The past 18 months have witnessed considerable turmoil in countries of the MENA region. The Syrian Arab Republic (SAR) is one such country, currently in the midst of a civil war. This report draws attention to some of the recent achievements of its health services, where, despite a dearth of published materials, the country achieved remarkable declines in maternal mortality and infant mortality rates. Its health sector now faces destruction from on-going violence compounded by economic sanctions that has affected access to health care, to medicines and to basic essentials as well as the destruction of infrastructure. This paper draws attention to the achievements of the country's health services and explores some of the consequences of conflict and of sanctions on population health. Readers need to be mindful that the situation on the ground in a civil war can alter on a daily basis. This is the case for Syria with much destruction of health facilities and increasing numbers of people killed and injured. We retain however our focus on the core theme of this paper which is on conflict and on sanctions.

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EU guidance impedes humanitarian action to prevent COVID-19 in SyriaAt the Global Vaccine Summit on June 4, 2020, UK Prime Minister Boris Johnson called for a united front from all nations. He described the need for a NATO-style alliance to defend humanity from the common enemy of COVID-19. This type of statement has become a familiar cry of multiple Western leaders. It is also a message that is undermined by the actions of many of those same politicians.As well as devastating lives, the COVID-19 pandemic has exposed enormous inadequacies in political leadership and highlighted the fragility of public health systems throughout the world, in terms of equipment, human resources, and preparedness. Nowhere are these weaknesses more apparent than in countries of the Middle East, where conflict has been succeeded by sanctions and other, more specific coercive measures.The blunt bilateral instruments, which have not been approved by the UN Security Council and have been opposed by the UN Commission on Human Rights, imposed on Syria in the unsupported belief that they will hasten regime change, have seriously impeded the country's ability to cope with the pandemic. Actions such as the US Caesar Act (which went into effect on June 17, 2020, and which sanctions any country or entity worldwide that does business with the Assad government) are being applied within the context of an 89% poverty rate. 1,2 COVID-19 infection rates and deaths in Syria are currently believed to be low, with just over 177 cases and six deaths reported in early June, 2020. 3 However, surveillance systems are poor, with unstable conditions in many regions and no standardised method for reporting infections. Justifiable concerns exist that the real figures are much higher 3,4 and that a winter surge will occur unless the virus is contained now.The Syrian health system, already fractured by years of conflict, is being further destroyed by sanctions. 5,6 Although WHO and the Syrian Ministry of Health have made huge efforts to trace, track, and isolate, the balkanised nature of the country makes success difficult. Jihadi-controlled parts in the northwest of Syria encompass more than 2 million people. Kurdish and US forces control large areas of the northeast.

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