Dwindling international aid to north-west Syria this past year has left approximately 3.1 million people, including 2.8 million internally displaced people, facing a health crisis as hospitals and other medical facilities struggle to operate on low resources, Amnesty International said today.
Medical facilities in this part of the country, which is under the control of the armed opposition group Hay’at Tahrir al Sham, rely entirely on funding from the international community to provide free health services and medication. Over the past ten months, international aid to the health sector, dropped by more than 40% due to the overall reduction of international assistance to Syria.
“It should go without saying and, particularly after two years of the pandemic, that healthcare systems are critical services that people need for survival. This past year’s massive funding drop has immediately translated into the closure of hospitals and vital services, and has left millions of Syrians – who have already suffered conflict and violence – struggling to access medication and other essential health care,” said Lynn Maalouf, Deputy Regional Director for the Middle East and North Africa at Amnesty International.
“International donors meeting in Brussels next week should prioritize ensuring adequate funding for health and other essential services as millions of people face the appalling prospect of being denied access to health care amid a worsening crisis. Everyone’s right to health must be protected, which means being able to access health services when needed, without worrying about the financial cost.”
Amnesty International interviewed eight doctors and health workers, four people who recently sought medical care and four humanitarian aid workers, each of whom described how the funding cuts have led to a shortage of resources and medication, leading to a scaling-down of operations and vital services.
Reduced capacity and supplies place health and lives at risk
Shortages in staff, medicines, equipment, and reduced operational capacities prompted hospitals to scale back their services putting people’s lives at risk. Four hospital managers told Amnesty International that their facilities face imminent risk of closure if funding is not secured urgently.
His parents begged me for help, but I had no choice but to turn them away.
Manager of obstetrics and paediatrics hospital in north-west Syria
Another doctor told Amnesty International how shortages in health care services were threatening lives: “On one occasion this year, a patient with a heart attack was rushed to our emergency unit. We did not have oxygen for a ventilator, so we tried to transfer him to another hospital in an ambulance, but he passed away before getting there.”
A doctor working in another hospital that lost funding in August 2021 shared a similar story, saying: “In January , we received a five-month-old baby in the emergency unit with severe malnutrition and respiratory failure. He needed intensive care support, but we didn’t have a spot for him due to lack of capacity and staff shortages. We intubated him in the emergency unit and gave him manual respiratory support for four hours as we tried to find him a spot in another hospital. Unfortunately, we were not able to find any and he passed away.”
All doctors and health system users interviewed by Amnesty International said they had seen a shortage in essential medications, especially for chronic illnesses. One doctor said his hospital had even struggled to obtain anaesthetics.
A lack of funding also means that health workers, whose salaries were covered by aid contracts, now work at multiple facilities simultaneously to secure a sufficient income. Other health workers have not been paid due to a lack of funding. Seven medical workers told Amnesty International that they have been working without pay for months.
Inaccessible, unaffordable healthcare
Hospital closures coupled with a reduction in services and the high cost of private healthcare services make accessing healthcare extremely difficult for many people in north-west Syria. Patients now have to travel longer distances to find a hospital or a medical centre. Public transportation is often limited and, for many, the cost of transportation is unaffordable.
The father of a child who suffers from asthma said: “A while back, my son had an asthma attack. As usual, I rushed him to a nearby hospital, but found out the hospital lost funding… The one available doctor in the emergency room told me the child needed urgent admission to a hospital. I had to borrow money and take him in a private car to a hospital in Idlib, around 60 kilometres away.”
The anti-torture law was enacted by Presidential Decree on 30 March after being discussed in Syria’s parliament for the first time on 28 March.
Amnesty International has previously documented inhuman conditions across Syria’s prisons. The widespread and systematic use of enforced disappearance, torture and other ill-treatment, which has led to deaths in detention, and extrajudicial executions following sham trials, amount to crimes against humanity.
With a number of states – including Denmark, Sweden and Turkey – restricting protection and putting pressure on refugees from Syria to go home, the harrowing testimony in Amnesty International’s report is proof that no part of Syria is safe to return to. Returnees told Amnesty International that intelligence officers explicitly targeted them for their decision to flee Syria, accusing them of disloyalty or “terrorism.”
Syrian security forces have subjected Syrians who returned home after seeking refuge abroad to detention, disappearance and torture, including sexual violence, Amnesty International said today. In a new report, “You’re going to your death”, the organization documented a catalogue of horrific violations committed by Syrian intelligence officers against 66 returnees, including 13 children. Among these violations, Amnesty International documented five cases whereby detainees had died in custody after returning to Syria, while the fate of 17 forcibly disappeared people remains unknown.
“Military hostilities may have subsided, but the Syrian government’s propensity for egregious human rights violations has not. The torture, enforced disappearances, and arbitrary or unlawful detention which forced many Syrians to seek asylum abroad are as rife as ever in Syria today. What’s more, the very fact of having fled Syria is enough to put returnees at risk of being targeted by authorities,” said Marie Forestier, Researcher on Refugee and Migrants Rights at Amnesty International.
In 2014, the UN designated four border crossings for delivering aid (including medical and surgical supplies) to Syrians in need. Russia and China blocked the UNSC from using all but one border crossing, which serves Northwestern Syria, and its mandate is set to expire in January of 2022. The Ambassador for Syria characterized the SC’s resolution for humanitarian aid delivery through border crossings as a “politicized mechanism” that violates Syria’s sovereignty. Bab al-Hawa is therefore the only existing and last remaining crossing for UN cross-border aid. Humanitarian workers in north-west Syria say that its closure would have a devastating impact as such aid currently reaches 85% of people in need every month.
