Aleppo – Mohammad Deeb Bazat
Aleppo University Hospital is trying to provide satisfactory medical services to patients and overcome the obstacles it faces in a healthcare sector that is collapsing across Syria.
For years, hospitals and medical centers have been living in a suffocating crisis, besieged by a severe shortage of medicines, a catastrophic deterioration of medical equipment, and a continuous depletion of healthcare staff, who have fled due to war and deteriorating living conditions.
Enab Baladi looked into the state of Aleppo University Hospital and met with the hospital director, Dr. Ibrahim al-Asaad, the head of the radiology technicians department, and several resident doctors to learn about the most prominent difficulties and the demands of the medical, administrative, and technical staff.
An ailing medical system
Ibrahim al-Asaad confirmed that the healthcare sector inherited from the Assad regime suffers from almost complete collapse due to rampant corruption, administrative slackness, and the crumbling of infrastructure, in addition to a severe shortage of medical devices and medicines, especially cancer medications, which has exacerbated patients’ suffering.
The hospital director explained that the absence of effective oversight has led to the spread of corruption, as the low salaries of medical and administrative staff have pushed many to resort to illegal practices.
Al-Asaad added to Enab Baladi that the extent of corruption exceeds expectations, citing contracts for medical supplies that were supposed to enter the hospital but never arrived, which also applies to cancer patients’ medications.
Deliberate disabling to increase profits
In the same context, al-Asaad revealed the deliberate disabling of certain medical equipment in an attempt to force patients to resort to private services or to repeat maintenance operations for financial gain.
He provided an example of the contrived malfunctions, stating that one of the elevators in the hospital was frequently disabled by tampering with its sensors, requiring regular maintenance costing about $20,000 under the previous administration, while the cost dropped to only $4,000 after Aleppo was liberated from the previous regime’s forces, and maintenance was outsourced to a new entity from northwestern Syria.
Al-Asaad noted that most of the staff involved in corruption, led by the former director Ibrahim Hadeed, have left, confirming their ties to various security branches.
He pointed out that the year 2019 saw the hiring of a large number of workers under the title “Fifth Category” (cleaning workers), but they were placed in offices instead of performing their duties, which led to a decline in cleanliness levels in the hospital.
With the new administration taking over, these employees were forced to return to their jobs, resulting in a positive impact on the cleanliness of the facility.
Between bombing and looting
Al-Asaad explained that the shelling (from Russia and the regime during the control of the new Syrian administration over Aleppo) caused extensive destruction affecting more than seven floors and led to a large portion of the staff leaving, allowing for widespread looting.
He added that the theft included more than 50 laptop devices, in addition to essential medical equipment and consumables, without any mechanism for retrieving them. The strikes also caused five hospital departments to go out of service, leading to a decline in the hospital’s capacity.
Regarding restoration efforts, al-Asaad confirmed that work is still ongoing, with the Red Crescent and Red Cross carrying out repair operations, expecting the work to be completed within days, which will improve the hospital’s capacity and resume some of the halted services.
Emigration, congestion crisis, and shortages
According to the hospital director, the emigration of medical staff has resulted in two major problems:
The first is related to the regime’s policies, which relied on significantly increasing the number of students in universities. However, upon graduation, many face difficulties traveling, leading to a large accumulation of resident doctors without sufficient practical opportunities.
For example, there are currently 990 resident doctors at Aleppo University Hospital, creating a clear imbalance, as each doctor needs a certain number of surgical operations to gain the required experience. However, due to the large numbers, not everyone receives adequate training, which negatively impacts the level of medical expertise.
The second problem lies in the shortage of medical staff after years of specialization, as most doctors plan to emigrate immediately after graduation, leaving a substantial gap in hospitals. Thus, the crisis manifests in two phases: the first during the specialization period, where doctors do not receive enough training due to large numbers, and the second after graduation when doctors leave the country, leading to a severe shortage of qualified staff.
