In the territory of northern and eastern Syria, known as Rojava or Western Kurdistan, the decentralization of power promoted by self-administration has also put forth interesting proposals in the health field. The commune model developed with the revolution that began in 2012, in which neighbors organize themselves to solve their problems in a community and confederal model, seeks to collectively solve the needs experienced by the population of northern and eastern Syria. In this stateless society, municipal councils serve as an alternative to the centralism that the nation-state model tries to impose, instead building a diverse and plural society.
After Turkey’s latest invasion of Turkey in October 2019, most of the NGOs that provided support in health matters withdrew from the area, leaving a huge gap in both the supply of medicine and health care. The war situation generated a great need for medical and health care and military hospitals are among the main elements that must be taken into account when analyzing the health system. It can be confusing to talk about public health here, since the Syrian State has a very small presence in the self- administered territories. The civil hospitals are managed by the Health Committee linked to democratic self-administration and are the main institution working to cover the population’s health needs. The military hospitals are managed by the Military Health Committee, linked to the SDF (Syrian Democratic Forces) and the two committees coordinately well with one another. There are also some examples of cooperation with structures loyal to the Bashar Al-Assad regime, such as the dialysis unit of the Haseke civil hospital, where the Syrian state maintains its presence (security, supplies, salaries). The Health Committee maintains a health system that combines civil hospitals with local health committees, linked to municipal structures.
Heyva Sor a Kurdistan (Red Moon Kurdistan, a humanitarian organization founded by the Kurdish diaspora in Europe) has been the main actor organizing healthcare and coordinating with the few international organizations present. One of these, Cadus, reports its activities and provides some data on the existing infrastructure in Rojava. Heyva Sor and the organizations with which it collaborates aim to provide free or very low-cost medical care. Of the original 700 doctors in the three cantons in the Rojava territory, only about 100 remain. Heyva Sor has a small number of specialized staff and administrative staff, but more than 200 volunteers who work on an unpaid basis, receiving education and training to later join as specialized personnel. For years, internationalist volunteers, including doctors, paramedics and nurses, have been involved in the
Heyva Sor’s work. This has facilitated international cooperation to create infrastructure, including the building of new hospitals, such as Qamishlo, Kobane, Haseke and Til Temir. The latter bears the name of Sehid Legerin, in memory of the internationalist doctor who arrived from Argentina. Legerîn (Alina Sánchez) fought against Daesh in the ranks of the YPJ andlater served as co-chair of the Health Committee, until she died in a traffic accident shortly before the new Til Temir hospital could open its doors to the public.
Healthcare in times of war
The war affects the health system not only because of medical needs, but also because of the reorganization of the territory. After the victory against Daesh, a huge number of territories joined the democratic self-administration, leading to new challenges and difficulties. The large presence of refugee camps also entails enormous difficulties for the health system. The Al-Hol camp, the main detention center for relatives of Islamic State fighters, currently has more than 60,000 people, mostly women and children, who are receiving health care. Washokani camp, outside Haseke, hosts around 20,000 refugees, who were forced to leave their own Serekaniye homes right in front of them, after the invasion by Turkish-backed groups. In the Shabba region there are also tens of thousands of refugees from the Afrin region, today occupied by Salafist groups affiliated with pro-Turkish militias. Three large refugee camps have been built by Heyva Sor in Shahba, although the conditions in these camps are extremely difficult due to their location in northwestern Syria, which is isolated from the territory managed by the self-administration. The regime forces deploy a rigid embargo around these camps, meaning that, along with the enormous health difficulties typical of refugee camps, we must add the excessive fees imposed to supply necessary food and medicine, which reach up to 10,000 dollars for each truck that access the fields. The UNCHR (United Nations High Commissioner for Refugees) does not provide any support to these camps in Shahba, although it does provide limited support to the other camps in the self-administration territories.
The lack of means in the refugee camps is a serious problem, and although it is somewhat better in the hospitals, there are still enormous deficiencies. There are no Doppler echocardiogram, or CT or MRT diagnoses. Laboratory diagnoses are reduced to a minimum, with the exception perhaps of the Haseke hospital, in which Dr. Abbas, who is of Iranian origin but a resident in Sweden where he has practiced for decades as a virologist, has built a laboratory that has been of great help. Haseke civilian hospital has eight beds for intensive care monitoring, there are another eight in Qamishlo hospital, six more in Manbij and Raqqa, four in Derik and three in Kobane. There are 25 total ICU beds in North and East Syria. Medical supplies are limited, and despite easy
access to Syrian-produced medicines, specialized drugs are virtually impossible to obtain due to Rojava’s embargo. Heyva Sor works to ensure the importation of certain drugs for chronic patients, for example, immunosuppressants such as Cyclosporin or Micofenolat, which are necessary for people with kidney transplants that could not survive without them. Heyva Sor’s long history as a humanitarian organization allows them to import these medications from the Kurdistan Regional Government area in Iraq and to organize their free distribution to those who need it.
