Exodus of doctors and health workers leave sick and ailing Syrians out on a limb

Sanctions, isolation, earthquakes and a grinding civil war have devastated Syria’s health system, leaving medical personnel underresourced and overwhelmed, forcing many to leave for Europe. (AFP)
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Updated 13 June 2024
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Exodus of doctors and health workers leave sick and ailing Syrians out on a limb

  • Sanctions, isolation, earthquakes and a grinding civil war have devastated Syria’s health system
  • Overwhelmed, under-resourced, and often unpaid, medical personnel are leaving for Europe in droves 

LONDON: More than a decade of civil war, economic sanctions, regional tensions, and a devastating earthquake have left Syria’s healthcare system in tatters and, according to a top World Health Organization official, forgotten by the international community.

Hanan Balkhy, WHO’s regional director for the Eastern Mediterranean, said last week that almost half of Syria’s health workers had fled the war-torn country. She called for innovative approaches to halt the exodus of Syrian medical staff abroad.

In an interview with the AFP news agency, she said that young doctors needed to be offered better prospects than practicing “fourth-century” medicine amid dire conditions, “where you cauterize people and send them on their merry way.”




An injured man receives emergency treatment at the Samez hospital following bombardment by pro Syrian regime forces in rebel-held northwestern city of Idlib on October 6, 2023. (AFP)

The International Rescue Committee highlighted in a 2021 report that about 70 percent of the medical workforce had fled the country, leaving one doctor for every 10,000 people.

Balkhy told AFP that in addition to earning extremely low wages, if any at all, Syria’s medical staff faced a severe shortage of resources and equipment, including operating rooms, sterilization units, and medications.

However, according to Dr. Zaher Sahloul, a Syrian-American critical care specialist and president of the medical NGO MedGlobal, every young Syrian physician he knows either plans to or dreams of leaving Syria and pursuing opportunities in other countries, “especially Germany, other European nations, or the US.”

“The flight is across the board and not related to war or conflict,” he told Arab News.

According to data released by the German Medical Association earlier this year, 6,120 Syrian doctors work in Germany without holding a German passport. These doctors account for 10 percent of the EU country’s foreign medical staff.

INNUMBERS

• 70 percent Proportion of Syria’s medical workforce that fled the country, leaving one doctor for every 10,000 people. (IRC, 2021)

• 6,120 Number of Syrian doctors working in Germany, accounting for 10 percent of the country’s foreign medical staff. (GMA, 2024)

• 65 percent Proportion of Syria’s hospitals deemed fully operational, making access to healthcare heavily constrained. (WHO, 2024)

• $80 million Funding needed by the WHO for 2024 to ensure access to health services and prevent further deterioration in Syria.

Balkhy said many young doctors in Syria are learning the German language on the side “so that they can be ready to jump,” which she believes is a significant concern for the region and its population.

But she also believes that finding creative solutions may encourage Syrian doctors to stay or return to their country — a choice she says many would make “willingly” with access to adequate support.




A man stands at the entrance of Adnan Kiwan hospital that was hit during reported airstrikes by pro-regime forces in the town of Kansafrah, in the south of Syria's Idlib province on November 25, 2019. The patients of the hospital were reportedly evacuated shortly before the strike took place. (AFP/File)

Sahloul says the main reasons behind the exodus of medical workers “are the economic collapse, hyperinflation, corruption, the collapse of the healthcare system due to long years of war, the regime’s policies of destroying what is left and pushing away anyone who wants to leave, and the lack of a viable political solution.”

Following a brief visit to the country between May 11 and 16, WHO’s Balkhy described the healthcare situation as “catastrophic,” warning that the number of people in need is “staggering, and pockets of critical vulnerabilities persist in many parts of the country.”

In a statement published on May 18, the WHO official wrote that intensifying tensions in the region, including the Israeli operation in the Gaza Strip and the Iran-Israel shadow war, have exacerbated this catastrophic situation.

The civil war has forced more than 14 million Syrians to flee their homes and seek refuge both within the country and beyond its borders. Among them, more than 7.2 million remain internally displaced, while about 70 percent of the population needs humanitarian assistance, according to UN figures.




