By Oliver Holmes
BEIRUT, Dec 6 (Reuters) - Alongside guns, pirated DVDs and foreign currency, a new type of product has appeared on war-torn Syria's thriving black market: stolen medical supplies.
The country's vast and under-funded public health system was already struggling when protesters took the streets to demand democratic rights in March 2011. President Bashar al-Assad - a trained eye doctor - sent forces to crush the revolt and 20 months later a civil war has left 40,000 dead.
The government says more than half of Syria's hospitals have now been damaged and a quarter are non-operational.
Rebels and pro-Assad militia have looted medical supplies from hospitals to use on the battlefield and opportunist criminals have stolen equipment to sell, doctors say.
"Many times, myself and other doctors have had to put our money together to buy hospital equipment because it was stolen," said a 30-year-old nurse from the Damascus suburb of Sayida Zeinab. She, like all the healthcare workers interviewed for this article, asked to remain anonymous to protect herself.
Sayida Zeinab is ostensibly controlled by the government, the nurse said, but security forces have been stretched by battles with rebels elsewhere and armed groups have exploited the light security presence to rob the hospital several times.
"We can't buy the medicine ourselves forever," she said.
Many pharmacies only supply limited goods such as over-the-counter pain killers and basic first aid -- the war has made travel around the country precarious so it is hard to resupply.
For more specific needs, residents say, a black market dealer can provide.
BRING YOUR OWN MEDICINE
Doctors interviewed in Aleppo, Deir al-Zor and in the suburbs of Damascus - all areas where battles rage - told Reuters some patients had bought their own supplies such as anaesthetic and oxygen cylinders.
Anything from plastic gloves to X-ray machines to dialysis machines can be bought at inflated prices on the black market by desperate patients, they say.
Access to healthcare in central Damascus, an area that government forces have so far blocked off from rebel advances, is better than in districts controlled by the rebels or contested areas, like Sayida Zeinab.
A doctor at a government hospital in the central suburb of Mezzeh said there were shortages but they were manageable.
"The two areas where there are shortages are in antibiotics and medicines for chronic conditions," he told Reuters, adding that medicines that expire are sometimes hard to restock.
"Of course, I'm worried about the situation, because it is unpredictable. You don't know what you may be missing from one month to the next," he said, adding that the hospital has just been able to cover its monthly needs.
Whether the situation will deteriorate or not, he says, depends on whether Syrian pharmaceutical companies - which produce 90 percent of its medicines and drugs - can stay open.
It is not looking good. Seventy percent of pharmaceutical production stopped in Aleppo after rebels stormed into the city in July, prompting fierce fighting, he said. In August, the World Health Organisation said most Syrian drug makers had closed down.
Syrian state media regularly accuse rebels of kidnap, murder and now, stealing medicine.
One state news report this week said armed forces in Aleppo province had seized 100 million Syria pounds ($14,000) of medicine from what it called "dens of armed terrorist groups".
Reuters was not able to independently confirm such reports due to government restrictions on media access to the country.
A doctor from Aleppo told Reuters the lack of supplies had been so dire in some hospitals that doctors had at times been forced to conduct operations without the necessary equipment.
"Some equipment is too expensive to buy again. We can't find an affordable replacement for the X-ray," he said.
ACCESS TO HEALTHCARE
Elizabeth Hoff, head of World Health Organization in Syria, said Syria's ministry of health frequently asks for help to supply and distribute medicines and other medical supplies.
"Local pharmacies are increasingly unable to provide regular medicines such as simple pain killers and insulin," Hoff said, adding that health centres around the country are not receiving sufficient supplies from the central authorities.
She said the WHO has no first-hand information on the black market but that during a recent visit to a maternity hospital in Damascus, the director had said he had to buy oxytocin, routinely given during birth, from the private sector because it had not been supplied by the government.
Alexia Jade, an opposition activist who helps supply medical aid to residents in areas of Damascus where there is little government presence, said she was finding it increasingly difficult to get supplies.
"The government does not want the opposition to get medical supplies," she said. "I have a friend who was caught trying to smuggle some antibiotics into an opposition area. She was detained for 43 days."
