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HTS’ expansion aggravates medical sector and threatens millions, Northern Syria

Editing: Obaida Al Nabwani |
TranslationEditor: Farah Nassif |


Turkey -SMART

The medical sector in areas controlled by the Hayat Tahrir al-Sham (HTS) in Northern Syria suffers from several problems often related to the lack of support and suitable atmosphere for medical work. The HTS’ expansion following recent clashes against Free Syrian Army (FSA) factions in most areas of Idlib and western Aleppo aggravated these problems, pushing the donor sides to suspend supporting medical sector without considering the need of millions of civilians for medical services.  

HTS’ control majorly affects the medical sector
Four million people live in the areas recently controlled by the HTS. Most of these people depend on humanitarian aid and need medical services amidst difficult conditions in the area such as cold weather,  bombings, and lack of significant materials. 

The HTS is an Islamist opposition faction previously known as the al-Nusra Front, consisting of fighting groups including the Haqq Brigade, Jabhat Ansar al-Din, and Jaysh al-Sunnah.

Despite the dire need for the medical sector, the HTS’ control majorly affected the pharmaceutical industry in the area. The German Agency for Technical Cooperation (GIZ) suspended supporting medical projects and free health directorates of Idlib, Hama, Latakia, and Aleppo, on the background of the clashes between the HTS and the FSA. 

Founded in 2012, the GIZ undertook to support ambulance systems, hospitals, and medical centers in Northern Syria. In early January 2019, the GIZ informed the free health of directorates of Idlib, Hama, Latakia, and Aleppo, of suspending support until further notice. The health directorates turned their work into voluntary in all hospitals, medical centers, and clinics.   

Mustafa al-’Idou, the assistant manager of the Free Idlib Health Directorate, said that suspending support included 33 facilities belonging to the directorates, depriving 630 medical staff and other employees of their salaries. Al-’Idou added that suspending support will deprive 80, 000 civilians from medical care.

Al-’Idou noted that the donor's sides decided to suspend support by 2019 as the clashes between the HTS and FSA broke out in western Aleppo. Al-’Idou said that the Free Idlib Health Directorate underwent such circumstances earlier as the donor sides suspend support during conflict before they make their final decision whether to resume the support or not after evaluating the new field situation.

A source from the Free Aleppo Health Directorate reported that suspending support will deprive  450 nurses, doctors, and other employees in 43 medical facilities of the Directorate from their salaries. The source added that suspending support will also deprive 250,000 people of medical care. Ibrahim al-Shamali, the manager of the Media Office of the Free Hama Health Directorate, said that suspending support will deprive 200,000  civilians a third of whom is children in northern and western Hama from medical care. 

After suspending support, sides took procedures to put pressure on the organizations and donor countries to resume supporting the medical sector in Northern Syria. The manager assistant of the Free Idlib Health Directorate said that they would launch a large supporting campaign on the internal and international levels. The Free Aleppo Health Directorate appealed and delivered messages to international organizations and countries such as the United States and the European Union.  
The Free Idlib Governorate Council of the Interim Syrian Government urged the donor sides to resume supporting the medical directorates, emphasizing that they are civil institutions that work under international laws and criteria. The council warned against stopping the work of hospitals and medical centers that serve 3 million people in Idlib, saying that the international community and its institutions would bear the responsibility for the humanitarian disaster in the area.
The Syria Response Coordinators Team that documents and counts forcibly displaced people and their needs published a statement saying that suspending support will force 179 medical centers serving 4,7 million people in Northern Syria, to close. The Idlib Political Committee, which was founded in 2016, called upon the United Nations and humanitarian organizations to intervene to resume support. The committee emphasized that the health directorates are independent and were not affected by the recent changes in military control.  

Medical services deteriorate in HTS-controlled areas before its recent expansion 
Although the HTS’ control over large areas of Northern Syria was a direct reason to stop support for the most extensive medical facilities in the region, the HTS-controlled areas was always suffering from poor services and projects, especially medical ones, because donors refrained from working in a region controlled by a globally classified entity on the terrorism lists. 
In November 2017, the director of the health clinics’ work center in the city of Idlib, Kamal Sarmini, reported that the organizations refuse to provide support to the center due to the HTS’ control on the governorate. In August 2017, the director of the Ihsan Hospital in the city of Saraqib, southern Idlib, Ali al-Faraj, said that the hospital was shut down due to the lack of support from Relief International Organization. 
In December 2017, the Doctors Without Borders stopped supporting a medical center, which was serving 22 villages, in the village of Meshmashan, western Idlib. In the same month, a medical source at the Omar Ibn Abdul Aziz Hospital, which is the largest hospital in the city of Jisr al-Shughur, said that the hospital was threatened to shut down due to lack of support. Also, the health center in the nearby village of Khirbat al-Jawz had to limit its medical services for the same reason. 
In December 2018, the medical director of the Kafr Nubl health center, Dhu al-Faqar Ghazul, said that Syria for Relief and Development Organization stopped to support the center clinics since mid-September. The management of the al-Ikhlas hospital in the village of Shanan in the southern countryside appealed to humanitarian and relief organizations to support the hospital, which serves 72 thousand people. 
The medical management of the Tal Minis town’s hospital, Ibrahim Sabagh, said that the organization Relief International stopped its support of the hospital, which serves about 150,000 civilians, three months ago. Sabagh noted that they requested support from different organizations, but received no guarantees. 
In May 2017, the director of hospitals at the Idlib Health Directorate, Dr. Abdul Hamid Dabbak, warned of a medical disaster due to lack of support. The Idlib Health Directorate also declared that the number of doctors has decreased by about 90 percent. 
The medical sector in HTS-controlled areas suffered from other problems, such as HTS members’ repeated violations against medical workers. The HTS detained the director of the Hama Health Directorate and two doctors after storming the directorate’s building in the city of Kafr Nubl, southern Idlib. The HTS also committed other violations against other doctors and nurses. 
Since 2011, medical staff in Syria have been providing services to the needy for seven years, despite all the difficulties they faced. However, all of these services began to deteriorate due to the cessation of support by international organizations, although the medical sector was steadfastness for years in the face of direct shelling by the Syrian government, kidnappings, and assassinations that targeted medical workers.