Power crisis threatens health sector in Syria’s Aleppo

Al-Akhbar is currently going through a transitional phase whereby the English website is available for Archival purposes only. All new content will be published in Arabic on the main website (www.al-akhbar.com).

Al-Akhbar Management

Dar al-Shifa hospital after bombing, Aleppo, Syria,2012. AFP/Getty Images

Published Wednesday, November 12, 2014

The health sector in Aleppo went through many trials and tribulations during the war. The alarm bell was sounded several times, warning against a crisis affecting the city’s health sector only to be quickly contained, often through emergency solutions. Today, warnings have been renewed of a disaster that may put the city’s health system on the brink of collapse.

“The health system in Aleppo is on the brink of collapse.” Workers in the health sector have raised their voices again warning against a crisis that might subject neighborhoods under the control of the Syrian state to a disaster where emergency solutions may not work. The causes for this disaster can be summarized in two words: electricity and fuel.

Public hospitals

Since control of Aleppo has been divided – part of the city falls under the authority of the Syrian state and part outside its authority – health services provided by the government have been limited to western neighborhoods. Major hospitals were no longer receiving services because they were located in the eastern section or along its border (such as the Children’s Hospital, the Eye Hospital, Zahi Azraq Hospital and al-Kindi Hospital).

As an emergency solution, these hospitals were annexed to other government-run hospitals in western neighborhoods. Thus, state-run hospitals were divided into three main groups, Aleppo University Hospital, al-Razi Hospital and Ibn Rushd Hospital. Zahi Azraq Hospital, the Eye Hospital and the Children’s Hospital joined al-Razi Hospital, which is already under a lot of pressure. The General Authority for Surgical College Hospital and al-Basel Center for Cardiac Diseases and Surgery joined Ibn Rushd Hospital.

All three hospital groups are being supplied with government electricity and are subject to the same kind of power rationing affecting western neighborhoods. Power outages have increased lately to 23 hours a day. This means total reliance on huge generators allocated for these hospitals. These generators consume huge amounts of fuel paid for from the budget of each hospital, specifically the fuel item. If fuel allocations in the budget are not enough, funds are transferred from other items. Or fuel is provided with direct subsidies from the province by sending a letter to Sadkop Fuel Depot company in order to provide the necessary fuel, if it is not otherwise available, and hospitals pay for it from their budgets.

Private hospitals

There are 63 hospitals in the area that are subject to state control and they are divided between large, medium size and small hospitals. The number of hospitals that have shut down is 23, while 40 hospitals are still operating. Many hospitals decided to close some sections such as neonatal and intensive care units.

A source from the Association of Private Hospitals told Al-Akhbar that “most remaining hospitals are at risk of not being able to provide services because of the terrible electricity situation. If that were to happen, it will put the health system on the brink of collapse.” He said that “in light of the daily clashes raging on the outskirts of the city and the shells falling on neighborhoods, most hospitals have turned into emergency rooms working nonstop. With rising pressure on public hospitals, priority is given to severe emergency cases and people with connections. Besides, the number of vacant beds has decreased dramatically.” He added, “Private hospitals that are still operating have played a positive role so far. But owners of most private hospitals are thinking seriously about closing their hospitals because of their inability to provide the necessary amounts of fuel in light of ongoing power outages.” He also pointed out “the added burden with the onset of winter given hospitals’ rising need for heating oil.”

Searching for solutions

Most hospital owners realize that finding a lasting solution includes stabilizing the electricity situation in the city, which is almost impossible in light of the complex military conditions in Aleppo. At the same time, they believe that the Syrian government can find a way to provide their hospitals with fuel at a subsidized price.

One hospital owner who requested anonymity told Al-Akhbar: “The government’s insistence to end fuel subsidies for private hospitals is tantamount to firing the bullet of mercy on us at a time when we are in dire need of not only every health institution but of every hospital bed.” He added, “The amount of fuel needed to operate a power generator in a mid-size hospital is 20 liters per hour, which means 400 liters in 20 hours. If the price is 155 Syrian pounds ($0.918) per liter, it means we need 62,000 pounds ($367) per day and 1,860,000 pounds ($11,019) per month. If we add expenditures for oil and maintenance, the cost will be about 2 million pounds ($11,848) per month. How much do they want us to raise hospital bills? And who can pay these bills in light of the deplorable economic situation?”

A source from the Association of Private Hospitals suggested the following solution: “Provide the three government-run hospital groups with a special power line that won’t be subject to outages.” He explained: “These power lines exist. They are known as the golden lines and are used to supply security agencies, demarcation lines, telephone networks and the houses of some officials with power.” If this solution is implemented, “public hospitals will no longer need generators and the subsidized fuel can be transferred to private hospitals depending on the size of the hospital.”

Dr. Ayman, an obstetrician, said: “We don’t know what to tell patients anymore, they complain about not being able to pay, and the hospitals say they are forced to raise their prices to cover their expenditures. It is known that some hospital sections require 24-hour power supplies, like the intensive care unit and incubators for premature babies.” He added: “I don’t know what the solution is but it’s everyone’s responsibility, especially the government’s, to find one. Perhaps providing hospitals with subsidized fuel is a good solution as long as it is accompanied by strict oversight of hospital bills otherwise people won’t benefit.”

Before and after raising prices

Hospitals used to be provided with nearly 3,000 liters of fuel per week for the price of 85 Syrian pounds $0.50) per liter. If the amount wasn’t enough, hospitals would buy more fuel from the black market for 125 to 170 pounds ($0.75 - 1.00) per liter. With the government’s decision to raise the price of fuel, government-supplied fuel now costs 155 pounds ($0.91) per liter and black market fuel costs more than 200 pounds ($1.18) per liter.

The efficacy of the private sector in Aleppo is nothing new
Statistics from the State Planning Commission indicate that government expenditures on the health sector between 2005 and 2009 was $547 per capita in Damascus and about $310 in Tartous and Sweida. The amount, however, was only $100 in Aleppo. According to the Association of Private Hospitals, the amount spent in Aleppo was less because “reliance on the private health sector in Aleppo was substantial, even during the years that preceded the crisis.” For example, “there were 103 private hospitals in Aleppo during that period versus 50 private hospitals in Damascus.”

(Al-Akhbar)

This article is an edited translation from the Arabic Edition.

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