Inside Syria’s Fight to Keep Patients Alive
Amid war and sanctions, Syria’s health care system has collapsed. These new photos from Jacobin’s correspondent in Syria show how, in the absence of a functioning state, volunteers and doctors have become the last line of defense.
A child undergoing open-heart surgery at Damascus University’s cardiac hospital. With waiting lists over two years long, many patients die at home or during the procedure. (Omar Hamed Beato / Jacobin)
It’s a crowded morning at Damascus University’s cardiac hospital. Families from across Syria have gathered here with their children — many in urgent need of open-heart surgery. This hospital is the only functioning public facility in the country equipped to perform such procedures, and it is staffed by just five doctors trained to carry them out. Across Syria, most health care centers have been destroyed or left to decay. The atmosphere is tense. Some children have waited months, others years, for their turn. For them, even a short delay could mean the difference between life and death.
In a cramped hospital room shared with three other families lies six-month-old Ahed al-Ahmad. He was born with a ventricular septal defect — a hole in the wall separating the heart’s chambers that makes it harder for blood to circulate properly. Ahed needs emergency open-heart surgery. It’s the family’s fifth trip to the hospital since his birth, each requiring a grueling five-hour journey.
“He needs the surgery now,” says his father, forty-three-year-old Najdat Fares al-Ahmad. Ahed’s father, holding his son gently. “The delay is harming his growth — his brain and cognitive development too.”
Private hospitals charge $7,000 to $9,000 for the procedure, a sum far beyond Najdat’s reach. He earns just $20 a month as a government-employed veterinarian.
“Ahed doesn’t understand what is happening around him,” Najdat says quietly. “We feel more pain than he does because we can’t help him — we can’t afford to take to a private hospital. I don’t even have the words.”
A week after Jacobin met Ahed, he passed away. He never received the lifesaving medical treatment he needed in time.
Syria’s Health Care Collapse
Since the outbreak of civil war in 2011, Syria’s health care system has all but collapsed. Fourteen years on, it can no longer meet the needs of the more than 15 million Syrians who require humanitarian health assistance. Roughly half of the health care facilities in the country have been destroyed, and thousands of trained doctors have either been killed or forced to flee. In the early years of the conflict, the doctor-to-patient ratio fell dramatically — from one doctor for every 661 people in 2010 to just one for every 4,000 by 2014. Today only 57 percent of hospitals and 37 percent of primary health care centers remain fully operational.
Compounding the crisis are international sanctions imposed in response to Bashar al-Assad’s brutal regime. Although medical supplies are not always explicitly targeted, sanctions have triggered complex and costly bureaucratic hurdles for importing medical equipment. Hospitals across the country are now severely underresourced, with limited access to medicine and a dire shortage of functioning equipment. In many cases, outdated machines are cannibalized for spare parts to keep other essential devices running. The dismantling of the US Agency for International Development and foreign aid cuts across the West threaten to make recovery and reconstruction all the more difficult.
“We just do whatever we can,” says Mohammad Bashar Izzat, professor of cardiac surgery at Damascus University and director of the university’s cardiac hospital:
We don’t even know how the machines are still working. The newest machine we have for the surgeries is sixteen years old. It is out of service because the company that produces it is no longer making spare parts. We don’t have the sensors to take a baby’s temperature during surgery. So we just place our hands on the child and say, “He’s warm; he’s fine.” Nothing is working; nothing is running. Either we keep going or we stop working — and that is out of the question.
Because of the dire state of the health care system, countries like Qatar and Saudi Arabia have flown in teams of doctors and medical equipment to help with recovery. “The Qatari mission went to Homs,” says Bashar:
Last night, they reported that there’s no way to perform any procedures there — hospitals have zero operational capacity. Same in Aleppo — zero ability to perform any surgeries. It is not just a matter of a shortage of doctors. The hospitals can’t function. There are no technicians, no nurses — and let’s not talk about basic supplies. The whole health care system has fallen apart because it has not been maintained for years.
”It is a total disaster,” he continues. For a country of Syria’s size — with over 23 million inhabitants — he says at least 1,600 children should be receiving open heart surgeries annually. “We manage about 300 surgeries a year. Another 100 might get surgery in private hospitals. That leaves over 1,000 children every year without treatment. And all we can tell them is, ‘Go die at home. There is nothing we can do.’”
What Sanctions Leave Behind
This crisis extends far beyond cardiac care. Medication shortages are affecting nearly every branch of medicine across the country.
Outside Al-Beiruni Hospital in Damascus, we met Suad Khalif Gadaan, a thirty-five-year-old woman with lung cancer. She had traveled from Syria’s remote eastern desert region in search of chemotherapy treatment. Now living with her family on the outskirts of Damascus, she makes the difficult journey to the hospital each week.
But like many medical centers in Syria, Al-Beiruni is facing severe shortages. Chemotherapy drugs are simply not available. If Gadaan is to have any chance of survival, her family must pay for the medicine out of pocket.
“We bought the Indian brand because we couldn’t afford anything better,” says her husband, forty-seven-year old Shaher Saleh Nayef, as Gadaan sits silently beside him, too weak to speak. “Al-Beiruni doesn’t have the medication we need. We have to buy everything from pharmacies. I asked the doctors several times why my wife’s treatment wasn’t available. They said it’s because it’s expensive — the hospital simply doesn’t have it.”
Since Ahmed al-Sharaa assumed Syria’s presidency following the lightning rebel offensive that forced longtime dictator Bashar al-Assad into exile in Moscow late last year, he has repeatedly called on the international community to lift sanctions on Syria. A key demand is the release of Syria’s frozen assets held abroad. While the exact value of these assets remains difficult to determine, the transitional government is reportedly seeking access to approximately $400 million.
A portion of these funds could be allocated to restart a long-stalled major infrastructure project: the construction of a new cardiac hospital in central Damascus. Work on the facility was halted when the war began in 2011. To become fully operational, it requires an estimated $50 million for furnishing and medical equipment.
The Last Line of Help
While the international community continues to debate whether to lift sanctions on Syria, the country’s battered health care system struggles to survive on its last remaining resources. Every Tuesday morning, a volunteer-run initiative known as the Afieh Fund gathers on the first floor of an unfinished hospital to distribute desperately needed financial aid to patients who can’t afford medical care.
At the front desk stands forty-four-year old Furat Al-Abbas, the program’s manager, reviewing each case. The atmosphere is heavy with anxiety. For many, the possibility of receiving care hinges entirely on whether they can secure support from the fund — often the difference between life and death.
Two weeks before Jacobin met Abbas, she came across a family with a newborn in need of open-heart surgery. Like for Ahed, death was only a few days away. Fortunately, by making calls to twelve different donors, she managed to fundraise the $7,000 necessary to perform the surgery at a private hospital. However, Syria’s instability makes it harder to collect a stable stream of funds. Usually the fund distributes $40,000 to the roughly 500 patients who make it to the center every week; however, for this week, it only managed to collect $8,000.
“We work with doctors and companies — we only reach out to good people, people who care — so all our donations come from them,” says Abbas. “Most of the patients are living in tents, displaced, or just extremely poor. If I couldn’t get chemotherapy, I’d be devastated. I think about those patients who need chemo or surgery. . . . Imagine having a child and no money to care for them. I just want to help everyone. I don’t want anyone to be left in need.”