The infections continued to expand for ongoing weeks on the body of 50-year-old Um Emad, but she remained without treatment and without getting the suitable medicines, which aggravated her health condition.
50-year-old Um Emad’s husband passed away 2 years ago leaving 6 children behind. They all pose a heavy economic burden on her especially with the noticeable rise in prices and the poor purchase value, causing her to do homemade handicrafts to try to feed her kids.
About two months ago, the woman suffered from constant pains that never ceased, leading her to visit the health center in Daboq.
Um Emad was surprised when she did not find a female doctor at the center. Therefore, she had to pay a lot of money to go to the hospital in Azaz city 30 kilometres away, where she found out that she is suffering from uterus infections.
After being diagnosed, the center prescribed an anti-inflammatory medication and asked her to continue taking it in addition to following a certain food and drink diet.
The medication finished after a few days so she tried to visit the health center in Daboq to get a new prescription but she didn’t get it because she was informed there that the suitable medication is not available. So she had only two options, the first was to go back to the hospital in Azaz, and the second was to buy the medication at her own expense, and both cases would pose a financial burden that she wasn’t even able to handle.
The journey of crawling after the medication
The village of Daboq is located in Azaz city in Aleppo governorate, and the village is administratively affiliated to Akhtarin, about 35 kilometres northeast of Aleppo.
ISIS took over the village of Daboq before being kicked out after battles against the Syrian opposition supported by Tukey.
After safety returned to the city, the Syrian opposition formed civic institutions including educational, health and other institutions operating under the local council.
However, the health situation in the village is not at its best, especially that the only health center in the city, which serves around 18,000 civilians (13,000 residents and 5,000 displaced persons), is a modest health center operating under the local council.
In Daboq village, there are many women who are not provided for, some of them have chronic diseases and cannot go on living without getting the proper medications, which are often periodic and continuous.
Um Emad explains that she has to pay 18,000 liras monthly (around 35 USD) for different medications including anti-inflammatory medications and other medications for her treatment, pointing out that she cannot provide this sum on a monthly basis as she is providing for a whole family.
The woman blames the health center whose main role is to provide medications. She stated: “it is obvious that the health center is aware of the situation of the civilians and the displaced people here in Daboq, and it is aware that the vast majority of residents cannot buy expensive medications. And despite of that, the center hasn’t provided these medications for a long time.”
A document revealing the root of the problem
“Sada al Sham” obtained a document issued by the local council in Daboq, which addressed the problem raised by Um Emad and other residents in the area.
The document issued by the medical office in Daboq Health Center on July 18th, 2019 stated that the health center is serving 13,000 civilians in Daboq village in addition to 5,000 people from three neighbouring villages, making the total of 18,000 people served, and it’s the only center in the village.
The center includes several sections, including a pharmacy and an internal clinic that conducts about 40 examinations daily, and a children’s clinic that conducts about 50 examinations daily, and a women’s clinic that conducts 10 examinations daily and a 24-hour first aid department.
The council mentioned in the document itself: “the problem the center faces is the scarcity of medications and the difficulty of obtaining and providing them, which reflects negatively on the category of widowed women who have no steady income.”
This document explains many aspects of the problem that the health center in DAboq faces, among them are the shortage in or absence of medications which affects those with low income. Widows and women without providers are on top of the list of affected people because they have no one providing for them financially, which turns the process of receiving medication into a long adventure.
Poor coordination with the Turkish health directorate
We asked the medical center about the reason the medications are not available, pharmacist Ali Mustafa the director of the health center in Daboq said: “there is a defect in the process of dispensing medications.”
Mustafa explained the problem to “Sada Al Sham” saying: “previously, NGOs were in charge of providing medications, and they used to provide all we required from first aid kits and medications for chronic diseases, and everything was alright.” However, according to Mustafa, when the work of NGOs was limited and the medical center became affiliated with the Turkish health directorate, the problems began and the defect occurred in the process of providing necessary medications.
The pharmacist indicates that the health level in Turkey is better than it is in Syria in terms of medications and the process of dispensing them to patients. In Turkey, there are specific conditions for the approval of dispensing medications like having a doctor’s prescription and his identification and claiming responsibility for dispensing this medication, conditions that are non-existent in Syria.
