Cuts in international aid create severe ‘health crisis’ in north-west Syria

Dwindling international aid to north-west Syria this past year has left approximately 3.1 million people, including 2.8 million internally displaced people, facing a health crisis as hospitals and other medical facilities struggle to operate on low resources, Amnesty International said today.

Medical facilities in this part of the country, which is under the control of the armed opposition group Hay’at Tahrir al Sham, rely entirely on funding from the international community to provide free health services and medication. Over the past ten months, international aid to the health sector, dropped by more than 40% due to the overall reduction of international assistance to Syria.

“It should go without saying and, particularly after two years of the pandemic, that healthcare systems are critical services that people need for survival. This past year’s massive funding drop has immediately translated into the closure of hospitals and vital services, and has left millions of Syrians – who have already suffered conflict and violence – struggling to access medication and other essential health care,” said Lynn Maalouf, Deputy Regional Director for the Middle East and North Africa at Amnesty International.

“International donors meeting in Brussels next week should prioritize ensuring adequate funding for health and other essential services as millions of people face the appalling prospect of being denied access to health care amid a worsening crisis. Everyone’s right to health must be protected, which means being able to access health services when needed, without worrying about the financial cost.”

Amnesty International interviewed eight doctors and health workers, four people who recently sought medical care and four humanitarian aid workers, each of whom described how the funding cuts have led to a shortage of resources and medication, leading to a scaling-down of operations and vital services.

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that only 25% of the required funds for Syria’s health sector had been secured as of December 2021, compared to 67% in July 2021. According to Idlib’s health directorate, 10 out of 50 hospitals, including six gynaecology and pediatric hospitals, 12 primary healthcare centres and three specialist medical centres have lost funding in 2022.  Other healthcare facilities that have longer contracts for the next few months or years, will also be at risk of closure if their contracts are not renewed.

Reduced capacity and supplies place health and lives at risk

Shortages in staff, medicines, equipment, and reduced operational capacities prompted hospitals to scale back their services putting people’s lives at risk. Four hospital managers told Amnesty International that their facilities face imminent risk of closure if funding is not secured urgently.

“Before the funding cuts in December 2021, we used to receive about 500 outpatients and inpatients a day. Today, we can receive 10% of that number, because we suspended all services except for basic treatment in the emergency room,” the manager of an obstetrics and paediatrics hospital said.

The manager of another obstetrics and paediatrics hospital said they had to close the neonatal intensive care unit and operate only four out of eight incubators. He described a distressing incident that took place shortly after the funding cuts early this year, when he couldn’t offer respiratory support to an infant who needed a ventilator: “His parents begged me for help, but I had no choice but to turn them away.”

His parents begged me for help, but I had no choice but to turn them away.

Manager of obstetrics and paediatrics hospital in north-west Syria

Another doctor told Amnesty International how shortages in health care services were threatening lives: “On one occasion this year, a patient with a heart attack was rushed to our emergency unit. We did not have oxygen for a ventilator, so we tried to transfer him to another hospital in an ambulance, but he passed away before getting there.”

A doctor working in another hospital that lost funding in August 2021 shared a similar story, saying: “In January [2022], we received a five-month-old baby in the emergency unit with severe malnutrition and respiratory failure. He needed intensive care support, but we didn’t have a spot for him due to lack of capacity and staff shortages. We intubated him in the emergency unit and gave him manual respiratory support for four hours as we tried to find him a spot in another hospital. Unfortunately, we were not able to find any and he passed away.”

All doctors and health system users interviewed by Amnesty International said they had seen a shortage in essential medications, especially for chronic illnesses. One doctor said his hospital had even struggled to obtain anaesthetics.

A midwife said that the lack of medication and supplies deterred women from seeking antenatal care. She said: “Women told me they wouldn’t go all the way to a health centre that wouldn’t offer them the needed medications for free. Sometimes even the most basic supplements for pregnant women, like folic acid, are not available.”

A woman who had recently given birth told Amnesty International: “I could not afford the medicines the doctor prescribed me, so I did not buy them. The hospital used to provide us with such medication for free before it lost funding.”

A lack of funding also means that health workers, whose salaries were covered by aid contracts, now work at multiple facilities simultaneously to secure a sufficient income. Other health workers have not been paid due to a lack of funding. Seven medical workers told Amnesty International that they have been working without pay for months.

Inaccessible, unaffordable healthcare

Hospital closures coupled with a reduction in services and the high cost of private healthcare services make accessing healthcare extremely difficult for many people in north-west Syria. Patients now have to travel longer distances to find a hospital or a medical centre. Public transportation is often limited and, for many, the cost of transportation is unaffordable.

