Nour al-Deen Ramadan | Ali Darwish | Zeinab Masri
On 16 August, Ali traveled with his uncle, who was infected with the COVID-19, from Raqqa to Damascus, to find him a place in the hospital, as his condition became critical, and he was in urgent need of oxygen.
However, Ali was unable to find a bed for his uncle in Damascus hospitals, because the answer was always: “There are no beds,” he told Enab Baladi, even though Syrian hospitals only receive critical cases of those infected with the virus.
Afterward, Ali called his friend, who works as a doctor at the “al-Assad University Hospital,” and asked him to secure admission to the hospital with a ventilator, in exchange for a sum of money for a third party which ensures the needs of the patient. This way, the uncle was admitted to the hospital, where he recovered after staying for days in the intensive care unit.
This story and others circulating about corruption in the procedures followed to confront the coronavirus open the door to questions about the extent to which corruption has deepened in a file that is considered a priority for governments all over the world, and its impact on responding and providing aid to those affected by the pandemic. In this file, Enab Baladi is trying to answer these questions by interviewing people infected with the COVID-19, doctors, and neutral experts.
The writers of the investigation were forced to anonymize the names of the doctors who had communicated with while they were on the front lines confronting the COVID-19, in order to secure their safety.
Crowded market full of bribes
Ali, who came from Raqqa with his uncle, did not mention the amount he paid in exchange for a “ventilator” in “al-Assad University Hospital.” But, following this case, questions were raised about the capacity of the infrastructure in Syria to serve tens or perhaps hundreds of persons infected with the COVID-19.
In response to this case, a doctor, who works in the “Al-Mouwasat” and “Al-Assad University” hospitals in Damascus, told Enab Baladi that hospitals and confinement places were quickly filled in Syria, even before the announcement of a thousand registered cases. This has increased the demand for the “ventilators” that patients in advanced stages need.
The doctor added that the “ventilator” costs about 450,000 Syrian Pounds (SYP- around 208 USD)per day in private hospitals that do not receive “Coronavirus” patients. This has compelled patients’ families to search for other ways to get a bed in the hospital, where some workers take advantage of patients’ need for a “ventilator” to get bribes.
The doctor explained that there are some beds and “ventilators” in some government hospitals that are not declared, and he always saw them unoccupied. They are left in case they are needed by a hospital director or health officials in general.
Regarding the services provided by hospitals to coronavirus patients, the doctor confirmed that there is a standard prescription on the wall in “al-Mouwasat” hospital, which requires the patient’s family to take a picture of it and buy the prescribed medicines, which contain some antibiotics and immunity supplements, from the pharmacy. This has caused an increase in the demand for these medicines and their prices. But, the hospital administration removed it after the prescription had been circulated on social media platforms.
Coronavirus tests … a livelihood opportunity!
On 22 July, the Syrian regime’s Ministry of Health imposed a “PCR” test for diagnosing the COVID-19, on those wishing to travel from Syria via “Beirut” airport, at the cost of 100 USD for a single test. Several government centers have been allocated to obtain it before the crowding of public centers pushed them to announce the establishment of private examination centers.
This procedure led to endless queues in front of testing centers, despite the Ministry of Health assigning a hotline number (195) to book an examination appointment. However, this number was out of service, and it caused an embarrassing situation for a doctor in the Ministry of Health on the air via the “Syrian Satellite Channel.” Actually, the presenter tried to contact him, but without a response, after the spread of talk on social media about this ineffective number, and the circulation of pictures and video recordings of gatherings that do not respect the social distancing recommended for the prevention of the COVID-19 in front of the testing centers.
A trip to the Syrian coast
Between requiring COVID-19 tests to leave Syria, overcrowding at examination centers, and delaying obtaining a place to receive it, those wishing to travel are looking for faster ways to get a medical report proving that they are not infected with the COVID, in order to avoid delays and overcrowding.
Enab Baladi followed the methods of obtaining a “PCR” test and reached one of the facilitators to get the results (a broker whose name will not be revealed by Enab Baladi) in exchange for a sum of money.
During a recorded phone call via the Internet with Enab Baladi, the service facilitator explained how to obtain a PCR test in one day. He said that a private car takes those who wish to do the test from Latakia to get a quick test and obtain the result on the same day in order to be able to travel if the test result turns to be negative. He noted that examining regularly requires booking a period of one week to ten days, with difficulties in making the appointment officially. If the examination is carried out, the results need from one to two days to be released.
According to the service facilitator, whoever wishes to conduct the examination pays 300,000 SYP ($ 150) in addition to 126,000 SYP (58 USD) to the bank, as a fee for the test.
