Syria’s enduring front lines: Public health care amid COVID-19

    One cannot help but think of the situation in Syria when one hears of the collapse of health systems and the targeting of health professionals in hospitals.

    It is of no surprise that the alarm bells have acutely rung for the prospect of a calamitous outbreak of COVID-19 among areas most vulnerable to it and the most incapable of dealing with it. The province of Idlib in northwestern Syria comes to mind first, and when combined with the dire state of health care there, the situation becomes all the more susceptible to yet another humanitarian disaster in the region.

    The culprit, this time, is not directly the Bashar Assad regime, although the indirect implications of the destruction wrought upon the health care sector in the province by regime and regime-allied forces certainly has not helped. What are in effect tantamount to war crimes, 595 attacks on medical facilities have been registered and mapped by the Physicians for Human Rights group since the outbreak of violence in 2011. Some 537 of those attacks have been attributed to either the Syrian regime, the regime’s forces or Russian forces.

    Numerous other international groups have also documented this wicked chapter in what has been a catastrophic civil war. But what makes the matter all the more nefarious is the “systematic and deliberate” nature of the attacks, to use words from Amnesty International. The U.N.’s emergency aid coordination body, the Office for the Coordination of Humanitarian Affairs (OCHA), had produced a voluntary “no-strike” list in an effort to register the presence of humanitarian actors and facilities so as to avoid their targeting. It has been alleged that the geographic coordinates of health care facilities shared between the parties have been put to effective use in the leveling of such facilities by the regime and regime-allied aerial bombardments of the opposition-held Idlib province.

    Late last March, U.N. Secretary-General Antonio Guterres appealed for a global cease-fire in the wake of a new common enemy to all of mankind. Guterres explained that “in war-ravaged countries health systems have collapsed, health professionals, already few in number, have often been targeted.” One cannot help but think of the situation in Syria when one hears of the collapse of health systems and the targeting of health professionals in hospitals. U.N. Special Envoy for Syria Geir Pedersen soon after called specifically for a nationwide cease-fire in Syria, and that sustained lull in hostilities was necessary to enable an all-out effort to counter COVID-19. A cease-fire was brokered between Russia and Turkey earlier on March 5, halting the Assad regime’s unilateral assault on Idlib province which the Middle East Eye reported as having been incited by the United Arab Emirates, solely to draw Turkey into a costly engagement there.

    Pedersen duly noted how years of conflict have left the country’s health care system degraded or destroyed, with health professionals, medical equipment and supplies all desperately lacking. Pedersen drew attention to a directive in the de-escalation agreement concerning the Idlib region that “the targeting of civilians and civilian infrastructure cannot be justified under any pretext,” presumably referring here to the nefarious catch-all ruse of counterterrorism though probably hindered diplomatically from making such a direct charge. Interestingly, the envoy also spoke of the call made by the secretary-general for the waiving of sanctions that may countervail capacities to counteract the pandemic and even spoke of engagement with China and Cuba in order to procure direct assistance for Syria. “A complete shift in mindset was needed,” noted the envoy, in order to curtail the enormous threat to Syrians across the country – one envisioned to breed a “new consciousness and a new determination.” It is dubious as to whether such a new consciousness emerges without effective deterrence and intervention against the regime and any other actors who are fundamentally uninterested in justice and democratic reconciliation.

    Interestingly, the special envoy offered his assistance to all parties to the dispute, saying, “The government, the opposition, all relevant players on the ground and key countries with influence that can support a scaling-up of action and ensure that the cease-fire holds.” Questions have emerged as to just how far the regime is willing to facilitate the transfer of medical aid and equipment to opposition-held areas. In December 2019, Russia and China vetoed a U.N. resolution that meant cross-border humanitarian aid into the country from Turkey and Iraq were no longer “authorized” to be used.

    The deliberate targeting of health care facilities seems inexplicable at first sight, an egregious transgression in an already catastrophic civil war squarely in the realm of a war crime, of which no good can possibly come. Such madness, however, must still be guided by some method, the elucidation of which may bring the observer closer to just how malevolent the regime has been over the years.

    One major reason that has emerged is that the regime has sought the de-population of opposition-held areas, as it is not really interested in any form of reconciliation but simply the termination of any and all opponents to its rule. Such a rationale makes all the more sense when considering the sheer scale of the devastation wrought upon millions of Syrians by the regime, considered alongside the nature of the regime itself – a totalitarian rule facilitated by an entrenched network of sectarian, familial and military-bureaucratic structures.

    Syrian refugees’ access to health care within Turkey is now also a pertinent issue. Turkey had already provided free health care to all registered refugees before the pandemic broke. On April 14, by presidential decree, the Turkish government extended free access to health care for Turkish citizens in need of treatment for COVID-19, regardless of social insurance coverage. Refugees around the world are in a precarious situation in the best of times, let alone amid a global pandemic. Anti-refugee and anti-immigration sentiments are, unfortunately, a feature harbored by certain sections of all societies around the world, though the extrapolation of any such views into state policy in health care is certainly not the case in Turkey at all.

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