Thank you, Steve, and CSIS, for inviting me to be a part of this important discussion. It’s an honor to serve on this panel with Dr. Sahloul and the other panelists, who have shown real commitment – and made personal sacrifice – to address the health needs of conflict-affected Syrians. In my remarks, I will review the severity of the attacks on Syria’s medical personnel and facilities. I will then highlight the work that humanitarian agencies are engaged in to provide assistance, in spite of these circumstances. I will then say a word about the precarious funding situation they face, and conclude with some thoughts about the longer term.
Two years of conflict in Syria have taken a severe toll on the health care system. Steve noted the grim statistics that shape our work in this area – the tragic civilian deaths, the huge refugee flows, the massive displacements.
Hospitals, clinics, doctors, and medical staff are being directly and violently targeted. According to the World Health Organization, 52 health care providers have been killed, 75 injured, and 14 kidnapped since the conflict began. 58% of all public hospitals have been damaged and 38% are out of service. 306 out of 520 ambulances are damaged, and 168 are out of service. We’ve seen reports that 469 medical workers have been imprisoned. Fearing for their safety, thousands of health care providers have fled.
The United States strongly condemns these deliberate attacks. Patients must not be prevented from seeking care, health care professionals must not be impeded from providing it, and medical facilities and transport must not be targeted. Medical care providers who remain in Syria face challenges in caring for the sick and wounded in facilities that lack fuel, electricity, and equipment.
Against this backdrop, the heroic work of saving lives continues. Many organizations are working tirelessly, under extremely dangerous conditions, to provide health and other services. I am proud that the United States government is supporting their work. For example:
• Since the beginning of the conflict, Syrian Arab Red Crescent volunteers have provided medical services at great personal risk. In an environment where battle lines are constantly shifting, volunteers have reached communities in both and government- opposition-held areas. 18 have been killed while in service. The International Committee of the Red Cross is providing medical supplies, water, food. ICRC is providing access to clean drinking water to at least ten million people.
• The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) provides health, education, and social services to 525,000 Palestinian refugees in Syria. 235,000 have been displaced by the conflict. UNRWA health clinics report a significant decline in consultations, illustrating how inaccessible those clinics have become with the intensifying conflict. Six UNRWA staff have died, and 13 are missing.
• The United Nations Population Fund (UNFPA) has delivered ambulances, ventilators, and other medical equipment in Syria and is promoting access to reproductive health services for refugees in neighboring countries. UNFPA and other partners are responding to gender-based violence in Syria and neighboring countries.
• The United Nations Children’s Fund (UNICEF) has been instrumental in maintaining access to education for conflict-affected children in Syria and in expanding access to water, sanitation, and hygiene programs. With the breakdown of Syria’s health care system and vaccination programs, there have been measles outbreaks among refugee populations in Lebanon, Jordan, and Iraq. In order to address this situation, the U.S. government has funded the vaccination of nearly 1 million displaced children in Syria.
• Prior to the conflict, the United Nations High Commissioner for Refugees (UNHCR) was providing assistance to Iraqi refugees: health care, education, legal services, and preventing and responding to gender-based violence. UNHCR expanded these services to help meet needs of displaced Syrians. And, in neighboring countries, UNHCR coordinates the full range of services for refugees, including basic health care.
• Of course, countless NGOs also play a vital role. Including those on this panel….
The governments and civil society organizations of neighboring countries have played important roles providing health care to refugees, even as the refugee influx has strained national health care systems and local economies. We commend their generosity and respect for humanitarian principles.
To date, mortality and malnutrition rates in the refugee camps are low. The chronic disease burden primarily consists of diabetes, cardiovascular and lung disease. Given the trauma that many refugees have experienced, mental health and psychosocial services are very important. Infectious diseases remain a concern. TB control is also an issue, especially for Syrians whose treatment was interrupted by the conflict. In the desert conditions in Jordan and Iraq, acute respiratory infections are common. There have also been some instances of refugees with leishmaniasis.
Of the $1.6 billion requested in the UN appeals, donors have provided nearly $816 million, or 51%. The U.S. government is leading the international response, contributing nearly $510 million. We are grateful to Congress for the strong support they have shown, which allows funding to the UN appeals, but also to NGOs carrying out assistance outside the appeals, coordinated with the Syrian Opposition Coalition’s Assistance Coordination Unit.
We know that even if a political solution were secured tomorrow, humanitarian needs will persist. So, it’s important that humanitarian actors anticipate, and work in coordination with, those who will be playing a role in Syria’s reconstruction and development over the longer-term. To give just one example of how this can play out in the health sector: We’ve asked WHO to engage Ministries of Health in neighboring countries to allow Syrian health care providers who can prove their credentials to support humanitarian health operations. This would provide much needed surge capacity, allow them to contribute to the response effort, and keep their skills sharp until such a time as they can help rebuild the Syrian health care system.
This crisis is severe. Some have characterized it as a catastrophe. So, we need to be prepared to be in it for the long haul. The U.S. government remains committed to promoting access to health and other basic services in Syria and neighboring countries for as long as this emergency lasts. Thank you.