Al-Hasakah – Majd al-Salem

Residents of the northeastern governorate of al-Hasakah suffer from the high prices of medical examinations in light of the deteriorating living conditions and the continuous decline in the value of the Syrian pound against the dollar.

High prices have greatly affected people with limited incomes and workers with daily wages, as well as the unemployed.

In the absence of alternatives, some residents of the region neglect their illnesses and pains or postpone their treatment until solutions are available.

Some towns and villages in al-Hasakah governorate are outside the areas covered by humanitarian and medical organizations, while the activity of some of these organizations is limited to types of medicines and simple medical services.

Postpone treatment

Ali al-Mikhlif, 55, of Qamishli city, suffers from back pain and needs spinal surgery, but the cost of the operation, which amounts to millions of Syrian pounds, forces him to bear his pain until he finds a solution.

Al-Mikhilf told Enab Baladi that the examination of the specialist doctor supervising his condition had cost 25,000 Syrian pounds (about $4), so he stopped the periodic review and became completely dependent on painkillers to temporarily relieve his pain, despite the danger of excessive use, according to what the doctor told him.

($1=7,550 SYP) according to the S-P Today website that covers the trading rate of the Syrian pound to the dollar.

There is no particular job that brings a “good” income for al-Mikhlif and his family, except for a small plot of land that he has been working on for two years, but he has not gained anything from it due to the drought that has struck the area for years.

Al-Mikhlif added that he no longer asks about the doctor’s reputation, skill, and experience, as what matters now is the price of the medical examination.

The continuous rise in prices had a negative impact on the life of Hussein al-Ali, 35, of Qamishli, who told Enab Baladi that the high prices of medical examinations made him and “many like him” only see doctors in cases of extreme necessity.

He endures bouts of high temperatures, fever, or tooth and joint pain and relies on his natural immunity due to his inability to see a doctor.

Al-Ali works in one of the brick workshops, which causes him severe fatigue and exhaustion, as well as joint and back pain, as a result of the effort required by this type of work.

With the accumulation of fatigue in al-Ali’s body, he needed to undergo some X-rays to inspect some of the bones in his body that hurt him, but he was unable to perform them due to the high costs.

Availability of medical services

As one of the alternative solutions for al-Ali, to avoid the pain and costs, he sometimes resorts to the pharmacist, who in turn has turned into his “private doctor” to prescribe the appropriate medicine for him, he told Enab Baladi.

Despite the existence of such medical services in the National Hospital in Qamishli, within the regime-held areas, and its almost free cost, he refuses to visit it for fear of being arrested for being wanted for reserve military service.

“The location of the National Hospital in regime-controlled areas in Qamishli deprives civilians of visiting it, especially young people of the age of compulsory service or reserve military service,” al-Ali added.

This is not only about patients but also their families and companions, such as the situation narrated by Samir al-Hawas, 46, when his father suffers from kidney failure that requires dialysis twice a week.

Al-Hawas told Enab Baladi that he worries a lot when he accompanies his father to the hospital and remains tense during the four hours required for dialysis in the National Hospital, which prompted him to search recently for an alternative center within the areas of control of the Autonomous Administration of North and East Syria (AANES), even if it is far from his place of residence.

According to what Enab Baladi monitored, there is a state of lack of regulation in the prices of medical examinations, as they range between 15,000 and 25,000 SYP, while the prices of surgeries vary, according to the type of operation, the doctor’s personal assessment, and the extent to which the doctor takes into account the patient’s financial condition.

Cesarean sections cost about one million Syrian pounds, while residents pay about 800,000 Syrian pounds for an appendectomy and between 600,000 and 900,000 Syrian pounds for gallbladder removal.

Blaming doctors

Dr. Abdullah, an internal medicine physician, confirmed that the high prices of medical supplies, including laboratory tests, X-rays, and other diagnostic tools, lead to higher costs of services, including examinations, which is the right of a doctor who, like others, suffers from the high cost of living.

At the same time, some doctors face difficulty in “maintaining a decent standard of living,” according to Dr. Abdullah, as they pay heavy taxes to the Autonomous Administration.

Even the fees deducted from the doctors’ wages by the region’s authorities amount to “several million” on the pretext that they are high-income people.

Dr. Abdullah added that these taxes and the continuous demands for doctors to reduce wages “as if they were the only party responsible” prompted some of them to travel to Europe.

MSF comments

Al-Hasakah governorate is one of the areas that witnessed over the past years the activity of organizations concerned with providing medical services, but these services have gradually decreased over time.

Regarding the decline in medical services in the northeastern governorate, Enab Baladi contacted the Médecins Sans Frontières organization (Doctors Without Borders), which is active in the region, and stated that the organization does not represent a substitute for health facilities and authorities in the countries in which it intervenes.

Through its activities, the organization tries to bridge the gap of medical and humanitarian needs. When these needs are met, it hands over responsibility to local health institutions and provides support to other populations in need.

MSF considers a number of different factors when deciding where to intervene, including looking at places where needs are greatest, and access is permitted.

The organization’s teams are constantly monitoring the humanitarian situation in northeastern Syria for emergency needs, and as part of that, they have recently conducted emergency responses in Raqqa city as a result of cholera and influenza outbreaks.

The activity also included the cholera response in al-Hasakah governorate as well.

Insufficient solutions

In 2011, the Autonomous Administration of North and East Syria (AANES) opened what is known as “People’s Clinics,” and the value of a medical examination in them amounts to 5000 Syrian pounds.

According to Hawar News Agency, which is close to the AANES, the specializations available in the clinics are: internal, gynecological, neurological, pediatric, ear, nose and throat, kidney, urinary, orthopedic, and general surgery departments, in addition to the dental clinic, laboratory department, X-ray imaging and pharmacy with a staff of 54, including doctors, administrators, and technicians.

According to “Hawar,” the People’s Clinic’s pharmacy offers medicines at a price that is 10-20% lower than that of regular pharmacies, and the ultrasonography service is 60% less, medical tests 30%, and X-rays 50%.

Imad, an ophthalmologist in al-Hasakah governorate, told Enab Baladi that the failure to generalize the “People’s Clinic” experience in all regions prevents everyone from benefiting from it, and most doctors do not continue to contribute to it due to the delay in paying their dues.

In addition to the high prices of examinations, the residents suffer from the high cost of medicines and the lack of some of them, the poor medical services provided by associations and international organizations, and the high costs of private hospitals.