The Islamic State has lured thousands of foreign fighters and their families to Syria with the promise of building a utopian caliphate. And even Syrians living in IS-run cities like Raqqa say it is providing basic governance, in a country roiled by civil war.
But restoring the health care system – ravaged by the conflict and constrained by rigid new social rules – is proving a much tougher task, raising concerns about the ability of women to get proper medical attention, and even the potential for an outbreak of HIV/AIDS.
Syrians living in Raqqa, IS’s de facto capital, say health services were better when the city was still under control of President Bashar al-Assad’s regime. For one thing, the Assad regime would cover most medical costs, whereas now the national hospital in Raqqa charges for services. Drugs are hard to find at pharmacies. And IS-governed hospitals can’t carry out more complex surgeries and procedures, or cope with cancer patients.
“People shuttle to regime-controlled areas to bring medicines unavailable in Raqqa,” says Wahda, who traveled to Turkey for a joint replacement because she could not get the procedure done in Syria. She said blood tests cost $10 at the public hospital and $20 in private clinics.
Volunteer doctors for Islamic State
And, while there are female doctors and nurses on staff at hospitals and specialized clinics for women, IS insistence on rigid segregation of the sexes has taken a toll.
“If the husband or son is not with the woman, a male doctor cannot check her,” says 17-year-old Fatma, the daughter of Wahda. “This is really a problem in emergency cases.”
In Raqqa, the staff of local hospitals has been supplemented by the many foreign doctors and new medicine graduates – both Arab and Western – who have traveled to support the Islamic State. But they usually lack experience treating war-zone injuries, so critically wounded IS fighters are transferred to Mosul, which has better medical facilities. And some medics take issue with how they handle emergencies. “They force medical staff to treat combatants before civilians,” says Abu Osama.
IS recruitment videos have focused on medical volunteers, as well as fighters. Tareq Kamleh, an Australian doctor, starred in a propaganda video aired in April that was allegedly filmed in Raqqa. “I saw this as the path of my jihad in Islam,” he tells the camera, decked in blue scrubs. He is later seen holding a baby in a pristine ward.
In June, a man calling himself Abu Amir al-Mujahir made a video address encouraging Muslim doctors in Sudan and Britain to join IS. Two groups of Sudanese medicine students, including British nationals who were pursuing their studies in Sudan, travelled from Khartoum in March and June to IS-run territory via Turkey, according to British and Turkish news reports.
"There is actually a really good medical service being provided here,” Al-Mujahir says with a stethoscope round his neck.
Threat of AIDS?
But the limitations are evident in the response to a potential outbreak of AIDS in IS ranks.
The activist group Raqqa is Being Slaughtered Silently, says it has documented two civilian cases of AIDS infection in the city. One involved a Tunisian woman who gave birth in late July. An earlier case involved a French female migrant of Moroccan origin.
The activist network says several factors have contributed to an increased risk of HIV infection among IS fighters and their sexual partners. These include transfusions of blood without proper screening; the prevalence of injecting drug users among some foreign and local fighters; short-term marriages and a high turnover of partners.
Wahda, who has rebuffed several IS suitors interested in her daughter, says the new marriage patterns are a concern.
“No one is doing health controls or tests,” she says, “whereas in the later years of the Assad regime everyone was getting checked for HIV/AIDS before marriage.”
In response to the threat, IS has begun to bring in testing equipment from its Iraqi stronghold, Mosul.
“AIDS represents a major fear for [Islamic State] due to the lack of AIDS detection devices (in Raqqa),” says Doctor Abu Osama Al-Raqqawi, a pseudonym. “There are many reasons that can lead foreign fighters to contract AIDS. One of them is the blood transfer between fighters or people without any prior analysis for contagious diseases.”
Emergency room trials
Hospitals in IS-held areas are said to be faring better than those in rebel-controlled territory. Neonatal units in Raqqa, for example, have generators loaded with fuel for power cuts. But doctors can only do so much, and some take a fatalistic view in emergency situations, say activists and residents.
“They try their best but often patients dies because the medical staff is unable to carry out large operations,” says Abu Osama.
The biggest challenge, he says, comes during airstrikes by either the Asssad regime or US-led coalition forces. On one recent night of heavy bombardment, IS called on female nurses and doctors to pitch in, he recalls.
For that night, at least, its gender restrictions were cast aside.