Editorial by K. Sen

There is by now considerable evidence on the ground to show that economic sanctions have a serious impact on the health of all Syrian citizens.  Because restricting them to the economy just does not work as they are all pervasive.

Since May 2011, Syria has faced economic sanctions that are having a serious effect on the economy and society and as I shall discuss in this comment, health services. Western governments have long used sanctions and economic embargos as a tool for pushing for regime change.  US sanctions againstSyriahave been in place since 1979 and have been further strengthened in the past year.  Although members of the Arab League and Turkey have recently imposed sanctions it is the decision to impose trade sanctions,  including a ban on Syrian oil imports  by Syria’s largest trading partner, the European Union, that will likely have the greatest economic and social impact.  As the Syrian government comes under mounting international pressure, sanctions continue to destroy people’s lives. It is worth noting however that despite the legacy of one party rule, the loss of lives and freedoms, Syria’s achievements in the health and education sectors have been unblemished and unique for a lower middle income country. Much of this success story is the achievement of public health doctors and workers over a period of 3-4 decades, some of it in close collaboration with the WHO. Public health in Syriahas had a social mission with an integrated health system coupled with an own production pharmaceutical sector that provided more than 90 percent of generic medicines.  Somewhat isolated from the reach of global capital Syria was well on its way to achieving the Health MDGs.

The deep desire among the population at large is for all the violence to end and the setting up of a transition to democratic rule through a political process. However, Syrians are faced instead with a scenario of violence and destruction including of its impressive health and social infrastructure. At the time of writing the population continues to reel from the consequences of sanctions whilst the country slips further towards civil war in its worst form.

Public health doctors and scholars Faisal, Saleh and Sen wrote to the Lancet last week calling upon health activists, in particular those engaged in  the debate about health as an economic, political and a social right, to have the courage to ask whether western imposed sanctions have the right to punish  whole populations.  Their call echoes the concerns raised about sanctions back in 1997 by the United Nations Committee on Economic, Social and Cultural Rights in a General Comment on the relationship between economic sanctions and respect for economic, social and cultural rights.  In a wide-ranging discussion of the impact of sanctions the Committee noted that sanctions almost always have a dramatic impact on the rights recognized in the Covenant on Economic, Social and Cultural Rights often causing “significant disruption in the disruption of food, pharmaceuticals and sanitation supplies.” (para 3).  The justification the Committee provides for the General Comment bears quoting in full:

In adopting this general comment the sole aim of the Committee is to draw attention to the fact that the inhabitants of a given country do not forfeit their basic economic, social and cultural rights by virtue of any determination that their leaders have violated norms relating to international peace and security… it is to insist that lawlessness of one kind should not be met by lawlessness of  another kind which pays no heed to the fundamental rights that underlie and give legitimacy to any such collective action.” (para 16)

The consequences of the post-Gulf war sanctions on the health and nutritional status of Iraqis, and in particular children, were well documented by Ali and Shah in a 2000 Lancet article, as well as by Garfield.  One would hope that the world would learn lessons from this experience before the situation in Syria gets totally out of control and the world has to churn out humanitarian aid.

Sanctions statistics: http://www.bbc.co.uk

General Comment 8 on sanctions: http://www.unhcr.org

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