Enab Baladi asked the service facilitator to communicate with one of the beneficiaries of his services to conduct the examination, so we reached a man who works in Turkey and who identified himself as “Abu Ahmed.” He said that he had his wife and child examined in Syria through the same broker.
So, a private car (by the broker) took Abu Ahmed’s family from the city of al-Nabek city in Damascus Countryside to Latakia, so that the examination would be carried out and the result obtained within hours. Abu Ahmed sent the test to Enab Baladi, and it was issued on 2 September by the “Early Intervention Center in Latakia,” which only took a few hours, as Abu Ahmed said.
Regarding the reason for not obtaining an examination according to the method specified by the Ministry of Health, Abu Ahmed asserted that he tried to call the number designated for reservation for more than two weeks. Still, he was unable to book an appointment, as the number is always busy.
Involved doctors .. the ministry confirms
Abu Daniel, a resident of Damascus, confirmed to Enab Baladi that he tried to book an appointment by calling the designated number from the Ministry of Health, but he did not get a response.
Afterward, he contacted a student at the Faculty of Medicine at the University of Damascus, who secured an appointment for an examination over the phone in exchange for a 100,000 SYP (46 USD), in addition to the cost of conducting the examination ($100) paid at the bank.
These stories are in line with a Syrian Ministry of Health’s assertion that on 18 August, people, including health ministry workers, were physically involved in exploiting and blackmailing citizens in exchange for a “PCR” test.
However, the ministry did not clarify the nature of this exploitation, and this statement did not prevent the continuation of exploitation that beneficiaries attribute to the complicated government procedures.
Weak prevention measures
Doctors sell their shifts to colleagues who are willing to take a risk
During a conversation with a doctor (Enab Baladi prefers to keep the names anonymous) at al-Mouwasat Hospital, the doctor said that after the spread of a list of 60 doctors who have died from the coronavirus, he refrained from going to the hospital and opted for selling his shifts to another doctor. This way, he can stay at home and avoid contact in order to reduce exposure amid procedures that do not protect medical staff.
The doctor stated that he sold the hours of his work at the hospital to another doctor by the intermediary of friends in exchange for 10,000 SYP (4.5 USD) that he pays to his colleague for each day.
Enab Baladi has been following this story to ascertain whether it is an individual case or a common practice in Syrian hospitals. A doctor working in al-Assad University Hospital and al-Mouwasat Hospital said that all public hospitals in Damascus, especially al-Mouwasat and al-Assad University Hospital, are experiencing this phenomenon. But this practice is most common among people who know each other well or with a third party that both parties trust.
As for the price, it starts with 5,000 SYP (around 2 USD) per day, and each post has a specific price. For example, the price in the emergency service and health isolation centers differs from that of other departments.
The doctor, also infected with the coronavirus, added that the sale of posts existed before, but on special occasions and in emergency cases, especially among students who are from other governorates. He also highlighted the increasing demand for unpaid monthly leave for some senior doctors.
He pointed out that the reason for selling working hours and asking for long vacations is the fear of “coronavirus” infection, given the inadequate protective equipment in governmental hospitals. The doctor stated that the protective gowns which are in the doctor’s room are switched by turns, and this has urged some of them to buy their own protective gowns with their own money.
The two previous testimonies do not contradict the report of Human Rights Watch published on 2 September, which stated that “the Syrian government does not provide protection to health sector workers and frontline workers to confront the coronavirus.”
The organization’s report came after the spreading of lists of deaths of doctors in Syria due to the coronavirus, reaching 80, as monitored by Enab Baladi via the medical pages and the news of obituaries published on social media.
Although the World Health Organization has secured 4.4 million items of personal protective equipment, including medical and respiratory masks, gloves, protective clothing, shoe covers, and hand sanitizers, the Human Rights Watch report documented that hospitals in areas controlled by the Syrian regime went beyond their capacity and had a lack of preventive equipment, besides suffering from a limited ability to use oxygen cylinders. These hospitals can only provide primary medical care for people who cannot afford the financial cost.
Human Rights Watch called on the World Health Organization and other relief organizations working in the health sector to urge the Syrian government to expand the screening capacity, provide transparent and accurate reporting on the number of coronavirus infections, and the equitable distribution of adequate personal protective equipment to health workers in the country, including rural areas. It also called on the government to publicly declare its commitment to increase testing capacity throughout Syria, including areas beyond its control and in the countryside, and to take concrete steps to facilitate the development of testing centers available for equal use.