Dr. Hanan Balkhy, WHO’s regional director for the Eastern Mediterranean. (Supplied)

Balkhy said in her statement that she was “extremely alarmed” by the increasing malnutrition rates among children under 5 and nursing mothers as a result of rising poverty.

The UN warned last year that 90 percent of Syria’s population lived below the poverty line, with millions facing a reduction in food rations due to a shortfall in funding for aid agencies.

According to the WHO regional director, almost three-quarters of all deaths in Syria are caused by chronic conditions, including cancer, cardiovascular diseases, diabetes, and mental health disorders, many of which are going untreated.

She also noted the number of burn injuries in Syria has been disproportionately high, especially among children, as people, deprived of traditional means of heating and cooking, burn unsuitable materials, such as tires, plastics, and fabrics.




In this picture taken on May 2, 2023, male patients receive treatment at the Haematology and Oncology department run by the Syrian American Medical Society (SAMS) at Idlib Central Hospital in the rebel-held northwestern Syrian city.(AFP/File)

Fumes produced by burning these substances also result in respiratory issues.

With just 65 percent of hospitals and 62 percent of primary healthcare centers fully operational, combined with a severe shortage of essential medicines and medical equipment, access to healthcare is constrained.

Before the war erupted in 2011, Syria’s pharmaceutical industry covered about 90 percent of the national needs of medicines, according to a 2010 paper by academics from the University of Medicine and Pharmacy in Romania.

In 2013, WHO reported that the country’s local drug production plunged after the fighting caused substantial damage to pharmaceutical plants in the governorates of Aleppo and rural Damascus.




A picture taken on February 21, 2018 shows a view through the wall of a destroyed hospital's pharmacy after it was hit in a regime air strike in the rebel-held enclave of Hamouria in Ghouta near Damascus. (AFP/File)

Poverty also creates significant barriers to accessing medical services and affording essential medicines, said Balkhy.

What concerned her most was “the fact that almost half of the health workforce, which forms the backbone of any health system, has left the country.”

An investigation by Arab Reporters for Investigative Journalism last year found that although the exact number of Syrian physicians who left the country remains unknown, the true extent of this exodus is larger than the NGOs and the Syrian government have reported.

“Retaining a skilled health workforce and ensuring sufficient medical supplies in Syria and across the region is a key priority,” said Balkhy.




Members of the Syrian Civil Defense, also known as the White Helmets, carry the body of a woman recovered from the rubble of a building at the site of a reported airstrike on the rebel-held town of Ariha in the northern countryside of Syria's Idlib province early on January 30, 2020. (AFP/File)

She proposed engaging young Syrian physicians on research projects with a pathway to publishing so they can “feel that they’re doing something worthwhile,” in addition to ensuring they “at least have the equipment” to perform operations.

For Sahloul of MedGlobal, fostering a belief in a brighter future is essential to retaining both new and seasoned doctors.

“What will encourage young and old doctors to stay in Syria is believing in a better future — a new leadership that respects its human capital,” he said.

Sahloul said that international and Arab actors need to devote more attention to finding a genuine solution to the Syrian conflict — “one that ensures respect for human rights and dignity, and focuses on rebuilding.”




A man and woman carry malnourished children at a camp for Syrians displaced by conflict near the town of Deir al-Ballut by Syria's border with Turkey in the Afrin region in the northwest of the rebel-held side of the Aleppo province on September 28, 2020. (AFP/File)

He added: “The current Arab normalization with the regime is flawed because it gives no hope for any meaningful change.”

Sahloul said normalization’s priorities, including refugee repatriation, curbing the manufacture of and trade in the amphetamine drug Captagon, and limiting Iran’s influence, “are not the most important priorities to the young graduates and aspiring doctors in Syria.”

Balkhy emphasized that the decline in humanitarian funding for Syria was a “central and troubling concern.” 

For instance, Al-Hol camp in Syria’s northeast — home to the wives and children of Daesh militants captured in 2019 — has grappled with many significant challenges since funding shortages forced WHO to halt medical referrals, prompting camp administrators to revoke its access.