The other side of the coin of the healthcare system is the rise of private medicine, which has been growing widely in recent years. Two years after the victory against Daesh’s last redoubt in Baguz (Deir Ezzor), and a year and a half after the last military invasion by pro-Turkish groups in Serekaniye and Tal Abyad, the north and east of Syria is going through a period of relative military stability. There are still sporadic clashes against pro-Turkish groups on the fronts, but the emergency situation of war is no longer quite so present. This stability has been accompanied by a large number of private clinics that have opened their doors in the last year. Specialized health personnel work in the mornings in civil and military hospitals, but more and more doctors dedicate their afternoons to their private initiatives. Self-administration keeps hospitals running, but this military stability has also been accompanied by a collapse in the value of the Syrian pound. The US economic sanctions against the Syrian economy (Caesar act), signed by Trump in December 2019 and in effect since June 2020, have had a devastating effect. In early 2011, the Syrian pound was trading at just under 50 pounds to the dollar, but in February 2020 the pound hit historic highs with a black market exchange rate of 1,000 pounds to 1 dollar. A year later, in February 2021, the exchange rate was 4,000 pounds to 1 dollar. Few economies can absorb a drop like this, and although self-management tries to compensate for this collapse by increasing wages, it is not clear how this situation will affect not only the health care system, but the entire self-management model. The local health committees maintain their work without major differences, and hospitals keep their doors open, but it remains to be seen to what extent this expansion of the private health care sector will affect the general health development of the region.
Covid crisis in Rojava
In March 2020, the first cases of Covid-19 were detected in Syria, and an improvised response protocol was activated. The self-administration decreed curfews and mobility between cities was restricted for two weeks. A coronavirus response committee was organized, which assessed the needs and risks. Once again it was Heyva Sor which took on the heaviest workload. Emergency protocols were drawn up and the construction of new specialized sites was planned, such as the new hospital for Covid-19
built in Qamishlo. The lack of ventilators for assisted breathing was seen as a priority and a commission was organized to solve this problem. With the help of 3D printers, the first functional prototype was made, to later build more and thus supply hospitals. PCR testing machines were purchased, as well as supplies of masks and protective equipment. The response to the emergency was quick and effective, and the number of cases remained very low. The Rojava Information Center produced reports on the situation on a regular basis. The blockade in the region greatly restricts mobility abroad, and despite the difficulties that this creates for the population, it also helped contain the spread of the virus. The number of recorded cases has been low, around 10,000 infected people, and the number of deaths reached just 70 by the end of 2020. It should be noted that much of the population only goes to the hospital for emergencies, and the capacity of testing has been relatively limited. Another factor to take into account is the population pyramid, since the war and other difficulties affect a demography with little aging population – the main risk group for coronavirus infection. This combination of factors has contributed to the fact that the pandemic went practically unnoticed in this region, where masks, the safety distance, and curfews have been nothing more than mere recommendations for the population.
Health as a political project
As stated in the documentary Neither State Nor Market: Communal Health Care In Rojava: “The problem is that before the revolution there was a deep connection between health and the power of the State. So we are building a new system with a new base, trying to eliminate this connection.” Health is one of the key areas that is represented by specific structures and institutions in the new system. So the main goals regarding health in Rojava are: first, to solve the problem of relations between health and power; second, to make a critique and reconstruction of the relationship between society and doctors; and third, to return control of health to society.
The community health care system seeks to combine technology and medical research with traditional natural medicine, without discounting the value of either. One crucial issue for the health committees disease prevention, since they see how states spend enormous amounts of money on the treatment of diseases, but do not invest the same resources in prevention: “The state system sees society as if it were sick and it will need to be cured, but it is the system itself that is the disease of society.” Jiyan, an Indonesian-German doctor on the military health committee, told us: “When we talk about medicine, we assume that pharmaceutical medicine is not the solution. It is everything that comes before pharmaceuticals, our way of life, but also using research to find solutions to serious illnesses or needs for proper surgery. It shouldn’t be about money or medication as a way to make profit. It is about sharing and caring for each other, connecting decisions to a more general framework.”
One hopeful example is that of the “Şîfa Jin” health clinic, located in Jinwar, the women’s village. By now, it is widely known that Rojava revolution is the revolution of women, and Şîfa Jin is perhaps the best practical example of this revolution in the field of health. Merivan, a Galician-Catalan doctor who worked for months in Şîfa Jin, describes the project as follows: “It is a health and healing center for women and children based on natural and modern medicine, and it has been a fundamental part of the village since the beginning of Jinwar construction. In addition to all other areas of our lives, we want to organize and shape our health care and therefore also be an example for all places where women seek alternatives to previous health care systems.”
Rojava is a social revolution, it is a revolutionary society, where people organize themselves to solve their problems through direct democracy. The communes and local councils, the cooperatives and academies, function with the strength and will of the neighbors who form them. This model is inherent to all aspects of life, including health, as well as the economy, education, justice, self- defense, ecology, culture, and art. Rojava shows us that a stateless society is not only possible, but is the only way to achieve a truly democratic society. This model has begun its journey in the Middle East, between the harshness of war and the black gold that moves the arteries of capitalism. Rojava is a door to another way of thinking about society, to another way of understanding democracy that escapes the Eurocentric model of the nation-state. And it is the women who open this door with cry “Jin Jiyan Azadî” (Woman, Life, Freedom!).
SOURCE: Rok Brossa