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
tv
News
Katie Hopkins appearing on 'This Morning' after she purposefully put on 4 stone.
peopleKatie Hopkins breaks down in tears over weight gain challenge
Life and Style
fashionModel of the moment shoots for first time with catwalk veteran
Life and Style
fashionAngelina Jolie's wedding dressed revealed
News
i100
Sport
Alexis Sanchez, Radamel Falcao, Diego Costa and Mario Balotelli
footballRadamel Falcao and Diego Costa head record £835m influx
News
i100
Arts and Entertainment
Madame Vastra and Jenny Flint kiss in Doctor Who episode 'Deep Breath'
tv
Arts and Entertainment
Olivia Colman topped the list of the 30 most influential females in broadcasting
tv
Life and Style
techIf those brochure kitchens look a little too perfect to be true, well, that’s probably because they are
Arts and Entertainment
Danish director Lars von Trier
tvEnglish-language series with 'huge' international cast set for 2016
Life and Style
tech
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

Project Officer (HMP Brixton Mentoring Project)

£24,000 per annum pro rata (21 hours per week): Belong: Work as part of a cutt...

Trainee Recruitment Consultant

£20000 - £45000 per annum + uncapped: SThree: Key featuresA highly motivated ...

DT teachers required for supply roles in Cambridge

£21000 - £35000 per annum: Randstad Education Cambridge: DT teachers required ...

Secondary supply teachers required in Wisbech

£21000 - £35000 per annum: Randstad Education Cambridge: Secondary teachers ne...

Day In a Page

'I’ll tell you what I would not serve - lamb and potatoes': US ambassador hits out at stodgy British food served at diplomatic dinners

'I’ll tell you what I would not serve - lamb and potatoes'

US ambassador hits out at stodgy British food
Radio Times female powerlist: A 'revolution' in TV gender roles

A 'revolution' in TV gender roles

Inside the Radio Times female powerlist
Endgame: James Frey's literary treasure hunt

James Frey's literary treasure hunt

Riddling trilogy could net you $3m
Fitbit: Because the tingle feels so good

Fitbit: Because the tingle feels so good

What David Sedaris learnt about the world from his fitness tracker
Saudis risk new Muslim division with proposal to move Mohamed’s tomb

Saudis risk new Muslim division with proposal to move Mohamed’s tomb

Second-holiest site in Islam attracts millions of pilgrims each year
Alexander Fury: The designer names to look for at fashion week this season

The big names to look for this fashion week

This week, designers begin to show their spring 2015 collections in New York
Will Self: 'I like Orwell's writing as much as the next talented mediocrity'

'I like Orwell's writing as much as the next talented mediocrity'

Will Self takes aim at Orwell's rules for writing plain English
Meet Afghanistan's middle-class paint-ballers

Meet Afghanistan's middle-class paint-ballers

Toy guns proving a popular diversion in a country flooded with the real thing
Al Pacino wows Venice

Al Pacino wows Venice

Ham among the brilliance as actor premieres two films at festival
Neil Lawson Baker interview: ‘I’ve gained so much from art. It’s only right to give something back’.

Neil Lawson Baker interview

‘I’ve gained so much from art. It’s only right to give something back’.
The other Mugabe who is lining up for the Zimbabwean presidency

The other Mugabe who is lining up for the Zimbabwean presidency

Wife of President Robert Mugabe appears to have her sights set on succeeding her husband
The model of a gadget launch: Cultivate an atmosphere of mystery and excitement to sell stuff people didn't realise they needed

The model for a gadget launch

Cultivate an atmosphere of mystery and excitement to sell stuff people didn't realise they needed
Alice Roberts: She's done pretty well, for a boffin without a beard

She's done pretty well, for a boffin without a beard

Alice Roberts talks about her new book on evolution - and why her early TV work drew flak from (mostly male) colleagues
Get well soon, Joan Rivers - an inspiration, whether she likes it or not

Get well soon, Joan Rivers

She is awful. But she's also wonderful, not in spite of but because of the fact she's forever saying appalling things, argues Ellen E Jones
Doctor Who Into the Dalek review: A classic sci-fi adventure with all the spectacle of a blockbuster

A fresh take on an old foe

Doctor Who Into the Dalek more than compensated for last week's nonsensical offering