By Nurman al-Abbas
DAMASCUS, Syria (North Press) – In Syria, under the rule of Bashar al-Assad’s regime, centralized procurement law devastated the healthcare sector, creating monopolies, corruption, and devastating shortages in public hospitals.
Standing on the sidewalk in front of the University Children’s Hospital in Damascus, Asaad al-Abdullah, who traveled from Deir ez-Zor in eastern Syria, waits patiently to secure medication for his son, who is battling leukemia.
Al-Abdullah says with a tone heavy with exhaustion, the nine-month treatment journey cost him 230 million Syrian pounds (SYP which equals about $19,000).
Arbitrary decisions
Government hospitals have long suffered from severe medication shortages, but arbitrary decisions have exacerbated the problem. In 2018, a decree mandated the unification of procurement for medications and medical equipment for public institutions under the supervision of the Ministry of Health. This included the Ministries of Health, Higher Education, Defense, and Interior.
Under the “Central Procurement Law,” the ministry became responsible for securing medical supplies. Despite repeated objections from doctors to the centralization of procurement, the Ministry of Health insisted on implementing the law, resulting in catastrophic outcomes for Syrian hospitals and leaving them almost devoid of necessary medications and medical equipment.
Ayman al-Balkhi, head of the intensive care unit at the Children’s Hospital, told North Press that the central procurement decision caused an acute crisis in securing medications at the hospital, forcing families to take on the responsibility of obtaining their children’s medications.
He pointed out that the hospital largely relied on families to provide medications that were not supplied adequately by the Ministry of Health.
According to al-Balkhi, the Ministry provided only 20 percent of the hospital’s annual medication needs, making the situation increasingly dire.
Monopoly
Regarding drug procurement, al-Balkhi said that the central procurement system abolished local tenders that each hospital used to organize to meet its specific needs.
He added that the law centralized tenders under the Ministry of Health, resulting in a monopoly over medications and medical supplies by a single authority. He viewed this as a means of controlling and exploiting resources to benefit a select group.
The previous regime caused significant damage to the healthcare sector, al-Balkhi noted, by enabling black market traders to manipulate drug and medical supply prices. These traders sold medical equipment to public hospitals at exorbitant prices compared to private hospitals.
He pointed out that this wastage was a direct consequence of the previous regime’s policies in the medical sector and tender management, which allowed state resources to be exploited.
The lack of emergency medications was one of the most dangerous outcomes of the law, he stressed, leading to a rise in deaths in the intensive care unit because families could not secure the necessary medications.
Al-Abdullah added that every day two or three children leave the Children’s Hospital deceased, saying their families are unable to bear the costs that government hospitals failed to cover.
Theft under legal cover
The central procurement law saved about 10 billion SYP ($833,333) annually, according to al-Balkhi. However, he said this “savings” were stolen for the benefit of the presidential palace treasury.
He described it as theft under legal cover, noting that the money saved came from the pockets of impoverished citizens who were forced to pay hundreds of thousands daily for their children’s medications, despite struggling to afford basic necessities like bread.
The previous regime forced the poor to pay for medications that government hospitals were supposed to provide, he stated.
Al-Balkhi argued that the situation was better before the implementation of the central procurement law, as hospitals had more freedom to procure medications, leading to a more stable healthcare environment.
He emphasized the need for the new government in Syria to find alternative solutions for reforming the tender system rather than perpetuating a system that enriched corrupt procurement committees and hospital administrators.
Corruption networks
Nader Eed, head of the Incubator Department at the Children’s Hospital, highlighted how the central procurement law unified corruption networks under the Ministry of Health’s umbrella.
Speaking to North Press, Eed explained that foreign medical supplies were imported through a company. Hospitals would submit a request to the Ministry indicating 100 percent of their needs, but the Ministry would approve only 25 percent, delivering just 15 percent of the requested amount.
Eed revealed that the hospital’s incubators were in a state of disrepair, and despite the pressing need for maintenance, the Ministry refused to refurbish them.
Eighty percent of patient families had to procure medications themselves, according to Eed, who linked the rise in deaths to widespread infections caused by poor sterilization in hospitals.