Syria's healthcare system on life support after 13 years of war and western sanctions

Doctors warn that the struggle to obtain medicine and repair hospitals has put patients' lives at risk

A nurse at the Ibn Al Nafis Hospital, in Damascus. Only 50 per cent of Syria's hospitals are fully functional. AFP

Thirteen years of grinding war and crippling western sanctions have left Syria’s healthcare system in ruins, with the stricken sector marred by collapsed hospitals and pharmaceutical factories, as well as chronic shortages of medical staff and life-saving medicine, humanitarian officials and health professionals told The National.

The country's healthcare system was once among the most self-sufficient in the region, but now only 50 per cent of hospitals are fully functional. About 26 per cent maintain partial operations and 24 per cent are not functional at all, said Guglielmo Zambiasi, a healthcare specialist with the International Committee of the Red Cross.

The functional hospitals are mainly found in major cities including Damascus, Hama, Aleppo, Tartus and Latakia.

“A lot of people are trying to find health care in these hospitals, but their medical systems are damaged and have reached a level where they need to be rehabilitated,” Mr Zambiasi told The National.

In government-held areas, authorities are “trying to keep hospitals functional”, but there have been many cases when the “overwhelming number of patients and damage to the machines" affected the care given to those in need, he added.

Suhair Zakkout, a spokeswoman for the ICRC in Syria, told The National that the civil war, which began with an uprising against the Syrian governement in 2011, has devastated every aspect of life in the country. “The efforts of the ICRC and other humanitarian groups have been just to sustain the minimum basic needs of the population. It cannot amount to the level of having people to recover from the conflict,” she added.

She warned that humanitarian assistance in the country is only enough to keep "Syrians' noses above the water".

"This is not enough. What Syrians need now is to really start the recovery."

More than 12 million people in Syria are in dire need of health care, the World Health Organisation says. The crisis has been exacerbated by a lack of medical staff, a problem the UN body says has been "driven by displacement, death, injury and flight of health workers, particularly in north-east Syria".

The destruction of infrastructure during the war, strict sanctions imposed by western powers and the Covid-19 pandemic have pushed Syria's health services to the brink. The fighting has eased since 2011, but many organisations warn the health sector remains in a critical state.

“Now the situation is impacting everyone,” Mr Zambiasi said. “Before we were able to react to an emergency, now we don’t have the means to respond to a crisis."

Hospitals and health centres require extensive repairs if they are to deliver a basic level of care, the UN says. But fixing hospitals is costly and humanitarian groups in Syria do not have the means to restore them. Sanctions also pose major obstacles to the Syrian government's efforts to import medical devices, Aleppo health director Dr Ziad Al Hajj Taha told The National.

“Even the [devices] that we have we can’t repair or get spare parts for, because most companies have left Syria after the sanctions were imposed and do not do business with us any more," he added.

Pressure is mounting on health workers in Idlib province, north-west Syria, after the 7.8-magnitude earthquake last year. Large parts of southern Turkey and northern Syria were devastated, with more than 50,000 people killed.

Syrian GP Wael Al Jerk, 37, told The National that the disaster damaged dozens of clinics and hospitals. “We don’t have enough beds or equipment to cater to the amount of people who need immediate care,” Dr Al Jerk warned.

He said border restrictions also had a severe effect on health care. “People are dying due to lack of medicine and equipment, and because of the border closures and movement restrictions."

Damage to power stations after years of fighting has also hit health hard. It means that even hospitals with medical devices are unable to rely on them.

Sanctions on Syria

External factors have also harmed medical services in Syria. Most prominent are the sanctions imposed by western countries including the US.

Since the beginning of the conflict, Syria has been under one of the most extensive sanctions programmes in the world, the EU Parliament says. The bloc last year extended its sanctions on Syria until June 2024 and, while they do not directly prohibit European exports of medicine, medical equipment and medical assistance, the EU acknowledged its sanctions had unintended side effects on humanitarian efforts.

US sanctions, some of which were imposed before the war, are broader.

“We have lost so many lives because our equipment does not work efficiently and all of that is caused by the sanctions imposed,“ Dr Taha said.

A pharmacist in Damascus agreed that sanctions are "the main issue" harming Syria's health care. "There’s a blockade even on medicine,” he said.

The difficulty of bypassing restrictions has led to a surge in demand for life-saving medication. While only 10 per cent of medicine used in Syria are imported, they include the latest treatments for diseases including cancer.

“There are sanctions on banks so we can’t transfer money to pay for the imported medicine, there are sanctions on flights into Syria, and there’s an embargo on shipping through other countries," the pharmacist added. "How are we supposed to overcome that?”

Dr Taha warned that “imported medicines are almost non existent" in Syria, affecting patients with conditions including cancer and multiple sclerosis.

The EU said some companies were unwilling to engage in any transactions related to a country under sanctions. A health official said companies refused to send supplies "when they know these medicines are going to Syria".

Patients face death

Many patients are facing death due to the shortages, Dr Al Jerk warned. “I had a patient who had a stomach infection but I couldn’t find him the right medicine, which is available all over the world, but we didn’t have it so he died.”

Syria produces between 70 per cent and 90 per cent of its medicine locally, but a lack of raw materials has posed problems to the pharmaceutical industry.

“Many medicines are not available because the factories can’t make them. Some patients live, others don’t make it,” the pharmacist said.

He accused western powers of caring little for the Syrian patients affected by sanctions. “They know Syrians are dying because of these sanctions," he said.

The issue is compounded by the destruction of pharmaceutical factories. It is estimated that about 40 per cent of factories, mainly in Aleppo, have been destroyed or ceased operations. The city still produces up to 70 per cent of the country’s medicine.

Government criticism

The Syrian government and opposition groups have accused one another of deepening the crisis. The government has been criticised for policies such as imposing fixed prices for medicine through the Health Ministry, which fines those who breach the rules "whether it be pharmacists or anyone who manipulates the market prices of medications”, Dr Taha says.

The pharmacist believes that the policy does not take into account the expenses passed on to importers. He also said the monitoring body lacks independence.

“Usually pharmaceutical products are registered through an independent body such as the FDA [the US Food and Drug Administration] which has no relation to the [Ministry of Health] and it would have no effect on it. In Syria, we don’t have this," he said. “If there was a FDA to control the issue, it would be a different situation."

Last year, the ministry launched the National Primary Health Care Strategy 2023-2027, an initiative developed with technical support from the WHO. It outlines the ministry's priorities in achieving universal health coverage and sets out a road map for the recover of Syria's health system, the WHO said.

The UN agency’s representative in Syria, Dr Iman Shankiti, said the strategy “has the potential to impact the lives of millions of Syrians by ensuring access to the care they need, reducing health care costs and improving health outcomes, particularly for those most vulnerable and in need".