Syria in crisis: Country's healthcare system is 'going backwards in time, at a rate of a decade a month'

Its hospitals are in tatters; doctors and nurses are fleeing the country; treatable diseases have become death sentences. Charlie Cooper reports on the collapse of a country’s healthcare system

Three years ago, Syria’s hospitals were the envy of the Middle East. The average life expectancy was 75, higher than in many parts of the UK. Nine out of every 10 medicines provided by the country’s extensive network of public and private clinics were made by the country’s own flourishing pharmaceutical industry. Back then, Syrians could expect a long healthy life, and care and comfort in times of sickness.

Today, when Elizabeth Hoff, the World Health Organisation’s (WHO) representative in Syria, walks to her office through the wintry streets of central Damascus, she passes families of refugees shivering in the cold. They have come to the capital for security and because it is one of the few places where the hospitals are still open.

“It really breaks my heart,” she says, her voice, which until now has recounted official statistics in steady stoic monotone, cracking with emotion.

“I have been in Syria for a year and a half and the difference in that time is devastating to see. The healthcare system has totally, totally broken down. Have you seen a child build up a beautiful Lego house? And then someone has stepped all over it. This is what the health system in Syria looks like when you get outside Damascus.” Nearly three years since the outbreak of the civil war, Syria is now in an unprecedented situation. It is the first state ever to have established a fully functioning, highly effective, 21st-century healthcare system – and then seen it collapse.

Read more:

Let them in: Britain has a moral duty to help Syria’s refugees  

Let them in: Britain has a moral duty to help Syria’s refugees

'I hope for a better world': Pope Francis calls for peace for Syria and dignity for refugees fleeing misery and conflict in Christmas Day speech  

Two-thirds of the country’s hospitals have been affected by the fighting and 40 per cent of them have been destroyed or rendered altogether useless. Ninety per cent of the pharmaceutical industry, which used to pump out drugs not only for domestic use but for export to 50 countries globally, is defunct. The government is now dependent on medical supplies from its allies – Russia, Iran and, to a lesser extent, Cuba and Honduras, as well as UN-co-ordinated aid coming in through Damascus and one border crossing with Iraq.

In areas completely out of government control, smaller aid agencies and NGOs are the main source of drugs and equipment, ferried in from neighbouring countries.

Near the front lines, medical facilities have been targeted, along with medical professionals, by forces on both sides, under the grim logic that the fewer doctors there are to put to put people back together, the fewer men will come back to fight.

Syria recorded its first case of polio in the past year. Only 50 per cent of children are now immunised against the disease Syria recorded its first case of polio in the past year. Only 50 per cent of children are now immunised against the disease (AFP)  

Doctors, nurses, surgeons, anaesthetists and other health professionals have left the country. Charities, either independently or co-ordinated by the UN and the WHO, which are still working out of Damascus, have tried to fill the gaps, and the influx of heroic foreign doctors has made headlines in their home countries. But as Elizabeth Hoff repeats again and again: “It is not enough.”

The war has killed 120,000 – an estimate that puts the number of injured, combatant and civilian, at around 575,000, according the WHO. In other words, more than 2 per cent of the entire population has been maimed by armed conflict.

But the underlying burden is far greater. Syria’s population, like the rest of the developed world, had for years been lifted up by the safety net of modern medicine. Now that it has been taken away, people are falling hard. Around six million are refugees in their own country, living in crowded, unhygienic temporary shelters, bombed out buildings, or wherever they can – served only by undersupplied, undermanned field clinics.

Kidney failure, and some cancers – conditions that would previously have been managed by dedicated professionals in specialist clinics – have now become death sentences. Diseases that had been nearly or totally eradicated have returned.

In countries with poor sanitation, early exposure leads to increased immunity to many diseases. But in Syria, these natural defences have not built up in populations that were, until now, protected by a fully developed health system and civil infrastructure. The situation is most dire in rebel-held and Kurdish northern regions bordering Turkey, which have become no-go areas for UN and WHO supply lines out of Damascus. Ragtag health committees have been set up in individual towns and regions, often by a few brave local nurses and doctors who have refused to flee, and supported by NGOs. Médecins Sans Frontières (MSF), for example, runs six hospitals in northern Syria with local help.

Natalie Roberts, a British doctor who spent nine months in northern Syria with MSF, said that she had seen children as young as eight dying of liver failure caused by hepatitis A contracted from unclean drinking water – something unheard of before.

In Aleppo and surrounding towns, sandflies that breed in rubble and rubbish tips have multiplied amid the ruins and are spreading leishmaniasis – a skin disease that was dubbed “Jericho Buttons” by British soldiers when they encountered it in Palestine during the First World War because of the big, painful and disfiguring ulcers it forms upon the skin.

“The dramatic picture we see of Syria is of war trauma injuries,” Dr Roberts says. “But underneath there is also a huge problem with everyday healthcare. It’s like they’re going backwards in time, at a rate of a decade a month. All the medicines are running out. When they run out of antibiotics they’ll be in the pre-penicillin era.”

Only once in the past year did the world’s attention turn to Syria’s health crisis, when the country recorded its first case of polio since 1999 – as a consequence of a broken health system. Previously 85 to 90 per cent of Syrian children were immunised against it early. Today around half don’t get their vaccine.

The crisis inspired a rare instance of co-operation, with the Syrian regime turning a blind eye to the UN delivering vaccines to charities like the Syrian Arab Red Crescent, which then supplies them to rebel health authorities. Some 825,000 children had been vaccinated by the start of December, but the isolated success has only thrown into sharper relief the extent to which the war has cut people off from care – be it in small pockets around Damascus or in vast regions to the north.