Jade says her reserves are depleting. Activists in areas that are getting shelled and bombed by aerial attacks will call her to ask if she can get certain medical supplies.
"Normally they ask for pain killers and blood bags. But the other day I got an odd request. They wanted body bags," she said. "You can't bury bodies when you are being shelled and they have nowhere to store them."
Also on HuffPost:
Turkey has struck the Syrian military repeatedly in response to shelling and mortar rounds from Syria since Oct. 3, when shells from Syria struck the Turkish village of Akcakale, killing two women and three children. The incident prompted NATO to convene an emergency meeting and Turkey sent tanks and anti-aircraft batteries to the area. Turkey's military has also scrambled fighter jets after Syrian helicopters flew close to the border. <em>Caption: Turkish soldiers patrols as Syrian nationals pass the border between Syria and Turkey on November 10, 2012, near the town of Ceylanpinar. (BULENT KILIC/AFP/Getty Images)</em>
There are about 120,000 Syrian refugees sheltering in Turkish camps, with up to 70,000 more living in Turkey outside the camps. Thousands more wait at the border, held up as Turkey struggles to cope with the influx. Turkey also hosts much of the opposition and rebel leadership. <em>Caption: A Syrian-Kurdish woman refugee sits in the courtyard of a house in the Turkish town of Ceylanpinar, bordering Syria, on November 10, 2012. (PHILIPPE DESMAZES/AFP/Getty Images)</em>
Turkey has called for a buffer zone in Syria where the opposition and civilians would be protected, a step that would likely require international enforcement of a no-fly zone. Russia and China have blocked robust moves against the Syrian regime at the U.N. Security Council, and the United States has been reluctant to use its military in another Mideast conflict. <em>Caption: Turkish soldiers patrols as Syrian nationals pass the border between Syria and Turkey on November 10, 2012, near the town of Ceylanpinar. (BULENT KILIC/AFP/Getty Images)</em>
Israel on Monday became the second country to strike the Syrian military, after Turkey. An Israeli tank hit a Syrian armored vehicle after shells from fighting in Syria exploded in Israel-controlled Golan Heights. A day earlier, Israel fired a warning shot near a group of Syrian fighters. <em>Caption: Israeli tanks, one in position, the other getting into a firing position in the Israeli-controlled Golan Heights overlooking the Syrian village of Bariqa, Monday, Nov. 12, 2012. (AP Photo/Ariel Schalit)</em>
Syrian shells have exploded inside the Golan several times in recent weeks damaging apple orchards, sparking fires and spreading panic but causing no injuries. In early November, three Syrian tanks entered the Golan demilitarized zone, and in a separate incident an Israeli patrol vehicle was peppered with bullets fired from Syria; no one was hurt in the incident and the Israeli military deemed it accidental. <em>Caption: Smoke rises after shells fired by the Syrian army explode in the Syrian village of Bariqa, Monday, Nov. 12, 2012. (AP Photo/Ariel Schalit)</em>
There is concern in Israel that Assad may try to spark a conflict with Israel, opening up the potential for attacks by Lebanon's militant Hezbollah and Hamas in the Gaza Strip. Israel has also warned that Syria's chemical weapons could be turned on the Jewish state. Still, while no friend of Assad, Israel is also worried that if he is toppled, Syria could fall into the hands of Islamic extremists or descend into sectarian warfare. <em>Caption: Israeli troops and UN peacekeepers inspect on November 8, 2012 the area where three mortar shells fired from Syria landed in Alonei Habashan in the Israeli-occupied Golan Heights, which Israel seized from Syria in 1967. (JALAA MAREY/AFP/Getty Images)</em>
