Dwindling international aid to north-west Syria this past year has left approximately 3.1 million people, including 2.8 million internally displaced people, facing a health crisis as hospitals and other medical facilities struggle to operate on low resources, Amnesty International said today.
Medical facilities in this part of the country, which is under the control of the armed opposition group Hay’at Tahrir al Sham, rely entirely on funding from the international community to provide free health services and medication. Over the past ten months, international aid to the health sector, dropped by more than 40% due to the overall reduction of international assistance to Syria.
“It should go without saying and, particularly after two years of the pandemic, that healthcare systems are critical services that people need for survival. This past year’s massive funding drop has immediately translated into the closure of hospitals and vital services, and has left millions of Syrians – who have already suffered conflict and violence – struggling to access medication and other essential health care,” said Lynn Maalouf, Deputy Regional Director for the Middle East and North Africa at Amnesty International.
“International donors meeting in Brussels next week should prioritize ensuring adequate funding for health and other essential services as millions of people face the appalling prospect of being denied access to health care amid a worsening crisis. Everyone’s right to health must be protected, which means being able to access health services when needed, without worrying about the financial cost.”
Amnesty International interviewed eight doctors and health workers, four people who recently sought medical care and four humanitarian aid workers, each of whom described how the funding cuts have led to a shortage of resources and medication, leading to a scaling-down of operations and vital services.
The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that only 25% of the required funds for Syria’s health sector had been secured as of December 2021, compared to 67% in July 2021. According to Idlib’s health directorate, 10 out of 50 hospitals, including six gynaecology and pediatric hospitals, 12 primary healthcare centres and three specialist medical centres have lost funding in 2022. Other healthcare facilities that have longer contracts for the next few months or years, will also be at risk of closure if their contracts are not renewed.
Reduced capacity and supplies place health and lives at risk
Shortages in staff, medicines, equipment, and reduced operational capacities prompted hospitals to scale back their services putting people’s lives at risk. Four hospital managers told Amnesty International that their facilities face imminent risk of closure if funding is not secured urgently.
“Before the funding cuts in December 2021, we used to receive about 500 outpatients and inpatients a day. Today, we can receive 10% of that number, because we suspended all services except for basic treatment in the emergency room,” the manager of an obstetrics and paediatrics hospital said.
The manager of another obstetrics and paediatrics hospital said they had to close the neonatal intensive care unit and operate only four out of eight incubators. He described a distressing incident that took place shortly after the funding cuts early this year, when he couldn’t offer respiratory support to an infant who needed a ventilator: “His parents begged me for help, but I had no choice but to turn them away.”
Another doctor told Amnesty International how shortages in health care services were threatening lives: “On one occasion this year, a patient with a heart attack was rushed to our emergency unit. We did not have oxygen for a ventilator, so we tried to transfer him to another hospital in an ambulance, but he passed away before getting there.”
A doctor working in another hospital that lost funding in August 2021 shared a similar story, saying: “In January , we received a five-month-old baby in the emergency unit with severe malnutrition and respiratory failure. He needed intensive care support, but we didn’t have a spot for him due to lack of capacity and staff shortages. We intubated him in the emergency unit and gave him manual respiratory support for four hours as we tried to find him a spot in another hospital. Unfortunately, we were not able to find any and he passed away.”
All doctors and health system users interviewed by Amnesty International said they had seen a shortage in essential medications, especially for chronic illnesses. One doctor said his hospital had even struggled to obtain anaesthetics.
A midwife said that the lack of medication and supplies deterred women from seeking antenatal care. She said: “Women told me they wouldn’t go all the way to a health centre that wouldn’t offer them the needed medications for free. Sometimes even the most basic supplements for pregnant women, like folic acid, are not available.”
A woman who had recently given birth told Amnesty International: “I could not afford the medicines the doctor prescribed me, so I did not buy them. The hospital used to provide us with such medication for free before it lost funding.”
A lack of funding also means that health workers, whose salaries were covered by aid contracts, now work at multiple facilities simultaneously to secure a sufficient income. Other health workers have not been paid due to a lack of funding. Seven medical workers told Amnesty International that they have been working without pay for months.
Inaccessible, unaffordable healthcare
Hospital closures coupled with a reduction in services and the high cost of private healthcare services make accessing healthcare extremely difficult for many people in north-west Syria. Patients now have to travel longer distances to find a hospital or a medical centre. Public transportation is often limited and, for many, the cost of transportation is unaffordable.
The father of a child who suffers from asthma said: “A while back, my son had an asthma attack. As usual, I rushed him to a nearby hospital, but found out the hospital lost funding… The one available doctor in the emergency room told me the child needed urgent admission to a hospital. I had to borrow money and take him in a private car to a hospital in Idlib, around 60 kilometres away.”
A pregnant woman had been receiving antenatal care in a local hospital, but struggled to find a hospital in which to give birth after the local facility suspended its operations due to funding cuts.
She told Amnesty: “I was in severe pain. My husband asked around until someone told him there is an available spot in Jisr Al-Shughour, which is an hour away. We went all the way there. But then it turned out there were only midwives available, not an obstetrician, and I needed a C-section. Eventually, I had to go to a private hospital. We borrowed money and paid every penny we had to cover the costs.”
“Donors have the power to rectify this devastating situation. Their decisions have a direct impact on people’s access to healthcare at a time when they are suffering more than ever. What is happening in north-west Syria right now is a terrible humanitarian crisis,” said Lynn Maalouf.