Dr Roberts recounts the story of one girl in a village near Al-Safira, who accidentally burned herself. The injuries were not major, let alone life-threatening. But the village was cut off from any kind of hospital or clinic and healthcare workers could not get in because the front line cut off access. For three months, the girl lay on a wooden bed in the shelter where her family lived, scared to move for fear of brushing her burns.

“When eventually the frontline moved on and an MSF team reached the village, the girl had pressure sores the like of which I have never seen,” Dr Roberts says. “Anyone with any nursing skills would know that […] she needed to be turned regularly. But no one knew that in their shelter. She had become malnourished and contracted pneumonia, lying still in that shelter for three months. We tried, but after five days, she died. She was three years old.”

Throughout Syria, the same kinds of winter illnesses are likely to kill thousands.

“We are far from doing enough,” Ms Hoff says. “I would just like to say to people please don’t forget Syria. They are wonderful people. They need help.”

PROMOTED VIDEO
News
ebooksAn unforgettable anthology of contemporary reportage
Arts and Entertainment
Architect Frank Gehry is regarded by many as the most important architect of the modern era
arts + entsGehry has declared that 98 per cent of modern architecture is "s**t"
Sport
Luis Suarez and Lionel Messi during Barcelona training in August
footballPete Jenson co-ghost wrote Suarez’s autobiography and reveals how desperate he's been to return
Money
Welcome to tinsel town: retailers such as Selfridges will be Santa's little helpers this Christmas, working hard to persuade shoppers to stock up on gifts
news
Arts and Entertainment
Soul singer Sam Smith cleared up at the Mobo awards this week
newsSam Smith’s Mobo triumph is just the latest example of a trend
News
Laurence Easeman and Russell Brand
people
Sport
Fans of Dulwich Hamlet FC at their ground Champion Hill
footballFans are rejecting the £2,000 season tickets, officious stewarding, and airline-stadium sponsorship
News
Shami Chakrabarti
people
Arts and Entertainment
Benedict Cumberbatch has refused to deny his involvement in the upcoming new Star Wars film
filmBenedict Cumberbatch reignites Star Wars 7 rumours
Sport
football
News
news
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Maths Teacher

£110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for spe...

Business Analyst - Surrey - Permanent - Up to £50k DOE

£40000 - £50000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

***ASP.NET Developer - Cheshire - £35k - Permanent***

£30000 - £35000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

***Solutions Architect*** - Brighton - £40k - Permanent

£35000 - £40000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

Day In a Page

Wilko Johnson, now the bad news: musician splits with manager after police investigate assault claims

Wilko Johnson, now the bad news

Former Dr Feelgood splits with manager after police investigate assault claims
Mark Udall: The Democrat Senator with a fight on his hands ahead of the US midterm elections

Mark Udall: The Democrat Senator with a fight on his hands

The Senator for Colorado is for gay rights, for abortion rights – and in the Republicans’ sights as they threaten to take control of the Senate next month
New discoveries show more contact between far-flung prehistoric humans than had been thought

New discoveries show more contact between far-flung prehistoric humans than had been thought

Evidence found of contact between Easter Islanders and South America
Cerys Matthews reveals how her uncle taped 150 interviews for a biography of Dylan Thomas

Cerys Matthews on Dylan Thomas

The singer reveals how her uncle taped 150 interviews for a biography of the famous Welsh poet
DIY is not fun and we've finally realised this as a nation

Homebase closures: 'DIY is not fun'

Homebase has announced the closure of one in four of its stores. Nick Harding, who never did know his awl from his elbow, is glad to see the back of DIY
The Battle of the Five Armies: Air New Zealand releases new Hobbit-inspired in-flight video

Air New Zealand's wizard in-flight video

The airline has released a new Hobbit-inspired clip dubbed "The most epic safety video ever made"
Pumpkin spice is the flavour of the month - but can you stomach the sweetness?

Pumpkin spice is the flavour of the month

The combination of cinnamon, clove, nutmeg (and no actual pumpkin), now flavours everything from lattes to cream cheese in the US
11 best sonic skincare brushes

11 best sonic skincare brushes

Forget the flannel - take skincare to the next level by using your favourite cleanser with a sonic facial brush
Paul Scholes column: I'm not worried about Manchester United's defence - Chelsea test can be the making of Phil Jones and Marcos Rojo

Paul Scholes column

I'm not worried about Manchester United's defence - Chelsea test can be the making of Jones and Rojo
Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

While other sports are stalked by corruption, we are an easy target for the critics
Jamie Roberts exclusive interview: 'I'm a man of my word – I'll stay in Paris'

Jamie Roberts: 'I'm a man of my word – I'll stay in Paris'

Wales centre says he’s not coming home but is looking to establish himself at Racing Métro
How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?

A crime that reveals London's dark heart

How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?
Meet 'Porridge' and 'Vampire': Chinese state TV is offering advice for citizens picking a Western moniker

Lost in translation: Western monikers

Chinese state TV is offering advice for citizens picking a Western moniker. Simon Usborne, who met a 'Porridge' and a 'Vampire' while in China, can see the problem
Handy hacks that make life easier: New book reveals how to rid your inbox of spam, protect your passwords and amplify your iPhone

Handy hacks that make life easier

New book reveals how to rid your email inbox of spam, protect your passwords and amplify your iPhone with a loo-roll
KidZania lets children try their hands at being a firefighter, doctor or factory worker for the day

KidZania: It's a small world

The new 'educational entertainment experience' in London's Shepherd's Bush will allow children to try out the jobs that are usually undertaken by adults, including firefighter, doctor or factory worker