This July, we urge China and Russia to extend the humanitarian access through Bab al-Hawa and allow the crossing through two additional aid corridors – Bab al-Salam and al-Yarubiyah.
The al-Hol camp is under the control of the Asayish, the Autonomous Administration’s police force. The main section of the camp hosts Syrians and Iraqis while the camp area known as the Annex hosts all women and children from third countries (other than Iraq). Children in the Annex are subjected to various forms of forced separation from their caregivers.
Amnesty International interviewed 10 individuals with knowledge of the situation in the camps, including eight eyewitnesses, who described the precarious conditions in al-Hol as well as abuses by the Autonomous Administration, which runs the camp and has effective control over north-east Syria.
Over the past year, the Asayish have been arbitrarily detaining boys as young as 12 in the Annex, separating them from their mothers and caregivers, solely on suspicion of the boys’ potential “radicalization” in the future and without any evidence of wrongdoing. The Asayish transfers the boys to detention centres described as “rehabilitation centres” outside of al-Hol camp, which lack adequate access to food, water and healthcare and where diseases such as tuberculosis and scabies are rampant.
Children in the Annex as young as two are forced to separate from their mothers or caregivers in order to go to a hospital. When children need to access healthcare services outside of the camp, humanitarian organizations provide a referral based on a lengthy process. Armed security forces escort the children to the healthcare services and refuse to allow mothers or caregivers to join, and then fail to follow up directly with the caregivers who are left with no information about their children’s medical condition.
Under the Convention on the Rights of the Child, no child should be deprived of his or her liberty arbitrarily and the detention of a child should be a measure of last resort and for the shortest appropriate period of time.
“The Autonomous Administration must immediately release all boys who have been arbitrarily detained and cease the practice of family separation and reunify as quickly as possible any child who remains separated from their parents or guardians,” said Diana Semaan, Syria Researcher from Amnesty International.
For Iraqi and third national children, repatriation is their only chance of leaving the camp. In 2021, Iraq slowly began a repatriation process. However, the majority of other states have been reluctant to fully commit to the repatriation of all children.
Amnesty International urges at least 60 governments to repatriate children held in Al-Hol.
Parties to the armed conflict in Syria continued to commit with impunity serious violations of international humanitarian law, including war crimes, and gross human rights abuses. Government and allied forces carried out indiscriminate attacks and direct attacks on civilians and civilian objects using aerial and artillery bombing, killing and injuring hundreds of people in Idlib and Hama in north-west Syria. Government forces continued restricting access to humanitarian and medical aid to civilians living in government-controlled areas.
Security forces arbitrarily arrested civilians and former fighters who had reconciled with the government and continued to detain tens of thousands of people, including peaceful activists, humanitarian workers, lawyers and journalists, subjecting many to enforced disappearance and torture or other ill-treatment, and causing deaths in detention. Armed groups working with the support of Turkey continued to subject civilians in Afrin to a wide range of abuses, including confiscation and looting of property, and arbitrary detention. They and Turkey were likely responsible for indiscriminate attacks during hostilities in north-east Syria.
In the same region, the Autonomous Administration carried out several arbitrary detentions. The US-led coalition failed to investigate the many civilian deaths caused by its 2017 bombing campaign on Raqqa against the armed group calling itself the Islamic State (IS). Military offensives in north-west and north-east Syria internally displaced 684,000 and 174,600 people respectively. Tens of thousands of displaced people continued to live in makeshift camps, schools and mosques that did not provide an adequate standard of living.
The Danish government should immediately stop plans to withdraw Syrian residence permits.
Hundreds of Syrian refugees, including children, have been told by the Danish Immigration Service to return to Syria, assessing that Damascus and the surrounding areas are safe to return to. At least 39 Syrians have received their final assessment in the Refugee Board – and are now in a deportation position.
But Syria is far from a safe country. Although military hostilities have diminished in most of the country, Syrian citizens continue to risk persecution and human rights abuses – including in Damascus and the surrounding area.
“In Damascus, the Assad regime has consolidated its power now, not with bombs, but with horrific human rights violations, extremely arbitrary arrests and extensive torture laboratories. Can our Prime Minister Mette Frederiksen guarantee the lives of Syrian refugees when they cross the border when the UN and the United States cannot? ” said activist, Dr Haifaa Awad.
Responding to a decision of the Higher Regional Court in Koblenz, Germany, which has convicted former Syrian intelligence officer Anwar Raslan to life in prison for crimes against humanity, including torture, murder and rape of detainees in Branch 251, an infamous military intelligence facility in Damascus city, Amnesty International’s Deputy Director for the Middle East and North Africa, Lynn Maalouf, said: “Today’s verdict is a historic victory that amplifies the voices of tens of thousands of survivors of unlawful detention, torture and sexual violence, as well as the voices of the families of victims who died in Syria’s prisons and detention centres as a result of the treatment of Syrian security forces for over a decade. Notably, it also recognizes the systematized nature of sexual violence as crime against humanity. This wouldn’t have come about without those who dared to share their stories, Syria’s civil society actors, and human rights and litigation organizations who have doggedly pursued justice, truth and reparation over the years.
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