Syria Feature: The Growing Crisis in Health Care (IRIN)

Doctor with Syrian Refugees in LebanonIRIN, the news service of the United Nations Office for the Coordination of Humanitarian Affairs, writes in The Guardian:

Eid Hanani has not been affected by the bombs, the snipers or the shelling that have engulfed many parts of Syria. He only barely escaped death, but faced a threat of a different kind. In July, he was diagnosed with cancer of the bladder. But the only cancer hospital in the capital, Damascus, was out of the serum injections used for treatment.

The nearly two-year conflict in Syria has claimed tens of thousands of lives, destroyed entire neighbourhoods, and sent hundreds of thousands of people fleeing. More quietly, however, it has eaten away at the country's healthcare system. Pharmaceutical factories, which used to produce more than 90% of the country's drug needs, are down to one-third of their former production, according to Elizabeth Hoff, the representative of the World Health Organisation (WHO) in Syria.

Many have been destroyed or damaged in the fighting --- sometimes directly targeted by the opposition. The northern city of Aleppo, one of the worst affected, was home to most of the factories. Other factories are struggling to import raw materials due to sanctions imposed on Syria by western countries. Insecure routes have affected supply lines.

On the black market, Hanani was able to find an alternative to the cancer serum, smuggled in from Lebanon. The dose costs him 5,000 Syrian pounds (£43) a month, half the monthly salary of his son, the family's sole breadwinner. "Without it, the pain is extreme, I don't sleep, and eventually I would die," said Hanani, who wore a small cloth tied around his neck to cover the hole in his throat --- a legacy of another bout of cancer he overcame four years ago. His dirty fingernails hold a machine against his throat to help him speak. "My life is in God's hands," he told IRIN with a smile, exposing missing teeth.

The shortage of medicines is just one part of the healthcare crisis in Syria, as hospitals run out of space and supplies, health workers struggle to get to work, patients lose access to health facilities, and medicines shoot up in price.

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Many pharmacies, even in Damascus, are struggling to keep up with demand; their shelves are empty and specific brands are unavailable. Amid shortages as high as 40%, some pharmacies have limited the amount of medicine they give each customer.

"Just give me a few more boxes --- I beg you," one customer recently pleaded at a pharmacy in an upper-middle class neighbourhood of Damascus. "I need this medicine and we have no pharmacy in Harasta." Two pharmacies used to service Harasta, a suburb of Damascus that has experienced heavy fighting in recent months. The first was looted amid the chaos; the owner of the second left when the government started shelling the area, the Harasta resident said.

To get the medicine she needs daily, she walks for 20 minutes to an area still served by public transport, and rides into the capital. As she begs for more boxes, another customer calls into the pharmacy looking for Vitamin B complex. Normally, the pharmacy carries 10 different brands, but on this day, none remain.

"I have to turn away many customers," said the pharmacist. "Often, we can offer the patient an alternative to the brand they usually take, but sometimes, we have nothing."

Pharmacies have tried to make up for the gap in local production by bringing in medicines from outside, but they have only managed to do so in limited and unorganised ways, and at a higher cost that many Syrians can no longer afford. (International medicines are not always covered by Syrian insurance companies.)

According to Hoff, insulin is no longer available in some areas. Previously, she said, 40,000 diabetic children in the country depended on insulin pens that are no longer available through public health centres. Now they must resort to a method that is more painful and harder to use.

Those medicines that are available have risen in price, and amid spiralling unemployment and rising food prices, many Syrians --- especially those displaced by the violence --- are struggling to afford their usual medication.

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