In addition, hospitals face significant financial difficulties, primarily due to weak cash flow and low salaries for doctors, where the average monthly income for a doctor does not exceed 400,000 Syrian pounds, making improving the financial situation an urgent necessity.
Hospitals suffer from a shortage of supplies and medical devices, most of which have not been updated for over 15 years, making them outdated compared to modern medical developments.
Corruption and sanctions: Who is responsible for the collapse?
Despite the fact that economic sanctions have impacted the healthcare sector, rampant corruption within the system has played a larger role in exacerbating the crisis through mismanagement and waste of resources, making the healthcare situation even worse, according to Dr. al-Asaad.
In discussing the radiology devices at the hospital, Mustafa al-Baj, the head of radiology technicians, revealed to Enab Baladi that the hospital has three CT scan machines, but only one of them works properly, noting that these devices have a limited lifespan, yet the currently available machines have practically been out of service for a long time.
Al-Baj explained that buying a new CT scan device is a better option than repairing the malfunctioning machines, as the cost of repairing them is almost equivalent to the price of a new device.
He added that the hospital has seven simple X-ray machines, but most of them are out of service except for one DR type.
He noted problems in providing films and developing them to the extent that patients are forced to take pictures of the X-ray results with their mobile phones due to the lack of the necessary films.
He pointed out that the imaging device in the emergency department operates under great pressure, serving about 300 patients daily and conducting between 800 to 1,000 X-ray images daily, which increases the need for updating imaging equipment and infrastructure in the hospital.
In this context, Dr. Omar Hilali, a third-year resident in the radiology department, explained that the devices suffer from severe wear, especially the echo machines, which have been in use for a long time and need urgent maintenance.
Hilali also mentioned another main issue related to the breast imaging device, which is a key tool in diagnosing breast cancer and monitoring the condition of female patients aged 30 to 70. He pointed out that the malfunction of this device hinders early disease detection and negatively affects patient care.
He also addressed the administrative neglect in maintaining the devices during the previous administrations, along with the issues related to poor funding, weak organization, and widespread corruption, which contributed to the exacerbation of the radiology sector crisis within the hospital.
For his part, Hassan Ali, a fourth-year general internal medicine doctor, discussed the challenges facing the emergency department, noting the acute shortage of resources, which directly affects the quality of services provided to patients.
He also highlighted the poor quality of food provided in the hospital, explaining that it often comes from donations, and called for its improvement and the addition of other food items, emphasizing that doctors have the right to have decent meals that support them during their long working hours.
He also mentioned issues related to the hospital’s capacity to accommodate patients, as many emergency cases struggle to find a bed due to full wings and insufficient available spaces.
Despite the administration’s attempts to open new rooms and additional beds, the situation remains complicated, especially with some departments going out of service due to the shelling the hospital endured from the previous regime’s forces and their allies, leading to a significant decline in its capacity.
During the control of the new Syrian administration over the city of Aleppo, the previous Syrian regime’s forces and Russia continued to escalate attacks on northwestern Syria.
On December 1, 2024, airstrikes by the Assad regime targeted the entrance of the university hospital in the city of Aleppo, with Syria Civil Defence teams documenting the deaths of 12 people and the injuries of 23 others.
The airstrikes also targeted a nearby church, with several neighborhoods subjected to airstrikes that resulted in civilian casualties.
The Health Ministry in the interim government in Damascus announced at the end of 2024 that it had laid out work plans for four years, noting that the healthcare sector in Syria has been nearly destroyed.
The acting Minister of Health at the time, Maher al-Sharaa, stated that the ministry has work plans for three months, six months, nine months, one year, two years, and four years, and that they have begun earnest work in this regard.
Musab Nazzal al-Ali took over as Minister of Health in the new Syrian government, succeeding Maher al-Sharaa, and asserted that the rehabilitation of hospitals and medical centers requires intensive efforts, emphasizing the importance of strengthening cooperation with Syrian doctors abroad and international organizations.
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