23 June 2022
In the fourth part of our series of articles on of the tenth anniversary of the Rojava revolution, Anita Starosta looked back at the medico history in Rojava and discussed the importance of international humanitarian aid in Syria for us.
A blood bank for Kobanê was medico’s first donation-funded project for Rojava and was to be the beginning of an intimate partnership of solidarity that continues to this day. In the summer of 2014, together with the Kobanê Medical Commission, medico succeeded in bringing a life-saving blood bank to the hard-pressed enclave. Only a few weeks later, in September 2014, the Islamic State (IS) attacked the city and a fierce house-to-house battle between IS, Kurdish forces and anti-IS coalition dragged on over the next weeks. Tens of thousands of people fled the fighting and fear of IS atrocities to neighboring Turkey. Local medico partners supplied them on the Turkish side at that time. On 27 October 2014, the hospital in which the blood bank was located was destroyed by an IS attack. Until the end of January, the fighting continued, hundreds of fighters and civilians died, and eighty percent of the city was destroyed – but IS was driven out of the city. Until today, the battle for Kobanê is considered a turning point in the fight against IS and symbolizes the defense of the “democratic experiment Rojava” – as medico called the attempt of the Kurds to establish a self-government under the principles of democracy and equality.
For medico, a cooperation began that has lasted until today and has intensified and expanded over the years. It was not to be the end of the blood bank – after the liberation of Kobanê, thanks to the great willingness of medico supporters to donate, it was replaced and put into operation in the rebuilt hospital.
From the beginning, the partnership with Rojava was based on medico’s principle of supporting local actors who take an emancipatory approach. As an aid and human rights organization that has been defending the right to health globally and working in emergency contexts for decades, it was therefore natural to support the “democratic experiment” in building a new health system. A central project of the newly formed self-governing health commission was to ensure free access to basic health care for the entire population. Under the Syrian regime, much of the health system had been privatized and the public sector had a very poor reputation. A big task, then, under these difficult conditions and in a region where a third of the health infrastructure had been destroyed by the war. Not only the Syrian and Russian military targeted civilians, but also the radical Islamist groups such as al-Nusra or IS destroyed hospitals and clinics. The Turkish military, in turn, captured hospitals that had already been rebuilt in recent years and continues to occupy them to this day.
In all these times of crisis, it was the emergency helpers of the Kurdish Red Crescent (Heyva Sor a Kurd) who stood by the local population and provided vital assistance. It was founded in 2012 out of necessity by a few medical students and doctors, who were involved, for example, in the rescue of Yezidis from the hell of the Shengal in August 2014, cared for the injured in the Raqqa battle, and evacuated people from Efrîn from the Turkish bombardments. For a long time, the independent NGO did not receive any official, international aid from states for its work, but instead relied on donations from abroad during these crises, such as those passed on to the Crescent by medico or other solidarity initiatives. At the same time, from the very beginning, the Crescent has been committed to the humanitarian principles of the Red Cross/Crescent movement, the most important of which are humanity, neutrality and independence. Despite this unambiguity, they have not managed to integrate into the international structure to date – the Syrian Arab Crescent, operating under the Assad regime, is considered the Syrian representative – there is no provision for two movements in one country. In the meantime, the Kurdish Crescent has nevertheless established hundreds of staff members and a professional operational structure in Rojava. They are also caring for over 100,000 displaced people in camps where UN aid is not reaching. The emergency structure’s ability to act quickly was most recently demonstrated in the COVID-19-pandemic: large-scale prevention campaigns and the construction of several specific COVID-19-hospitals were used to respond to the pandemic events. In addition to crisis management, the Kurdish Crescent is now also responsible for many important healthcare infrastructure projects in the region. In March 2022, the long-awaited prosthetic center in Qamişlo finally opened. It is the only one for the entire region, where over ten thousand war-disabled people can now receive treatment, prostheses and rehabilitation.
To this day, the success story of the Kurdish Red Crescent lacks support and recognition from the international community. This is because the funds for humanitarian aid, which are decided at the annual donor conferences of the EU and UN, do not reach the Crescent. On the contrary – this official aid is either distributed through UN (sub)organizations in Syria, which must operate under the Assad government, or have access via Turkey to the Idlib region, where 2-3 million refugees live in camps under catastrophic conditions.
For years, the instrumentalization of aid in the Syrian conflict has been criticized. Experts inside observe that the Syrian government withholds vital aid to areas outside its control and uses the aid system to monitor and control people in areas where it has restored its rule. Thus, much aid money is being funneled to pro-government organizations. Damascus-based U. agencies are bound by agreements and permits from the Assad regime, and access to people in need of aid is restricted. In the Syrian proxy war, humanitarian aid has become a means of political pressure.
Although actors such as the Kurdish Crescent represent the necessary independence and could often help more quickly and effectively with direct support from UN funds and access to relief supplies, they are being bypassed. For years, the Kurdish Red Crescent has sought to obtain international support and access to crucial international emergency relief networks, so far without success. This is because Rojava is still part of Syria under international law, led by the current president Bashar al Assad. For humanitarian aid, this means that international actors such as the WHO or UN aid organizations refuse to cooperate with the Crescent or only offer it “through the back door” because they have their Syria offices in Damascus and coordination with the Syrian regime and corresponding ministries is necessary under international law.
