������

Looking at Syria today, it is difficult to believe that in 2009 its flourishing pharmaceuticals industry supplied over 90 percent of the country’s needs and exported its products regionally and globally.

Likewise, the country’s clinics, notably for plastic surgery, had become a destination for patients from abroad seeking high-quality services at a low price, including many Russians. Syrian medical schools even offered exchange programs with universities in France and Russia.

What happened next has been thoroughly documented by NGOs and multinational institutions: the�� the country’s medical infrastructure and personnel through imprisonment, torture, “disappearances”, artillery and air strikes, while opposition militias targeted physicians and their families for kidnapping.

Tens of thousands of doctors, nurses and other healthcare personnel fled the country.��So did businessmen in the pharmaceuticals sector, leaving their looted or shattered factories behind.��The Diligencia Group, a corporate intelligence firm, noted that the Syrian pharmaceutical industry’s “overall production rate dropped by 75%.”��

"After helping to destroy Syria's healthcare system, the Russian state and private firms close to the Kremlin are profiting from its reconstruction"

By any standard, this is a massive tragedy. It is also a business opportunity for Russia. A continually growing list of events shows that after helping to destroy Syria’s healthcare system, the Russian state and private firms close to the Kremlin are profiting from its reconstruction.

This business model was previously seen in Chechnya, where the Russian tactic of destroying civilian infrastructure was followed by eight billion rubles worth of ��that were riddled with corruption.��

In Syria, a similar process is taking shape on a grand new scale. A Russian official in 2018 that “$200bn to $500bn will be needed for the reconstruction of the Syrian economy,” and added that "the first priority will, as President Bashar al-Assad has said, be given to Russian businesses".����

When Russia entered the conflict on the side of Syrian President Bashar Al-Assad in September 2015, sanctions had further crippled the regime’s ability to maintain what was left of the healthcare system. Syria’s main suppliers for medical goods ignored the sanctions: Iran held the largest market share with 35 percent of the total, followed by Russia and Belarus with 25 percent, .����

Russia surged to the forefront. , the Assad regime had signed deals for nearly $1 billion in loans from Russia. The following November, Assad gave Russia priority for such contracts. Russia also offered protection for Assad’s own efforts to revive the medical sector. In September 2017, the Sputnik news network that a “large pharmaceutical plant” called��had been rebuilt in a Damascus suburb under Russian protection.

Access to the Russian market appears to have been part of these deals. At the end of 2018, Syria’s largest pharmaceutical company, Dimas, partly owned by the Syrian State, to ��ܲ�������’s TASS news service that they would build three new production lines to produce antibiotics and painkillers for exportation, in particular to Russia. TASS noted that “the plant includes a laboratory which conducts research to��create generic versions of��Western drugs.” This capability is likewise important in the Russian industry, where over four-fifths of all packaged medication sales as of 2021 were .��

Simultaneously, ��ܲ�������’s pharmaceutical sector increased exports to Syria. This market was a main focus of interest at the , held at Moscow in February 2018. ��ܲ�������’s Deputy Minister of Economic Development, Alexei Gruzdev, said that Russian firms applying for registration of medical goods in Syria were being “assisted”, and promised more help: “It is necessary to form a network of pharmacy points, and here, of course, Russian companies could offer worthy drugs that are in demand on the market.”

The overall goal, wrote , was to “ensure that Russia is primed to benefit economically from an influx of foreign investment in Syria, which it hopes will follow naturally from a peaceful resolution to the conflict.”

There was no resolution. The smashing of Syria’s health assets, gear, buildings, and people, by Assad and Putin continued. On 2 June 2019, a coalition of medical professionals and scholars called The Syria Campaign it: “Over the past month, Syria and Russia have bombed 25 medical facilities in northwest Syria. We are appalled by the deliberate and systematic targeting of healthcare facilities and medical staff, which is a flagrant violation of international humanitarian law.”

It appeared to a physician in Idlib that “all of the hospitals which had shared their coordinates with the UN before had been directly targeted." On 4 June, The Independent (UK) that “Doctors in Idlib will no longer share coordinates of hospitals with the UN after repeated attacks from Russian and Syrian forces.”

Business went on.��

Further loans from Russia to Syria followed in 2020, with the provision that they “be used exclusively for payment to specific Russian companies during a six-month window, with a penalty on any unused funds thereafter.” Owners of the firms included Russian oligarchs Gennady Timchenko and Yevgeny Prigozhin (best known before his death for the active direction of his private army, the Wagner Group, who were engaged in the illegal invasion of Ukraine), who were under US and EU sanctions.��

Citing leaked documents, the independent website New Lines Magazine�� that among other goods, the Russians provided “two dozen pharmaceutical drugs [and] medical supplies.” Russian physicians also promoted their expertise to Syrian peers. In March 2021, a delegation of Syrian surgeons.

"The Covid-19 pandemic widened Russia's footprint in Syria's health sector"

Its leader, the director of Tishreen Military Hospital, Dr Moufid Darwish, told Russian media, “Today, in presence of our Russian colleagues, we [observed] a surgical operation to replace artificial limbs and discussed issues on providing assistance to Syria with prosthetic limbs in addition to assistance in other domains.”��

One of those other domains was oncology. Syria had suffered from a shortage of oncologists and well-equipped clinics even before the civil war. The shortage had grown much, much worse – clinics looted and destroyed, physicians in flight – since the war began. In November 2019, Syria’s National Committee for Cancer Control (NCCC) and the Society of Oncologists of the Russian Federation signed a scientific cooperation agreement.