False figures, then a tardy acknowledgment
The Syria-in-Context site estimated that there were 85,000 confirmed coronavirus cases in Damascus only. This was based on the death pages published on the Internet from 29 July to 1 August, in addition to satellite images of graves, interviews with doctors, and extrapolation of data based on a model created by “Imperial College London” on virus transmission.
This estimation comes after numerous critics and attacks on the official figures announced by the Ministry of Health, reaching 3,041 cases on 5 September.
Estimates on the number of cases were also promoted by Syrian experts in Damascus. Indeed, the Dean of the Faculty of Human Medicine at the University of “Damascus,” Mohamed Naboug al-Awa, predicted that there would be about 150,000 Coronavirus cases in Damascus and its countryside alone, according to the content that was published by the page”sama3t.Hakeem” (Medical Facebook page) on 25 August.
The Director of al-Suwayda Health Center, Doctor Nizar Muhanna, said through his Facebook page on 13 August, directing his speech to the people of al-Suwayda, that when they read or heard about the daily numbers of cases, estimated in the dozens in al-Suwayda, as a result of sampling of positive cases, in addition to the daily deaths, this implies that “the actual numbers that exist are effectively doubled compared to the number recorded.”
He added: “We are in the middle of the pandemic storm that has not yet reached its peak.”
Human Rights Watch’s Syrian researcher, Sarah Kayali, criticized the lack of transparency in the numbers of reported infections, while news of deceased doctors and nurses that are “fighting the coronavirus” was piling up.
According to Enab Baladi, the Ministry of Health’s statements confirmed that the reported numbers reflected the actual number of cases in Syria, before backing off a bit and using the term “recorded cases” in its subsequent statements regarding these assessments and the emergence of evidence of increased cases.
The increase in the number of coronavirus infection has doubled the pressure on the fragile health system in Syria, in addition to the fact that many people are unwilling to be treated in medical facilities. This would lead to more severe complications, according to the United Nations Assistant Secretary-General for Humanitarian Affairs, Ramesh Rajasingham, on 27 August.
The testing capacity for the coronavirus is still minimal, so that cases may pass unnoticed by the medical sector. The reported figures represent only a small percentage of the number of cases, according to Rajasingham, who warned that the closure of health facilities and the shortage of workers in the health sector “are serious impediments in the face of any response to the pandemic.”
According to the Director of Medical Emergencies for the Eastern Mediterranean Region of the World Health Organization, Dr. Richard Brennan, “global rates of virus infection among medical teams vary between 10 and 15 percent of total infections.”
Lack of transparency
Challenges that the Syrian regime does not know how to address
The Human Rights Watch report raises questions about the working mechanism of medical and humanitarian organizations in Syria, and the impact of coordination with them on the government’s performance in dealing with the pandemic.
Sarah Kayali, a researcher in Syrian affairs at “Human Rights Watch,” told Enab Baladi that there are significant problems in the Syrian government’s mechanism in dealing with the coronavirus pandemic.
The first problem that Kayali addressed was the lack of accuracy of official figures on the number of infected cases with the virus when compared to the figures circulating among doctors and nurses working in medical centers and hospitals in areas under the control of the Syrian regime.
Kayali finds no justification for the inconsistency of these figures spread among doctors with the official statistics published by the Syrian regime, which may affect the volume of UN aid and relief programs in Syria.
According to her, there is no particular protocol to deal with the “Corona” virus in rural areas far from the big cities under the regime’s control, without the implementation of precautionary measures that would reduce the spread of the disease, including the obligation to wear a medical mask.
The lack of transparency in the official figures announced regarding the number of people infected by the pandemic comes in conjunction with the cooperation between the Syrian government’s Ministry of Health and a number of international and regional organizations, and other non-governmental organizations, which are facing restrictions from the government on their work to monitor the effectiveness of the mechanism to limit the spread of coronavirus,” insisted Kayali.
Among the forms of restrictions that the regime has imposed on these organizations, according to Kayali, are the non-approval of projects proposed by international organizations, the monopolization of information related to the number of cases by the Syrian authorities, and the lack of access to international organizations. Indeed, the regime must publicly declare any challenge faced by its medical personnel to control the spread of the pandemic.
The negligence of international organizations in their relations with the regime, explained Kayali, lies in fear of the increasing aggression they might face by the Syrian government, in addition to the fear of halting their relief programs and being expelled from Syria.
According to Kayali, “there are challenges in dealing with the pandemic in Syria which people are not aware of. The Syrian government is unaware of how to solve them or the tools needed to overcome the outbreak.”