The father of a child who suffers from asthma said: “A while back, my son had an asthma attack. As usual, I rushed him to a nearby hospital, but found out the hospital lost funding… The one available doctor in the emergency room told me the child needed urgent admission to a hospital. I had to borrow money and take him in a private car to a hospital in Idlib, around 60 kilometres away.”

A pregnant woman had been receiving antenatal care in a local hospital, but struggled to find a hospital in which to give birth after the local facility suspended its operations due to funding cuts.

She told Amnesty: “I was in severe pain. My husband asked around until someone told him there is an available spot in Jisr Al-Shughour, which is an hour away. We went all the way there. But then it turned out there were only midwives available, not an obstetrician, and I needed a C-section. Eventually, I had to go to a private hospital. We borrowed money and paid every penny we had to cover the costs.”

“Donors have the power to rectify this devastating situation. Their decisions have a direct impact on people’s access to healthcare at a time when they are suffering more than ever. What is happening in north-west Syria right now is a terrible humanitarian crisis,” said Lynn Maalouf.

What is happening in north-west Syria right now is a terrible humanitarian crisis.

Lynn Maalouf, Amnesty International

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Sri Lanka: Drop all charges against peaceful protesters


QUOTE

Responding to the news that atleast 12 peaceful protesters were unlawfully arrested today by police officers for demonstrating outside the Parliament of Sri Lanka, Yamini Mishra, Amnesty International’s South Asia Regional Director, said:

“These protesters have the right to demonstrate peacefully outside the Parliament of Sri Lanka and to express themselves and speak with their MPs as the country’s economy crumbles. The charges against all the protesters must be dropped as they were detained solely for peacefully exercising their human rights.

“Sri Lankan authorities must respect, protect, promote and fulfil the rights to freedom of expression and peaceful assembly, and allow people to freely exercise their human rights.

Yamini Mishra, Amnesty International’s South Asia Regional Director

“Any restrictions placed on these rights must be necessary, proportionate and provided by law. Today’s arrests were undoubtedly arbitrary and unlawful. After they arrested protesters recently in Mirihana, the Sri Lankan authorities subjected them to ill-treatment in police custody and refused to allow access to legal counsel. It is crucial that the authorities do not commit the same rights violations with the protesters arrested today.”

“Excessive use of force, intimidation and unlawful arrests seem to be a pattern in which the Sri Lankan authorities’ respond to dissent and peaceful assembly. These repressive actions clearly do not meet Sri Lanka’s obligations under international human rights law.”

Background

On 4 April, the police arrested 12 people near the Parliament of Sri Lanka for allegedly obstructing the vehicles of MPs.

In footage seen by Amnesty International, a small group of protesters can be seen holding up placards that called for MPs to support a motion of no confidence that was tabled in parliament today. The protesters were then forced into a police bus.

The protestors were later released on bail.

Contact: press@amnesty.org   

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Ecuador: Authorities and companies threaten the Amazon and its Indigenous Peoples

Legislation, policies and extractive projects without consent have affected Indigenous territories

Authorities and companies in Ecuador threaten the Amazon through legislation, policies and extractive projects (mainly oil and mining) that have not obtained the free, prior and informed consent of Indigenous Peoples or that have affected their territories, environment, health, water or food, Amnesty International said today, as it released the report Ecuador: Amazon at risk.

“Ecuador must guarantee the consent of Indigenous Peoples to legislation, policies and projects that may put their existence at risk. The Amazon is also a critical ecosystem for overcoming the climate crisis that threatens all life on our planet, and Indigenous Peoples have protected it for centuries. We cannot turn our backs on them,” said Fernanda Doz Costa, deputy director of research for the Americas at Amnesty International.

In this regard, the organization welcomed the victory of the A’i Cofán community of Sinangoe before the Constitutional Court on 27 January 2022. In its ruling, which has not yet been complied with by the relevant authorities, the Court confirmed that the state had violated the community’s “rights to prior consultation, to nature, to water, to a healthy environment, to culture and to territory” by granting 20 mining concessions without their consent and processing 32 others that affected their territory. In addition, the Court ordered comprehensive reparation measures for the community.

Ecuador must guarantee the consent of Indigenous Peoples to legislation, policies and projects that may put their existence at risk

Fernanda Doz Costa, deputy director of research for the Americas at Amnesty International

In addition, the authorities have yet to promptly, thoroughly, and impartially investigate the oil spills that occurred on 7 April 2020 and 28 January 2022 in the Amazon, establish the relevant administrative and criminal responsibilities, and guarantee truth, justice and reparation for the affected communities.

