Raqqa residents unable to afford healthcare as private hospitals operate with ‘no oversight’

Raqqa residents sell produce near a collapsed building on May 17. Photo by AFP.

AMMAN: In the final days of the battle for Raqqa, what remained of the city’s Islamic State fighters barricaded themselves in a public hospital and soccer arena downtown.

Warplanes—mostly American—pummeled Raqqa for months and, by June 2017, the US-backed, Kurdish-majority Syrian Democratic Forces (SDF) had advanced on the city limits. What followed was a bloody, months-long fight for control of the de facto Islamic State (IS) capital.

The National Hospital—the city’s last remaining public hospital—was devastated during the battle. SDF forces laid siege to IS fighters holed up inside, while a combination of street clashes and airstrikes left the facility in total disrepair.

The hospital became the “last battleground in Raqqa,” Osama al-Khalaf, a spokesman for the SDF-backed Raqqa Civil Council, tells Syria Direct. “And Daesh [IS] didn’t leave before burning everything inside.”

Then, in late October, a US-brokered deal ended the fighting and allowed IS remnants to evacuate to the Syrian desert, leaving Raqqa—and the ruined hospital—behind.

Nearly one year later, the National Hospital remains completely out of service, leaving Raqqa residents with few options for healthcare other than an under-equipped public clinic and a handful of largely unregulated, expensive private hospitals.

More than half a dozen Raqqa residents describe a devastated medical infrastructure where procedures and drugs are either unavailable or prohibitively expensive for most of the city’s residents.

The lack of public healthcare facilities and the price of private hospitals is currently leaving much of Raqqa’s populace without access to crucially important medical care, residents say.

“When people get sick they’ll just take painkillers,” says Raqqa resident Mahmoud, who asked that his full name not be published. “That way, they don’t have to pay for an expensive doctor.”

For Raqqa residents, the nearest fully equipped hospital offering complete medical services is in Tal Abyad, some 80 kilometers north of the city, near the Syrian-Turkish border. For the critically injured, the elderly or those in urgent need of surgery or other life-saving procedures, it is a long journey they cannot make.

Only one public clinic—supported by Medecins Sans Frontieres (MSF)—remains in the city, months since IS evacuated. Located in the neighborhood of al-Mashlab in the city’s east, treatment there is limited, but free.

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The Raqqa National Hospital in October 2017. Photo by AFP/Getty Images.

The al-Mashlab clinic lacks a full trauma center and surgical wing, meaning that those with more serious injuries or medical needs must either travel outside Raqqa or visit one of three private hospitals that opened in Raqqa over the past few months.

“All surgeries in Raqqa cost money and are only available in private hospitals,” says Bashar a-Naif, a 35-year-old Raqqa resident who volunteers with Oxygen Shabab, a local group that leads projects to rebuild public spaces.

Syria Direct contacted MSF about its healthcare facilities in northern Syria, but the NGO declined to comment.

For those who are unable or unwilling to travel to Tal Abyad, private hospitals are their only choice. But with no competition and limited access to equipment and medication, several Raqqa residents tell Syria Direct that private hospitals can charge virtually whatever they want.

‘No oversight’

“The owners of these hospitals act as if they own a company,” al-Naif says. “There’s great demand for [treatment] but no oversight… and almost no competition.”

When local journalist Mazen Khalil’s niece began choking on a small bead that she’d swallowed accidentally, her father took her to the al-Furat Private Hospital in Raqqa city.

“The whole procedure lasted two minutes and there was no surgery,” Khalil explains. But then doctors requested 40,000 Syrian Pounds (SP)—roughly $90—from the family.

“That’s a month’s salary,” Khalil adds.

Many prescription drugs are unavailable in Raqqa, and what remains in the inventories of local pharmacies are often exorbitantly priced, says local resident and engineer Abu Ahmad.

“There’s no oversight for pharmacies,” Abu Ahmad tells Syria Direct. “The prices aren’t set—even from pharmacy to pharmacy they differ.”

The Raqqa Civil Council, the SDF-supported entity formed in April 2017 that has been tasked with administering the city after the defeat of IS, issued a list of prices for medicines and medical procedures on August 8 in an attempt to bring the cost of healthcare under control.

Private hospitals are now required by law to adhere to prices set out by the council, and yet local residents say that the decree has still had limited effect.

“There is no oversight” for private hospitals in spite of that decree, resident a-Naif tells Syria Direct, adding that even the council’s prices are out of reach for most Raqqa residents.

“Maybe this decree will help set prices [in the future],” a-Naif suggests, “but the suggested prices are still expensive. They need a second look.”

Muhammad al-Ahmad is the director of one of Raqqa’s private hospitals. He argues that privately run facilities are themselves dealing with soaring care costs. What constitutes a suitable price remains open to debate, he says.

“The current prices are totally normal—in fact they’re cheaper than other nearby cities like Manbij, Qamishli and Hasakah,” al-Ahmad tells Syria Direct. He requested that neither his name nor the name of his hospital be published in this report.

IS took control over major swathes of territory across Syria and Iraq in 2013 and 2014 in a brutal, blitzkrieg military campaign waged against pro-government forces, rebel groups as well as civilians.

In early 2014, the IS onslaught reached Raqqa as it advanced eastward along the banks of the Euphrates River. The city went on to become a major IS stronghold and the de facto capital of the group’s self-proclaimed Islamic caliphate.

IS ruled over Raqqa for three long years, enforcing a strict interpretation of Islamic law on the local populace. Women were forced to cover their faces in public, men were forced to pray and attend mosque, and most forms of communication with the outside world were banned. Public beatings and executions became commonplace.

Entire sections of Raqqa were flattened by airstrikes and ground fighting as retreating IS forces booby-trapped entire buildings and streets. IS fighters dug underground tunnels that gutted the city’s infrastructure.

Removing IS came at a price. When US-backed coalition and SDF forces announced they had finally taken control of Raqqa in October 2017, the city was destroyed. Almost a year later, mines and explosives dot the cityscape, while water and electricity haven’t returned to most neighborhoods. The rubble of collapsed buildings conceal bodies that still have not been recovered by local authorities.

One of the final battlegrounds—the National Hospital—remains in ruins, private hospital director al-Ahmad tells Syria Direct, and will take “millions” of dollars to repair.

And while the shortage of adequate, affordable healthcare is just one of the myriad challenges facing Raqqa residents since the fall of IS—as well as high unemployment and a growing trend of drug abuse in the city—al-Ahmad says that Raqqa residents will simply have to make do with what is available.

“When someone becomes ill, he must visit a doctor,” he says. “So—people will accept going to a private hospital.”

“They have to.”

This report is part of Syria’s month-long coverage of former Islamic State-held territories in partnership with the Konrad Adenauer Foundation and reporters on the ground in Syria. Read our primer here.