Syria Deeply: Syria is No Longer Able to Treat Chronic Diseases, Leading Health Expert Says

Syria Deeply

“It is estimated that about 600,000 to 800,000 people have been injured because of the war.”

A leading Syrian public health expert, Dr. Fouad M. Fouad, told Syria Deeply that the country’s supply of medications has dwindled to less than 20 percent of what was available before the war. Fouad, who is currently an assistant research professor at the American University of Beirut, was once the director of the Primary Health Care Department in Aleppo. Now he says the supply of medications to treat chronic illnesses such as kidney failure, cancer, diabetes and cardiac diseases has virtually dried up.

Overall, the country’s official and non-official hospital networks are both unsurprisingly in dire straits, said Fouad, who ran mobile clinics across the country before the civil war and has written extensively on the health crises that have emerged from the conflict that has displaced about 10 million people and injured hundreds of thousands.

He spoke to Syria Deeply about the state of the country’s health sector and how it will leave lasting issues in physical and mental health that will challenge Syria for years to come.

Syria Deeply: Based on your research on Syria’s healthcare system, where are the public health services most vulnerable?

Fouad: In principal, the problem inside Syria is caused by the fact that we have several health systems. The first system in place is the principal one, which is affiliated with the Ministry of Health and is part of the regime. The second system exists in areas that are outside the control of the regime. And the third one – if we can call it a healthcare system – exists in the areas under the control of the extremist Islamists. This problem forms a huge challenge for the humanitarian and healthcare response systems, which are functioning and under regime control, and aid is possible. As for the second healthcare system, it has also been possible to deliver some aid through neighbouring countries to the areas that are outside regime control, but it is not enough and far from efficient. The third system, if we can call it a system, is in the areas under the control of the extremist Islamists and there is no chance to deliver aid. We actually don’t know what the problems are that they have.

Syria Deeply: What are some of the biggest problems facing the population today?

Fouad: The healthcare problems were triggered by the collapse of the infrastructure in areas that were under regime control. That led to the spread of contagious diseases, mainly Hepatitis A, diseases related to lack of water sanitation, typhoid, lipidosis, diarrhea. In addition, the services that could be offered and given to women have suffered a lot. We have had cases of unsafe child delivery. The problems resulting from that were numerous including, complications, bleeding and eventually death.

Because the Syrian crisis has taken a longer time, we began to see problems in treating chronic illnesses such as kidney failure, cancer, diabetes, heart operations and others. These illnesses got more complicated because the proper treatment is not available, or is very expensive. Many of the healthcare sector workers have left the country for fear of being targeted or kidnapped. They sought a safe place outside the country, and that placed a bigger burden on the system inside the country.

Syria Deeply: How are people coping? What are some of the creative solutions you’ve seen?

Fouad: In Syria today, we began to see serious problems with the availability of medication. Even the existing medications we had problems with. The medications available to the patients are less than 20% of what was available before the crisis. Many of those who engaged in the past in the medicine production sector are facing a lot of difficulty today. They suffer from disrupted electricity supply, lack of general security and lack of secure movement of their employees and their production and materials. Life and medication became very expensive, hard currency was not available all the time, sanctions were imposed, and there was a lack of safe access to deliver medication to points of need. Many medications disappeared from the markets, including those treating cancers, antibiotics, heart diseases and children’s and women’s diseases. As a result of the above, we started to see a shortage in proper treatment, and the destruction of hospitals and healthcare centers.

As a result, more than 77% of the hospitals have been damaged severely, are non-functional, or it’s very hard for them to operate with full capacity. In the areas that are not under regime control, the healthcare situation is extremely dire and needs help to treat patients in areas such as Idlib, Deir Ezzor and Aleppo. Medication reaches these areas through smuggling, and so often the condition of its safety or preservation are not guaranteed. We really do not know the quality of medication that is being distributed in areas that are outside our control.

More than 15,000 doctors left Syria; many of them were highly qualified and specialized in their fields. Those who are left behind are the young generation who have less experience. As a result, we started to see different problems related to injuries. It is estimated that about 600,000 to 800,000 people have been injured because of the war. Some have their homes destroyed by military attacks, shrapnel or they were in the line of fire.

We do not have information about those who have permanent disabilities, such as the loss of a hand or a leg.

Studies say at least 100,000 suffer from huge disabilities, and will form an economic and social burden, and will be in need of continued services. Many of them have left the job market and need financial support. Therefore, we should provide services for them very soon.