Trainings in radiotherapy, cancer surgery, and intensive care were offered to the Syrians, along with research partnerships, seminars and conferences. The NCCC’s chairman, Dr Arwa Al-Azmeh, Syria’s official news agency, SANA, that “the agreement is of great importance for the development of oncology in Syria and to benefit from the Russian expertise in that.”��

Further assistance appears to have been provided by the Russian BIOCAD company. It had agreed in October 2016 to supply up to 4,000 doses of cancer drugs to Syria every year through 2021, in a deal worth 250 million rubles (about $US 4 million at then-current exchange rates).

The founder (in 2001) and CEO of BIOCAD, Dmitry Morozov, has a certain importance to the Putin regime, as a member of the Council for the Development of Pharmaceutical and Medical Industry of the Russian Government and one of 500 members of the so-called “High-Potential Management Personnel Reserve under the auspices of the Russian President.” initially specialised in “biological alternatives”, such as plant-based substitutes for medicines produced by multinational firms. It is now branching out, thanks in part to Syria.

The Covid-19 pandemic widened ��ܲ�������’s footprint in Syria's health sector, and BIOCAD played a key role. Unable to produce its own vaccines, Damascus turned to Moscow. The Russians could offer their Sputnik V vaccine, produced by BIOCAD. Sputnik V had not been approved for use by any major Western country, severely limiting its global market. The problem is in the Russian pharmaceutical industry, according to the industry intelligence firm GlobalData: “Russian facilities lack many US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals, meaning Russian manufacturing is more focused on the domestic market.”��

Syria approved Sputnik V for use in February 2021. The following month, CNN quoted a State Department spokesperson to the effect that a “Russian disinformation campaign working to undermine confidence” in the Pfizer and Moderna vaccines. The campaign was based in online news sites called News Front (based in Russia-occupied Crimea), (an article headline at this writing: “Putin and Trump vs. The [sic] New World Order: The Final Battle”) and New Eastern Outlook, based in Moscow, self-described as “focused on creating a new culture of partnership where opinions influence decisions.” The decision subject to influence in the above campaign was whether to buy Sputnik V.��

The first doses of Sputnik V arrived in Syria in June 2021, and the first recipients included Assad and his key officials. Russian deputy foreign minister Mikhail Bogdanov ��ܲ�������’s Interfax news agency that "if there is demand and if it is possible,” further shipments would follow.��

That year, Russia provided a reported one million Sputnik V doses to Syria. The for Sputnik was just under $10 per dose, so that sale represented a value of approximately $10 million. That was three percent of all ��ܲ�������’s vaccine exports in the first five months of 2021, to the Moscow Times.��

In other words, at a moment when the commercial success of Sputnik V was in doubt, and with it global prospects for ��ܲ�������’s pharmaceutical industry, Syria provided crucial momentum for its makers.��

The market in Syria soon became even more important for Sputnik V. In October 2021, Syria’s largest pharmaceuticals firm, Tamico, , proposed by the country’s Russian friends, to produce Sputnik V locally. Syrian officials said that new production lines would provide five million doses of the vaccine annually. Some of that production would be sold abroad, pending an agreement with ��ܲ�������’s Association of Importers and Exporters of Medicines and Medical Equipment. The deal, which included knowledge and equipment transfers necessary for production, was trumpeted by the Syrian regime “as a basis for long-term investment in the pharmaceutical industry.”��

"The Russian presence in Syria's health system keeps widening"

Ironically, that momentum was wasted on the global market when ��ܲ�������’s invasion of�� Ukraine led to new on individuals and entities involved in the development of Sputnik V. A further consequence was the freezing of the World Health Organization’s pending Emergency Use Listing for the vaccine, which scuttled the sale of 110 million doses (worth over a billion dollars) through UNICEF to the Global South. Syria offered some compensation. By March 2022, its Ministry of Health reported that 1.9 million Syrians had been vaccinated, 1.1 million of them twice. The initial order of one million doses had tripled in a year.

The Russian presence in Syria’s health system keeps widening. At in June 2022, the Minister of Social Affairs and Labour, Muhammed Seif El-Dinh, declared that “Syrian-Russian cooperation is important in all sectors, especially health.” That month, SANA reported an upcoming “bilateral cooperation agreement in the field of manufacturing medicines and medical equipment, as well as signing a new agreement on training of the Syrian doctors in Russia.”��

It will not narrow soon. On 16 March this year, Assad gave an interview to the Russian state news agency, RIA, in which he , "We think that expanding the Russian presence in Syria is a good thing.” He was speaking of "Russia's military presence,” and the same clearly applies to the country’s medical presence. “Today, citizens are thinking about��their security first of��all, about��the security of��their lives, then��— about��everyday problems, children’s education, health,” Assad told the Russian TV network, Sputnik, in 2016.��

The crisis of Syria’s healthcare has not abated. What has changed is that the ally who helped to bomb out Syria’s health sector is now a crucial investor in its future.

Mark Lee Hunter is the principal author of 'Story-Based Inquiry: A manual for investigative journalists' (UNESCO 2009). He has worked with Arab Reporters for Investigative Journalism (ARIJ) since 2006

Loujein��Haj Youssef is a Syrian investigative journalist with expertise in Middle Eastern affairs. She is the recipient of the 2018 Migration Media Award

This article is co-published with Arab Reporters for Investigative Journalism (ARIJ) and Rozana Radio. Click to read the Arabic version.