Generally speaking, Syria is a relatively new and young country only gaining its independence from French rule in 1946. In the years to follow there were multiple coups that took place and jostled power around between many groups until it ultimately found its way into the Assad family in 1970. Hafiz al-Assad remained in control for 30 years until his passing in June of 2000.(The Editors of Encyclopædia Britannica, 2017) The following day, the People’s Assembly amended the Syrian constitution to make the minimum age of a President to be 34, thus allowing Hafiz’s second son, Bashar, to take over reign.

 

Bashar was not intended to succeed his father, but rather his older brother Basil. However, this was no longer a possibility when Basil died in a car crash in 1994.(The Editors of Encyclopædia Britannica, 2017) Bashar at the time was in London studying ophthalmology when he became his father's successor and returned home when he finished his schooling. The medical degree he obtained in the UK will become the basis of a lot of irony in the years to come.

 

During his first few months in office, Bashar made a lot of moves that were seen as intentions to advance and move forward with democratic reforms, like the releasing of 600 political prisoners.(The Editors of Encyclopædia Britannica, 2017) This was quickly reversed in the next year when he issued a huge crackdown on reformist politicians and activists shutting down all hopes that the new president would lead Syria away from authoritarian rule.

 

These activists and reformers were held quiet for many years until 2011 when the Arab Spring brought rise to pro-democracy campaigns in Egypt, Tunisia, and Libya. These messages slowly but surely made their way into Syria and many non-violent protests were held in cities across Syria. The Syrian government responded by literally closing off and containing whole cities where these demonstrations were occurring so they wouldn’t spread any further. The success of this tactic was short lived. It was not long before the government responded with lethal force, having security forces open fire on protests and killing hundreds.(The Editors of Encyclopædia Britannica, 2017) Assad pointed fingers at foreign conspirators seeking to destabilize Syria. This event marked the beginning of the Syrian Civil War.

 

The violence did not stop and instead steadily increased as the government continued to use lethal force against anyone speaking out against Assad and his regime. In March 2011, the first large scale battle between government forces and the opposition took place and lasted over 5 days in the city of Al-Rastan. Government forces were victorious. Shortly after this incident, the United Nations (UN) put out a report stating that over 3000 people had been killed since the start of the protests at the beginning of the year and 90% of these deaths were the result of government force.(Walsh, 2015) This bitter war against what the government claims is terrorism has evolved a complete collapse of infrastructure within Syria and has resulted in a near non-existent health care system.

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

The United Nations has performed multiple investigations on the Syrian government and has found them guilty of deliberately attacking hospitals and medical personnel. A report published by the U.N. stated, “The pattern of attacks indicates that government forces purposely targeted hospitals and medical units to gain military advantage by depriving anti-government armed groups and their perceived supporters of medical assistance.”(Nebehay, 2013) This method of attack is in direct violation of the Geneva Convention which states that direct attacks on hospitals, places housing the sick and wounded, or units displaying the red cross emblem is a war crime. Despite the glaring evidence, the Syrian government denies any wrongdoing and claims they are directly fighting ISIS and other jihadists groups.

 

As terrible as it is, the abuse does not stop there. The hospitals that are being attacked are then being taken over and used by the Syrian army as bases and points to attack anyone else seeking medical attention. There have been multiple accounts of patients being burned, beaten, and tortured to death in military hospitals across the country and victims languishing at checkpoints unable to get to the treatment facilities they need as they fall under repeated attack.(Nebehay, 2013) Doctors, nurses, and other medical personnel are fleeing the country in fear of being arrested or killed for providing care; the ones who remain have had to move into basements of houses and other inconspicuous places in order to continue practicing.

 

Adding to the complexity of the problem, there are many outside forces that have been launching their own attacks within Syria. Most notable of these is Russia, which has been very open about their involvement backing Assad’s said “war on terrorism”. One notable attack happened in late October, 2015 in a little city outside of Aleppo. Russian forces dropped an initial bomb near a hospital which appeared to injured no one but as the first responders were there they struck again killing 12 medical personnel. This style of attack is deemed a double tap.(Walsh, 2015) The Russians and Syrians are not the only ones to blame as there are many other countries including the US that have launched attacks in Syria, these just tend to be more appropriately directed. The Rebels even have been at fault in some cases, though far less, where they have failed to respect the neutrality of medical facilities.(Nebehay, 2013)

 

In 2016 alone there was more than 100 reported attacks on hospitals. (WHO) Prior to this war the Syrian health care system was on a steady rise. In 1970 the life expectancy was 56 By 2000, this had risen to over 73, comparable to western societies with modern medicine. The infant death mortality  as well as the death by communicable diseases also fell during this time.(Kherallah, 2012) Total government expenditure on health as a percentage of Gross Domestic Product was 2.9 in 2009.  Despite such low public investment, access to health services increased dramatically since the 1980s even in rural populations achieving better access and care than before. All of this is on the decline due to the fact that Syrians own people and government are destroying all the infrastructure as a result of this civil war. Statistics concerning this matter are not yet quantifiable due to the ongoing crisis. 

 

Syria is experiencing a protracted political and socioeconomic crisis that resulted in a severe deterioration of living conditions which has also significantly eroded the health system. More than 90,000 people have been killed since the beginning of this war and over half a million Syrians are registered as refugees in neighboring countries like Turkey and Jordan.(Kherallah, Alahfez, Sahloul, Eddin, & Jamil, 2012) All the improvements and advances in the medical world are being reversed as vital infrastructure has been compromised or destroyed, resulting in a lack of shelter, energy sources, water and sanitation services, food insecurity and serious overcrowding in some areas. The quality of health care has been further affected by the deterioration in the functionality of medical equipment due to the lack of spare parts and maintenance shortages of drugs and medical supplies due to sanctions imposed on imports/exports by the United States and the European Union.(Kherallah, Alahfez, Sahloul, Eddin, & Jamil, 2012) The chronically ill that were receiving the treatments they needed before the war have been compromised. Elective surgeries and non-urgent routine medical practices have been halted in order to tend to the life –threatening injuries seen almost daily. This indicates that a growing number of patients, mainly with chronic conditions are facing a dire situation, while awaiting treatment not to mention the victims of war who are also being sacrificed as there is not enough personnel to tend to everyone.

 

With what has been taking place within Syria its not hard to understand why two thirds of the countries health care workers have either fled or been killed. At this point in time the Syrian Health Coalition is trying to prevent the total collapse of the health care system before its all over, but its very apparent the work that will need to be done to restore normal functioning post-war is substantial. As stated before, a good majority of the infrastructure has been destroyed throughout the country of Syria and a major assessment will need to be done to determine the actual extent of the damage. To go along with this, the absence of medical facilities for the previous handful of years has not only compromised the health of patients who were receiving the treatments they needed, but created more patients with war time injuries and illnesses like postpartum treatment for mothers/children, epidemics and food-borne illness outbreaks, vaccine preventable outbreaks, and mental health issues like PTS reesulting from the constant violence.(Kherallah, Alahfez, Sahloul, Eddin, & Jamil, 2012)

A situation like this is hard to fathom in a first world country but it is not something we can just turn a blind eye to either. The people of Syria are being punished for standing up to their government, wanting the power back in their hands rather than in that of wealthy family’s. Before the conflict, the Syrian healthcare system was seen as one of the most developed in the Middle East and the statistics proved this as life expectancy, child mortality, and communicable disease rate were all moving in the right direction. However, with the extent of the damage all of these advances seem to have never happened. It will take years, perhaps decades, to rebuild Syria's health care to such a standard.