Syria Deeply:: What has been the impact on women?

Fouad: In most wars, and long-term wars, women are affected badly. So often the husband leaves home either to make a living, or to carry arms to fight. The woman becomes the head of the family, and this places a huge burden. This aspect is ignored most of the time, and physiological health becomes a secondary concern. But this is a major element that we have to pay attention to, as it could lead to further complications for a whole generation.

Women are exposed more to problems also because they take care of children, work hard and get a lack of proper nutrition. In addition to that, when an area is besieged, or when goods become very expensive or unavailable, children are those who are affected most.

Syria Deeply: We’ve heard that pregnancy is on the rise in Syria. How are women managing to give birth in such dire circumstances?

Fouad: Child deliveries are conducted most of the time under unsafe conditions, especially in areas where the war is still raging. Unsafe deliveries are also taking place in remote areas that are far from health services or transport routes and areas that have seen influxes of refugees. We hear of complications, premature deliveries, bleeding and lack of first aid emergency services, which eventually leads to deaths.

One of the most important problems women face in wars is actually the availability of proper services.

When women flee to an area whether locally or abroad, the host community often does not provide proper shelter and services. This is what happened when people fled from Idlib, for example, to areas inside Syria or in Lebanon.

Syria Deeply: You ran mobile clinics in Syria before the war. Could they be deployed in a situation like this to provide care? What other flexible methods could work?

Fouad: This is a very important subject when we have a crisis, and when we have areas that are not receiving any services, we can work with different forms of mobile clinics. But this could only work if the area is secure and accessible.

We can also use new technology. For example, we can diagnose and deliver the service through the internet, or smartphones. This applies in cases where a consultation is needed but the physician cannot reach the area in need, provided that the area actually has technological services and equipment such as a laptop, etc.

This kind of tele-clinic is effective for diagnosis and health education, but it is not very effective in areas of treatment, where you need a mobile clinic. But there is a strong need to use the technology of mobile clinics in refugee areas and informal settlements. An example of that is Lebanon, where you have gatherings of refugees or settlements. In this case, mobile clinics are very important, and serve several communities.

Syria Deeply: What is the most basic thing that could be done to improve public health provision today?

Fouad: We have to distinguish and talk on two levels: one is Syrians inside Syria, and the other one is Syrians in neighbouring countries.

For the Syrians inside Syria, the most important element is that there should be coordination between workers in the healthcare sector. If I work to provide a service in a certain area, I need to work with the people who are in charge of distributing the services in this region.

Organizing and managing the service is very important so we do not end up having an overlap or waste.

Coordination, actually, is only possible in secure areas. But security is not the only element. One important element to a better healthcare is funding.

In addition to that, we need an innovative approach to treat health problems. When we have a problem with the vaccination of children, for example, we need to educate a number of people about that at the same time.

When we talk about healthcare outside Syria, it should be comprehensive, especially in hosting countries and communities. When you provide services and aid to the refugees, and you exempt the hosting communities from the aid, you are actually increasing tension. For example in Lebanon, 80% of the national healthcare services that are being offered are private. Therefore, we have to develop the healthcare services in a balanced and equal way.

In areas outside regime control, there is lack of information about the kind of healthcare problems that we face or may face. If we have a problem with diarrhea or polio, the evaluation of these problems is left to the estimation of average people who so often have no experience. We need to know who is providing medical aid and who decides how to distribute it. Unfortunately, there aren’t enough efficient personnel with medical backgrounds to prioritize. As a result we have seen some tragic deaths resulting from medical complications and vaccines.

Health management is really an important issue in the area of healthcare. Mismanagement could lead to tragic results and could be worse than corruption.

Largest Oil Worker Strike in the United States since 1980 Widens

By Kathryn Maureen Ryan
Impunity Watch, Managing Editor

WASHINGTON D.C., United Sates of America – A strike carried out by refinery workers in the United States will likely widen to 11 refinery plants late Saturday night as planned walkouts have been scheduled at BP plc refineries in India and Ohio. Currently approximately 4,000 workers represented by the United Steel Workers Union (USW), which represents hourly workers at the 65 U.S. refineries, are on strike in nine plants in California, Kentucky and Texas including seven refineries that account for about 10% of the nation’s refining capacity. The action is the largest strike in the oil refinery sector since 1980. The United Steel Workers represent workers at 65 American oil refineries that produce approximately 64 percent of nation’s refined oil. The USW was in negotiations as part of the collective bargaining process with Shell Oil (Royal Dutch Shell) as part of a national pattern bargaining process when Shell walked away from the labor negotiating triggering the strike.