This year the Constitutional Court is expected to rule on the sentences issued in the case of the oil spill of 7 April 2020, and on the extraordinary protection action filed by the affected communities.

In this report – presented in the context of Ecuador’s Universal Periodic Review before the UN Human Rights Council this year – Amnesty International also analyses the excessive restrictions in the law regulating abortion in cases of rape; the lack of a policy to protect human rights defenders and investigate attacks and threats against them; and impunity for human rights violations committed during the protests of October 2019.

For more information or to arrange an interview, contact Duncan Tucker at: duncan.tucker@amnesty.org

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Bitter Memories and Unknown Future: What will happen to the Free Press in Afghanistan?

On 15 August 2021, in the morning, rumours started circulating on social media that the Taliban had entered Kabul, the capital of Afghanistan. I was at my office and was looking for the confirmed news on social media. As chaos took over our office, it was confirmed around noon that Taliban had taken over Kabul. Many photos of the Taliban riding in military vehicles on Kabul streets were posted on social media.  Shortly, the then president of Afghanistan fled the country with some of his ministers and advisers. The government system collapsed, governmental agencies were closed and the Taliban took over Afghanistan. Several critical events in a single day put Afghan people in an unexpected and concerning situation. Many people decided to close their businesses for some days or even forever, many more decided to flee the country.

I was then working as video editor and photographer for Etilaatroz Newspaper. I had worked for nearly two years for the newspaper and I sometimes used to write the text of video reports, beside editing and photography. After the collapse of Kabul, our work decreased and the workload reduced. Some of our colleagues left the office in the afternoon on 15 August and went to their homes. The anarchy in the city made everyone worried and terrified, and our major concern was the possibility of an armed conflict or getting stuck in a bloody war.

A few days later, people started returning to their jobs and businesses. The Taliban were trying to facilitate for their leaders to come to Kabul to carry out talks and decide on the establishment of a cabinet and a new government for Afghanistan.

The fall of the government and the subsequent rule of Taliban were full of important events, events which should have been covered and reported by journalists around the country. Unfortunately, a number of media outlets stopped their operations and were closed. Many journalists lost their jobs and access to information in different cities and provinces was quite difficult. The rule of the Taliban, who had committed many attacks against the right to freedom of expression for decades, including direct attacks against many Afghan journalists, made us more concerned and terrified than ever before.

The situation in our office was disappointing and it was intolerable for me that I was unable to continue working for Etilaatroz Newspaper. In spite of fear of reprisals from the Taliban, I thought that they might stand on their promises made during Doha Talks in Qatar and would allow journalists and media outlets to continue working freely and safely.  Therefore, my hope motivated me to cover women protests in response to the removal of the Ministry of Women Affairs from the cabinet on 8 September 2021.

The protests were held in different parts of Kabul. My colleague Nemat Naqdi and I went to PD-3 (Police District-3) of Kabul to cover the protest. We started filming when women gathered and started the protest, but the Taliban tried to stop us and simply told us not to film. We asked about their reason but received no answer. After that, one of them took me to the PD. Before entering the PD, I thought they had brought me to talk and negotiate but I soon realized what awaited me: I was tortured until I fainted. They kept me in one of the rooms of the PD for four hours. I fainted several times and would regain consciousness when they would spray cold water on my face.  

Every time I would regain consciousness, I felt like I was inside an oven. My whole body would burn and my body kept losing strength, making me to faint again and again. Finally, when they told us that we were free, I felt happy that we would at least get out. While we were waiting in the PD to receive our belongings, which had been taken from us before they started torturing us, several of them, all of my age who were carrying heavy weapons, gathered around us. I asked them, ”Why are you torturing us? What is our crime? Is torturing the only way? Is not torturing someone like this so cowardly?” One of them said: “Did I torture you? I did not and you know it.” Another one said: “Thank God that I was not there, or else, I would have beheaded you (pointing under his throat)”.

That was my last working day for Etilaatroz Newspaper. When I returned to the office from the PD, most of my colleagues and friends had been waiting me there. The news of our torture had already been widespread. My cell phone was full of missed calls; my parents, family members, and many friends called me. When I entered the office, I saw their sad faces and eyes full of tears. Seeing them was more painful than the lashes of the Taliban. When I was finally able to sit down, I told some jokes to make them laugh. After that my parents called me, I lied by telling them I received only three lashes from the Taliban but my body was full of wounds from the torture I was subjected to.  

