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Medical check-ups fees raise controversy in northern Syria

The examination of a patient in the internal medicine department at Mamdouh Abaza Hospital - 13 March 2020 (the hospital's Facebook account)

The examination of a patient in the internal medicine department at Mamdouh Abaza Hospital - 13 March 2020 (the hospital's Facebook account)

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Enab Baladi – Zeynep Masri

The determination of medical check-ups fees in Idlib province has raised controversy, amid attempts by the syndicate authorities to control the fees, which was met by refusal for several reasons.

On 3 June, the council of the “Idlib Free Doctors Syndicate” issued a decision specifying the cost of medical examinations in Idlib province; however, the council withdrew the decision’s statement hours after releasing it.

According to the decision, the general doctor is to be paid a minimum of two and a maximum of six US dollars or their equivalent currency.

Meanwhile, the fees paid for a specialist physician are a minimum of three and a maximum of eight USD or their equivalent currency.

The syndicate’s statement gave the doctor the right to determine the medical examination cost “as it may deem appropriate,” within the lower and the upper limits.

The statement pointed out that the cost of diagnostic procedures, according to each specialty, is added to the examination fee, leaving it to the doctor to estimate its value within the recognized limits of each medical specialty.

 Individual or collective responsibility

The decision provoked controversy on social media outlets. Activists discussed details of the decision, considering that raising the fees of medical check-ups is “inhuman,” especially in the light of the economic conditions of citizens in Syria.

The President of the “North Free Doctors Syndicate, “Dr. Mohammed Walid Tamer told Enab Baladi that the head of Idlib doctors was the one who determined the new fee and then withdrew the decision.

Tamer indicated that the Central Union did not agree to the decision and exerted pressure to withdraw it.

On its part, Enab Baladi contacted the head of Idlib doctors, Abdul Hamid Dabak, to find out more about the decision’s details; however, no reply was received.

Nevertheless, a doctor working in Idlib city whom Enab Baladi did not reveal his name said that Dabak did not issue the decision. Instead, the syndicate issued the decision on consultations among the member doctors; it was not a personal decision.

He added that some doctors who objected to the decision exploited it “for personal purposes and gain.”

They viewed the decision as “inhumane” within the continuous decline in the Syrian Pound’s value against the US dollar, as the dollar exchange rate exceeded 2,000 Syrian pounds (SYP) along with the price increase.

The same physicians work in the public sector, with contracts registered up to three decades with three medical bodies for salaries up to 3,500 USD (around seven million SYP), which is why they do not charge fees from patients in their private clinics.

 “Illegal” syndicate

According to the doctor, the “Idlib Free Doctors Syndicate” was formed about two years ago “in difficult circumstances” and for six months only, before the Syrian regime forces arrived in the southern countryside of Idlib.

He pointed out that the term of the current syndicate president ended six months after its establishment.

He added that due to later events of battles and displacement, there was no re-election for a new head or members for the syndicate.

Besides, he said that most of the physicians working in Idlib city do not recognize the syndicate as their representative, despite its necessity.

A large part of the doctors in Idlib consider the syndicate as “illegal” for the non-repetition of elections; thus, any decision, regardless of the new cost determination decision, will not be recognized, the doctor said.

As for Tamer, The president of the “North Free Doctors Syndicate,” he said that the syndicate brings together several sub-unions of Aleppo, Hama, Syria’s coastal regions, and the “Idlib Free Doctors Syndicate.”

According to Tamer, the “North Free Doctors Syndicate” is the “only” medical body that covers the entire Syrian north.

Tamer added that the number of doctors working in the Syrian north who are registered in the syndicate is about 700, beside another 150 unregistered doctors.

He pointed out that the syndicate established a legal committee of a judge and two doctors, which aimed at protecting doctors if any of them were legally held accountable or arbitrarily dismissed by organizations or workplaces.

Regarding doctors’ contracts, Tamer said that they differ according to their specialty; nevertheless, doctors of “uncommon” medicine specialties have more than one contract.

This was discussed with the doctors in northern Syria, for some of them have no contracts at all, according to Tamer.

 How medical examinations’ fees are determined 

The medical sector in Idlib has been suffering from a shortage of doctors working there. Moreover, not all the doctors work in the public sector which is often supported by organizations and provides salaries that are considered “good” given the current economic conditions.

While a “fair” proportion of doctors work in the private sector and medical clinics, which rely mainly on “check-ups fees.” Most prominent of these doctors are the medical specialists who do not perform surgical operations, such as gastroenterologists, pediatricians, cardiologists who do not perform catheter operations, endocrinologists, and dermatologists, as well as gynecologists, according to a doctor met by Enab Baladi.

The doctor supported the syndicate’s decision to set the medical check-ups fees, for he believes that doctors need to set a ceiling for their fees, preventing them from demanding high amounts that are overburdening the patients.

At the same time, the decision guarantees their rights, and help them pay the costs of their clinics.

He said doctors in northern Syrian regions are affected by the severe economic conditions just like the rest of the society.

He pointed out that the patient pays only 1,000 SYP as a medical examination fee (half a dollar), thus increasing the financial burden on doctors of the private doctor to pay the clinic costs including the rent, electricity, internet, and salaries for the nurses working with them.

Because of the 1,000 SYP fee, a doctor should examine 50 patients a day to receive a daily amount of 25 USD, which is “impossible.”

According to the doctor, the decision was “wrong” to set the upper limit of the fee (six and eight USD), which confused people and led to misunderstanding the decision.

He also believes that the syndicate should not have published the decision for the public, instead share it with doctors’ chambers.

High-cost surgical operations

The doctor talked about the medical fees from his personal experience. He explained that as a general practitioner, he conducts special surgeries that require “expensive” measures.

He wondered, ” would it be reasonable to perform a surgical operation of only 2,000 or 3,000 (SYP = 1.50 USD)”.

He pointed out that the decision to specify the medical examination fees, which was not discussed, was to control the prices of medical procedures (operations) in private hospitals, such as the cardiac catheterization.

According to the doctor, performing surgery in private hospital costs between 50 and 75 USD, including the cost of medicine, accommodation, and rental of an operation room, except for the doctor’s fee.

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