Syrian Arab Republic | News | WHO Representative to the Syrian Arab Republic Elizabeth Hoff - written text of speech to the UN Security Council, 21 November 2016


WHO Representative to the Syrian Arab Republic Elizabeth Hoff - written text of speech to the UN Security Council, 21 November 2016

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Mr President, distinguished representatives of the Security Council,

I speak to you today from WHO’s country office in Damascus, from where I have led WHO’s work in Syria for more than four years. 

As the conflict and violence continue unabated, I have seen the worst of humanity – but more importantly, I have seen its best. I wish to begin by paying tribute to WHO’s staff in Syria for their selflessness and determination, and to the health care workers, health partners and national NGOs working on the front line, who put their own lives at risk every day when they reach out to Syrians in need. Observing their dedication and the sacrifices they make has been the greatest privilege of my life.

It is also a privilege to speak to you today to describe the health situation inside Syria and the challenges it presents. 

Mr President,

Before the conflict began, Syria had one of the most advanced health care systems in the Middle East. As the country reached middle income status, noncommunicable diseases were becoming the predominant health concern. National vaccination coverage rates were 95%. Syria’s thriving pharmaceutical industry produced over 90% of the country’s medicines and exported its products to 53 countries. 

Now, almost six years later, the picture is starkly different. According to the UN, well over 300,000 people have been killed and over 1.5 million have been injured since the conflict began. Each month, the number of people injured in the conflict rises by 30 000. Almost five million people have left the country, and just over 6 million have been internally displaced. Within Syria, 13.5 million people are in need of humanitarian assistance. Almost 5 million people live in besieged or hard-to-reach locations. These numbers are staggering.

Health care services have been devastated. Over half the country’s public hospitals and primary health care centres are either closed or only partially functioning. Almost two thirds of all health professionals have left the country. Domestic production of medicines has dropped by two thirds and vaccination coverage rates have dropped by half.

What does this mean for the Syrian people? It means that they no longer have sustainable and reliable access to medicines for chronic diseases that are manageable with treatment but life-threatening without. It means that unvaccinated children are at risk of life-threatening childhood illnesses such as polio (which re-emerged in Syria in late 2013 before being re-eradicated thanks to concerted efforts by WHO and UNICEF). It means that Syrians with traumatic injuries do not receive timely treatment and die or suffer life-changing disabilities. It means that pregnant women do not have access to safe delivery. It means that huge numbers will suffer lifelong mental health problems related to prolonged, traumatic stress and displacement. 

Mr President,

There have been repeated attacks on health care facilities in Syria. Between January and September this year, there were 126 such attacks. They account for almost two thirds of all attacks reported in countries with emergencies. In November alone, 11 hospitals were attacked in Aleppo, Idleb, and Hama governorates, and some were attacked more than once. 

The direct targeting of health care facilities is the most visible violation against the health care system in Syria today, but there are others as well: the militarization of health care facilities by several parties to the conflict, the targeting of health care personnel, and the denial of medical and surgical supplies in many areas. Many patients are simply too afraid to travel to hospitals or clinics because they fear attacks, detention or abuse.  

Attacks on health care facilities and workers have enormous impacts on the communities that they serve. For example, before three hospitals in rural Western Aleppo were attacked last week, they provided more than 10 000 consultations and 1500 surgeries per month.  

Firstly, denying ordinary citizens access to health care is an affront to our common humanity. Everyone has the right to health –it is inscribed in many international agreements, including the UN Declaration. 

Secondly, these attacks are an unacceptable violation of International Humanitarian Law.  Even in war, there are rules against such attacks, inscribed in the Geneva Conventions.  Respect for the neutrality of health facilities is one of our most important humanitarian principles and laws.

Thirdly, these attacks also represent something more.  We all have a sense that there is something very special – even sacred – about providing health care to children, mothers, and the disabled.  When health care facilities providing care to the most vulnerable are targeted, something very precious is lost.  We have not only violated a right and a law, we have lost our collective humanity.  