Unionized workers picket outside of the Marathon Petroleum Corp. Galveston Bay refinery in Texas, the union demands better safety standards for workers. (Photo courtesy of Bloomberg Business)

Among other requests, the union is demanding a better policy to prevent workplace fatigue, which federal officials have said contributes to dangerous refinery accidents. According to the United Steel Workers union the union’s primary concern in calling for future strikes is the health and safety concerns of hourly workers at U.S. refineries. USW Local 12-591 President Steve Garey argued that urgent safety concerns forced the 3,800 oil workers to walk out on Feb. 1. The Local 12-591 staffs the Tesoro refinery which is one of nine USW facilities that are currently on strike.

USW International Vice-President Tom Conway argued the strikes are focused on the Union’s safety demands. “This strike is about safe staffing levels inside the refineries and staffing levels of our maintenance workforces and having safe and reliable staffing in the refineries. And the situation that exists today just has become unacceptable,” said Conway. “We have people who are working twelve, fourteen, sixteen, eighteen continuous days without a day off on 12 hour shifts. And people are stressed with an amazing amount of overtime and fatigues and sleep deprivation. It’s dangerous. It’s a dangerous way to run an operation like a fuel refinery.”

“We didn’t seek this strike,” Conway said, arguing his union is ready to return to the bargaining table, “We’re not lookin’ for it. But we need problems solved. And just an intransigent attitude from them isn’t gonna get us there. It’s not going to solve the problem. So hopefully they look at these in a genuine way and come back and are willing to sit with us and have an honest discussion about how do we make sure we have a well-trained adequate workforce. They don’t seem to us to be difficult discussions that a management should be so unwilling to have with its workforce.”

A United Steel Workers spokeswoman confirmed that notices of intent to strike had been given to the BP (formally British Petroleum) refineries in Indiana and Ohio .BP spokesman Scott Dean said the two refineries were operating normally on Friday. The Spokesperson also announced the company’s intention to hire temporary replacement workers to take the jobs of the workers represented by the union, known as “scabs” within the Union community.

For more information please see:

Bloomberg Business – U.S. Oil Workers’ Strike Expands To BP Plants with Talks on Hold – 6 February 2015

Reuters – UPDATE 1-U.S. Refineries Strike To Widen As Walkouts Planned At BP Plants – 6 February 2015

United Steel Workers – Health and Safety Must Come First In Oil Bargaining – 6 February 2015

United Steel Workers – WIN News Report: Steelworkers Refinery Strike Is About Safe Staffing – 4 February 2015

Nigeria to Postpone Presidential Elections Citing fight Against Boko Haram

By Kathryn Maureen Ryan
Impunity Watch, Managing Editor

ABUJA, Nigeria – Nigeria’s electoral commission has announced that it will postpone Nigeria’s presidential and legislative elections, which were initial scheduled to be held on February 14, 2015, for six weeks to give a new multinational force time to secure northeastern areas under the heavy attack from Boko Haram, an official close to the commission told said on Saturday. Millions of Nigerian voters could be disenfranchised if next week’s elections went ahead while Boko Haram continues to hold large swaths of the northeast region of the country and continues commit attacks against civilian populations which have driven 1.5 million people from their homes.

Supporters of the Nigerian president, Goodluck Jonathan, gather at a rally in Yenagoa, Nigeria. (Photo courtesy of the Guardian)

Electoral officials reportedly met with political parties Saturday, asking for their views on a postponement requested by the national security adviser, politician Bashir Yusuf told reporters saying the adviser argued the military will be unable to provide adequate security for the elections because of operations in the northeast.

A postponement in the elections will also allow for more time for electoral officials more time to deliver 30 million voter cards. The commission had previously stated that the non-delivery of cards to nearly half of Nigeria’s 68.8 million registered voters was not a good enough reason to delay the elections.

Civil rights groups staged a small protest on Saturday in opposing any proposed postponement of the elections. Police reportedly prevented demonstrators from entering the electoral commission headquarters in the nation’s capital, Abuja. Armed police blocked roads leading to the government building. Officials in President Goodluck Jonathan’s administration have previously called for postponement of the elections. Jonathan’s party has won every election since the end of military dictatorship in Nigeria in 1997 but the failure of the military stop the Islamic uprising, which has grown over the past 5 years, coupled with growing corruption and an economy hit hard by the recent dive in international oil prices have hurt Goodluck Jonathan, the head of state of Africa’s largest oil producer and most populous nation.