This was most clearly manifested in the closure of the only border crossing for UN aid supplies to the self-governing areas in January 2020. Official UN aid supplies from Iraq were brought directly to the northeast via the “Al Yarubiyah” border, especially needed for the al Hol camp, where over 50,000 IS supporters still live in poor conditions. This access was anchored in UN Resolution 2156 on Cross-Border Humanitarian Assistance in Syria, which also governs access from Turkey to northwestern Syria, to Idlib. Due to a veto by Russia and China during the vote to extend the resolution in the UN Security Council, it was closed 2.5 years ago. Russia’s political goal behind this is more than obvious: to strengthen the Assad regime again. Since then, UN aid has only reached the region with Damascus’ permission. This has had fatal consequences – until today. Since then, up to 30 percent of direct aid supplies have been missing from the al Hol camp, or they arrive from Damascus only after considerable delays. The situation was particularly dramatic at the height of the pandemic. There were no PCR testing facilities in all of Rojava. The only device with which PCR testing was possible was in the Turkish-occupied hospital in Serêkaniyê. Thus, tests had to be brought to the laboratory in Damascus, which often communicated the result weeks later – effective pandemic control was thus not possible. Protective equipment and ventilators were also in short supply for a long time and were organized over time by the Crescent and self-government themselves instead of waiting for announced WHO help. Especially vaccine distribution, which was arranged through the WHO in Damascus, was repeatedly delayed. To date, less than 10 percent of the population has received a COVID-19-vaccination.
The last donor conference (organized by the EU and UN) for Syria took place in May 2022, where international donors pledged 6.4 billion euros. Eleven years after the beginning of the civil war, however, 15 million Syrians need aid, as was stated at the conference itself. The economic situation in Syria has deteriorated drastically due to inflation, with devastating effects for the population, who can barely afford bread. Ninety percent of the people in Syria live below the poverty line, it is said. This is even though $40 billion has been spent on Syria aid over the past decade. Given this dire humanitarian situation, there is an urgent need for a fundamental reformation of UN aid that bypasses Assad and strengthens local actors who have already become relevant aid actors:in the region too independently – such as the Kurdish Red Crescent. In addition, the self-government should become a recognized interlocutor for the international community to negotiate direct opportunities in the northeast. The Swedish government pledged around ten million euros at the end of 2019, among other things to promote a water supply in the region and to support women who have suffered under IS. The fact that Sweden now must behave in the face of Erdogan’s threats, which in the context of NATO accession talks dubbed this aid “terrorist support,” is a reflection of how aid is once again being firmed up into a political bargaining chip.
Even though North and East Syria plasy no role in international negotiations, more than 30 international aid organizations are now active there. Since the self-government does not deny the organizations access, the northeast is “popular” among NGOs to implement the millions of aid funds they can apply for in their countries or receive through donations. In this way, non-governmental aid organizations enter the region – this prevents governmental actors from directly contacting local organizations or the self-government and accepting them as interlocutors. However, there is a lack of coordinated action between the aid actors – and this is often criticized by both sides. In addition, international organizations are withdrawing qualified Syrian staff from local NGOs because they can pay much better salaries. The rents for offices or houses of the international staff are also driving up rents so much that displacement is taking place in some neighborhoods. This is a typical phenomenon in crisis regions, where aid money is implemented without any controlled authorities.
The humanitarian situation in Syria will continue to worsen, with inflation and rising food and oil prices driving almost the entire population into poverty – the northeast is increasingly becoming a place of refuge, although the economic situation there is also precarious. In addition, the permanent threat of war from Turkey is also making Rojava an unsafe place. The air pollution, caused by the inadequate oil production – until today there are no proper refineries, because sanctions make the import of the required parts impossible – already leads to severe health problems for residents near the oil fields. For the last three years, the drought caused by climate change has become more and more of a problem. In Syria’s “breadbasket,” wheat fields are drying up and Turkey is reducing the flow of water from the Euphrates River and blocking water pumping stations, so that last summer, for example, tens of thousands of people in the Heseke region were temporarily cut off from access to water.
Aid in Syria always takes place in a highly political context and cannot be thought of without this. For example, the support and recognition of local actors, such as the Kurdish Red Crescent, is indispensable if there is to be a rethinking of the way aid is handled in Syria. However, without finally officially recognizing the status of self-government at the international level and opposing Turkey and its violent threats, even such measures will only be successful in the medium term.
The fact that, despite all these conditions, it has been possible in the last 10 years to create a health care system for the population and to build emergency aid structures that are on the ground in all crises and care for tens of thousands of refugees, shows the persistence and perseverance not to give up, but to make Rojava a place where the “democratic experiment” endures.
Anita Starosta, medico international (Consultant Syria, Iraq, Turkey)