WHO condemns attacks on health care in the strongest terms. We condemn the inappropriate use of health facilities for any military or political purpose. As the global health agency, we take seriously our responsibility to speak out against these abuses whenever we can. We do so regularly. Nonetheless, our repeated calls for protecting health care, facilities and personnel always fall on deaf ears. 

I would like to highlight other challenges that WHO and its partners face on a daily basis, notably our difficulties accessing hard-to-reach and besieged locations to deliver life-saving medicines and supplies. The government routinely withholds its approvals for the delivery of medical supplies and equipment – particularly surgical supplies and safe blood and blood products – to these locations. Moreover, the operating environment is now so dangerous that many health partners, especially those managing cross-border operations, have limited their activities. 

Aleppo is the most visible face of Syria’s suffering. It illustrates our difficulties accessing besieged and hard-to-reach locations. Over a quarter of a million people are trapped in Eastern Aleppo. All eight of its hospitals have either been put out of action or are barely functioning. Its few remaining doctors are exhausted and overwhelmed. Eastern Aleppo is running out of food, water, and medicine. WHO along with humanitarian partners has painstakingly prepared detailed plans to evacuate the critically ill and injured and allow convoys to deliver supplies to Eastern Aleppo. The Organization is awaiting the removal of all obstacles that would allow it to implement its plans. 

Western Aleppo is also under attack by non-state armed groups in Eastern Aleppo. Hospitals in Western Aleppo have been overwhelmed with wounded patients following indiscriminate shelling. Scores of children were killed or injured when a mortar landed on a school in Western Aleppo last Saturday. 

Mr President, Members of the Council,

Thus far in 2016, WHO has delivered over 9 million medical treatments throughout Syria, through both cross-line deliveries from Damascus and cross-border from Gaziantep (Turkey) and Amman (Jordan). Over one third of these supplies were delivered to hard-to-reach and besieged areas. For the first time in several years, WHO, along with UN partners and the Syrian Arab Red Crescent, was able to reach all besieged areas as part of UN inter-agency convoys. However, WHO is not able to reach these areas systematically due to the lack of approvals of several parties to the conflict. The government has withheld approval to deliver 75 tons of medical supplies – mainly to support surgical, anaesthesiology, laboratory and mental health services – to these areas. As a result, around 150 000 people were deprived of essential health care.

WHO has established a nationwide disease surveillance system to detect and respond to outbreak alerts. Fortunately, no major disease outbreaks have occurred in Syria. The Organization has trained over 16 000 health care workers to help fill the gap left by the mass exodus of health professionals. WHO and UNICEF have supported the vaccination of millions of children against polio, measles and other vaccine-preventable diseases. We have done all this with the sustained support of the Syrian Arab Red Crescent and our national NGO partners.

Lastly, WHO has used its position as the lead agency of the health sector to consistently advocate for the sanctity of health care and for sustained access to all parts of Syria to ensure that people are able to access the health care they need.

However, the situation is getting worse. WHO appeals to all members of the Security Council to use every last ounce of your influence to bring an immediate end to the suffering in Syria. 

We ask you to approve the establishment of a system to ensure that all parties have the coordinates of all humanitarian convoys and health facilities, and all attacks are registered. 

We ask you to help end the attacks on health care facilities and their personnel. 

We ask you to support sustained, unconditional access to all besieged and hard-to-reach areas. 

We ask your help to allow us to evacuate critically ill and wounded patients and their families from all areas, and to ensure their safe passage.

Mr President, Members of the Council,

I would like to reiterate that WHO's priority remains the people of Syria. As a humanitarian agency, we will continue our work to help ensure that all people, in all parts of the country, have access to essential, life-saving health care. 

WHO stands ready to give a more formal in-depth briefing on the above issues should the Council so desire. 

Let me end by thanking you Mr President and Members of the Security Council for your time and attention today.

Key health-related statistics

Total population (000s)

22 712

Total health expenditure (% of general government expenditure)

4.8

Maternal mortality ratio (per 100 000 live births)

68

Primary health care centres and units (per 10 000 population)

0.9

Total life expectancy at birth (years)

64.5

Source: Country statistical profiles 2016

See Syrian Arab Republic country profile

Regional Health Observatory