Syrian public health sector fights Covid-19 amid US-EU sanctions

They seek donors to send cash to build hospitals in secret locations employing doctors who refuse to state their name. Yet, Syria is full of University medical teaching hospitals, public hospitals, and private hospitals, including the French and Italian hospitals. Additionally, the Syrian system of neighbourhood and village public clinics is being used for inoculations of the newest Covid-19 vaccines.

Syrian Ministry of Health and the WHO

On May 24 the 74th session of the World Health Assembly was held virtually in Geneva, with Syria participating among the 194 member states. The Syrian delegation was headed by Syrian Minister of Health Dr. Hassan al-Ghabash, who presented Syria’s plans to respond to the Covid-19 pandemic, especially about supporting medical analysis laboratories and tracking the implementation of vaccination plans against the Coronavirus and the impact of its spread in health and the application of the primary health care program.

On May 9 the World Health Organization (WHO) delivered 40 equipped ambulances to the Syrian Ministry of Health. “The ambulances, which will be put into service immediately, will enhance the emergency health system that has been devastated by attacks against health facilities. While further assistance is required to strengthen emergency services, I would like to convey my appreciation to the WHO country office in Syria and to Dr. Ahmed Al-Mandhari, WHO’s Regional Director for the Eastern Mediterranean, who discussed the provision of this support during his last visit to Syria in October 2020,” said Dr. Hassan al-Ghabash.

The delivery of these ambulances will enhance the ability of public health services to respond to medical emergencies, provide timely referrals for patients in severe and life-threatening conditions, especially for people living in hard-to-reach areas or those not able to afford transportation. The delivery is part of a strategy to strengthen the capacity of Syria’s public health emergency operations center, established with the support of WHO in 2020, in Damascus.

Covid-19

Syria has signed on to the Covax initiative, with the first shipment of the AstraZeneca vaccine having arrived in Damascus and the vaccination of health care workers having been followed by ongoing inoculations of the public over 50-years of age across the country.

The Syrian Ministry of Health, with the support of WHO and UNICEF, has trained field staff at the governorate level on microplanning, service delivery, communication, infection, prevention, and control, as well as adverse events following immunization.

The United Arab Emirates sent their 4th shipment of Covid-19 vaccine doses to Damascus on May 5. The plane was sent by the Emirates Red Crescent (ERC), in coordination with the Syrian Red Crescent Association, to assist the Syrian health sector in addressing the repercussions of the pandemic and support local preventive measures aimed at curbing the spread of the virus.

The government has recorded 19 000 Covid-19 cases, including more than 1200 deaths.

Sanctions

The US-EU sanctions have continued against the Syrian people, despite the spread of the coronavirus. Last year, the former Syrian Health Minister, Dr. Nizar Yazigi, said during the 73rd Session of the WHO World Health Assembly that “harsh and unjust” US and European sanctions hinder efforts to combat the coronavirus in Syria.

The EU imposed sanctions on the Syrian government in 2011, renewing them on an annual basis. The sanctions include an oil embargo, restrictions on certain investments, a freeze of the assets of the Syrian central bank held in the EU, export restrictions on equipment and technology with dual use as well as on equipment and technology for the monitoring or interception of internet or telephone communications. The sanctions make it costly and difficult for western companies to get a sanctions deferment to sell medical products, including medicines, to Syrian hospitals and doctors, including private facilities. This results in medical machines sitting idle in hospitals and clinics for want of a replacement part, which can’t be obtained because of sanctions.

On May 25 the Syriac Catholic patriarch, Patriarch Ignace Joseph III Younan, called on Western countries to lift “all economic sanctions against Syria because they only harm the innocent.”

“The economic sanctions imposed on Syrian people by the Western governments in the name of democracy and political liberty have created horrendous consequences in a country that endured wars, siege, and abandonment for over 10 years,” Patriarch Younan said after visiting Syria for 10 days and visiting three dioceses: Homs, in central Syria; Aleppo in the north; and Damascus, the capital.

“Ordinary people are suffering poverty that borders on starvation,” Patriarch Younan said. He cited the lack of medicine, food, and fuel for electricity and transportation. “Despite the joy of the encounters and visits, one could not ignore the feelings of sadness and resentment in the heart of many,” Patriarch Younan said.

“It is time for all people of goodwill, especially in Western nations, to understand that the situation in Syria continues to be humanly unbearable and devastating. It risks emptying this war-torn country of its Christian community for good,” Patriarch Younan stressed.

The Syrian-born patriarch, who led Syriac Catholics in the United States and Canada from 1986 to 2009, said “It is clear that the Western governments have had a wrong reading of the Syrian situation, its religious, confessional and ethnic diversity. They hastened to support the violent uprising, mostly for geopolitical reasons, imagining a democracy that is undoubtedly unfit for the Middle East region, that ignores the separation of church and state, religion and politics.”

In Aleppo, Patriarch Younan chaired the May 18-20 annual meeting of the Council of Heads of Catholic Churches in Syria with Cardinal Mario Zenari, the Vatican nuncio to Syria, attending. In his opening remarks, Zenari noted that the economic sanctions implemented against Syria, including those implemented by the US, affect the most vulnerable Syrian citizens “in the heart of their daily life,” so much so that “the garbage containers in the streets have become a source of food for the poorest.”

The final statement issued from the meeting demanded that “the unjust sanctions imposed on Syria” be lifted immediately.

