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By Design or Neglect, Syrian Government Has Damaged Health System, Suppressed COVID-19 Data in Daraa: PHR Report

Accounts from key informants in a Physician for Human Rights report corroborate the obstruction of humanitarian aid and systemic neglect of the health care system in southern Syria, exacerbated by COVID-19, creating a human rights crisis

A new report from Physicians for Human Rights (PHR) details systemic and willful neglect by the Syrian government of the overall health system in Daraa governorate after it regained control of the opposition-held territory following the June 2018 military offensive led by Syria and Russia. The report corroborates accounts from key sources which detail the decline of Daraa’s health system since 2018 and further demonstrate a pattern of the Syrian government denying access to humanitarian assistance and withholding aid. During the COVID-19 pandemic, the government has suppressed vital data collection and dissemination efforts in Daraa, exacerbating death and suffering in the southern region.

In “reconciliation agreements,” offered by the Syrian government and Russian allies following fierce aerial bombings of Daraa during the 2018 offensive, the Syrian government reportedly agreed to reinstate all dismissed government employees, including former Ministry of Health employees, and to rebuild the public health sector. PHR’s report finds the Syrian government has grossly failed to fulfill its promises from the Daraa reconciliation agreements. It has not rebuilt areas formerly under opposition control nor replaced the essential health services that were provided by Daraa’s NGO-led health sector, which helped coordinate aid and services in Daraa between 2012 and 2018. Furthermore, after these agreements were completed, the Syrian government suspended all cross-border humanitarian activities from Jordan, which benefited at least 568,000 civilians.

The new report, “Obstruction and Denial: Health System Disparities and COVID-19 in Daraa, Syria,” presents qualitative data gathered through 19 in-depth interviews with key informants, including humanitarian workers, research analysts, academics, and journalists, based in Jordan, Lebanon, Syria, Türkiye, the United Kingdom, and the United States. All interviewees had close contacts inside Daraa, a working knowledge of its health system before and after the 2018 reconciliation between the Syrian government and the opposition, and/or familiarity with COVID-19 in Daraa. A PHR research team comprised of native Syrian Arabic and English speakers conducted the interviews via Zoom between August and October 2020. The interviews were supplemented by a desk research review regarding COVID-19 and health system trends in Daraa and in southern Syria more broadly.

“As the Syrian government regained control of the opposition-held territory of Daraa, the pattern of violence by Syrian and Russian forces shifted to include reprisals, willful neglect, deliberate interruption of humanitarian services and aid, and the egregious violation of civilians’ fundamental human rights to health and information,” said Justine McGowan, research consultant and co-author of the report. “The government’s repeated attacks on health care and deliberate suppression of aid have led to the critical failure of Daraa’s health system during a global health emergency, leaving Syrian civilians unable to handle or control the spread and devastation of COVID-19.” 

The dismantling of Daraa’s health care system by the Syrian government has placed added strain on the governorate’s COVID-19 response measures.Patients in Daraa were already struggling to receive necessary care before March 22, 2020, when the first cases of COVID-19 in Syria were acknowledged by the government. Today, testing capacity remains severely inadequate and there are no laboratories capable of processing COVID-19 tests in Daraa. While, as of November 25, official reports indicate no more than 7,369 cases of COVID-19 (and 385 deaths) in government-controlled areas since March, PHR’s research documents widespread consensus that these numbers reflect the Syrian government’s suppression of public information about the realities of the pandemic and do not capture the true caseload. Accounts from knowledgeable key informants detailed in the report point to an undersupplied and understaffed health system in Daraa that is incapable of handling a more widespread COVID-19 outbreak.

Well-informed sources with direct knowledge of the Daraa health system included in PHR’s report note deplorable, crowded, and unsanitary conditions in Daraa’s limited quarantine or isolation centers as well as instances of people fearing arrest or poor treatment in government-run quarantine centers and hospitals, leading many in Daraa to avoid seeking treatment for COVID-19 complications. Respondents also reported a lack of critical supplies such as ventilators in Daraa as compared to the relative availability of ventilation machines in areas of the country considered loyal to the Syrian government.

