DAMASCUS - International sanctions are depriving Syria’s hospitals of essential machinery, spare parts and even drugs which is having a significant impact on ordinary Syrians, but little effect on their stated aim of changing Bashar al-Assad’s policies, Syrian doctors and businesspeople told Middle East Eye.

“We cannot import nitrous oxide which is needed for anaesthetics because they say it can be used to make bombs. We need helium to cool our MRI scanners but none is allowed to be imported. Many MRI centres are out of service across Syria,” Dr Joseph Fares, the director of the Italian hospital in Damascus, told MEE.

The sanctions were targeted on the Syrian government but I cannot understand why all Syrians should suffer - Dr Joseph Fares, director of the Italian hospital

His hospital was built more than a hundred years ago to help Roman Catholic missionaries in Syria but now serves thousands of ordinary Syrians every year.

It used to be financed in part by donations from Italy but “we cannot receive money from Italy anymore because they can’t transfer funds to Syrian banks,” Dr Fares went on.

“The sanctions were targeted on the Syrian government but I cannot understand why all Syrians should suffer.”

As he outlined the lopsided nature of the effect of sanctions - leaving the Syrian government untouched but hurting private citizens - it was impossible not to remember the similar impact of sanctions on Saddam Hussein’s Iraq 25 years ago. They starved hospitals of supplies and impoverished the country while leaving the dictator and his elite secure and unaffected.

Dr Joseph Fares (MEE/Jonathan Steele) Evidence of Assad’s free hand is clear in rebel-held areas where the Syrian government and, after 2015, Russia systematically attacked hospitals and medical personnel, documented in a Syrian American Medical Society report released earlier this year.

Last month, Jan Egeland, the UN special advisor for Syria and rights groups, accused the Russians and Syrians of intensifying such attacks.

"Every time a hospital is attacked in Syria,” SAMS president Dr Ahman Tarakji said in a statement, “the local community suffers an immense loss, and crucial access to health care is lost.”

Unilateral sanctions

There is one difference between Sadaam Hussein’s Iraq and Syria today. International sanctions on Iraq had United Nations backing and were approved by all the major powers. The ones on Syria are unilateral. They derive from decisions taken by Britain and the rest of the European Union as well as the United States.

Not only were they not given international legal authorisation by any UN Security Council resolution, they were explicitly condemned by a UN General Assembly resolution of 20 December 2013, which states that “unilateral coercive economic measures adversely affect the economies and development efforts of developing countries in particular”.

Foreign equipment in Children's Hospital in Damascus (MEE/Jonathan Steele)

“Such measures”, the resolution continues, “constitute a flagrant violation of the principles of international law as well as the basic principles of the multilateral trading system”.

Britain and the EU first imposed sanctions in 2011 at the start of Syria’s war, and have tightened them repeatedly. They include an embargo on importing Syrian oil, asset freezes and restrictions on financial services as well as prohibitions on the export of certain “dual use” items. US sanctions go further. They impose a blanket embargo on all exports to Syria.

Because Syria was designated by the US as a state sponsor of terrorism as far back as 1979, there is an export ban on almost all US-origin items. It includes foreign-produced items in which US content accounts for 10 percent or more of the value of the finished product.

Although the sanctions legislation offers exceptions for humanitarian work, the practical effect of the restrictions is to block much of this too because aid agencies need to cover the legal costs and the use of office time needed to navigate the complexity of getting export licences.

They are also inhibited by fears of being charged with violating EU or US law if the items exported are subsequently not recognised by government regulators as having been legitimate. “In practice we cannot buy any new machines,” Dr Fares said.

Dr Mazen Hadad, the director of the Children’s Hospital in Damascus, told me a similar story. Hundreds of mothers were queuing outside the building when I arrived a few minutes before the gates opened for visiting hours.

Inside, staff showed me what amounted to a museum of antiquated medical machines which could not be upgraded or were lacking spare parts, including the software that controls them. Babies were lying in ancient incubators. CT scan monitors were out of date.

Because sanctions are not UN approved and have only been imposed by Western countries, the hospital now imports some 30 percent of its drugs from other countries, including Iran, India and China. It also coordinates with the World Health Organisation which is allowed to pass drugs on to Syria in certain circumstances.

