(Repeats Wednesday item)
* Sanctions make it harder to import to Syria
* US and EU sanctions are not designed to target medicine
* But foreign drugs firms, banks wary of dealing with Syria
* State spending cuts, currency dive also hit drugs imports
By Dahlia Nehme
DAMASCUS, March 15 In the cancer ward at
Damascus Children's Hospital, doctors are struggling with a
critical shortage of specialist drugs to treat their young
patients - and it's not just due to the general chaos of the
Syrian civil war.
Local and World Health Organization (WHO) officials also
blame Western sanctions for severely restricting pharmaceutical
imports, even though medical supplies are largely exempt from
measures imposed by the United States and European Union.
Six years of conflict have brought the Syrian health
service, once one of the best in the Middle East, close to
collapse. Fewer than half of the country's hospitals are fully
functioning and numbers of doctors have dived.
The result is tumbling life expectancy - even after
accounting for the hundreds of thousands directly killed in the
fighting - and soaring deaths in pregnancy and childbirth.
On top of this, cuts in health spending by the government
that is fighting a hugely expensive war, a drastic fall in the
Syrian currency and indirect effects of the sanctions are all
deepening the misery of patients who need foreign-made drugs.
For families with sick children, the situation is dire.
At the children's hospital in government-held Damascus, the
waiting room outside the cancer ward was crowded with relatives,
many of whom had brought clothes, mattresses and blankets in
case they had to spend long periods far from their homes outside
One of them was Naim Der Moussa, 55, who has been living in
Damascus for a year to secure regular treatment for his
10-year-old daughter Waad. They left his wife and six other
children behind in the eastern city of Deir al-Zor, where
government forces are besieged by Islamic State.
"My daughter was first diagnosed with kidney cancer and
treated," he said. "Now cancer has been found also in her
Before the conflict, Syria produced 90 percent of the
medicines it needed but anti-cancer drugs were among those where
it traditionally relied on imports.
Elizabeth Hoff, the WHO representative in Syria, said
medicine imports have been hit by significant cuts in the
government's health budget since the war began in 2011 plus a 90
percent drop in the value of the Syrian pound, which has made
some pharmaceuticals prohibitively expensive.
However, a lack of cash is not the only reason why supplies
of cancer drugs are falling far short of increasing demand.
"The impact of economic sanctions imposed on Syria heavily
affected the procurement of some specific medicine including
anti-cancer medicines," said Hoff. The sanctions were preventing
many international pharmaceutical companies from dealing with
the Syrian authorities as well as hindering foreign banks in
handling payments for imported drugs, she added.
The United States and EU have imposed a range of measures
targeted both at the government and some of the many armed
groups operating in the country.
Washington has banned the export or sale of goods and
services to Syria from the United States or by U.S. citizens.
The EU has imposed travel bans, asset freezes and an arms
embargo, with sanctions also targeting financial ties with
Syrian institutions, buying oil and gas from the country or
investing in its energy industry.
President Bashar al-Assad has partly blamed the sanctions
for turning many Syrians into refugees, often heading to Europe.
Both the U.S. and EU regimes include exemptions for
medicines and other humanitarian supplies. However, by clamping
down on financial transactions and barring much business with
the Syrian government, the sanctions are indirectly affecting
trade in pharmaceuticals.
Many drugs companies have erred on the side of caution,
avoiding any business with Syria for fear of inadvertently
falling foul of the sanctions.
The U.S. State Department said the Treasury had authorised
services in support of humanitarian activities in Syria, adding
that there were legal ways to bring medicine into the country.
The EU also rejected criticism of its sanctions. "Such
measures are not aimed at the civilian population," an EU
spokeswoman said. "EU sanctions do not apply to key sectors of
the Syrian economy such as food and medicine."
She acknowledged firms had increasingly pulled out of
business with Syria but said this was also due to other reasons,
including "security, reputation, commercial motivation,
anti-money laundering measures" and the presence of jihadist
CRITICAL SHORTAGES ABOUND
The WHO brings essential medicines and medical supplies into
Syria, procuring generic drugs from approved sources in Europe,
North Africa and Asia. Branded U.S. products cannot be imported
due to the sanctions situation, Hoff said.
With funds from Kuwait, the WHO has delivered life-saving
medicine including to more than 16,000 cancer patients, of whom
thousands are children with leukaemia.
But this does not meet demand. Besides cancer medication,
there are critical shortages of insulin, anaesthetics, specific
antibiotics needed for intensive care, serums, intravenous
fluids and other blood products and vaccines, Hoff said.
The overall collapse in Syrian healthcare has contributed to
a drop in life expectancy to 60 years for men and 70 for women
in 2014, from 72 and 75 respectively in 2009. Only 44 percent of
hospitals are now fully functioning and more than a quarter
aren't working at all, the WHO said.
By 2014, the number of doctors in Syria had dropped to 1.3
per 1,000 people, less than half the level in neighbouring
Jordan and Lebanon.
Against this deterioration, Damascus Children's Hospital has
also come under increasing pressure. Cancer units in the
provincial cities of Aleppo and Latakia were both put out of
service in fighting earlier in the war.
Now about 200 children visit the Damascus hospital every
week, with more than 70 percent from outside the capital,
according to its head, Maher Haddad.
The weight of demand has delayed treatment for dozens of
sick children by 15-20 days, affecting their prospects, overall
health and response to medication, he added.
Haddad also singled out the sanctions. Pharmex, the
state-owned company that buys drugs for government-funded
hospitals across Syria, was able to provide only 5-10 percent of
the cancer medication that is required, he told Reuters.
"Most of the cancer medicines are imported. Pharmex used to
import the stock of medicines that public hospitals need. But it
has not been able to do so largely because of the economic
sanctions, I believe," he said.
His hospital has only 36 free beds, with 17 of those
allocated to children with cancer.
In the waiting room, a woman who identified herself only by
her first name Nawal, said she travels from the Qalamoun area
north of Damascus every fortnight with her 14-year-old daughter
who requires chemotherapy treatment for leukaemia.
"We don't have hospitals or charities in Qalamoun. Free
treatment is offered only at the Children's Hospital in
Damascus," Nawal said.
One private charity, Basma, is trying to help out by funding
cancer drugs for poor families. The proportion of patients who
need assistance has risen from about 30 percent to nearly 80
percent since the war began, executive manager Rima Salem said.
Salem finds the delays in treatment worrying. "A child with
cancer might die waiting for his turn to get treatment," she
(Additional reporting by Yeganeh Torbati in Washington and
Robin Emmott in Brussels; Editing by Angus McDowall and David