Since the onset of the Syrian conflict in March 2011, PHR has researched, documented, and mapped attacks on medical infrastructure across Syria, attributing more than 90 percent of documented attacks on health facilities and personnel to the Syrian government and its allies, including Russia. From March 2011 through February 2020, PHR has confirmed 595 attacks on at least 350 separate facilities, as well as at least 923 medical personnel killed – 89 percent of whom were suspected to have been killed by shelling, bombardment, small arms fire, torture, and extrajudicial executions. In 2019, PHR’s research documented the purposeful, illegal, and brutal strategy by the Syrian government to arrest, detain, and torture health professionals. PHR’s latest report reiterates longstanding calls by PHR for Syria to end the killing and detaining of health care workers from across the country and release all health care workers arbitrarily detained or persecuted for carrying out their medical duties.

“The Syrian government’s systematic destruction of health facility infrastructure during the past 10 years of conflict, targeted assassinations and kidnappings of health care workers, and current suppression of critical data have led to a health system that fails to supply basic health care – let alone adequate treatment, personal protective equipment (PPE), and facility conditions during the COVID-19 pandemic,” said Susannah Sirkin, PHR’s director of policy. “Governments and international humanitarian organizations must hold the Syrian government and its Russian allies accountable for the destruction of Daraa’s health system and demand transparent reporting by Syria of COVID-19 data and equitable distribution of health resources. Daraa is an object lesson in how territory retaken by the government can be effectively deprived of health care.”

The report includes a series of recommendations to the government of Syria, humanitarian agencies and donors, the United Nations Security Council and UN member states, and guarantors of the southern de-escalation zone, including the governments of Jordan, Türkiye, and the United States. Specifically, PHR calls on the government of Syria to expand access for desperately needed humanitarian aid, lift barriers for reconciled health care workers seeking public sector employment, adopt transparent measures with regard to COVID-19 testing and PPE distribution, and verify that public sector services and those provided by the Syrian Arab Red Crescent are equitable and accessible to all civilians without discrimination or preference.

PHR also calls on the governments of Jordan, Türkiye, and the United States as guarantors of the southern de-escalation zone to pressure the Syrian government to include the health system in any negotiated settlements and to facilitate humanitarian access by increasing security, travel permits, independent data collection, and publication of health system data. Additionally, PHR calls on the UN Security Council and UN member states to demand that the Syrian government ensure the delivery of aid and allocation of health services so that organizations such as the World Health Organization and other UN agencies, international NGOs, and local actors can reach populations in a neutral, effective, and equitable manner. Further detailed recommendations are addressed to humanitarian actors and donors.

Additional PHR resources on human rights-related issues in Syria:

  • Multimedia: Illegal Attacks on Health Care in Syria (Interactive Map)
  • Multimedia: Medical Personnel Are Targeted in Syria (Data Tracker)
  • Report: “‘My Only Crime Was That I Was a Doctor: How the Syrian Government Targets Health Workers for Arrest, Detention, and Torture,” December 4, 2019
  • Report: “The Syrian Conflict: Eight Years of Devastation and Destruction of the Health System,” March 12, 2019
  • Statement: “PHR Briefing to the United Nations Security Council on the Humanitarian Situation in Syria,” June 29, 2020
  • Blog: “Voices from the COVID-19 Pandemic: ‘Within 20 Days of the First COVID-19 Case, our Health System will Collapse,’” April 21, 2020
  • Blog: “Syria’s Northwest Is on the Brink of a Coronavirus Disaster,” April 2, 2020
  • Report: “Aleppo Abandoned: A Case Study on Health Care in Syria,” November 1, 2015
  • Press Release: “PHR: Russia and China Hold UN Security Council Hostage, Today Blocking Life-Saving Aid to More than One Million in Need in Syria,” July 11, 2020

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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