Any postponement in the vote is opposed by an opposition coalition which has fielded the former military dictator, Muhammadu Buhari, in this year’s elections. The coalition opposes the postponement despite the act that it is expected to win most votes in the northeast region of the country. Analysts say the vote is too close to call and believe it is the closest election since the end of military dictatorship in 1999.

Supporters of both candidates are threatening violence if their candidate does not prevail in the elections. An estimated 800 people were killed in riots in the majority Muslim northern regions of Nigeria after Buhari, a Muslim, lost the 2011 elections to Jonathan, a Christian from the southern region of the country.

For more information please see:

ABC News – Nigeria Postponing Feb. 14 Vote Amid Boko Haram Violence – 7 February 2015

The Boston Globe – Nigeria Postpones Elections amid Violence – 7 February 2015

The Guardian – Nigeria To Postpone Elections To Fight Boko Haram – 7 February 2015

Al Jazeera America – The Real Reason Nigeria Should Delay Elections – 5 February 2015

Death Toll in Syrian Civil War Now Exceeds 210,000 Lives

By Kathryn Maureen Ryan
Impunity Watch, Managing Editor

DAMASCUS, Syria – The Syrian Observatory for Human Rights, a watchdog human rights organization based in the United Kingdom, reports that the death toll from the Syrian Civil War, which has raged on for nearly four years, now exceeds 210,060 deaths. The group noted Saturday that the actual figures are likely much higher. According to the Observatory, which has networks of reporters operating within Syria, the lives of at least 10,664 children and 6,783 women have been lost over the past four years. The Observatory also reported that 35,827 Syrian rebels and 45,385 Syrian army soldiers have been killed in the civil war. 24,989 foreign jihadist fighters from radical Sunni rebel groups including the Nusra Front and Islamic State of Syria and the Levant have also been killed. The group’s Chief, Abdul Rahman said all the cases included in its 210,000 deaths reported were those it could verify with either name and identification documents, or pictures or videos. According to the Observatory, at least 1.5 million Syrians have some type of injury and permanent disability as a result of the war.

Residents walk past damaged buildings after what activists said were air strikes by forces loyal to Syria’s President Bashar al-Assad in the Douma neighborhood of Damascus February 6, 2015. (Photo Courtesy of Reuters)

The brutal killings of Syrian civilians began when peaceful protests began calling for democratic reforms after four decades of rule by the family of Syrian President Bashar al-Assad. The protests, which began in March 2011 followed an organic rise in protests and democratic demonstrations that began in Tunisia and became known as the Arab Spring. The Assad regime responded to the peaceful protests with brutal crackdowns and attacks on civilians and degenerated into an armed insurgency. Syria had a population of approximately 23 million before the outbreak of the deadly civil war. At least 3.73 million Syrians have fled the country and have been officially registered as refugees abroad.

While the world’s attention remains on the horrific attacks committed by extremists groups like the Islamic State of Iraq and the Levant (ISIS), attention on the atrocities committed by the Assad regime have waned in recent months, despite the regime’s continued use of tactics aimed at targeting and punishing civilian populations perceived to be loyal to rebel groups. Deadly barrel bomb attacks on crowded areas populated by civilians have already been reported in Syrian cities this year, including in the northern city of Aleppo.

Marie Harf, a spokesperson for the United States Department of State condemned the Assad regime’s latest barrel bomb attacks. “These attacks show an utter disregard for human life,” she said, arguing that “there can never be a stable, inclusive Syria under the leadership of this ruthless dictator. … Assad has lost all legitimacy and must go.”

For more information please see:

The Denver Post – Death Toll Mounts, Attention Wanes in Syria’s Bloody Civil War – 7 February 2015

Global News Canada – Death Toll in Syria’s Civil War keeps rising as World Focuses on Islamic State – 7 February 2015

The Irish Times – Syria Death Toll Exceeds 210,000, Says Human Rights Group – 7 February 2015

Reuters – Syria Death Toll Now Exceeds 210,000: Rights Group – 7 February 2015

ICTJ: Boko Haram and the Lessons of the LRA

2/2/2015

By ICTJ President David Tolbert

On January 10, a particularly atrocious terrorist attack was mounted in a bustling market in the northern Nigerian town of Maiduguri: a ten-year-old girl detonated an explosive device hidden beneath her dress, killing 16 people and injuring dozens of others. The child bomber – who, witnesses claim, was unaware that she was carrying explosives at all – was sent by the militant Islamist group Boko Haram.

