Dr Mohammad Awak, an oncologist and Assistant Director General of Al-Biruni Hospital in Damascus, faces a daily dilemma: how to diagnose and treat cancer patients effectively when none of the hospital’s three CT scanners are operational.
“We can’t repair them because of the sanctions,” he explains from his office on the hospital’s underground level.
“They strongly affect medical equipment, and we can’t get spare parts to fix MRI or CT scanners,” he adds, watching helplessly as millions of dollars’ worth of equipment lie unused, unable to help the patients who need them.
Patients who require such procedures are typically referred to facilities with functioning machines. However, many eventually return to Al-Biruni Hospital, the largest of Syria’s few oncology centres, which treats approximately 70% of the country’s cancer patients. These patients often travel long distances to receive care at this specialised hospital.
Commuting between medical facilities amid skyrocketing fuel prices poses another significant challenge for Syria’s impoverished population — more than 90% of whom live below the poverty line, according to the UN.
“The greatest impact of the sanctions is the suffering of the Syrian people,” says Dr Awak.
Furthermore, as the conversation continues, Dr Awak details how the sanctions have crippled the hospital’s ability to acquire new equipment, order spare parts, import crucial medications, or even dispatch ambulances due to fuel shortages.
Unchanged reality
The devastating condition of Syria’s healthcare system is starkly evident in government-run clinics.
Overwhelmed hospitals often lack spare beds, forcing patients to lie on the floor or squeeze into any available space.
Adding to this crisis, decades-old equipment and a severe shortage of essential diagnostic tools and laboratory supplies make even the most basic medical care a struggle.
Meanwhile, ongoing electricity and fuel shortages exacerbate the situation, with doctors left scrambling just to keep the lights on — let alone save lives.
Although portraits of Assad are being removed from hospital walls, the reality remains unchanged: when it comes to the quality of care and the state of the hospitals, little has improved.
“We face a lot of problems daily. This is a central hospital in Damascus, and we only have one [functioning] ultrasound machine. Because of sanctions, we can’t do any repairs to equipment so old it doesn’t work anymore,” admits General Practitioner Ahmad As-Sadnawi from Al Mouwasat Hospital in Damascus.
Suppliers are hesitant to deliver goods to Syria, including medical supplies, due to concerns over sanctions, and when they are willing, restrictions on the banking sector make processing payments nearly impossible.
The sanction debate
Since the downfall of Bashar al-Assad’s regime, Western leaders have debated whether — and to what extent — sanctions should remain in place.
Under the rule of Assad’s family, Syria became one of the most heavily sanctioned countries in the world.
The sanctions began in 1979, when, during Hafez al-Assad’s presidency, the US designated Syria as a ‘state sponsor of terrorism’. Then, in 2011, following Bashar al-Assad’s brutal crackdown on anti-government protests, both the US and the EU imposed targeted sanctions on key government officials.
The most severe sanctions came with the 2019 Caesar Syria Civilian Protection Act, which effectively blocked any country or private entity from conducting business with Assad’s government.
The programme, aimed at pressuring the government over human rights abuses, was named after Caesar, a former Syrian military photographer who defected in 2013, smuggling out thousands of images documenting the torture and killing of detainees in regime prisons, which galvanised international calls for accountability.
Designed to penalise the regime, critics argue, it has instead disproportionately harmed ordinary Syrians.
What was meant to function like a scalpel, they say, has worked more like an axe, cutting indiscriminately through the country’s economy.
Despite the hardships faced by the population, the regime’s elite maintained a lavish lifestyle, sustained by an extensive illicit economy centred on Captagon production and smuggling.
Healthcare collapse
In recent months, some residents of Damascus have caught a glimpse of the luxury once enjoyed by Assad’s family — abandoned villas in elite neighbourhoods, with Cartier jewellery boxes scattered across the floors.
“I don’t think Assad’s family suffered from sanctions. Their main effect, the Caesar programme, is felt by all the people of Syria. We can’t get anything in our lives. Now, after the collapse of Assad’s government, I think there’s no excuse for this,” says Dr Awak.
While US and EU policymakers insist the measures do not directly target the healthcare sector, the chilling effect is undeniable.
For example, nitrous oxide — an anaesthetic commonly used during labour and surgeries — is also used in explosives, which places it on the list of restricted ‘dual-use’ items. Similarly, helium, which is critical for MRI scanners, faces the same restrictions. To make matters worse, even life-saving cancer drugs are in short supply. Although Syria produced 90% of its pharmaceuticals before the civil war, it never produced any for cancer treatment.
