Editors’ note: The fall of the Bashar al Assad regime in Syria on 8 December 2024, after almost 14 years of civil war, began soon after the pro-democracy, anti-Assad protests of the Arab Spring in 2011. The war killed more than 606,000 people, including 159,774 civilians, according to the Syrian Observatory for Human Rights. The war also caused mass migration. At the end of 2024, Syrian refugees numbered about 5.5. million and more than 7.4 million people remained internally displaced. Crippling damage to infrastructure and institutions, compounded by Western sanctions, left the population vulnerable and without basic social services.
It is unclear what the future will hold for Syrians, particularly for Syrian Christians, in the changing political landscape. The Islamist militant group Hayat Tahrir al Sham appointed a new prime minister to head the Syrian Transitional Government without consulting the national council, raising questions about the direction of governance. Additionally, the devaluation of the Syrian pound has exacerbated the challenges facing Syrians in this transitional period.
In this Letter From Syria, Dr. Nabil Antaki writes of the poor state of health care in Syria since the start of the civil war and the challenges that persist today. Dr. Antaki is a physician and a member of the Blue Marists, a Catholic lay apostolate providing social assistance to Syrians in need, funded in part by CNEWA-Pontifical Mission.
When I completed my specialization in Canada after graduating from the medical school at St. Joseph University in Beirut, my wife and I decided to return to Aleppo, my hometown, in Syria. We rightly thought I would be more useful to sick Syrians than in Canada.
For years, I practiced medicine in conditions acceptable to my patients and me. As there was no health insurance, health care was private. Patients paid out of pocket. As for the poor, we treated them free of charge in our Christian institutions or they sought care in public hospitals, which are also free.
In 2011, war broke out in Syria. Bombs and snipers wreaked havoc. Dozens of people died every day, hundreds were injured by bullets or shrapnel and many hospitals were destroyed or damaged. War-wounded civilians died from lack of care because of overcrowded emergency rooms in operable public hospitals. With the Blue Marists, I initiated the “War-Wounded Civilians” project to treat wounded civilians free of charge in the best private hospital in Aleppo, where I worked.
“After the military bombs, it was the poverty bomb that exploded — and its effects continue until today.”
The surgeons there volunteered to treat injured civilians and the hospital agreed to accept reduced fees. My fellow physicians did a heroic job, spending nights in the hospital near patients in critical states or making their way to the hospital under falling bombs and sniper bullets. For years, we treated tens of thousands of injured people free of charge and saved the lives of hundreds more.
When the fighting stopped, we discovered a catastrophic humanitarian, social and health situation: destroyed hospitals, reduced medical staff due to emigration, galloping inflation and extreme poverty. More than 90 percent of the population lived — and still lives — below the poverty line and could not make ends meet. After the military bombs, it was the poverty bomb that exploded — and its effects continue until today.
People could no longer take care of themselves. Their income, if they had any, was insufficient to pay for treatments, medications or surgical procedures.
“It would be a real shame if Syria, the cradle of Christianity, were emptied of its Christians.”
In response, the Blue Marists, along with other Christian associations, started a project to help people seeking medical care. We made agreements with hospitals, doctors and surgeons to obtain reduced rates and pay them directly for their services. Without this assistance, even someone with an average income could not afford the costs. A small procedure, such as a gallbladder removal, costs around 6 million Syrian pounds ($475), while the average monthly salary is about 600,000 Syrian pounds ($46) or less.
I remember Jeannette, a widow with four dependents. She had no income and needed open-heart surgery, which cost 100 million Syrian pounds (about $8,000). Although our association could not cover such a sum, Providence — which has never failed us — sent us two foreign donors who each covered half the cost.
I think of M.K., a 13-year-old boy born without arms. During the war, in 2015, a mine exploded as he and his family were fleeing ISIS. M.K. was struck and his legs had to be amputated. His medical needs are immense. The Blue Marists took him under our charge and he became my protégé.
To receive treatment, sick people are obliged to make requests from various Christian associations to cover the cost of their care. Each organization — Jesuit Refugee Service, Caritas, the Assembly of Catholic Bishops in Syria and the Blue Marists — contributes to cover the amount. The Blue Marists receive support from CNEWA, which contributes a good monthly sum toward health care. However, the funds we receive are clearly insufficient given the immense needs of the population.
Furthermore, Syria’s medical infrastructure is inadequate, insufficient and obsolete. Our devices are old and cannot be replaced because of a lack of resources, due in part to the sanctions imposed by the United States and the European Union.
On 8 December 2024, the regime of Bashar al Assad was overthrown by Hayat Tahrir al Sham, an Islamic jihadist rebel group. If the people are relieved by the fall of a long-running autocratic regime, the Christians in Syria are worried as they do not want to live in an Islamic state under Sharia law.
The Christian population has been especially impacted by the civil war and its consequences, declining from about 2 million in 2011 to about 500,000 currently. The total population in Syria is about 23 million. The Blue Marists want to help Christians, so they remain in the country and do not emigrate. It would be a real shame if Syria, the cradle of Christianity, were to be emptied of its Christians.
We currently face three challenges in health care in the country. First, we must improve the living conditions of families because poverty aggravates illness and prevents people from seeking treatment. Second, we need to ensure employment and a better income for people. This cannot be done without improvements to the economic sector, and the economy can grow only by lifting international sanctions. Third, we must continue to help people receive treatment, which requires greater financial resources and the replacement of our old or unusable medical devices.
The regime change has not affected health care so far. We face the same challenges and difficulties as before. The only good news is that the United States decided on 6 January to lift some of the sanctions regarding health care.
Currently, I am exhausted and pessimistic. The population is exhausted. Fourteen years of conflict, deprivation and shortage, poverty and economic crisis — in addition to a catastrophic earthquake in 2023 and the ongoing threat of Islamist jihadists — have gotten the better of people’s hopes. Some Syrian Christians, too, believe hope in Syria is dead and buried.
As for me, I keep deep within me a flame of hope that is not extinguished definitively — it is rooted in my Christian faith. This little flame of hope gives me strength when everything around me is shaky. It tells me that, at the end of the darkness, there will be light.
Pray for me, pray for us, pray for Syria.
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