The Syrian regime appears to have given up the effort to tackle the COVID-19 pandemic, as the real number of infections across the country have soared in recent months. Seeking to portray itself as a competent regime able to care for its population, Damascus is pretending the pandemic remains under control. Burying its head in the sand, the regime is coercing employees and students to return to work and packed classrooms, as if the official low number of cases reflects reality. While doctors are left to treat patients without protective equipment, the regime does take care, however, to protect the lives and health of employees in critical regime institutions, such as torturers and manufacturers of weaponry.
In response to the failure of the regime and officially registered NGOs and U.N. agencies, independent and semi-clandestine initiatives sprang up across the country to help the infected. Instead of supporting these efforts, Damascus views the independent initiatives with suspicion, heavily surveilling them and seeking to divert community-donated resources to serve the interests of the regime and private interests of its members. The mismanagement of the crisis not only means that more Syrians will die; it also will further compromise the future of the country’s already-ravaged health sector.
Undercover Health Care
“We distribute [the oxygen cylinders] at night, far from view, fearing reports to security [the secret police] if we take too long,” said Mahmoud, one of the volunteers involved in the secret distribution of free oxygen cylinders in the western Damascus countryside. As the number of Syrians infected by COVID in areas under regime control skyrocketed in recent months and hospitals are filled to capacity, Syrians have turned to buying oxygen tanks to survive without professional medical care. Explaining the need to work in secret, Mahmoud added: “the distribution [of aid] or any charity work requires the permission from the security branches, and this takes a long time and exposes the donations to theft or its diversion to segments of society selected by the branches.”
Mahmoud’s initiative is one of multiple local, independent efforts to assist those infected with COVID-19 that have sprung up in multiple towns and cities under Syrian regime control. These initiatives emerged due to the failure of the state’s health sector and officially registered NGOs to address the pandemic. Seeking to dominate all mobilization of its subjects, the Baath regime has spent decades surveilling and punishing initiatives developed outside of the framework of authorized Baath-linked and state-run institutions. Instead of facilitating the life-saving work of initiatives aiming to address the COVID-19 outbreak, the regime views them with suspicion, seeing any independent initiative (and particularly ones financed by Syrians from abroad) as a potential threat that could challenge its authority.
Faced with an unknown virus and fearing loss of control, initially, the secret police (known as the mukhabarat) was heavily involved in monitoring of COVID-19 cases, interrogating patients, and even making medical decisions about treatment. With the spread of the virus, the mukhabarat can no longer monitor everyone in Syria who is sick. Instead, particularly in areas once under rebel control, the mukhabarat is tasked with surveilling independent activists seeking to help their communities. Exploiting the vulnerability of the activists and doctors involved in non-officially permitted activities, regime officials have used threats in their efforts to divert resources donated by community members (most of them in the diaspora) into their own pockets and toward loyalists. This surveillance deters additional people from getting involved. “We are just a group of about 10 guys. Some people are afraid of appearing close to us. We try to hide from the beneficiaries that we are working independently so they do not refuse our assistance,” said Mahmoud.
Omar, a doctor working in a town in southern Syria, described a pattern that is repeating itself across the country; it began when a mukhabarat commander showed up at his office after news spread that he is accepting donations to provide free oxygen cylinders to the needy. “Abu Ali came to my office and said, ‘If you want to continue your work, hand over the list of beneficiaries and donors.’ I knew they would make trouble for them, so I said I only gave five oxygen tanks to people and had stopped accepting donations.” Abu Ali told the doctor, “The town is taking all the aid. Why don’t you direct some to the officers’ lodgings?”
Abu Ali referred to settlements established next to the town, on lands confiscated from the original inhabitants, to which officers’ families moved during the time of Hafez al-Assad. Following the mukhabarat’s intervention, the doctor stopped the operation after he had helped dozens of COVID-19 patients unable to secure a bed at a hospital. Fundraising campaigns among the town’s residents in the diaspora were halted.
Meanwhile, officially recognized NGOs have largely been missing in action. The Syrian Arab Red Crescent (SARC), which received hundreds of millions of dollars from foreign donors since the start of the uprising in 2011, is playing a marginal role in the response. Samira, a volunteer at SARC from the Damascus countryside, said the main focus of the organization’s response to the pandemic has been disinfection of public spaces, which according to scientists is largely useless. SARC also carries out informational sessions and schools and small-scale distributions: “We distribute disinfectants and masks, but to be honest, we distribute very little. For example, yesterday we were at a school with 1,500 students and distributed to only 50 students due to shortages.”
Interference From the Regime
The regime is not merely ignoring the pandemic and hindering independent efforts to cope with the crisis; it is also actively contributing to the spread of the virus by obligating state employees and university students to show up for work and studies unless they have a medical report indicating that they are infected with COVID-19. These reports cost at least $3, about 12% of an average salary of a state employee. This practice forces employees to take unpaid sick days, once they run out of the sick days allocated to them, or to show up to the office sick. This policy appears to stem from the desire of the regime to project to the population that the situation is under control, unwilling to admit its weakness and failures. Such incredulous denial of reality manifests in its current denials of the severe benzine and bread shortages in the country.