Talks with donors in the capital Damascus during her five-day visit revealed that while they acknowledge the extent of gaps and needs, they are hampered by competing regional and global agendas.

Medecins Sans Frontieres warned on April 29 that the severe lack of funding for a vital WHO-funded medical referral system in 11 camps in northeast Syria “will lead to a marked increase in the number of preventable deaths.”

WHO said in March that it required $80 million in funding for the year 2024 to ensure the continuity, quality, and accessibility of health services and infrastructure in Syria, and to prevent a further deterioration of the already precarious situation.


 


Israeli army attacks kill five Lebanese in 24 hours, including two women

Updated 57 min ago
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Israeli army attacks kill five Lebanese in 24 hours, including two women

  • Hezbollah responds by shelling Kiryat Shmona; warns of ‘severe response’ if Israel launches large-scale war in Lebanon
  • A Hezbollah member and his 2 sisters died on Monday night in an attack on their home, and 2 people on a motorcycle were killed on Tuesday by a drone attack

BEIRUT: Israel continued to target Hezbollah members on Tuesday with attacks by combat drones, less than 24 hours after a member of the party and his two sisters were killed in an air assault on their home in the town of Bint Jbeil.

On Tuesday afternoon, an Israeli drone launched a missile at a motorcycle on the Khardali road, a strategic route connecting the Nabatieh area to Marjayoun, killing two people.

An eyewitness said: “The motorcycle was carrying two persons, and when several citizens tried to approach the targeted motorcycle, it was subjected to a second airstrike with a guided missile.”

On Monday evening, Israeli warplanes had conducted intense raids on the towns of Bint Jbeil, Kfarkela, Mays Al-Jabal and Marwahin, destroying several homes and causing significant damage.

One of the strikes hit the home of Amer Jamil Dagher and his sisters, Taghreed and Fawzia, in Bint Jbeil, destroying it and killing all three, who were said to be in their 40s and 50s.

Hezbollah mourned their deaths and they were buried on Tuesday afternoon in their hometown, 18 people from which have been killed since fighting in southern Lebanon began on Oct. 8.

The Israeli army said it had “targeted Hezbollah infrastructure in several areas in southern Lebanon on Monday night to eliminate threats.”

Hezbollah said it responded to the attacks by “shelling the Kiryat Shmona settlement with dozens of Falaq and Katyusha rockets.”

Meanwhile, Israeli forces also shelled the outskirts of Deir Mimas and the town of Yohmor Al-Shaqif, along the Litani River.

Lebanese Civil Defense teams and paramedics from Hezbollah and the Amal Movement reportedly worked through the night fighting fires in forests alongside the river caused by Israeli phosphorus shells.

Hezbollah said it had targeted a “gathering of Israeli enemy soldiers around the Pranit barracks opposite the Lebanese border town of Rmeish,” “spy equipment at the Al-Raheb site” and “Al-Samaqa site in the occupied Kfarchouba hills.”

MP Mohammed Raad, the head of Hezbollah’s parliamentary bloc, threatened Israel with “a severe response if the Israeli army launches a large-scale war in Lebanon.”

He added: “The Israeli army knows this. We know the enemy’s strengths and weaknesses, and it knows we know its weaknesses.”

Raad urged the “enemy to stop its evil against Lebanon and Gaza; we are ready to cease fire on the Lebanese front if the aggression on Gaza stops and the enemy will comply with this.”


Israeli drone strike along Lebanon-Syria border kills Syrian businessman close to the government

Updated 46 min 59 sec ago
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Israeli drone strike along Lebanon-Syria border kills Syrian businessman close to the government

  • Mohammed Baraa Katerji was killed when a drone strike hit his car near the area of Saboura, a few kilometers inside Syria
  • Strike came as Israel and Lebanon’s Hezbollah group have been exchanging fire on an almost daily basis since early October