Mortars and shells from the Syrian side regularly crash in Lebanon, causing several casualties, though Lebanese forces have never fired back. More dangerously, Syria's conflict has heightened deep rivalries and sectarian tensions in its smaller neighbor. Lebanon is divided between pro-Assad and anti-Assad factions, a legacy of the nearly three decades when Damascus all but ruled Lebanon, until 2005. Assad's ally, the Hezbollah militia is Lebanon's strongest political and military movement. <em>Caption: Lebanese army commandos deploy in the Bab al-Tabbaneh and Jabal Mohsen neighbourhoods where clashes are taking place between Sunnis and Alawites in the northern city of Tripoli on October 23, 2012. (JOSEPH EID/AFP/Getty Images)</em>
On Oct. 19, a car bomb assassinated Lebanon's top intelligence chief, Wissam al-Hassan. Many in Lebanon blamed Syria and Hezbollah for the assassination. The northern Lebanese city of Tripoli has seen repeated clashes between Sunni Muslims and Alawites – the Shiite offshoot sect to which Assad belongs. Battles in the city in May and August killed at least 23 people total and wounded dozens. <em>Caption: A memorial poster of Brig. Gen. Wissam al-Hassan, who was assassinated Friday, hangs near the spot Friday's car bomb attack that killed Al-Hassan, in the Achrafieh district of Beirut, Lebanon, Tuesday, Oct. 23, 2012. (AP Photo/Maya Alleruzzo)</em>
The kidnapping of Lebanese Shiites in Syria by rebels has also had repercussions in Lebanon. In May, Shiites blocked roads and burned tires in protest over the abductions, and later in the summer a powerful Shiite clan took 20 Syrians and a Turk in Lebanon captive in retaliation, all of whom have since been released. Lebanon also shelters about 100,000 Syrian refugees. <em>Caption: A Syrian man Firas Qamro, 31, who was injured during clashes that erupted between supporters and opponents of the Syrian regime, in the northern port city of Tripoli, Lebanon, Monday, Oct. 22, 2012. (AP Photo/Bilal Hussein)</em>
Jordan has taken the brunt of the refugee exodus from Syria, with some 265,000 Syrians fleeing across the border. Around 42,000 of them are housed at Zaatari, a dust-filled refugee camp, where riots have broken out several times by Syrians angry over lack of services. A growing number of stray Syrian missiles have fallen on Jordanian villages in the north in recent weeks, wounding several civilians. <em>Caption: In this Saturday, Sept. 15, 2012 photo, a Jordanian army vehicle carries Syrian refugees who have fled violence in their country having crossed into Jordanian territory with their families near the town of Ramtha. (AP Photo/Raad Adayleh)</em>
Late last month, a Jordanian border patrol officer was killed in clashes with eight militants trying to cross into Syria. Hours earlier, Jordan announced the arrest of 11 suspected al-Qaida-linked militants allegedly planning to attack shopping malls and Western diplomatic missions in Jordan. <em>Caption: Jordanian border soldiers guard newly-arrived Syrian refugee families after they crossed the border from Tal Shehab city in Syria, through the Al Yarmouk River valley, into Thnebeh town, in Ramtha , Jordan, Wednesday, Sept. 5, 2012. (AP Photo / Mohammad Hannon)</em>
Sunni and Shiite fighters from Iraq have made their way to Syria to join the civil war – the former on the side of the opposition, the latter siding with Assad's regime, according to Iraqi officials and Shiite militants. Sunni al-Qaida fighters are believed to be moving between Iraq and Syria, and some al-Qaida fighters in Iraq's western Anbar province have regrouped under the name of the Free Iraqi Army, a nod to the rebels' Free Syrian Army, Iraqi officials say. <em>Caption: In this Saturday, March 17, 2012 file photo, Syrian security officers gather in front the damaged building of the aviation intelligence department, which was attacked by one of two explosions in Damascus, Syria. (AP Photo/Bassem Tellawi, File)</em>
About 49,000 Syrian refugees have temporarily resettled in Iraq, according to the U.N. refugee agency. The United States has pressured Baghdad to stop Iranian planes suspected of ferrying arms to Syria from using Iraqi airspace. Iraq has so far acknowledged only forcing two planes to land for inspection and said it didn't find any weapons either time. <em>Caption: Syrian refugees rest as they have crossed the border by the Iraqi town of Qaim, 200 miles (320 kilometers) west of Baghdad, Iraq, Tuesday, Aug. 7, 2012. (AP Photo/Hadi Mizban)</em>