'Chilling effect'

The harmful effect of sanctions on Syria was highlighted in a report commissioned by the Swiss Agency for Development and Co-operation last year for the Beirut-based UN Economic and Social Commission for Western Asia (UNESCWA).

Originally intended for publication, it was leaked to the website, The Intercept, and has since been held back as an internal UN document, although hard copies are widely available in the region and one was given to MEE.

One major European aid organisation complained that the legal costs of obtaining a US license for sending a computer to Syria were three times the cost of the actual computer

The report describes the US and EU sanctions as “some of the most complicated and far-reaching sanctions regimes ever imposed”. Sanctions on the largest banks in Syria including the Central Bank mean that only a few small banks can operate.

But the report says the sanctions have a “chilling effect” on private sector entities who may want to work with these smaller banks, but worry about inadvertently making technical violations of the rules.

Exporting the software for medical equipment needs licences but the complications in applying for them is “particularly debilitating” and the “humanitarian exemptions are too limited”, the report says.

The Central Bank of Damascus (Reuters) It includes 13 case studies of problems encountered by unnamed charities and aid agencies. One major European aid organisation complained that the legal costs of obtaining a US license for sending a computer to Syria were three times the cost of the actual computer.

Another European aid agency with an annual turnover of more than $100m tried to transfer funds to its partners in Syria by sending them to a bank in a neighbouring country so as to be passed on from there by agents. But when it revealed, in the interests of transparency, what the ultimate destination of the funds were, the foreign bank refused to process the transfer.

An extraordinary example of the effect of sanctions was provided by a large international non-governmental organisation which became a sub-contractor for a UN programme. It needed to purchase and distribute fuel in Syria, but this required an EU licence. The licence had to be acquired through the NGO’s national government where several different ministries had the duty to approve it after negotiating with each other.

EU sanctions Syrian soldiers and scientists over chemical weapons Read More »

According to the UNESCWA report, “This was dependent on identifying a source of fuel. The circumstances inside Syria at the time, the unreliability of private sources of fuel and the duration of the negotiations meant that the application had to be continuously updated which required further review within each department. Eventually the programme opportunity passed before the licence could be agreed upon”. The report did not specify what the fuel was needed for, but many projects involve using generators when normal electricity plants and power lines have been destroyed or damaged.

Everyday impacts

Beyond aid agencies, sanctions have a severe impact on private businesses and individual Syrian citizens. No US or European credit cards are accepted in Syria. It is impossible to get a letter of credit from a foreign bank. Western insurance companies will not cover goods bound for Syria.

Elia Samman runs an export-import business in Damascus. He has set up a separate company in Lebanon which imports goods, some of which are then exported to Syria.

“It’s hard to get the paperwork authorised by manufacturers if they know the goods are going to Syria. It adds about 35 percent to the cost of doing business and of course this is charged to the end user,” he told MEE.

If I’m a Syrian working for an international organisation in Lebanon and get paid with a dollar cheque, I can’t cash it - Dr Noha Chuck, chief executive officer of the Syrian Enterprise and Business Centre

Sanctions have been tightened since the war in Syria has intensified. Under US pressure, Lebanese banks no longer allow Syrians to open dollar accounts. Those with pre-existing accounts may find them frozen. Even traveling to Lebanon is difficult.

Dr Noha Chuck is chief executive officer of the Syrian Enterprise and Business Centre. She has dual Canadian and Syrian citizenship and can travel to Lebanon easily with her Canadian passport.

“If you’re on a Syrian passport you have to show the Lebanese border people you have a hotel reservation and they will often phone the hotel to check. You also have to have $1,000 in cash. Why would I need so much if I’m only staying one or two nights?” she said.

“If I’m a Syrian working for an international organisation in Lebanon and get paid with a dollar cheque, I can’t cash it. All I can do is to endorse it to a Lebanese or other friend who can cash it and pass the money on to me.”

Workers from the Danish Refugee Council unload aid Syrian refugee camp in Lebanon's border town of Arsal in 2014 (AFP) Inevitably, the embargo has led to criminality. “A new generation of sanctions-busters has emerged,” said Dr Chuck. “To give one example, goods which are unloaded in Latakia [a Syrian port on the Mediterranean] are declared in the documentation to have been unloaded in Lebanon.”