Nursing and midwives

Despite the 10 Years of conflict and Covid-19, midwives in Syria continue to save lives. May 5 marked the International Day of the Midwife, highlighting their contributions to the delivery of quality reproductive health services including safe delivery, especially in remote and rural areas. Currently, 10 nursing schools are functioning under the supervision of the Syrian Ministry of Health. About, 4070 midwives are working in the public sector in all Syrian governorates with the majority of midwives working in the central cities. Based on the recent reports of the Ministry of Health, these schools graduate around 300 nurses and 45 midwives per year. The support of the Ministry of Health is providing the health facilities with reproductive health equipment and supplies including Covid-19 protection kits and is building the capacity of health workforces on RH issues including midwifery subjects and rehabilitation of the health facilities.

Damascus

In mid-March, a health ministry official said intensive care units (ICUs) dedicated to coronavirus patients had reached full capacity across the capital for the first time since coronavirus swept into Syria. In April, Mouwasat Hospital, one of the largest Hospitals in Damascus, was inundated with Covid-19 patients. Damascus has a University medical center, numerous public hospitals, as well as the historic French and Italian Hospitals which never shut down even in the darkest days of terrorist attacks on the capital. Damascus is now free of terrorists and has been safe for families looking to rebuild their lives after the conflict.

Aleppo

On May 17, Syrian Minister of Health Dr. Hassan al-Ghabash inaugurated the building of the General Authority of Aleppo Eye Surgery Hospital. The hospital, which was destroyed by terrorists, has since been rehabilitated and equipped with the necessary medical equipment. It consists of two floors, 1,800 square meters, with a capacity of 25 beds, and it includes all specialized clinics and two operating rooms.

The University of Aleppo is a public university located in Aleppo, Syria, and is the second-largest university in Syria after the University of Damascus. The University of Aleppo operates numerous hospitals: Aleppo University Cardiovascular Surgical Centre; Aleppo University Hospital (AUH); OB/GYN Hospital; Oral and Maxillofacial Surgical Centre; Surgical Ambulance Hospital.

In January of 2013, rockets fired by Jibhat al-Nusra, the Al Qaeda affiliate in Syria, slammed into the University of Aleppo killing 15 people, and causing severe damage. Later the same year in Aleppo, the Al Kindi Hospital, considered one of the most modern in the country, was utterly destroyed by terrorists who used extensive explosives to blow the large facility into dust and rubble.

Latakia

On March 4 a technical medical report was published of the case of a 21‐year‐old Syrian female with a large ovarian steroid cell tumor. The medical report was issued by the Department of Pathology, Cancer Research Center, Faculty of Medicine, Tishreen University, Lattakia, Syria, the third-largest university in Syria. It was established in 1971 and has 21 faculties including Medicine, Pharmacy, Dentistry, Science, and Nursing.

Idlib

While 10-years of war have ravaged many parts of Syria, the fighting is over in all locations except the terrorist-controlled province of Idlib, which is an agricultural area east of Latakia and west of Aleppo. Hayat Tahrir al-Sham was formerly named Jibhat al-Nusra, the Al Qaeda affiliate in Syria.

Al Qaeda is an internationally recognized terrorist group following Radical Islam, and has never been a Syrian rebel group, or a ‘moderate rebel group’.

International charities and aid agencies are fully represented there and the medical needs of those civilians living under, or perhaps working with Hayat Tahrir al-Sham, are being administered to, including vaccines for COVID-19. The government of Turkey is also occupying areas in Idlib and has provided aid to the civilians held under armed occupation there.

Northeastern Syria

The SDF and YPG partnered with the US in the fight to defeat ISIS. In the process, the US-supported their partner, the Kurdish self-administered area of northeast Syria as they fought against the Syrian government to form their own ‘homeland’ from land they stole while committing ethnic cleansing. The area is not the scene of battles now and is stable. The US and Turkey are both foreign occupiers in the area, but the Russians and the Syrian government are both presents as well in a balancing game of the status quo. In this quadrant of Syria, there is real need and suffering, because the Turkish are the enemy of the SDF and YPG, and do not provide medical or humanitarian supplies. The US is the friend of the SDF and YPG but is also not supplying medical or humanitarian supplies, just a small group of ground troops with equipment. The Syrian government, and their ally Russia, do supply the sections they occupy with medical aid and humanitarian supplies, but the area they have access to is limited. To add to the misery, there are multiple detainment camps housing thousands of ISIS fighters and their wives and children. Many are foreigners, but European countries do not want to take back their terrorist citizens. These camps are under-funded hell-holes of misery. The Kurds are tasked with caring for the detainees, but the Kurds don’t have the financial resources to do the job adequately. There is no Covid-19 vaccine program in the area.

“It is shocking that one year into the outbreak, the region of Northeastern Syria still struggles to find the essential Covid-19 supplies,” said Crystal Van Leeuwen, MSF medical emergency manager for Syria. “There is a clear lack of laboratory testing, inadequate hospital capacity to manage patients, not enough oxygen to support those who need it most and limited availability of personal protective equipment for health workers.”

In the two Covid-19 hospitals that MSF supports in the region, in Hassakeh and Raqqa, medical teams have seen a sharp increase in confirmed cases in the past month, including among health workers. With a PCR test positivity rate as high as 47 percent, it is clear that many cases have gone unidentified due to limited testing capacity in the region.

Many people in northeast Syria are already experiencing limited access to health and water and sanitation services, making them especially vulnerable to this second wave of the outbreak. In the Covid-19 treatment facilities supported by MSF, the mortality rate continues to rise as the health services become more strained.

James Jeffrey, the former US envoy to Syria, advised the Kurdish leaders to make peace with the Syrian central government in Damascus. The Kurds chose to not heed his advice, and they have no one to blame but themselves.