A blood bank in Kafr Nubl, southern Idlib treats patients for blood disorder, Thalassemia. Photo courtesy of Idlib Health Directorate.
AMMAN: Civil society organizations and local government bodies in Syria’s rebel-held northwest are bracing for funding cuts and an encroaching transition towards hardline Islamist rule, after several health directorates in the region suspended employment salaries in response to at least one key donor reportedly pulling funding late last week.
Donors suspended funding in response to recent advances by hardline Islamist coalition Hay’at Tahrir a-Sham (HTS) across Syria’s rebel-held northwest, where international NGOs as well as local organizations and service providers previously operated alongside opposition-affiliated authorities.
Late last week, health directorates across opposition-held areas of Idlib, Hama and Aleppo provinces issued statements announcing that work in more than 50 health facilities under their administration would be “considered voluntary” until further notice, starting from January.
According to a statement released by Hama province’s health directorate on January 16, the body could no longer bear “any financial responsibilities towards any employee or facility.”
Funded primarily by German development agency GIZ, health directorates manage a range of medical facilities in the opposition-held northwest including hospitals, blood banks and mobile clinics.
Health directorates initially emerged out of a network of medical workers operating in the absence of Syrian government institutions linked to the Ministry of Health, after areas of the northwest began to shift to opposition control after 2011.
The decision came only days after GIZ suspended its projects in opposition-held parts of Idlib, Hama and Aleppo—according to a spokesperson from the Federal Ministry of Economic Cooperation and Development (BMZ), GIZ’s main donor—“with immediate effect” on January 11, after HTS fighters seized much of the rebel-held northwest in the previous 10 days.
Growing HTS control over the country’s last rebel stronghold has posed a threat to existing governance structures including local councils, as well as the long-term survival of civil society organizations.
The latest bout of rebel infighting began on January 1, when HTS launched an offensive on Harakat Nour a-Din a-Zinki, an Islamist rebel faction affiliated with the National Liberation Front (NLF), a Turkish-backed rebel formation present in opposition areas of the northwest.
Zinki was all but defeated within days, before HTS then moved against Ahrar a-Sham and other NLF-affiliated rebel factions in the Sahel al-Ghab region of nearby Hama province.
Donors 'concerned about latest developments'
The hardline Islamist coalition, which is spearheaded by a former Al-Qaeda affiliate, now reportedly controls around 80 percent of remaining rebel-held territory in Syria’s northwest.
“We are very concerned about the latest developments,” the BMZ spokesperson told Syria Direct in an email on Friday, referring to the fact that HTS is listed as a terrorist organization by the UN.
The spokesperson, however, emphasized that projects funded by the ministry in the area have been “have been suspended, not ended” while the agency “closely [monitors] the development of the political situation.”
It remains unclear how exactly areas seized by HTS in recent advances will transition from the administration of the opposition-run Syrian Interim Government (SIG), based in southeastern Turkey, to the HTS-affiliated Syrian Salvation Government (SSG).
The SSG was originally formed by HTS in late 2017 as an alternative to the Western-backed SIG, and has expanded through the northwest in step with HTS military advances. While HTS has repeatedly claimed the SSG is independent, the governance body has dissolved opposition-affiliated local councils and asserted the hardline group’s strict interpretation of Islamic law on local communities.
A January 10 ceasefire agreement between HTS and the NLF set out stipulations for local councils to transition to HTS-affiliated SSG control.
No specific timeline was set for that transition, though, while the NLF and HTS have purportedly agreed to share administration in two areas of Idlib province previously under NLF control—Ariha and Maarat a-Numan.
However, according to a member of the SIG-affiliated Free Aleppo Provincial Council, who requested that his name be withheld for security reasons, negotiations between the involved parties are still ongoing.
In the meantime, SIG-affiliated councils are continuing to work despite the encroaching threats to both funding and their independence as organizations.
One member of the Anjara Local Council in the western Aleppo countryside, speaking on condition of anonymity for security reasons, told Syria Direct on Friday that the council has been ordered to continue work as usual, despite the fact most NGOs have suspended work “until matters in the region become clear.”
The anonymous Free Aleppo Provincial Council member also confirmed that local councils in the province are still operating, although “activities are very limited.”
GIZ suspended work across several sectors—from education to agriculture, water provision to civil society empowerment—but for now the most tangible effects of the decision appear to be in the health sector.
According to Ibrahim Shamaly of the Hama Health Directorate, 70 percent of local medical facilities under its administration have already been affected by funding cuts, and the situation is even worse in Idlib. The head of the directorate, he said, is currently in Turkey to negotiate the potential resumption of funding, or alternative funding options.
A health directorate official working in southern Idlib, Mustafa al-Eido, also said that the directorate has launched a “massive advocacy campaign” aiming to restore funding.
“We hope that in the near future, the work of the directorate and its affiliated facilities will resume,” he told Syria Direct on Thursday.
For now, however, the health directorates’ employees should not expect to get paid for the work they do, read the statements published to the three health directorates’ Facebook pages—a stopgap that Shamaly estimates will only work for the next three months at most.
Mahmoud Shamaly, an administrative employee in the Idlib Health Directorate, relies on his income to support his family, and given the already difficult living conditions in Idlib, he worries about the consequences of losing his salary.
“If things don’t change, I will definitely search for a new job opportunity.”
According to Dr. Zedoun Al-Zoebi, CEO of the Switzerland-based Union of Medical Care and Relief Organizations (UOSSM)—a network of NGOs and medical organizations from Europe and the US—up to 1,000 doctors and administrative workers in the opposition-held northwest currently rely on their links with health directorates.
“If this continues, then everyone should expect a huge humanitarian disaster in Syria,” he warned.
Syria's rebel-held northwest 'already a disaster'
Home to an estimated three million people, of whom about half were displaced to the region from across Syria in a series of forcible evacuation deals since 2016, the opposition-held areas of Idlib, northern Hama and western Aleppo provinces are already badly under strain.
“This area is already a disaster,” said Hama Health Directorate’s Ibrahim Shamaly.
The Anjara Local Council member also worries that the suspension of funding will impact civilians disproportionately rather than factions or HTS-affiliated governance bodies.
“The actors in control will not be affected by the cessation of support,” he said, adding that “those who will be affected are the civilians—people in need and the poor—people who are [already] struggling.”
Meanwhile, BMZ maintains that it wants to “minimize the humanitarian effect” of the suspension, adding that the German government continues to fund humanitarian aid provided by the UN and international NGOs.
Cuts to funding for local organizations in Syria’s northwest pose the latest challenge to civilians in an increasingly unstable part of the country.
In the wake of recent advances by HTS, the fate of Syria’s last rebel stronghold remains in doubt—threatening a Russian and Turkish-brokered agreement that was celebrated last September for staving off a potential pro-government offensive on Idlib province.
Russian and Turkish officials acknowledged changes on the ground over the weekend, but vowed to stick to the agreement in place.
"The implementation of the Sochi agreements on Idlib is being successfully continued, despite of the provocations ongoing in the region [sic]," Turkey’s Defense Ministry said in a statement January 19.