Mrs. Rania had to wait for a whole year before she could find a donor, who would give up one of his/her kidneys to save her life in exchange for money, a sum that she describes as “massive,” added to previously paid expenses of dialysis, hospitals’ fees and the costs of a repeated travel from Aleppo to Damascus.  

Rania, a pseudonym, said that “with one of my family members, I used to travel to Damascus every month to have kidney dialysis’ sessions, when the sessions in Aleppo stopped paying off. We were compelled to rent a house in the capital because it was difficult to stay at relatives’ houses, in addition to the travel’s hardships and the dire financial conditions which worsened my health conditions. I also started to lose hope of finding a donor.”

Searching for a year, Rania’s family finally met one of Assad’s forces soldiers, who wanted to sell his kidney. After conducting the needed tests and examining the new kidney’s potential compatibility with the forty years old woman, the surgery was implemented in a private hospital in Damascus last year.

Rania, who refused to reveal her real name for security reasons, told Enab Baladi that “my health has went a lot better after the surgery, but still I insist to travel to Damascus to conduct a few tests, since that the number of specialized doctors in Aleppo has acutely declined.”

Rania fears a relapse, in the shadow of “lacking a doctor to help her in Aleppo,” according to what she said, pointing out that her suffering resembles that of many other people in the city, who continue to complain about the shortage of doctors and the complexity of medical care conditions.

In 2010, in the city of Aleppo were about 2000 doctors, the third of whom were female doctors, according to a census published by the Syrian regime’s Ministry of Health; the number is the largest in all Syrian governorates. However, the Ministry has published no further reports after the break out of the revolution, for the later years have witnessed an acute deterioration in the number of Syrian doctors that was not subject to surveys at the level of the governorate.

The situation inflated with Assad’s forces control of Eastern Aleppo’s neighborhoods, prior to which the doctors used to function in the city’s two parts. However, upon seizing the eastern neighborhoods, all the doctors left the area and boarded the displacement buses. With the return of some families to the city, the doctors, who stayed in the eastern neighborhoods, were supposed to cover the entire city’s medical needs.

Enab Baladi communicated with a number of medical sources in the city of Aleppo to address the medical sector’s dilemma, its reasons and repercussions; the majority of these sources refused to reveal their real names for security concerns.

 

Cardiologists and Orthopaedics Have Disappeared Almost Entirely

Mrs. Rania does not deny the presence of a few kidney specialists in the city of Aleppo, but the experience she had with kidney failure and doctors in the past two years, compelled her to say that “I had a difficulty in finding a good doctor and when I found one to supervise my case, the hospital where I had dialysis did not meet my needs all the time, for the dialysis machines kept breaking down, which forced me to travel to Damascus.”

“I also had trouble relying on other doctors to treat back pain that I experienced following the renal relapse,” Rania added.

Enab Baladi interviewed a pathologist, informed of the medical situation in Aleppo, who pointed out that the city is witnessing a crucial contradiction in relation to the number of specialized doctors, which is causing a state of confusion among the patients, who keep in pursuit of a new doctor.

The pathologist, who also for security reasons refused to use her real name, added that “most of the time the patients return to the laboratory to conduct tests that totally differ from the ones they have formerly done that depend on each visited doctor’s viewpoint, which indulges the patients in a constant state of worry.”

She pointed out that, today, doctors are failing to diagnose the most familiar diseases, giving as an example, “one of the patients who had to repeat the tests three time as required by an internist, after he suffered a general fatigue and a fever. My friends and I, based on the symptoms which he described, suspected that he had viral hepatitis, but the demanded test did not include any relating to the disease,” she continued saying that, “the patient, after a while, returned for a viral hepatitis test, demanded by a different doctor. The patient was actually infected.”

“We were shocked by the doctor’s failure to diagnose the disease, especially that it massively spread in the past period in the city of Aleppo due to dependence on fast food and the usage of meat, doubted as expired, to make those meals,” the pathologist commented.

The pharmacist Maisaa, a pseudonym, pointed out that the city is witnessing “a total absence” of well-reputed cardiologists, which she describes as an alarming situation, for the arteries and blood vessels’ illnesses are of the most common types, so are heart surgeries.

According to official statistics issued by the General Authority of Forensic Medicine in Syria in 2016, “the rate of natural deaths due to heart attacks and brain strokes rose to about 70% of the total deaths in the country, while it did not exceed 40% prior to the Syrian war.”