BEIRUT: An Israeli drone strike on a car Monday near the Lebanon-Syria border killed a prominent Syrian businessman who was sanctioned by the United States and had close ties to the government of Syrian President Bashar Assad, according to pro-government media and an official from an Iran-backed group.
Mohammed Baraa Katerji was killed when a drone strike hit his car near the area of Saboura, a few kilometers or miles inside Syria after apparently crossing from Lebanon. Israel’s air force has carried out hundreds of airstrikes in recent years, mainly targeting members of Iran-backed groups and Syria’s military. But it has been rare to hit personalities from within the government.
The strike also came as Israel and Lebanon’s Hezbollah group have been exchanging fire on an almost daily basis since early October, after the start of the Israel-Hamas war.
An official from an Iran-backed group said that Katerji was killed instantly while in his SUV on the highway linking Lebanon with Syria. The official spoke on condition of anonymity because he wasn’t authorized to speak to the media.
The pro-government Al-Watan daily quoted unnamed “sources” as saying that Katerji, 48, was killed in a “Zionist drone strike on his car.” It gave no further details.
Rami Abdurrahman, who heads the Britain-based opposition war monitor Syrian Observatory for Human Rights, said that Katerji was killed while in a car with Lebanese license plates, adding that he was apparently targeted because he used to fund the “Syrian resistance” against Israel in the Golan Heights, as well as his links to Iran-backed groups in Syria.
Israel, which has vowed to stop Iranian entrenchment in its northern neighbor, has carried out hundreds of strikes on targets in government-controlled parts of Syria in recent years, but it rarely acknowledges them.
The US Department of the Treasury’s Office of Foreign Assets Control, or OFAC, sanctioned Katerji in 2018 as Assad’s middleman to trade oil with the Daesh group and for facilitating weapons shipments from Iraq to Syria.
The US Treasury declined Associated Press requests for comment. The sanctions imposed on Katerji were authorized under an Obama-era executive order issued in 2011 that prohibits certain transactions with Syria. A search of the OFAC database indicates that the sanctions were still in effect against Katerji and his firm at the time of his death.
OFAC said in 2018 that Katerji was responsible for import and export activities in Syria and assisted with transporting weapons and ammunition under the pretext of importing and exporting food items. These shipments were overseen by the US­ designated Syrian General Intelligence Directorate, according to OFAC.
It added that the Syria-based Katerji Company is a trucking company that has also shipped weapons from Iraq to Syria. Additionally, in a 2016 trade deal between the government of Syria and IS, the Katerji Company was identified as the exclusive agent for providing supplies to IS-controlled areas, including oil and other commodities.
Katerji and his brother, Hussam — widely referred to in Syria as the “Katerji brothers” — got involved in oil business a few years after the country’s conflict began in March 2011. Hussam Katerji is a former member of Syria’s parliament.


US military destroys 5 Houthi drones amid escalating ship attacks

Updated 16 July 2024
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US military destroys 5 Houthi drones amid escalating ship attacks

  • Centcom: It was determined these UAVs presented an imminent threat to US, coalition forces and merchant vessels in the region
  • Houthis also fired an explosive and remotely controlled boat at the MT Chios Lion, a Greek-operated, Marshall Islands-owned, crude oil tanker

AL-MUKALLA: US naval forces in the Red Sea destroyed a barrage of drones launched by Yemen’s Houthis as the militia increased drone, boat and missile strikes on ships in international commercial channels.

The US military said in a statement on Tuesday that its forces intercepted three Houthi unmanned aerial vehicles over the Red Sea and two more over Houthi-held areas of war-torn Yemen during the past 24 hours, all of which were aimed against international commercial and navy ships.

“It was determined these UAVs presented an imminent threat to US, coalition forces and merchant vessels in the region. These actions were taken to protect freedom of navigation and make international waters safer and more secure,” US Central Command said on X.

During the last 24 hours, the Houthis targeted a Panama-flagged, Israel-owned, Monaco-operated tanker vessel, MT Bentley I, which was transporting vegetable oil from Russia to China. The militia deployed three surface ships, one explosive-laden drone boat and two small boats, causing no damage to the ship or casualties, according to the US military.

The Houthis subsequently launched a ballistic missile from Yemeni territory toward the same ship in the Red Sea.

The Houthis also fired an explosive and remotely controlled boat at the MT Chios Lion, a Greek-operated, Marshall Islands-owned crude oil tanker operating under the Liberian flag in the Red Sea, inflicting damage to the ship but no reported casualties.

