Providing basic services under siege: preliminary insights from interim councils and medical providers in besieged urban areas of Syria

Abstract

The interim councils and medical workers operating in besieged cities in opposition-held areas of Syria have faced enormous challenges in providing services to citizens. Despite the extremely difficult operating environment, some semblance of organized government has been installed by anti-regime rebels, whose functions include provision of basic services. Data collected from interviews with interim councils and medical workers in four opposition-held areas suggest that despite the acutely constrained environment and overwhelming challenges, governance structures there demonstrate a degree of success in delivering basic services to civilian populations. Their provision of basic services constitutes more than a bargaining tool or legitimacy signalling, and is better understood as an integral part of revolutionary struggle. Although producing an objective picture of events on the ground is hindered by the conflict conditions and heavy propaganda, the Syrian experience of service provision under siege merits further exploration and has relevance for other conflict environments.

Conflict-related health research in Syria, 2011–2019: a scoping review for The Lancet - AUB Commission on Syria

“… Damascus None Khamis (2018) [ 54 ] First: Syria Last: Lebanon First: government Last: academic Reports National AIDS Program data and examines how the war affected HIV surveillance and voluntary counselling and testing Health status; health system (service provision) 2010–2016 Secondary analysis of National AIDS Program surveillance data General population National Not reported Kubitary (2018) [ 55 ] First: Syria Last: Syria, France First: academic Last: academic Examines validity of the Arabic version of the two-question Quick Inventory of Depression (QID-2-Ar) in Syrian multiple sclerosis patients. Health status Not reported Cross-sectional study Multiple sclerosis patients aged 18–60 years seen at two hospitals Damascus None Kubitary (2018) [ 56 ] First: Syria Last: France, Syria First: academic Last: academic Examines the effects of Therapy by Repeating Phrases of Positive Thoughts (TRPPT) on PTSD, Sleep Disorder and War Experiences among school children and adolescents Health systems (service provision); health status Not reported Clinical trial Children & adolescents aged 13–17 years Damascus Not reported Meiqari (2018) [ 57 ] First: Netherlands Last: Netherlands First: humanitarian, academic Last: humanitarian Describes the impact of the war on child health in Tal Al-Abyad and Kobane, using available medical and humanitarian data from Médecins Sans Frontières Health status; humanitarian assessment, response or needs April 2013–September 2016 Analysis of MSF clinical data and reports Children < 5 years old who attended an MSF facility Aleppo, Al-Raqqa Not reported Morrison (2018) [ 58 ] First: UK Last: N/A First: academic Reports the experiences and challenges of health service delivery under siege Health system (service provision); war strategies / alleged IHL violations Mid-2016 …”

“…Twenty-one papers cover issues of service provision including renal [ 17 ], mental health [ 20 , 24 , 56 ], orthopaedic [ 73 ], cancer [ 40 ], communicable disease surveillance [ 54 ], respiratory [ 87 ], antenatal [ 93 ], and trauma services [ 25 , 74 , 89 ], disruptions to service provision due to attacks on healthcare [ 35 , 36 , 49 , 52 , 67 ], challenges of service provision under siege [ 58 , 80 ], factors enabling sustained UNRWA service delivery [ 85 ], and interplays of local service provision with cross-border humanitarian assistance [ 78 ].…”

“…Fourteen papers research health issues related to war strategies and alleged IHL violations, including an expert panel review of YouTube videos following a sarin gas attack [ 11 ] and interviews with healthcare workers in opposition-controlled areas regarding attacks on healthcare and challenges and experiences in responding to chemical attacks [ 49 ]. Other research in this theme examined attacks on health care [ 35 , 36 , 52 , 67 , 90 ], areas under or the effects of siege [ 40 , 58 , 80 ], and war-related mortality [ 15 , 45 , 51 , 90 ] including a study of characteristics of deceased victims of a chemical weapons attack [ 62 ].…”

“…These highly vulnerable populations are rarely studied. For example, only three papers [ 40 , 58 , 80 ], one field and operational activities publication [ 123 ] and one personal narrative [ 130 ] covered issues of siege. Understanding the health status and humanitarian needs of such populations is essential in order to inform programmatic action.…”