After that day, many friends came to visit me. Their presence was a source of encouragement, and I could for a moment forget what had happened to me. After the incident, I used to go to the office to talk and give interviews to journalists—both foreign and local—to bring the attention of the international community and media support organizations to the deplorable state of journalists and the media under the rule of Taliban. During the meetings, my family members accompanied me as I could not have meetings alone for some days. The period after my detention was traumatic. During the days I could not sleep and at nights I had nightmares about what happened to me, which kept me awake till morning.

After one month, a US organization helped me to get out of Afghanistan. I said goodbye to Kabul on 3 October 2021 and migrated to USA with a hope for safety and freedom. It took almost two months to get to the USA and where I started a new life. I feel safe here but I still lack psychological security.

The memories of the past few months still haunt me, even after arriving in the USA. Lack of support of the international community and media supporting organizations, the closure of many local media outlets, journalists’ unemployment and having seen many of my colleagues fleeing to different countries, coupled with the imposition of severe restrictions on the media by the Taliban, repeated torture of journalists, failure to achieve our wishes for our country, losing the values that we have fought for years to achieve and the daily painful events which happen to the people of my country completely destroy me. Every day I ask myself—what was our fault that we are in such adversity and miserable situation and why is prosperity impossible for us? Unfortunately, remembering my bitter memories is always difficult for me and whenever I remember that day, I instantaneously cry. I cry for the failure to fight for a humane society, good government, and a peaceful environment in the country which will never come true.

I wrote this note on the occasion of May 3, World Press Freedom Day. I kindly request all media supporting organizations to defend the few free and independent media outlets that are still running of Afghanistan. We need your support more than ever in order to keep the right to freedom of expression alive in Afghanistan and fight once again for a society in which human rights are a reality. Please do not allow our despair and distress to continue and do not let us feel alone in this struggle. Your cooperation and support can be like recovery for my pains and can save me from despair. Undoubtedly, with your support we can keep alive the free press in Afghanistan and can highlight the struggles of the people who have no other hope than the media to raise their voices. I hope to continue to work as a journalist in the USA and cooperate with Etilaatroz Newspaper, which is a famous and preferable press of Afghanistan. I will continue my education in the field of journalism so that I remain a journalist and I will try my best to effectively fulfill my responsibility in this field. To do so, we need the continued support from the international community.

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Libya:  Hold Stability Support Authority militia leaders to account

Entrenched impunity has emboldened the state-funded Stability Support Authority (SSA) militia to commit unlawful killings, arbitrary detentions, interception and subsequent arbitrary detention of migrants and refugees, torture, forced labour, and other shocking human rights violations and crimes under international law, Amnesty International said today.

Created by government decree in January 2021, the SSA militia is commanded by one of the most powerful militia leaders in Tripoli, Abdel Ghani al-Kikli, known as “Gheniwa” who was appointed despite the well-documented history of crimes under international law and other serious human rights violations committed by militias under his command. 

“Legitimizing abusive militia leaders and putting them on state payroll with no questions asked only empowers them to continue trampling on the rights of more people with complete impunity. It can come as no surprise that Abdel Ghani al-Kikli’s new militia is yet again involved in horrific crimes – whether against migrants and refugees or Libyans,” said Diana Eltahawy, Deputy Regional Director for the Middle East and North Africa at Amnesty International. 

“For over a decade, militias under his command terrorized people in the Tripoli neighbourhood of Abu Salim through enforced disappearances, torture, unlawful killings and other crimes under international law. He should be investigated and, if there is enough admissible evidence, prosecuted in a fair trial.”

Amnesty International wrote to the Libyan authorities on the complaints received against Abdel Ghani al-Kikli and his former deputy Lotfi al-Harari on 19 April 2022, demanding their removal from positions that would allow them to commit further violations, interfere in investigations or grant them immunity, pending investigations. No response was received in time for publication. 

An Amnesty International delegation visited Libya in February and spoke to nine people who said they suffered grave human rights violations at the hands of the SSA members, as well as eight family members and three activists. 

Migrants intercepted and detained in abysmal conditions

Ministry of Interior representatives in Tripoli confirmed to Amnesty International that the SSA intercepts refugees and migrants at sea and takes them to detention centres under SSA control. They said that the ministry has no oversight over the SSA’s operations since it answers to the Prime Minister, not the Minister of Interior. When asked on what legal basis the SSA had become involved in interception operations, the Ministry of Interior representatives said they did not know.

