Anas Alkharboutli (picture-alliance/ dpa/AP Images

HEALTH IN A TIME OF MONSTERS

THE WEAPONISATION OF HEALTHCARE IN SYRIA

SALMA DAOUDI OXFORD QATAR THATCHER SCHOLAR

The aftermath of a rocket attack launched by the Syrian government on the al-Shifaa Hospital and surrounding residential areas in Afrin. The town is controlled by Turkish-backed rebels. According to a war monitor, the attack killed 21 people, including 17 civilians.

The Syrian Conflict has witnessed the evolution in the brutal tactics of weaponising and strategically damaging healthcare. Our new Oxford Qatar Thatcher Scholar Salma Daoudi (2021 DPhil International Relations) is carrying out vital research to increase awareness of the strategy and evaluate its impact on the health security of the region as a whole.

“When the old world is dying and the new world struggles to be born…[it] is the time of monsters”. – Antonio Gramsci (1891-1937)

Witnessing the ‘monstrosity’ of the Arab Spring left many people (including myself) feeling utterly powerless in the face of raging injustice. While these movements began in hope, they soon progressed to violence as regimes fought back. In light of what many term to be failed democratic experiments, such as in Tunisia or Egypt, it might be tempting to lose faith in Arab revolutions as a force for good.

But the failure of a revolution lies not in the maintenance or re-establishment of an authoritarian government. Rather, it is when that order is longer contested. The uprisings of the last decade in the Arab world are an ongoing and transformative social, cultural and political phenomenon, continuously resisted by counter-revolutionary movements: there is no clear break separating the pre- from the post-revolutionary order.

The best example of this struggle for freedom and democracy in the face of repression is the Syrian revolution. As a scholar of health insecurity in conflicts and asymmetric warfare, the bravery and resilience of the Syrian people has long fascinated me and inspired my work. They have faced extremely difficult circumstances; the country has become the setting for high levels of indiscriminate violence, with severe human rights violations a fact of daily life.

In particular, the conflict has featured the strategic use of healthcare services as a weapon at hitherto unprecedented rates. This prompts several concerns: how and why has this been carried out in the course of the war, and how does the instrumentalisation of health infrastructure in this way translate into a threat to regional health security? Answering these questions lies at the heart of my research. Health weaponisation refers to a broad range of tactics used to restrict or deny access to care, including the

demolition and destruction of health facilities, or their subversion for military purposes; deliberate attempts to obstruct access to medical aid and facilities, such as curfews, checkpoints, or the shooting of ambulances; the criminalisation of medical neutrality through the imprisonment, torture, or killing of health workers who provide care to enemy factions; and humanitarian aid blockades.

In Syria, weaponisation has mostly taken the form of destroying healthcare facilities. Between 2011 and 2021, there over 1000 attacks were made against healthcare between 2011 and 2021, leading to the full or partial destruction of over 50% of local health facilities. The frequency of these attacks and their strategic targeting of hospitals in opposition-held areas hint to the incorporation of this warfare strategy to the Syrian regime’s arsenal of methods to punish dissent and weaken resistance. Many Syrians have been left vulnerable to the development or worsening of their pre-existing health conditions, with infectious diseases such as leishmaniosis, measles, tuberculosis, and polio surging in the country. Additionally, the years of protracted unrest and targeted destruction of health facilities eroded the resilience of the heavily fragmented Syrian healthcare system, rendering it profoundly ill-prepared for the COVID-19 pandemic.

These odious tactics, used mainly by the regime, represent a strong challenge to the human rights of Syria’s people. In a globalised context, they not only undermine local livelihoods but also present an international risk of epidemic disease, given Syria’s porous borders, refugee crisis, and poor capacity to provide adequate care and living conditions to refugees. A lack of international political and financial assistance can allow refugee camps to become vectors for transmitting diseases, a situation not aided by local healthcare infrastructure which lacks the resilience to prevent, diagnose, and treat infections. Conflicts, therefore, represent a multidimensional human and health security threat - the ramifications of which are far from spatially bound.

In my doctoral thesis, I aim to explore how the weaponisation of health in Syria fosters conditions favourable to the regional spread of infectious diseases, and how this increases socio-economic and health vulnerabilities. I will decipher challenges to the right to health within Syria, and then carry out a comprehensive overview of the obstructions to refugees’ right to health in neighbouring Lebanon and Jordan in order to understand how transboundary health threats perpetuate structural violence against both vulnerable refugee and host communities.

I am deeply grateful to the Oxford Qatar Thatcher Graduate Scholarship for its financial as well as academic support, which enables me to shed light on an understudied aspect of the suffering caused by the Syrian conflict and raise awareness about the importance of safeguarding international humanitarian laws and the right to healthcare.

This project is, at its heart, not only a call to explore an overlooked phenomenon and the wider interrelation between health and security, but also an attempt to put the importance of human life and dignity at the heart - instead of the margins - of the security literature. Carrying out this research in Oxford’s interdisciplinary and academically stimulating environment will prompt collaboration and intellectual exchange, helping me to develop the intersectionality of this work - and, I hope, its reach.