Despite existing provisions for humanitarian licences, reconstructing pharmaceutical facilities destroyed during the conflict is nearly impossible under current sanctions.
“Suppliers of branded medical equipment have been extremely reluctant to work with actors in Syria, limiting maintenance and upgrades of vital medical machinery,” a World Health Organisation (WHO) spokesperson in Syria told The New Arab.
“As a result, much of the country’s medical equipment is outdated by a decade or more, and hospitals struggle to obtain spare parts or even software updates,” they added.
Improvise or suffer
Annually, Al-Biruni Hospital treats 12,000 cancer patients who require chemotherapy, targeted therapy, immunotherapy, and radiation therapy.
“We have treatment guidelines, just like in Europe or America, but we can’t follow them because of medicine shortages,” Dr Awak explains.
The shortage forces doctors to improvise, often at the expense of patients’ prognoses.
For instance, says Dr Awak, standard breast cancer treatment requires a dual blockade of Pertuzumab and Trastuzumab.
“We don’t have Pertuzumab, so we only use Trastuzumab. In some hospitals, both drugs are available, but only in reduced doses. Patients who should receive treatment every 20 days might have to wait a month or even six weeks,” he explains.
“This undoubtedly affects their survival expectancy,” he adds.
Dr Zuhair Al-Karrat, a general surgeon and director at Syria’s Health Ministry, acknowledges the dire state of the sector.
“We have no new equipment, no maintenance, no spare parts, and no training missions,” he says, noting that these shortages cost lives.
“There is a significant need for ventilators for newborns and children. A few days ago, at a paediatric hospital in Damascus, I saw a mother waiting with her child, knowing they would die because there was no ventilator,” Dr Al-Karrat recounts.
Paving the way for reconstruction
After years of war and recent political upheaval, it is undeniable that Syria’s healthcare system is in deep crisis.
According to the WHO, as of December 2024, only 57% of hospitals and 37% of primary healthcare centres were fully functional, with 50% of buildings in former frontline areas damaged or destroyed, and the situation remaining under assessment.
Amidst the ongoing crisis, discussions about supporting Syria’s recovery have increasingly focused on sanctions relief, with several countries already taking steps in this direction since Assad’s fall.
The US Department of the Treasury recently issued General Licence 24, a six-month authorisation allowing specific transactions with Syrian governing institutions to facilitate humanitarian aid and essential services.
Similarly, Germany is leading efforts within the European Union to ease sanctions in sectors like banking, energy, and transportation to support Syria’s political transition and reconstruction.
The WHO welcomes the developments, but at the same time urges sanctioning states to “thoroughly reassess the humanitarian and civilian impact of their unilateral coercive measures and adjust them in line with recent changes in the country.”
“The impact of economic sanctions/unilateral coercive measures on humanitarian response has been documented over the years. It is crucial that sanctions include clear, consistent and broad humanitarian exemptions adapted to the needs of key sectors like health, water, and electricity, which enable the provision of basic services to the population,” says the agency’s representative in Syria.
Uncertain future
Syria’s political future remains uncertain, concerning those most disenfranchised.
German Foreign Minister Annalena Baerbock and the EU’s foreign policy chief Kaja Kallas have emphasised that the continuation of restrictions and EU support for Syria will depend on various political and human rights factors, including the establishment of an inclusive government and the protection of women and religious minorities.
Annalena stated that Europe “would not fund the creation of new Islamist structures in Syria.”
In light of these political and humanitarian considerations, Syrian economist Karam Sharaa told The New Arab that the unconditional removal of sectoral sanctions on infrastructure, banking, and energy is essential to preventing further economic deterioration — with benefits for the US and the EU alike.
“While targeted sanctions on key individuals should remain, broader economic penalties risk pushing Syria toward deeper instability and greater dependency on external actors like Russia, Iran, and China,” he warned. “Inaction risks repeating past mistakes, forcing Syria into further dependency and prolonging instability.”
While global debate continues on easing sanctions, Syrian doctors struggle against overwhelming odds, trying to keep their patients alive in a healthcare system on the brink of collapse.
For Dr Awak, he fears that ordinary citizens and medical staff will once again bear the heaviest burdens of political decisions.
“I think now the sanctions are against the people, not against the government,” he says. “Governments can find ways around them, but normal people cannot.”
Jagoda Grondecka is an award-winning independent journalist focusing on Afghanistan and the Middle East. She is currently reporting from Lebanon
Follow her on X: @jagodagrondecka and Instagram: @grondecka
