This week, people across the world are celebrating ten years of autonomy and hope in North and East Syria, but these have also been ten years of intense pressure from all sides, and of intense military defence. The Autonomous Administration of North and East Syria has had to build its structures and institutions in a situation of unrelenting struggle. In this interview, Dr Michael Wilk explains what this means for the development and practice of healthcare.
Dr Wilk is a political activist and writer as well as a practising doctor in Germany, and he has used his medical skills to support people where these are most needed. From 2014, various visits to northern Syrian have taken him to the battlefield and to IDP camps, and he has worked closely with Hevya Sor a Kurd, the Kurdish Red Crescent. Here he answers written questions sent to him by Sarah Glynn.
North and East Syria has had to try and develop and maintain essential infrastructure through a decade of war and blockade. Can you describe how this has impacted on medical services – both equipment and personnel, and both in established towns and in the IDP camps?
After the far-reaching withdrawal of the Assad regime from northeastern Syria ten years ago, health care has been the task of the self-government of the multi-ethnic region of Rojava [Now, officially known as North and East Syria]. This self-government is elected on a grassroots basis and represents not only men and women on an equal footing, but also the Aramaic, Assyrian, Yazidi, and Arab populations who live here alongside Kurdish people. Practices based on grassroots democratic principles and on equal rights for men and women are diametrically different from the authoritarian structures of the Assad regime, and they are defended by the region’s own armed units. The Assad regime is only marginally or symbolically involved [in healthcare], with some formerly national hospitals occasionally paying salaries from Damascus. De facto, the care of an estimated four million people in Rojava is in the hands of the health self-administration. Apart from the authoritarian centralist policies of the Assad regime, health care in Syria had been far from the worst by international standards. After years of confrontation with ISIS, the destruction of a large number of hospitals, the flight or death of many health workers, embargo conditions, and, above all, the repeated military invasions of Turkey, health care has become a huge and complex challenge. Nevertheless, under the most adverse circumstances, it has been possible to rebuild and re-establish a large number of hospitals, outpatient clinics, and care facilities. Medical care is free of charge for the poorer and most needy population, but, under the current conditions, special interventions and therapies cannot be carried out, or only with difficulty, e.g. complex neurosurgery, or chemotherapy for tumours. It is not only war victims and the injured who need to be cared for, but also the normal illnesses of a population of millions. There is still a glaring shortage of staff because many specialists and doctors, and also highly qualified nursing staff, are missing. Many were killed or fled the threatening situation with their families. War-related problems remain immense.
How are health services organised and run? What is the role of Heyva Sor? Are the grassroots democratic structures involved in developing and running health services? Is any external aid reaching the medical services in North and East Syria – either from governments or NGOs?
In addition to the health self-administration, another important pillar of care is the NGO, Kurdish Red Crescent (KRC), which I have been supporting for many years. At the beginning of 2012 it was still a small organisation of a few committed people, now about 2000 people work there. This NGO works closely with the self-administration and operates its own emergency ambulances, pharmacies, and hospitals, and, for example, also ensures the supply of medical services in the many camps of refugees/displaced persons. KRC also works under dangerous conditions in the Al Hol camp, where about 55,000 families of the shattered ISIS are in detention, and unrest among fanatical ISIS supporters is the order of the day. KRC is an important interface for international support through materials, medicines, and money. Important international NGOs transfer aid via the Kurdish Red Crescent. European Union funds also flow here, because official cooperation between the EU and the self-government is shunned. This cooperation is avoided because EU members do not want to upset their “NATO partner Turkey”, which is currently threatening a new invasion of Rojava. These invasions and the increasing bombing by Turkey of people and facilities in northeastern Syria and northern Iraq are currently the greatest human and health burdens on the population in Rojava.
Is there any link to Damascus?
There is a connection to Damascus, as well as at the general political level, since no separate national territory is sought, but rather autonomy and self-government. This autonomy actually exists, even if some medical supplies take place via the Assad-controlled area, or are bought and imported through there, and people are also occasionally given treatment in Damascus. The same is true of the conservative Kurdistan Regional Government in northern Iraq. Political relations with the Kurdistan Region of Iraq, which is controlled by family clans, are difficult and marked by repeated border closures. Nevertheless, imports, as well as occasional transfers of patients – to Erbil for example – also take place on this side.
What training is there for those who want to work as doctors or paramedics or in basic healthcare?
The situation of people, especially children and young people, has been burdened for years by a lack of training opportunities. However, for some years now, the situation has improved here, too, thanks to the great efforts of the Autonomous Administration. In addition to the important basis of a functioning school system, university academies are under construction, and there is also medical education here. How far this can lead to an internationally recognised degree is not yet foreseeable under the aforementioned circumstances.
What help is available for people wounded in the wars, and for people – especially children – traumatised by war and by living under ISIS?
The number of people killed and seriously injured, including many children, is high. It is estimated that more than 20,000 (physically) injured were seriously wounded in the fight against ISIS alone. The number of mutilated people who need prosthetic and physiotherapeutic help is in the thousands. A prosthetic centre with physiotherapy has recently been put into operation under the direction of the KRC: a start, at least. However, the number of psychologically traumatised people is much higher. For a long time, against the background of raging war, this problem could not be sufficiently taken care of. It is an immense task with the utmost importance. I am an emergency physician and psychotherapist and have to realise again and again that a psychological trauma can destroy a life as well as a grenade or bomb. Projects have been underway for several years, partly with the international support of trauma therapists who dedicate themselves to this important task. But there is still an incredible amount of work to be done, especially as the traumas, the consequences of flight and expulsion, are still being added to by the Turkish attacks.
What is the current situation with respect to Covid infection and treatment and access to vaccination?
A pandemic and the international approach associated with it is always a mirror of international power and domination. During my stay in a Covid emergency clinic near Haseke in the spring of 2021, I had to experience being the only vaccinated person. The vaccine arrived in Rojava extremely late and in small quantities. The consequences at that time were frightening. The lack of intensive care in relation to the standards of Central Europe, and the lack of vaccine, led to many deaths – people who would not have had to die under other circumstances.
And how can people reading this interview help?
It is not absolutely necessary to go to Rojava yourself and help on the spot. If someone wants to do this, it should be well considered and agreed with the local self-administration. What is urgently needed and helpful, however, is social pressure on the political level in Europe. The people of Rojava are not only fighting for a different, grassroots democratic society, they have also defeated the terror of ISIS at great sacrifice. For this, they deserve thanks, recognition, and help in rebuilding their society.
However, the reality has been their betrayal. They have been abandoned to the attacks of the authoritarian Erdoğan regime, and are exposed to the terror of air strikes and invasions. This must stop. To this end, everyone is needed to exert pressure and create publicity, with protests and direct actions. And, of course, you can donate by contacting organisations and NGOs that know what is missing in Rojava.
Hevya Sor has branches in different countries. You can find the links here.