Health crisis in Syria: a tragedy in numbers
In March 2021, the war in Syria regrettably entered its tenth year. The conflict has been brutal, and continues to be so. In 2020 the Independent International Commission of Inquiry on the Syrian Arab Republic stated that the decade-long confrontation has seen the use of extremely destructive weaponry, used indiscriminately even against civilian targets. This analysis was confirmed by the European Union’s Asylum Support Office (EASO) which, in a comprehensive report published in July 2021, reviewed the long list of world powers involved in the conflict and counted five independent clashes fought simultaneously in Syria.
It is precisely the EASO document that reports on the numerous attacks on health infrastructure in Syria. In 2020 alone, says the EASO report, there were 28, more than two a month. This translates into a human cost of fifty-five people between injured and dead.
The very high cost paid by the Syrian health system because of the conflict situation is mentioned by many. In a speech to mark the start of the tenth year of the war, Mark Lowcock, the former Under-Secretary of the United Nations Office for Humanitarian Affairs (UNOCHA), recalled that 70% of employees in the health sector had to leave Syria. A very serious haemorrhage, where a humanitarian crisis is raging.
The human damage is just one consequence of the endless barrage of bombings that continue inexorably to destroy the bloodless Levantine health infrastructure (14 attacks in the first six months of 2021 alone). Lowcock recalled in his speech that only 52% of primary care centres were fully functional in December 2019. A figure that had to be updated downwards: in a report that the WHO drew up in October 2020 as part of its health services monitoring programme (HeRAMS), it was found that only 48% of public health centres (emergency rooms, outpatient clinics, etc.) were fully functional. There is also another sad achievement for hospitals: only 49% of them are fully functional.
The health system in Syria is of great concern to institutional bodies: in its Humanitarian Response Plan (HRP) for Syria, drafted in September 2021, the UNOCHA lists health as the second largest item of funding to be raised. More than is required for shelter and non-food assistance. The $576 million that the UN Office estimates is needed for hospitals and medical expenses is exceeded only by the $1,630 million required to address the food emergency, one of the most serious ones currently (Lowcock puts the number of people without access to food at eight million).
Covid-19: a crisis within a crisis
It is within such a framework that efforts have had to be made to deal with the advancing pandemic situation due to Covid-19.
The official data on the number of infections appear to be of little concern, with a daily infection rate currently around 350 cases. They appear to be. In fact, as UNICEF Executive Director Henrietta Fore pointed out in her speech to the UN Security Council in March this year, the real number of infections in Syria cannot be accurately established.
In addition to the ruinous condition of the health facilities, the lack of reliable data is mainly due to the discrepancy in the monitoring systems in the various areas of the country. This discrepancy reflects the political and strategic complication of the ongoing war, rather than answering humanitarian questions.
In fact, according to the latest update (March 2021) of the UNOCHA and WHO report on the Covid in Syria, there seems to be a big difference in the processing of swab data between the North-West and North-East areas.
In the eastern part, between Ar Raqqah and al-Hasakah, governed by the Syrian Democratic Forces affiliated to the Kurdish PKK, the public health structure manages abundantly well, certifying 95% of positives on its own, leaving the rest to international organisations. In the western sector, on the other hand, infamous for hosting the governorates of Aleppo and Idlib and disputed between pro-Turkish militias and pro-government troops, the situation is reversed, and 95% of the swabs are carried out and processed by the WHO, as part of the EWARS programme.
NGOs are trying to fill up the hole left by the Government
This split undoubtedly reflects the state of intensity of the conflict in the various areas: it is precisely the governorate of Aleppo that holds the unfortunate record for the highest number of attacks on public health system centres. And it is again in the territory of Aleppo that all the health workers massacred by the war died on the job between January and March 2021. In short, in the most war-torn territory, international organisations are trying to make up for the lack of established authority.
Yet voices have been raised in protest against WHO’s involvement in north-west Syria, which looks as if it will happen at the expense of the north-eastern regions, cut off from assistance that they too would need, given the pandemic situation. Joan Mustafa, Deputy Director of the Public Health Committee for North-East Syria, has directed strong attacks at WHO, accusing the organisation of favouring north-western regions in the distribution of batches containing vaccine vials.
The first serums, which arrived in Syria between the end of April and the beginning of May, were allegedly entrusted by the WHO to the Syrian ad Interim Government (SIG), which operates in the Idlib governorate, excluding the north-eastern territories. This provoked the anger of Mustafa, who accused the WHO representative in Syria, Akjamal Majtimova, of being indifferent to the humanitarian catastrophe unfolding.
Majtimova responded promptly, assuring that vaccination in north-east Syria was a priority in the region’s vaccination programme, just as it was in the north-west. On the objectively recognised priority of the SIG, Majtimova does not seem to have acted capriciously. As explained in a lengthy article in May in the independent Syrian newspaper Enab Baladi, the SIG has been running the vaccination administration campaign in the area for seven years. It has considerable experience in this area.