In a similar vein, universities are forcing all students to attend and do their exams in large halls. On Sept. 13, schools reopened across regime-held areas. In apparently staged photos, official outlets showed relatively roomy classrooms, with about 30 students per class, when Syrian students are usually crammed three and even four per desk, with classrooms ranging in size from 50 students to even 100, unable to socially distance.
Syria’s health sector is not just too dilapidated to meet this moment; it is also becoming more compromised by the day. State hospitals, particularly in the Damascus area, are overwhelmed with patients. They have run out of ventilators, and there is a long line to be connected to one. The regime is not prioritizing the protection of the limited number of health care workers still operating in areas under its control. Doctors have been forced to purchase their own personal protective equipment (PPE) due to shortages. According to medical professionals interviewed across regime-held areas, hundreds of health care workers have been infected, with at least dozens of them dying of COVID. The Damascus Medical Association reported that at least 33 doctors have died of the virus in the city and its environs, not even counting the nurses and pharmacists.
The health care system in regime-held areas has been subjected to great pressure throughout the war, having to treat the war wounded while most doctors were forced to flee the country. Rana, a nurse in the al-Mujtahed Hospital in Damascus, compared prior years to today’s experience: “During the days of the military operations in eastern Ghouta, we had hundreds of wounded, and the situation was crazy.” She added, “At least then we could transfer the patient to another hospital.” Currently, “all hospitals the medical personnel are collapsing, unprepared and unable to help patients. You are forced to watch the patient die in front of you without being able to perform any medical procedure” to save them, she said.
Hospitals are losing personnel not just to illness. The salaries that do not last a week make the risky work simply not worthwhile. The nurse Rana, who was infected with COVID at work, described the impact of the pandemic on the nursing staff: “Most of the nurses have been infected and quarantined at the hospital. Many of them quit their jobs. Don’t blame them; at the end of the day, they have families and children who are more important than the monthly wage that is not enough to live on for even a week.”
The regime’s treatment of what it deems strategically vital institutions shows that it is capable of making more discerning choices. After a number of employees became infected at the Syrian Scientific Research Center (SSRC) branch in Damascus, which produces weapons and wireless communication devices for the Syrian Army, the administration decided to temporarily halt all work. An SSRC engineer, Ahmed, reported: “Two of the engineers were diagnosed through swabs [PCR] done by the Ministry of Health. They were quarantined in the Ibn al-Nafees Hospital, while all other employees were given a holiday to self-quarantine at home for eight days. Following those days, the holiday was extended again after the discovery of additional cases. The Center also underwent a large-scale disinfection campaign.”
Ensuring the safety of prison staff and mukhabarat interrogators also appears important enough for the regime to alter a decades-long practice of meting out particularly harsh torture on political detainees upon their incarceration to break their willingness to resist (a practice known as istiqbal, “a welcome,” or qasr al-Ayn, “breaking the gaze” [into guards’ eyes]). “In the Air Force Intelligence [Branch prison] they have a new measure: Every new detainee is placed in isolation for 20 days and then moved to the communal cells,” explained Ghiyath, sitting in his home three days after his release from detention. He spent three months in detention in Damascus after being arrested in June based on a false report to the secret police that he is a former rebel. “During those first 20 days, they do not let you out, don’t interrogate you. Afterwards, the interrogations and torture start.” His emaciated body, covered in bruises and burns stemming from electrocution, attested to his ordeal.
Questioning Damascus’ Priorities
The casualties of Damascus’ policies are Syria’s medical workers and most of the population who cannot afford private medical care. The regime’s prioritization of the war effort and persecution of medical staff left the health sector in areas under its control short on staff and supplies. This sector is now attempting – and failing – to respond to the spread of the COVID-19 pandemic. Once the pandemic ends its spread in Syria, either through achieving herd immunity or a vaccine, Syria will be left with a health sector that will have lost even more of its staff. Generations of Syrians will continue to pay the price for the mismanagement of their country’s health sector and inadequate COVID-19 response.
Western countries would put the lives of independent activists at risk if they were to receive foreign state assistance, and hence donor countries are forced to work through the dysfunctional NGO and U.N. system operating out of Damascus. Donors should collectively condition additional support to address COVID-19 with transparency regarding the assistance that has been delivered thus far to ensure life-saving assistance is not ending up on the black market or directed solely toward those the regime deems worthy of help. Donors should also provide additional resources to the debilitated health systems outside of regime control, as these areas are witnessing a spike in COVID-19 cases, most of them originating from regime-held Syria.
All names of Syrians mentioned were altered to protect them from retribution.
Qussai Jukhadar is a Syrian researcher based in Turkey. Elizabeth Tsurkov is a Non-Resident Fellow at the Center for Global Policy.
The views expressed herein are the authors’ and do not necessarily reflect those of CGP.