are the major states in America in which Syrian immigrants settled. Notice how California, Texas & Illinois are the top 3 states chosen by Syrian immigrants. As a New Yorker, I was confused (at first) as to why Syrians did not choose to settle in the “center of the universe”

It would actually take me 2 years to know the answer to that perplexing question. During those 2 years, I volunteered to take care of the medical needs of the Syrian refugees — most of whom had chronic conditions like CVD, DM, psych, endocrine disease.

Curiously, many had LTBI.

Here is the burden of LTBI in countries accepting most Syrian refugees.

The problem is, I attended to Syrian patients in Egypt, Lebanon, & Turkey. But most healthcare facilities (& healthcare workers including doctors) in those countries lack the drugs & training to treat LTBI.

I knew HIV & syphilis weren’t going to be prevalent in the Syrian refugee population (I was right).

But I was SHOCKED to find out the prevalence of HBV & HCV was not high either (I thought I would find many cases).

Most liver disease cases in these folks were from diabetes.

As I learned more about the culture & mentality of the Syrian people, I realized that they are natural entrepreneurs by default. Running a business is in their DNA.

That’s when I finally knew the answer to the question that was bugging me for 2 years!

California, Texas, & Illinois have better infrastructure & opportunities for individually run, family owned small business. New York is a BEAST, and the competition is horrible. So the Syrians preferred states that gave them more freedoms to run a business.

This was very different from the Syrian population of New York. Most of which immigrated many, many decades ago and are referred to as “old money” (ie import/export & oil/gas business).

While both are Syrian, the mentalities couldn’t be more different.

I have taught & mentored many medical students & residents from Syria. They’re FRIGHTFULLY smart people. I’ve been to many countries in Europe & saw how successful Syrian restaurants, tailor shops & cobblers are.

NONE of them would’ve opted to leave Syria if they weren’t forced.

I’m hopeful that Biden the President will be better than Biden the Vice President. There are many things America can do to help the Syrian refugees & restore some sort of normalcy in Syria.

As a final note, if you haven’t had a chance yet, please see Aleppo the film (produced by @SeeFisch, directed by @anthonygrippa & translated by @Rx_Ed) that portrays the HORRIFIC events Syrian doctors go through amid constant bombing of hospitals in #Syria. Here’s the trailer: