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Syria: Covid-19 Vaccine Access Should Be Expanded, Fair

Lack of Access, Damaged Infrastructure, Bias Pose Rollout Risk

A medic checks the temperature of a man inside a health isolation centre which has been established on the Syrian-Turkish borders in order to place people coming from Turkey to Idlib as a preventive measure against the spread of COVID-19.  © Anas Alkharboutli/picture-alliance/dpa/AP Images

(Beirut) – International aid groups should have support to secure the widest and most equitable distribution of Covid-19 vaccines possible across Syria, including all areas controlled by different groups, Human Rights Watch said today.

Although the Syrian government bears primary responsibility for providing health care to everyone in its territory, it has repeatedly withheld vital food, medicine, and aid from political opponents and civilians. The UN Security Council’s failure to maintain a cross-border aid system for northeast Syria also means there is no guaranteed channel for vaccine distribution for two million people living there.

“Those supplying vaccines for Syria should do everything in their power to ensure that Covid-19 vaccines reach those most vulnerable no matter where they are in the country,” said Sara Kayyali, Syria researcher at Human Rights Watch. “The Syrian government has never been shy about withholding health care as a weapon of war but playing this game with the vaccine undermines the global effort to control the pandemic.”

On December 15, 2020, the Syrian government submitted an official request to participate in the COVAX facility, a global initiative to expand Covid-19 vaccine access led by the World Health Organization, the Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, the Vaccine Alliance. However, it is unclear whether the submitted plan includes all parts of the country.

On January 21, the Syrian health minister said that among the most important conditions for Syria’s procurement of the vaccine is to ensure that it does not “impact Syria’s sovereignty.” That suggests that the government is unlikely to have included the northeast – which it does not control – in its plans.

Governing authorities in most of northwest Syria told Human Rights Watch that they too have submitted a formal proposal to COVAX for areas under their control. These plans have not been made public. Northeast Syria, though, currently has no arrangement to obtain vaccines independently.

As of January 12, the government’s Health Ministry announced that there had been 12,462 cases of Covid-19 in areas controlled by the government since the start of the pandemic, compared with 8,227 in the northeast and 20,717 in the northwest. Doctors and aid groups estimate that the numbers are most likely significantly higher, due to limited testing capacities and questionable reporting, particularly in northeast Syria.

Human Rights Watch spoke to four staff members in aid agencies, who expressed concern about a significant lack of clarity concerning if or how northeast Syria would be able to get vaccines, but they were hopeful they could work something out. If the government did not include the northeast in its COVAX application, the only other means of ensuring vaccines to the region, aid groups said, is through a COVAX humanitarian buffer for those left out of national plans. It was created to ensure that populations such as those living or working outside government-controlled areas, or refugees, internally displaced people, and asylum seekers, can access the vaccine.

Through this buffer, humanitarian or civil society organizations or UN agencies could request additional doses. The volume is expected to be 5 percent of the COVAX doses supplied globally, which means the buffer could have up to 100 million doses by the end of 2021. COVAX will use the Global Humanitarian Needs Overview and relevant inter-agency guidelines and data to identify target populations. Non-UN-affiliated groups should have access to this humanitarian buffer, given that the UN can only operate in northeast Syria under the serious government-imposed restrictions, Human Rights Watch said.

Ensuring Covid-19 vaccine access to the northeast solely through the government has several significant problems. In January and July 2020, three of four border crossings that had been authorized by the UN Security Council for aid distribution were closed for this purpose. While northwest Syria still has one border crossing open, UN agencies providing aid to northeast Syria are now reliant on Damascus for delivery and services across areas of control.

Cross-line operations require the UN to seek Syrian government permission for every delivery, project, and convoy from government-held areas to those held by the Kurdish-led authorities. The Syrian government has often withheld or delayed permission, prohibited certain medical and other supplies from reaching non-government-held areas, and prevented UN agencies from carrying out essential projects in these areas. An example of the Syrian government’s obstruction is its refusal to allow UN agencies to establish Covid-19 testing labs in northeast Syria. Furthermore the logistics of cross-line delivery are significantly slower than cross-border operations, requiring travel across longer distances and in less feasible conditions.

Even within areas under full government control, Human Rights Watch has documented the discriminatory distribution of Covid-19-related equipment, including personal protective equipment, testing kits, and oxygen ventilators. The Syrian government should guarantee equitable distribution of vaccines inside government-held Syria, based on needs and vulnerabilities. Humanitarian agencies should ensure that supplies are independently monitored and allocated in line with the COVAX/WHO’s commitment to equitable distribution.

The WHO and UNICEF should use their ongoing dialogue with the Syrian government to push for an equitable distribution plan both within areas of government control and areas where other groups maintain effective control. Since adequate independent monitoring of vaccine supplies and distribution will be difficult in Syria, identifying neutral distribution channels and monitoring them independently will be critical from the outset, Human Rights Watch said.

The significant logistical challenges of providing and distributing the vaccines across Syria need to be taken into consideration. Several of the vaccines require specific storage and distribution conditions, including “cold chain management,” a global challenge. In Syria, the conflict exacerbates these difficulties.

In Syria, 70 percent of health workers have fled the conflict and over 50 percent of the health infrastructure has been damaged or destroyed, due to almost 600 attacks on medical facilities, primarily by the Syrian-Russian military alliance, according to Physicians for Human Rights. Aid groups say that compromised transport capacities and the fuel crisis have further complicated their ability to procure and distribute supplies.

A damaged electricity network, resulting in frequent electricity reductions, is another factor that will compromise vaccine distribution. Those supplying the vaccine and supporting the rollout will have to take these conditions into account when determining the type of vaccine to allocate and ensure that external monitoring of distribution is available.

Under international law, everyone has the right to “the highest attainable standard of physical and mental health.” This means countries have a positive duty to “to make available and accessible to everyone, without discrimination, especially to the most vulnerable, all the best available applications of scientific progress necessary to enjoy the highest attainable standard of health.” This obligation extends to areas that are under the effective control of the state or governing actor, or where the consent or cooperation of a specific authority is required to facilitate it.

Moreover, international humanitarian law requires all parties to an armed conflict to allow and facilitate rapid and unimpeded passage of impartial humanitarian assistance for civilians in need. Humanitarian principles call for aid to be delivered impartially to those most in need, without any distinction or discrimination. This means that an international humanitarian agency should not deliver aid in a manner that promotes or advances discrimination on prohibited grounds – including discrimination based on political opinion, ethnicity, or religious belief.

“Between the Syrian government’s significant destruction of health infrastructure during the conflict and a broader lack of reliable aid delivery, distribution of Covid-19 vaccines in Syria will be extremely difficult even without the government’s discriminatory approach to aid,” Kayyali said. “But it is early enough to provide guarantees to ensure that everyone inside Syria receives the vaccine in an equitable manner.”

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