When we asked about the reason why the council does not communicate with the Turkish health directorate, Mustafa said: “we have regular and continuous contact with them and we inform them of all medicines we are short of. But when we order certain medicines we receive other medicines that have nothing to do with the ones we have ordered.”
He indicated that the medicines are dispatched according to what is available at the warehouses of the Turkish health directorate and not according to the needs of the health center and the civilians, making the center lacking medicines it needs.
As for the most important medicines missing at the center, Mustafa explained that the center constantly needs anti-inflammatory medicines especially in the winter but never receives those. The center also suffers from a severe shortage in medications for chronic diseases, like medications for diabetic patients, and insulin that is high in demand with little availability. According to Al Mustafa, many civilians require insulin but the incoming quantity is very little which makes very few diabetics get it.
In addition, the center suffers from a shortage of various types of blood pressure medications most notably hypotensive.
The main shortage is in women’s medications especially those targeted for pregnant women like vitamins and anti-fungal infections, medications that are considered very necessary but not at all available. In addition, there is a severe shortage in children’s medicines, most notably anti-inflammatory medicines and intestinal disinfectants.
A female clinic without a female doctor
Maisa (32 year old) from Eastern Ghouta was displaced to North Syria with her family. She settled in a broken down rented house in Daboq. After arriving there with her husband and only daughter, she got pregnant with her second child. And even though she was into her eighth month of pregnancy, she hadn’t had any medical care from the center all through that period.
Maisa tells “Sada Al Sham”: “I gave birth to my first daughter without any medical care, I was aided by an experienced midwife but I didn’t complain about it because of the siege in Eastern Ghouta at that time.”
She explains that after arriving to the Northern Aleppo countryside, which was not under any siege or war conditions, she was hoping to get pregnant under good healthy conditions where she can overcome any pregnancy-related illnesses, and where she can periodically check on her fetus, which did not happen either.
During her current pregnancy, Maisa got infected with Rubella which is a virus. Pregnant women usually have long-term health issues but when a pregnant woman becomes infected with this virus during her pregnancy, it causes her severe pain.
When Maisa visited the health center, she was surprised to find there are no devices to detect pregnancy and no female doctor. She only found a midwife that takes care of pregnant women primitively and gives them vitamins and supplements. Her health condition became aggravated and she had to go a long distance to a hospital in Al-Bab city where she was diagnosed.
There are four clinics in the health center in Daboq, one of them is a gynecology clinic. However, the shocking thing is the fact that there is no female doctor in the clinic because the center is unable to recruit one.
Pharmacist Ali Al Mustafa, the director of the health center, explained that there are only two doctors in the center, each works 3 days a week alternating shifts in order to cover all weekdays.
Mustafa attributes this to the lack of medical staff in Northern Syria, and the tendency of most of them to work in hospitals with better working conditions.
He said: “in the past we had female doctors but most of them went on to work in hospitals. We no longer have staff so we hired a midwife to care for pregnant women.”
The problem does not just lie here; the gynecology clinic at the center does not have an Echo device to detect pregnancy. According to Mustafa, there are conditions to bringing the Echo device into the center, which is to have a female doctor that can operate it, and because we don’t have a female doctor we don’t have an echo device, as the midwife is prohibited from using it.
He added: “the midwife based on her experience can work in family health planning and caring for pregnant women and giving them vitamins and medications, and this is her role at the center. But in case of sickness, the patient should go to Al Ra’i hospital situated 30 kilometres away or Mari’ hospital situated 20 kilometres away.
In this context, 50 year old Um Emad says that her only hope for the future is that the medicine will be available, so that whenever any woman gets sick and cannot afford the medication, she will be able to get her medication for free, especially with the existence of a public health center which is supposed to provide these medications.
Whereas Maisa who had to travel a long distance to Azaz hospital four times to check on her fetus and her illness, she hopes that more services will be included in health centers saying: “hospitals in Northern Syria are often concentrated in major cities, so the patients from small villages are forced to travel long distances to get medical services.”
Maisa thinks that if health centers are provided with medical staff and necessary equipment, this will facilitate the task for patients in small villages especially for women in emergency cases.
This human rights article was published with the support of Journalists for Human Rights (JHR) and the United Nations Democracy Fund (UNDEF).