Three migrants told Amnesty International that they and hundreds of others were held in February 2022 in the overcrowded and poorly ventilated al-Mayah detention centre controlled by SSA. They received little food or water, forcing them to drink toilet water. They told Amnesty International that they witnessed guards regularly beating detained migrants and refugees and subjecting them to forced labour, rape and other sexual violence, including forced prostitution.

The SSA does not share information about the number of detainees al-Mayah detention centre or allow access to independent organizations. 

SSA’s interceptions of refugees and migrants at sea since September 2021 have been marred by reports of violence, leading to loss of life at sea. On 18 February 2022, the SSA militiamen were responsible for the death of one man and the injury of others during the interception of a boat carrying migrants and refugees across the Mediterranean, according to the International Organization for Migration (IOM).

“Mass arbitrary detention, torture, forced labour, rape and other horrific violations by SSA militiamen against refugees and migrants are yet another grim reminder that refugees and migrants intercepted at sea should never be returned to Libya. EU and member states should urgently suspend any co-operation with Libya on migration and border control. They must ensure that any future cooperation is contingent upon Libyan authorities ending the policy of arbitrary detention of migrants and refugees and effectively investigating crimes against them,” said Diana Eltahawy.

Libyan detainees subjected to enforced disappearances, beatings, sexual violence and deaths in custody

Amnesty International has documented recent crimes including enforced disappearances and deaths in custody by SSA militiamen under “Gheniwa’s” command. For instance, the body of a 34-year-old man was found with clear signs of torture in August 2021. He had been abducted days earlier by men affiliated with the SSA in Tripoli. 

Legitimizing abusive militia leaders and putting them on state payroll with no questions asked only empowers them to continue trampling on the rights of more people with complete impunity.

Diana Eltahawy, Amnesty International

Over the past 10 years, Amnesty International and others have documented arbitrary detentions, enforced disappearances, torture, unlawful killings and other crimes under international law by the Central Security Force-Abu Salim militia and its predecessor Abu Salim Military Council under the command of “Gheniwa” and his then deputy and head of investigations Lotfi al-Harari, who is now heading the Tripoli-based Internal Security Agency, another militia implicated in crimes and human rights violations. 

Six former detainees held at a detention facility between 2016 and 2019 run by the Central Security Force-Abu Salim when “Gheniwa” was commander told Amnesty International that they were subjected to mock executions, food deprivation, beatings, electric shocks, sexual violence and denial of medical care while in custody.

One man who was detained between May and October 2018 said he was regularly beaten with water pipes, sticks and backs of rifles while held in a tiny room with no toilet. On several occasions, he said Lotfi al-Harari beat him, threatened to rape him and fired live ammunition at him. 

Another man detained around the same time told Amnesty International that Lotfi al-Harari had ordered him and other detainees to stand against a wall before shooting at them with his gun, wounding some of them in their limbs.

Most of those detained have been subjected to enforced disappearance, with militiamen refusing to inform detainees’ families of their fate and whereabouts for months and sometimes years. Those released were warned not to speak out. 

Families of eight men told Amnesty International how the Central Security Forces- Abu Salim abducted and detained their loved ones between 2017 and 2022, some of them their fates remain uncertain to date. One detainee was abducted in 2017 from the Abu Salim neighbourhood by men identified by witnesses as working with the Central Security Force-Abu Salim. His family approached the prosecution for help and said that a prosecutor telephoned Lotfi al-Hariri, who confirmed having him in custody. Yet, when the family visited the detention centre, militiamen denied having him in custody on six occasions and the prosecutor told them he was powerless to do anything.

Under international criminal law commanders are individually criminally responsible if they knew or must have known that the subordinates were about to commit or were committing such crimes and did not take all necessary and reasonable measures in their power to prevent their commission, or if such crimes had been committed, to hold the persons responsible accountable.

Background: 

The SSA is tasked with securing government buildings and officials, participating in combat operations, apprehending those suspected of national security crimes, and cooperating with other security bodies.

The SSA militia was formally established by government decree in January 2021. The Government of National Unity’s (NGU) 2021 proposed budget allocated 40 million LYD (8.9 million USD) to the SSA, of which 5 million LYD (1.1 million USD) was for payroll.  Additional ad hoc payments also take place: in February 2022, GNU Prime Minister Abdelhamid Debibah authorized a payment of 132 million LYD (around $28 million) to the SSA.

Since its founding, the militia rapidly expanded its influence beyond Tripoli to al-Zawiya and towns in western Libya. 

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