Syria: end sanctions and find a political solution to peace
Authors: Waleed Al-Faisal, Kasturi Sen, Yasser Al Saleh
Journal: The Lancet Global Health (2015)

Further attempts were made last month to initiate peace talks in the Syrian conflict, and in the context of the devastated economic, social, and health systems, such a political solution aimed at halting all fighting must be given priority over blaming one side or the other. There is evidence to suggest that a revival of basic health services can act as a trigger to bring together warring sides.1Bunde-Birouste A Eisenbruch M Grove N et al.Health and peacebuilding: securing the future. University of New South Wales, Sydney2004Google Scholar As Syrian public health doctors and advisers who once helped establish one of the best national health systems in the region,2Sen K Al-Faisal W Reforms and non-communicable disease—some challenges facing a conflict ridden country: the case of Syria.Int J Health Plann Manage. 2013; 28: 290-302Crossref PubMed Scopus (11) Google Scholar we do not find it difficult to understand concerns about failures of the humanitarian aid systems in Syria, as frequently suggested in The Lancet and elsewhere.3Cousins S Syrian crisis: health experts say more can be done.Lancet. 2015; 385: 931-934Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar However, Syria is rapidly descending into hell, Iraq-style, and the global health community needs to wake up to the implications of this reality. The economic losses of the country at the end of 2014 stood at US$143·8 billion,4Syrian Centre for Policy ResearchAlienation and violence: impact of Syrian crisis report. SCPR, UNRWA UNDP, Damascus2015Google Scholar with more than 80% of the population living in poverty, of whom a third (32·6%) were in abject poverty, unable to obtain even basic food items. More than half of the population (52·8%) is displaced, of whom a third are internally displaced. Life expectancy has been reduced from 75·9 years in 2010 (one of the highest in the region for countries not part of the Gulf Cooperation Council) to 55·7 years in 2014—a loss of 20 years.4Syrian Centre for Policy ResearchAlienation and violence: impact of Syrian crisis report. SCPR, UNRWA UNDP, Damascus2015Google Scholar The unemployment rate rose from 15%5Central Bureau of Statistics (Syria)Unemployment rate during 2001–2011 (%).http://www.cbssyr.sy/work/2012/TAB14.htmGoogle Scholar in 2011 to 55·7% in 2014, with more than 3 million losing work within the first 2 years of the conflict. The cost of basic food items has risen six-fold since 2010, although it varies regionally. With the exception of drugs for cancer and diabetes, Syria was 95% self-sufficient in terms of drug production before the war. This has virtually collapsed as have many hospitals and primary health-care centres. Economic sanctions have not removed the President: as with other countries under siege, in the region and elsewhere, only civilians are in the line of fire, attested to by the dire state of household and macroeconomies. Sanctions are among the biggest causes of suffering for the people of Syria and a major factor perpetuating the conflict,6Al Faisal W Al Saleh Y Sen K Syria: public health achievements and sanctions.Lancet. 2011; 379: 2241Summary Full Text Full Text PDF Google Scholar and our predictions of a warlord economy of plunder7Sen K Al Faisal W Al Saleh Y Syria: effects of conflict and sanctions on public health.J Public Health. 2013; 35: 195-199Crossref Scopus (43) Google Scholar has already taken hold as unemployed young people among others are opportunistically recruited to fight for Jihadist groups, now mainly ISIS, destroying infrastructure for economic and political gain. Economic sanctions have exacerbated the brutality of this conflict many-fold, removing any prospects for peace and reconciliation. We need some reality to gauge their manifold effects before Syria descends into another Iraq, the devastating health consequences of which were well documented.8Garfield R The impact of economic sanctions on health and well-being in Iraq. Oversears Development Institute, London1999http://www.essex.ac.uk/armedcon/story_id/The%20Impact%20of%20Econmoic%20Sanctins%20on%20Health%20abd%20Well-Being.pdfGoogle Scholar Syria urgently needs a political initiative for peace, before this military conflict generates a major humanitarian health catastrophe, worse than what we are now witnessing; then we cannot say we did not know. We only have to look at Iraq.9Burnham G Lafta R Doocy S Roberts L Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey.Lancet. 2006; 368: 1421-1428Summary Full Text Full Text PDF PubMed Scopus (427) Google Scholar We declare no competing interests. Revival of basic health services in SyriaWaleed Al-Faisal and colleagues (July, 2015)1 call for an end to sanctions in Syria. Sanctions do have unintended consequences for innocent citizens, but those imposed on Syria have been mostly on weapons and items of dual use, many of which were imposed years before the onset of the present conflict,2 including the period of the positive achievements in health care mentioned by Al-Faisal and colleagues. Furthermore, humanitarian items and drugs were exempted from the sanctions. Full-Text PDF Open Access