The pharmacist pointed out that orthopedics is facing a major crisis of proficiency, as it is monopolized by newly graduated doctors, who are not that experienced. As for the other specialties, Maisaa indicated that the situation is “relatively good” with respect to the number and experience of doctors.

 

Drug Companies Are Enhancing the Failure

The decline in the medical production, both in terms of quantity and quality, after the revolution, has created a competition-based crisis between the very few active companies; the competition impacted the doctors’ performance, according to the pharmacist, who stressed to Enab Baladi that the doctors today are prescribing medicines according to the drug companies desires in mind, which led to a further damage in the medical sector.

 

The pharmacist stresses the fact that “some doctors, in one way or another, have turned into merchants, who respond to the marketing demands of the drug companies, which drown them with money and gifts, thus triggering them to prescribe ineffective medicines, a thing made possible by the lacking accurate standards of medical production and the weak censorship imposed on the sector.”

“Both Asia and Human produce a medicine called Retin, used for the treatment of acne, and according to pharmaceutical standards Asia’s product is the most effective,” as the pharmacist has said, adding that “Asia Company has stopped the production process for a while, and following the release of its medicine in the market once more, the doctors kept prescribing Human’s product, a thing that many pharmacists have noticed.”

Before the revolution, drug factories in Aleppo constituted 55% of the total pharmaceutical production in Syria, but most of the factories in the governorate went out of business or stopped for long periods, while new companies emerged, and the imported medicines entered the already active field of competition.

 

Substandard Care, Medical Mistakes and Dozens of Victims

The decline in the number of doctors and many people’s turn to the services offered by government hospitals, the “University Hospital,” “al-Razi Hospital,” “Ibn Rushd Hospital,” “Ibn Khaldoun Hospital for Neurological and Psychological Disorders,” which are combated by more than 20 private hospitals.

The pathologist Mohammad, a pseudonym, pointed out that majority of these hospitals offer substandard care, affected by the decline in the number of needed doctors and because they are totally dependent on medicine trainee students.

He also told Enab Baladi that “throughout the crisis, most of the doppler devices (echocardiography) in the city’s hospitals have gone malfunction due to the constant power shutdown, in addition to the ICUs that were closed in many government hospitals, forcing most of the people to rely on the private hospitals.”

Local media outlets have repeatedly spotted what they referred to as “medical disasters” committed by doctors in some of Aleppo’s hospitals. In January,2018, for example, a news about a girl who underwent a successful thyroid gland surgery, to die immediately after exiting the operation room due to negligence in a private hospital went viral.

In February 2018, a two years old boy has also died after a simple thoracoscopy, during which his bronchial tree was “mistakenly pierced.

Doctor Mohammad pointed out to Enab Baladi that the “Specialized Shahbaa Hospital” has lately witnessed a serious medical error. While a woman gynaecologist was doing a curettage, one of the most common surgeries, a part of the patient’s intestines was damaged, by mistake also, putting the patient in a serious condition that required several additional surgeries.

 

The Doctors Have Left the Country, So Did the Patients

According to a statement by Abdul Qader Hassan, the Chief Medical Officer of the Syrian Doctors Union, the number of doctors in Syria has declined from 33 to 20 thousand. He explained that the Union has suspended about 1150 doctors from work on charges of dealing with the “opposition gunmen,” in addition to the suspension of more than a thousand doctors for illegal emigration and for not paying the union’s fees, stressing that the number of the doctors who formally left the country, through the regime’s crossings, is five thousand doctors.

To the above- mentioned numbers, thousands of dead or arrested Syrian doctors in the past seven years is added.

In 2015, “Doctors Without Borders” Organization said that the number of doctors in Aleppo did not exceed a 100, pointing out to both male and female doctors who performed in the eastern neighborhoods, and following the regime’s control over the whole city, late in 2016, the active doctors back then have also left the city.

The decline in the number of doctors in Aleppo, compelled the people to search for medical substitutes, for, in the past a few years, they have depended on the pharmacists’ prescriptions and the diagnoses made by newly graduating doctors.

Traveling for treatment was the best solution and Damascus the best destination, according to patient Rania, who narrated her story to Enab Baladi, who said that the medical treatment she received in Damascus was relatively better, but it similarly does not meet the demand.

“If my family’s financial situation was better, I would do not have hesitated about traveling to Beirut to conduct the surgery there. However, it costs a fortune, and I think that no one in Syria can afford it in the meantime,” she added.