Syrian doctors turn to smuggling supplies as war rages on

Tucked away in the underground garage of a nondescript apartment building in northern Jordan, the door to “the warehouse” is easy to miss. It looks like it should be a janitor’s closet or a boiler room. In fact, the tiny basement apartment is a way station for smugglers moving a vital product.

Inside, black and blue garbage bags are piled almost to the low ceiling: These are emergency kits, stuffed with medicine and medical equipment ready to be moved across the Syrian border to the makeshift “field hospitals” that serve Syrians wounded in the fighting.

“The guys who take it may be killed, or arrested,” says a Syrian physician who maintains the warehouse. “It’s a big risk.” For his own safety and that of his network, he asked that his name not be used in this story. His description of the networks of smugglers, rebels, and refugees that has developed in Jordan since the beginning of the Syrian uprising could not be verified firsthand, but independent sources have confirmed most major aspects of his account.

The increasing danger of providing medical care to those in the warzone is a reminder that Syria's war continues to deteriorate, despite a UN observer mission that its leader, Kofi Annan, predicted will quell the fighting. Hundreds of thousands of Syrians have been internally displaced by the war, and tens of thousands have fled to Turkey, Lebanon, and Jordan, creating concerns of spillover in some of those nations. 

Smuggling routes have existed between Syria and Jordan as long as there has been a border. Today, instead of tax-free cigarettes and Lebanese hashish, they are used mostly to supply Syria’s beleaguered activists. Food, clothing, satellite phones, and phone cards are all smuggled in, but perhaps the biggest trade is in clandestine medical supplies.

Hospitals in Syria are controlled or heavily monitored by the government, and it's been common practice during the recent unrest to treat anyone wounded as if they are a rebel. There are numerous accounts of doctors being harassed and arrested, along with the injured people they were trying to help. If a pharmacy orders blood bags, or drugs that might be used to treat the injured, the security services may show up and arrest the pharmacist.

“There is a strategy based on rendering access to medical facilities difficult,” says Antoine Foucher, the head of mission for Médecins Sans Frontières in Jordan and Iraq. MSF medical teams have gone into Syria to provide emergency medical aid, Mr. Foucher says, and have experienced the crackdown firsthand.

“Carrying drugs or surgical equipment in Syria is equal to carrying weapons, in the way you are treated by the security apparatus if you are caught,” he says.

Surging demand

With huge numbers of war-wounded, as well as people with ordinary injuries or illnesses who fear arrest if they use government hospitals, the demand for under-the-counter medical care is tremendous.

That is where people like the Syrian doctor come in. He and a colleague work in Jordan collecting medical supplies provided by wealthy donors, mainly Gulf Arabs or Syrian expatriates, and arrange for them to be carried over the border to the field hospitals. Until recently, both men were treating the wounded in Syria. Then they were found out and forced to flee.

In one room of the warehouse, a box is piled high with “sandwiches” – blister packs of related drugs that have been pulled out of the packaging and wrapped in cling film, making a fist-sized bundle. More drugs and equipment cover the carpet. The doctor explains how he divides the supplies into kits for different purposes. The surgery kit is roughly the size of a backpack, stuffed with gowns, gloves, bandages, paraffin-coated burn gauze, sutures, chest catheters, syringes — enough supplies for one operation. There are even individually-sealed brushes soaked with iodine for hand cleaning. “Most of our operations are not in hospitals,” he says. "Maybe in houses, so there is no water, no alcohol.”

The anesthesiology kit is smaller: a little bag full of vials of ketamine, adrenaline, antibiotics, and other supplies. These, the doctor says, are particularly hard to get in Syria — because they are addictive drugs, only one company manufactures them, and it’s a government company. There’s another kit for bandaging wounds. The kits can be packed together, or smuggled in piece by piece, depending on what kind of transport is available.

The two doctors don't move the kits themselves and rely on the guile of others: kits can be hidden in legitimate cargo, or concealed in cars, or carried across the border at night by relatives or professional smugglers. Refugees who have entered Jordan unnoticed can be used to carry goods back. Even large pieces of medical equipment can be broken down and sent piece-by-piece, the doctors say.

“Bashar Al Assad has taught us these new skills,” says one. “We haven’t had anyone come and teach us, we’ve been learning as we go along.”

The two doctors run what seems to be a particularly well-organized operation, but they are far from alone. There are plenty of people moving drugs from Jordan. Some belong to organized networks, but there are also individuals who say they will pay to send drugs to doctors or activists they know. There are groups backed by private donors, and others backed by aid organizations. MSF says it is also working to get medical supplies and equipment into Syria, but would offer little information about its methods.

Money and crisis

Some networks are run by rebel supporters who are trying to help the cause. Others are run for profit. “It’s a business,” two separate sources said.

One subject where sources gave markedly different accounts was the cost of shipping. Foucher says MSF uses a network of activists and pays nothing to send drugs across – though there may be costs borne by others. Other sources described paying smugglers, but the amounts varied. One of the two Syrian doctors says he can spend as much as half the cost of the supplies in order to get them taken over. Much of that money, he says, goes to bribes.

“The Syrian government knows perfectly well that things are getting sent over,” he says. “In every organization in Syria, there’s corruption.” Syrian Army border guards willing to turn a blind eye to smuggling in exchange for payoffs was a common refrain. Jafar, a Syrian activist living in Dera’a, who did not want his real name used, says the bribes often depend on the guy at the border. “Sometimes you might pay LS25,000 ($435) for a syringe, and sometimes LS10,000 ($175) for a whole car.”

Once the drugs are over the border, they are passed from contact to contact until they reach the field hospitals. These can be hidden in empty houses, in basements or the back rooms of stores or warehouses, explains Rami Jarrah, a Cairo-based activist who works to get news from Syria out to media organizations. Mr. Jarrah says much of the information he brokers comes from people working in these informal clinics.

“There were field hospitals with real equipment, and there were field hospitals where they could just do minor things. … But when [the fighting] was really serious there would be a field hospital in most areas,” he says.

In the past month or so, however, the situation has changed. “The field hospitals have become much more discreet than they were before,” Jarrah says. “The government … started raiding campaigns, arrest campaigns, door-to-door campaigns, and that led them to actually find a lot of those field hospitals.”

He says he’s spoken to people who described security services breaking down doors, arresting doctors, building owners and even patients on the operating table.

Starting new hospitals, of course, requires even more supplies. One of the Syrian doctors says that smuggling the equipment to set up one field hospital can take a month, with medical devices sent in piece by piece, hidden in other cargoes. (Here, too, sources differ: Jafar says there is no medical equipment at all coming into Dera’a, only drugs. Foucher, at MSF, says their networks can send equipment to Syria, but “it has to be tiny, rapidly movable … there is a limit to what you can do.”)

And though there is no hard data, the trade seems to be growing. There is no lack of supply, sources said: there are donors, particularly in the Gulf, ready at any moment to buy huge amounts of supplies to send. And there is plenty of demand. “Recently the attacks have been harder,” Jafar says. “At first they used to shoot us, now it’s [bomb] strikes, so the need is increasing. The requests and the quantities are increasing.”

As Foucher points out, with field clinics only able to offer limited treatment, the numbers of injured people in Syria will only grow. “There is a huge number of wounded people inside,” he says.

For the moment, smugglers like the doctors with their Jordanian basement full of medicine may be their only lifeline.