The next day, a similar attack was carried out in the Nigerian town of Potiskum by two ten-year-old girls with explosives strapped to their bodies. These attacks came just days after reports started trickling in of what may be Boko Haram’s deadliest terrorist attack yet: the massacre of up to 2,000 people in the town of Baga.

These were not isolated attacks. In fact, Boko Haram’s campaign of terror began long ago. The group gained global attention last year, when it abducted 276 girls from a school in Chibok; but the girls remain unrecovered, and now the “Bring Back Our Girls” campaign is all but forgotten. Estimates of the number of people Boko Haram has killed since 2009 range from 4,000 (according to international human-rights groups) to 13,000 (according to the Nigerian government).

The danger that Boko Haram poses cannot be overestimated. The group increasingly resembles the Lord’s Resistance Army (LRA), which wreaked havoc in northern Uganda and South Sudan for decades. Like the LRA, Boko Haram represents a serious threat to regional stability. It already controls large parts of Borno province, which borders Niger, Chad, and Cameroon, and its offensive has now spilled into Cameroon, where it recently attacked a military base.

There are other parallels between the two groups, including the targeting of children. The LRA has abducted boys and girls as young as seven to be used as soldiers and sex slaves. The LRA’s recipe for child recruitment has many ingredients, but central to their twisted method is forcing children to kill members of their own family and community in gruesome ways, making it less likely they will ever be able to return home again.

Despite clear evidence of massive human rights violations, the Ugandan government and the international community were slow to respond to the LRA threat.

LRA Leader Joseph Kony and his three top commanders have been wanted by the International Criminal Court (ICC) for war crimes and crimes against humanity since 2005. But it was only after the controversial internet campaign called “Kony 2012” made him the world’s most-wanted fugitive, raising the political stakes for Uganda and the region, that the United States sent some 200 troops to help an African Union force hunt down Kony. Three years later, he is still on the run.

And yet, the international community’s response to Boko Haram’s atrocities seems to be as slow and erratic as it was to the LRA. Absorbed in the attack against Charlie Hebdo journalists in Paris, it took days for the international community to even condemn the mass killing in Baga. Nigerian president Goodluck Johnathan sent condolences to Paris days before he publically reacted to the massacre of his own citizens. It seems no lessons were learned from the experience with the LRA.

A failure to act is both wrong and dangerous. One can rightly be concerned that political factors can get in the way of strong action to prevent further killings and to ensure accountability for the abuses committed thus far by Boko Haram. Indeed, Nigeria is an important source of oil and raw materials, with growing economic importance to the West, as well as to China, India, and other major emerging countries. Competing for lucrative contracts, global powers have in the past seemed inclined not to offend the Nigerian government by drawing attention to its inability to protect its citizens or to ensure accountability for atrocities.

But ignoring Boko Haram will only enable it to commit more atrocities. The failure to act in this case maybe another example of the international community averting its gaze from African suffering, as it has so often done in the past, most notably in Rwanda in 1994.

The ICC Prosecutor took an important step on 20 January by warning Nigeria’s government of its obligation to prosecute Boko Haram leaders for crimes that “deeply shock the conscience of the world”. While these are welcome words, the ICC should also issue a definitive timeline for Nigerian authorities to demonstrate convincingly their commitment and, perhaps more relevant, their capacity to investigate Boko Haram’s atrocities effectively. An ICC mission to the places affected by the group’s attacks would be needed to determine whether progress has been made; if Nigeria does not make sufficient progress, the ICC prosecutor should issue a proprio motu decision to open an independent investigation.

A clear course of action is required if perpetrators of Boko Haram’s atrocities are to be brought to justice sooner than it took to see Dominic Ongwen, one of the LRA’s top commanders, give himself up nine years after the ICC indicted him.

Boko Haram cannot be allowed to continue its campaign of terror, violence, and death in Nigeria and beyond. The Nigerian government and the international community must demonstrate that lessons have been learned from the case of the LRA, and act now to protect lives and ensure accountability of perpetrators.

A version of this op-ed appeared on Project Syndicate on January 31, 2015, here