Rateb Shallah, a banker who is president of the Syrian Enterprise and Business Centre, said: “Sanctions are not the right method of pressing people into different behaviour. The aim was to affect the Syrian government but if there ever was a justification, it’s no longer valid. Sanctions affect ordinary people. The suffering they cause is global. They impact every transaction in Syria. Syrians are put in a giant prison.”

Restricted reconstruction

Sanctions also affect charities working in rebel-held areas of Syria. They too have difficulties in sending money to partner charities.

While sanctions have had a catastrophic effect over the last six years of war, they are likely to have an even bigger effect now that the war is slowly coming to an end and aid agencies, as well as the Syrian government, turn their attention to rebuilding the country’s badly ruined infrastructure.

We need to understand that ceasefires are not enough. People fled not just because of the fighting but because of lack of services, health, livelihoods and jobs - Khaled Erksoussi, International Federation of Red Cross

“Sanctions will become more acute when we move to rehabilitating power stations, health services, water pumping and the rest,” said Khaled Erksoussi, the Damascus-based movement and partnership coordinator for the International Federation of Red Cross and Red Crescent Societies.

“If we are going to stop people being displaced or remaining as refugees and encourage them to return home, we need to understand that ceasefires are not enough. People fled not just because of the fighting but because of lack of services, health, livelihoods and jobs. We’re not in the full recovery phase yet, but even in pre-recovery people need sustained support, planning, and engagement by foreign donors and governments.”

A Syrian man cries as rescuers look for victims under the rubble of a building after an air strike in northern Aleppo (AFP) Similar arguments were set out in last year’s UNESCWA report. “The immense level of infrastructure destruction (transport, communications, hospitals, water, energy infrastructures and housing stock) has created an urgent need for development and reconstruction aid,” it said.

It urged the US and EU to undertake a strategic review of future reconstruction and development priorities and start “planning to move from a conflict situation to a reconstruction phase”.

A year later, nothing has changed. Neither the US nor the EU has amended their sanctions legislation nor are they making any moves towards planning for reconstruction. All they have done is issue some minor clarifications of the rules.

The lead author of the UNESCWA report was Dr Justine Walker, who is now director, financial crime (sanctions and bribery) at UK Finance, the main association for Britain’s banks and financial services companies.

How a UN health agency became an apologist for Assad's atrocities Read More »

She told MEE that as areas of Syria become more stable and refugees think of returning to their homes, NGOs are already developing programmes to help them. She spends much of her time talking to EU government officials, charities, law firms and banks.

“What we note from the dialogue across humanitarian programmes is that these programmes tend to be more forward-leaning than what is permissible from the regulations. They are already starting to look at reconstruction, at development, at livelihood issues, at supporting businesses and politically the sanctions have not fundamentally changed.

“So there is a tension between what we see happening on the ground where finance is needed and what is permissible and licensed by a competent authority,” she told MEE. “Somehow we have to remove the tension between the sanctions and the impact they have on civilians”.

At an impasse

According to analysts, the US and EU are still trapped in the policy assumption which lay behind sanctions, namely that Assad’s regime would be toppled quickly or could be forced to give up. The assumption looks as flawed today as it was when it was first enunciated by Western governments in 2011.

They are reluctant to recognise their mistake publicly, nor do they want to seem to be rewarding Assad for his looming victory by helping him to rebuild the country. They still want to impose conditions.

The most recent EU policy statement on Syria, issued in April 2017, says the EU “will be ready to assist in the reconstruction of Syria only when a comprehensive, genuine and inclusive political transition, negotiated by the Syrian parties, is firmly under way”.

“In this context, it could review the current restrictive measures,” it goes on. “Special responsibility for the costs of reconstruction should also be taken by those who have fuelled the conflict.”

Earlier this week, Assad with the Syrian national football team in Damascus (AFP) Is the EU referring to Assad’s allies, Iran and Russia – or to the West and its allies - Turkey, Qatar and Saudi Arabia - who have also inflamed the war? Who will be responsible for rebuilding the country that has been destroyed? The report never specifies.

Even more critically, the report says the EU will “continue to consider restrictive measures against Syria as long as the repression continues” and that there can be “no lasting peace in Syria under the current regime”.

With Assad – and Western sanctions – firmly in place, it seems Syrian suffering will continue.

This article is available in French on Middle East Eye French edition.