The impact of the COVID-19 pandemic on wealthy countries with stable health care systems in place was massive and front-page news globally throughout most of 2020. The impact of the pandemic on war-torn Syria, where fewer than 50% of hospitals were fully functioning, half the health care workforce had left and challenges to availability of and access to health services continue, has been utterly devastating. The country is currently experiencing its fourth wave of the coronavirus since the first case was detected back in March 2020. With the number of cases spiking at their highest rate since and less than 3% of the population vaccinated, the outlook remains bleak.
Delivering health care in a country in a protracted state of humanitarian emergency requires more than capacity building, resources and supplies. It demands diplomacy and strategic thinking to navigate complex dynamics.
Fragmented governance arrangements in place across the country involve multiple internal and external actors and call for adaptability and a willingness to negotiate and renegotiate, even in spaces where the demand and need for health services and supplies are urgent and evident.
WHO works towards “the attainment by all people of the highest possible level of health”. Striving to achieve this goal demands careful balance and tactful discretion, guided by the UN principles of humanity, neutrality, independence and impartiality. Our processes and achievements are complex and plentiful and rely on ongoing support and buy in. As the global authority on health and part of an organization founded to protect fundamental human rights, we are duty bound to serve the most vulnerable and promote access to health care for all. We are grateful that our donors continue to support our mandate and our efforts.
Acknowledging that the humanitarian crisis is likely to continue into the foreseeable future, WHO not only seeks to address the threat of the current and future pandemics but also mobilizes substantial resources to support essential health systems and services. The organization strives tirelessly to build on existing efforts and harness opportunities to implement a response geared toward achieving sustainable development gains and increasing the resilience of Syria’s health system within its fragile, conflict-affected and violent context.
The Syrian context is like no other. To ensure the provision of much needed structural rehabilitation, capacity building and equitable health service delivery, WHO engages and coordinates with different UN agencies, line ministries, health service facilities, multisectoral partners, INGOs, local NGOs and local authorities. This is, to say the least, very challenging. Each relevant actor on the ground has its own mandate, modus operandi and, given the highrisk environment, restrictions; WHO included. Ensuring access, optimizing the allocation of scarce resources and minimizing duplication demands mass collaboration at the local, national and international levels, and we are grateful to our donors, associates and partners that have supported and facilitated our work, particularly across the different phases of the ongoing COVID-19 pandemic.
As the virus continues to spread and mutate, threatening the health of thousands of lives across Syria, the humanitarian and economic crises in the country continue to worsen, denying more and more people access to medicines, medical supplies and basic and emergency health services. WHO has shouldered the burden, providing critical lifesaving medicines for patients with diabetes, kidney failure and cancer, and stands ready to strengthen partnerships and re-double efforts to stop COVID-19 transmission and protect the health and well-being of the Syrian people.
Throughout 2020 and 2021, WHO Syria continued to spearhead collective COVID-19 response efforts and to work on the front lines to prevent, detect and respond to epidemic-prone diseases, to maintain basic health services and to provide routine vaccination for children. As a result of these dedicated efforts, not a single outbreak of vaccine preventable disease was reported across Syria last year. Similarly, we aim to facilitate widespread adoption and administration of the COVID-19 vaccine in the hope that it will enable us to reduce mortality and hospitalization and to prevent transmission of the virus that has blighted an already depleted health care system.
While the cost of vaccines is covered by the COVAX initiative, funding gaps to cover COVID-19 response pillars as well as the cost of vaccine administration remain a key challenge. As the battle against the pandemic continues, the cost of the COVID-19 response in Syria is increasing due to the cost of vaccination, case management, laboratory supplies and testing. As of 30 September 2021, WHO received less than 22% of funding requirements for the COVID-19 response and COVAX vaccination operations. Funding of other response pillars, such as surveillance, laboratories, case management and ports of entry, remain severely underfunded though essential for timely epidemiological intelligence and direct reduction of excess morbidity and mortality. Exploring different approaches with donors is now a matter of urgency as increased funding will be critical to enabling demand generation and successful vaccination of a wide cross-section of the Syrian population, as well as enhancing laboratory and case management capacity and reinvigorating already exhausted national capacities through the development of more efficient, systematic and sustainable operational mechanisms.
Dr Akjemal Magtymova
September 2021, Damascus, Syria