The US statement came hours after Houthi military spokesman Yahya Sarea claimed in a televised statement that the militia’s naval, drone and missile forces launched a joint attack against MT Bentley I in the Red Sea, and struck the Chios Lion oil tanker ship with a drone boat.

The two ships were targeted because their owners defied the militia’s warnings against traveling to Israeli ports.

Sarea said that a third operation was carried out with the assistance of the Iraqi Islamic Resistance, targeting the Olvia ship in the Mediterranean.

Olvia was recognized by ship monitoring apps as a crude oil tanker flying the Cyprus flag when it left the Israeli port of Haifa on Saturday.

Since November, the Houthis have fired hundreds of ballistic missiles, drones and drone boats at more than 100 ships on international trade routes near Yemen, forcing major commercial firms to divert ships away from the Red Sea and on to longer and more costly routes via Africa.

The Houthis maintain that they solely strike Israeli-linked and Israeli-bound ships to put pressure on Israel to lift its blockade of Gaza. Critics say that the Houthis are using Yemenis’ fury over Israel’s war in Gaza to silence vocal voices calling for salary payments and public service improvements, as well as to recruit fighters.

On Tuesday, Houthi militia leader Abdul Malik Al-Houthi promised to keep striking ships until Israel stops its war in Gaza.

“Our missile and naval operations will continue and expand until the aggression ends and the Israeli embargo on Gaza is removed,” he said.

Meanwhile, Yemen’s internationally recognized government reiterated on Tuesday its request for international groups to shift their offices from Houthi-held Sanaa to the southern city of Aden, Yemen’s temporary capital.

Rashad Al-Alimi, chairman of the Presidential Leadership Council, demanded during a meeting with US Ambassador to Yemen Steven Fagin that international donors fulfill their commitments to the humanitarian response plan in Yemen and that international organizations relocate their main offices to Aden after the Houthis kidnapped dozens of aid workers in Sanaa.

Yemeni Minister of Interior Ibrahim Haidan reiterated the same request during a meeting with Mahmoud Salah, head of the Foreign Committee of the Red Cross mission in Aden on Tuesday.


Israeli military to begin drafting ultra-Orthodox seminary students next week

Updated 16 July 2024
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Israeli military to begin drafting ultra-Orthodox seminary students next week

  • In June, Israel’s Supreme Court mandated the government to begin drafting ultra-Orthodox Jewish seminary students

JERUSALEM: The Israeli military will next week begin issuing military draft summons to ultra-Orthodox seminary students who were previously exempt from military service, the military said on Tuesday.
The issue is especially sensitive amid the war against Hamas in Gaza and related fighting on other fronts that have caused the worst Israeli casualties — mostly among secular draftees and reservists — in decades.
In June, Israel’s Supreme Court mandated the government to begin drafting ultra-Orthodox Jewish seminary students into the military, creating new political strains for Prime Minister Benjamin Netanyahu.
An Israeli military statement said that starting next Sunday “the process of issuing initial summons orders for the first call-up” ahead of the upcoming July recruitment cycle would commence.
Netanyahu’s coalition includes two ultra-Orthodox parties that regard the exemptions as key to keeping their constituents in religious seminaries and away from a melting-pot military that might test their conservative values.
The issue has prompted protests by ultra-Orthodox Jews, who make up 13 percent of Israel’s 10 million population — a figure expected to reach 19 percent by 2035. Their refusal to serve in wars they generally support is a long festering schism in Israeli society.
Israel’s 21 percent Arab minority is also largely exempted from the draft, under which men and women are generally called up at the age of 18, with men serving 32 months and women 24 months.