Kayali insisted that due to the ambiguity of the Syrian health situation in the face of the spread of the new pandemic, the Ministry of Health failed to submit periodic reports to the Syrian government or international organizations, and there are no indications of transparency in the mechanism of distribution of personal protective medical equipment. The organizations are challenged to provide this protective equipment equitably to health centers located in rural areas, she added.
How does corruption, caused by coronavirus, affect the Syrian economy?
Transparency International ranked Syria 178th, with 13 points, in the list of its annual report on the corruption perceptions index, which monitors the state of transparency and corruption in 180 countries around the world.
Corruption is negatively affecting the medical sector
The health sector in all countries is a consuming sector, and governments are spending vast amounts of money on it, according to economist Abdel Hakim al-Masry (who is currently the Minister of Economy in the so-called Salvation Government).
Since all types of corruption already exist in Syria, a large proportion of the resources to treat COVID-19 patients and prevent its spread will be sent to the pockets of influential people in the government, who will try to exploit this pandemic.
According to al-Masry, this is noted by the methods of examination and treatment of people and the incorrect preventive strategies, such as the procedure of paying $ 100 for a “PCR” test. These resources are not crucial for a country, but they open the door to corruption and bribery.
The 2020 budget in Syria reached 4,000 billion SYP (around 9.2 billion USD at the exchange rate of the Syrian Central Bank), with a deficit of 1,400 billion SYP (approximately 1.8 billion USD), and the health sector’s share is 266 billion SYP (354 million USD). The regime allocated 100 billion SYP ( nearly 140 million USD) to face the coronavirus, which is not enough as a total amount of money for people to buy surgical masks, let alone hospitals, beds, examination machines, and medicines, according to al-Masry.
The regime does not provide necessary supplies, and in some governorates, such as Daraa, in southern Syria, people have collected donations to buy essential supplies and rehabilitate hospitals, in the absence of an influential government role.
The Syrian economy is at its lowest level
The wheel of the Syrian economy is operating at a minimum, as it is mainly under siege. So, the effects of the spread of the coronavirus and measures to prevent its spread will not be significant, according to economic researcher Khaled Tarkawi.
The most significant impact from the spread of the COVID-19 and quarantine operations will be reflected on workers in Syria, most of whom are daily workers and unable to resist much due to their lack of savings.
According to Tarkawi, the primary concern of the regime is to show that there are states and institutions providing services. But, the situation is different, as parts of the industrial, agricultural, and commercial sectors are suspended, and people no longer have the ability to go to hospitals.
Amid the spread of the virus, factories and shops will be closed. With the decrease in the number of regular employees in the sectors to a minimum, this will affect the transport sector, according to al-Masry.
There are no official figures about the impacts of “coronavirus” on the Syrian economy. Estimates talk about the loss of some sectors, the most important of which is the industry, trade, and transport, due to the complete suspension of movement within cities and rural areas or between governorates, as well as the tourism sector due to the suspension of visits, especially from Iran and Iraq, to sacred places. Tourism is one of the critical sectors for the government because it is a source of income and foreign currency to Syria, according to a previous interview by economic researcher Manaf Quman to Enab Baladi.
The head of the Finance Department at the Faculty of Economics at the University of Damascus, Ali Kanaan, estimated the economic losses at 1,000 billion SYP (around 140 million USD) per month, meaning more than 33.3 billion pounds per day, according to Al-Watan Online, in addition to estimating the economic losses, during March and April, up to 2,000 billion SYP.
The economic researcher at the Omran Center for strategic studies, Mohamed al-Abdullah, told Enab Baladi that given the worsening living conditions of the majority of the population due to this pandemic, the regime is now torn between two complicated options: either maintaining the current situation, which is marked by the mitigation of possible measures of closure or returning to the previous closure measures taken to deal with the pandemic, which has limited to some extent the spread of the epidemic.
The closure measures, if approved again after being implemented in March and April, could represent a double-edged weapon for the regime, in terms of its failure to bear the economic consequences of the closure due to the financial crisis that they are enduring, and also in terms of its incompetence to contain the pandemic in case it spreads. This is in addition to the subsequent action that the World Health Organization will bring under international control to fully access relevant data and information on the pandemic to address the spread of the virus. Nonetheless, the regime is trying to avoid this scenario as much as possible.
83 Percent of Syrians live below the poverty line, according to UN statistics, far from the effects of Corona, which has increased poverty and food insecurity.
The average salary in Syria amounts to $92.93 (about 120,000 SYP), according to the “Numbeo” site, which specializes in calculating the cost of living. This average includes both the private and public sectors.
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