How WHO and other international agencies aid Assad’s war against Syria’s civilians.
After the first miserable winter of 2013-2014, when the infant mortality rate skyrocketed to an estimated 300 per thousand live births, compared with 18 down the road in Damascus, the siege forced the construction of several secret tunnels connecting Eastern Ghouta to the Damascus suburbs of Barzeh and Qaboun, then under the control of opposition forces. The tunnels permitted not just food and commerce but also limited quantities of medical and surgical supplies, fuel for hospital generators and ambulances, and the sending of biopsies from cancer patients for diagnosis by cooperative labs in Damascus.
For two and a half years, these tunnels were Eastern Ghouta’s lifelines, providing thousands of patients with life-saving treatment and safe passage for tens of thousands more civilians who wished to leave the region. Then, after eastern Aleppo fell in December 2016, the Assad regime’s attempts to find the tunnels accelerated. By the end of February 2017, the warehouse hiding the exit point of the main tunnel fell under the control of the Syrian army, rendering it unusable. By mid-May, all four tunnels were breached, triggering self-destruct mechanisms to avoid giving the Syrian army direct lines into Eastern Ghouta.
Each month since then, doctors in Eastern Ghouta have sent a detailed list of urgent medical and surgical supplies and essential medicines such as insulin to the Health Cluster in Damascus, a group organized by OCHA and led by WHO. They also repeatedly request critical medicines such as prednisolone and methotrexate. Yet few convoys are allowed, and the contents of approved convoys fall far short of the basic clinical needs of the most vulnerable patients — women and children.
In what amounts to a whitewashing of the siege, U.N. reports on the convoys describe only the weight of items delivered and those deleted, as if a half a ton of lice shampoo is the medical equivalent of a 500-kilogram oxygen generator or a 50-kilogram wheelchair is worth more than 50 milliliters of adrenaline — enough to restart dozens of hearts.
The deprivation in Eastern Ghouta is all the more alarming because it is occurring down the road from specialized labs and pharmacies in Damascus and the U.N.’s vast humanitarian apparatus in the city, which includes World Food Program and UNICEF warehouses stocked with food and nutritional supplies, WHO’s piles of essential medicines and equipment, and hundreds of U.N. and other international aid workers. Douma, Eastern Ghouta’s largest city, is less than 10 miles from WHO’s office in Damascus and the luxurious Four Seasons Hotel frequented by U.N. agencies. During an earlier siege, while WHO officials ordered French pastries and chocolate chip cookies for their Health Cluster meetings at the Four Seasons, kids were eating grass and drinking from puddles in Darayya.
On Oct. 26, 2017, 430 critically ill patients needed evacuation from Eastern Ghouta. A high-level teleconference led by OCHA yielded an agreement to evacuate 29 patients within 48 hours to Damascus. It took an entire night of painful deliberations for Eastern Ghouta’s doctors to decide which 29 would benefit most from evacuation. On Oct. 27, this list was sent to OCHA, copying WHO and UNICEF. Nothing happened. Over the next two months, 18 of the 29 patients died.
In despair, the doctors wrote a highly unusual letter to the WHO’s director-general, Tedros Adhanom Ghebreyesus, asking WHO for criteria to help less academically qualified doctors decide who should live and who should die. A copy of the letter was sent to U.N. Secretary-General António Guterres. Tedros never responded. Nor did Guterres.
However, within days, both Staffan de Mistura, the U.N. special envoy for Syria, and Jan Egeland, his humanitarian advisor, made strong statements, and the Syrian government finally approved the evacuation of 29 patients. The doctors compiled a new list, replacing the dead, as well as those who wouldn’t risk transfer to government territory for fear of arrest. Even then, when evacuation finally took place on Dec. 26, the government allowed it not as a humanitarian matter but only as an exchange for 29 captured combatants detained by a militia in Eastern Ghouta — in essence, using critically ill civilian patients as pawns in its military plans.
To put this in historical perspective, during the siege of Leningrad in World War II, 1.3 million civilians were allowed to leave unharmed. During the 1992-1996 siege of Sarajevo, hundreds of patients were medically evacuated safely.
In an Al Jazeera interview on Jan. 8, WHO’s Syria director, Elizabeth Hoff, defended this state of affairs, saying, “As far as WHO is concerned, we have done everything in our power to try to assist with the medical evacuation.” What she didn’t address is why WHO keeps asking for hundreds of millions of dollars for medical supplies that demonstrably do not go to those who need it most in Eastern Ghouta and instead benefit NGOs run by Assad’s family and friends. By continuing to subsidize the Syrian military as it targets civilians and imposes deadly sieges, WHO is relieving the regime of the burden to purchase these items itself. The effect is to give the government more funds to purchase the bombs used to target hospitals and other civilian institutions.
A similar subsidy comes from U.N. operations in Damascus. At Syria’s insistence, the U.N. distributes the bulk of its billions of dollars of aid through Damascus. There is no evidence that these funds are distributed to those in greatest need.
The U.N. justifies this state of affairs on something akin to a trickle-down theory — that some people will eventually get something. But that claim ignores the role of this aid in enabling the Syrian government to continue to pursue its war crimes. Meanwhile, the people in greatest need — who should be WHO’s priority — continue to be killed in airstrikes or are left to die due to the deliberate denial of food and medical aid that WHO is enabling.
Four and a half years into the Assad regime’s siege warfare, U.N. agencies have failed to address the fundamental question of whether, by subsidizing these atrocities, their operations in Damascus are doing more harm than good.
Correction, Sept. 19, 2018: Al-Bustan Foundation was placed the U.S. Treasury Department’s sanctions list in May 2017. A previous version of this article mistakenly said Rami Makhluf, who was sanctioned years earlier, was placed on the list then.