US-supplied bombs used in Israeli strike of Gaza ‘safe zone’ — weapons experts

Updated 16 July 2024
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US-supplied bombs used in Israeli strike of Gaza ‘safe zone’ — weapons experts

  • A sliver of munition seen in a video of the blast site circulating online was a tail fin from a US-made Joint Direct Attack Munition
  • Former US Army explosive ordnance disposal technician: ‘it’s 100 percent a JDAM kit’ made in the United States

JERUSALEM: Israel’s deadly strike on Al-Mawasi, one of the bloodiest attacks in more than nine months of war in Gaza, used massive payload bombs provided by the United States, according to weapons experts.
The bombing of the Israeli-declared “safe zone” transformed the tent city on the Mediterranean coast into a charred wasteland, with nearby hospitals overrun with casualties.
According to the health ministry in the Hamas-run territory, the barrage killed at least 92 people and wounded more than 300.
The Israeli military said it targeted two “masterminds” of the October 7 attacks by Hamas that triggered the war. It said a top commander, Rafa Salama, was killed in the strike, but uncertainty remains over Hamas military chief Mohammed Deif.
AFP videos of the attack showed a white mushroom cloud billowing over a busy street, leaving behind a huge crater strewn with the wreckage of tents and a building blown to bits.
Here is what we know about the weaponry used in the attack:
Two weapons experts said that a sliver of munition seen in a video of the blast site circulating online was a tail fin from a US-made Joint Direct Attack Munition (JDAM). AFP could not independently verify the video.
The GPS-aided kit converts unguided free-fall bombs — so-called “dumb bombs” — into precision-guided “smart” munitions that can be directed toward single or multiple targets.
The United States developed the kit to improve accuracy in adverse weather after Operation Desert Storm in 1991.
The first JDAMs were delivered in 1997 and, according to the US Air Force, have a 95 percent system reliability.
Trevor Ball, a former US Army explosive ordnance disposal technician, concluded from images of the Al-Mawasi strike “it’s 100 percent a JDAM kit” made in the United States.
He said that given the types of bombs compatible with the guidance system and the size of the fin fragment, the JDAM was most likely used with either a 1,000 or 2,000 pound (450 or 900 kilogram) payload.
He said the fragment could also be compatible with the BLU-109 “bunker buster” warhead, which is designed to penetrate concrete.
Ball said it was not possible to definitively determine where the payload itself was made without “very specific fragments of the bomb body.”
Repeated use of such large bombs in the densely populated Gaza Strip has sparked humanitarian outcry and heaped pressure on US President Joe Biden to reconsider the munitions supplied to Israel.
On July 12, Israel’s main military backer announced it was ending a pause on supplying 500-pound bombs, though Biden said the 2,000-pound type would be withheld.
The White House has repeatedly voiced frustration over the civilian death toll in Gaza as Israel attempts to eradicate Hamas.
US Secretary of State Antony Blinken told two top Israeli officials on Monday that the civilian toll was “unacceptably high,” his spokesman said.
Israeli officials said their “precise strike” in Al-Mawasi hit an open area that housed a Hamas compound and not a civilian camp.
When contacted by AFP regarding the weapons used, the Israeli military declined to comment.
Based on Israel’s stated target, Wes Bryant, a retired US Air Force master sergeant and strike and joint targeting expert, said it would have been feasible to avoid collateral damage in the surrounding area.
“My assessment is that any civilians killed in this strike were in the compound — not in the surrounding vicinity. So the IDF either failed to assess presence of civilians, or... deemed the risk to civilians proportional to the military advantage of taking out the Hamas leaders.”
The strike left Al-Mawasi a scene of “absolute destruction” with no water, electricity or sewage treatment, the Islamic Relief charity said.
It condemned Israel for its willingness “to kill innocent men, women and children in pursuit of its end goals.”
Hamas said that by arming Israel, the Biden administration is “legally and morally responsible” for spawning a “major humanitarian catastrophe.”
It said US-supplied weapons used by Israel included GPS-guided bombs, dumb bombs, bunker busters and JDAMs.
After repeated high-casualty strikes in recent days, a Hamas official said the group was withdrawing from indirect talks for a truce and hostage release deal with Israel.
The war was sparked by Hamas’s October 7 attack on Israel, which resulted in the deaths of 1,195 people, mostly civilians, according to an AFP tally based on Israeli figures.
Israel responded with a military offensive that has killed at least 38,664 people in Gaza, also mostly civilians, according to the Hamas-ruled territory’s health ministry.