Although Americans fought mostly from the air, tens of thousands of Syrians pushed the Islamic State back on the ground, village by village, until its final stronghold fell in March 2019. More than 11,000 members of the U.S.-backed Syrian Democratic Forces (SDF) lost their lives in the battles that broke up the caliphate, whereas 9 U.S. troops have died in Syria since 2014. Rather than stand by the allies who contributed so much, former U.S. President Donald Trump sought to withdraw U.S. troops from northeast Syria, a situation Turkish forces exploited to attack the SDF and displace hundreds of thousands of civilians in the process. There is no easy way to reverse the consequences of Trump’s mistake, but there is something far more important the White House can do to alleviate suffering among SDF fighters and their families: Put the 3 million inhabitants of northeast Syria first in line to receive the COVID-19 vaccines that Washington will soon start shipping around the globe.
At the G-7 summit earlier this week, U.S. President Joe Biden pledged to donate 500 million doses of the BioNTech-Pfizer vaccine to low-income countries on top of the 80 million doses Washington is already in the process of shipping abroad. The other members of the G-7 will donate an additional 500 million doses, and the United Nations-backed COVAX initiative will handle distribution. That is a sensible plan overall but one likely to prolong suffering in northeast Syria since COVAX has to route its shipments through Damascus and the regime of Syrian leader Bashar al-Assad has systematically blocked the distribution of United Nations assistance to areas outside of its control.
The regime’s obstruction of aid has already compromised public health in northeast Syria. During 2018 and 2019, U.N. assistance reached the northeast via Iraq, but in January 2020, Russia vetoed a U.N. Security Council resolution that would have reauthorized the program. In February 2020, U.N. Secretary-General António Guterres reported “medical stocks are expected to run out in the coming months” in the northeast, including items needed for critical procedures, such as cesarean section deliveries. Guterres’s report noted that health care in northeast Syria was far from adequate even while the border crossing near the Syrian town of al-Ya’rubiyah remained open. And as of late 2019, only two of the region’s 16 public hospitals “were functioning at full capacity.” Then the pandemic hit.
The regime continued to block aid shipments even after COVID-19 began spreading. To process COVID-19 tests, the World Health Organization (WHO) provided five polymerase chain reaction machines to the Syrian Ministry of Health in Damascus by April 2020. The northeast received none, although local authorities eventually procured two machines with help from the government of neighboring Iraqi Kurdistan. Without sufficient testing, it is hard to know exactly how severely the pandemic affected the northeast. Reporting from journalists and humanitarian organizations indicates the most recent wave of infections crested in late April or early May. Doctors Without Borders warned on May 4, “there is a clear lack of laboratory testing, inadequate hospital capacity to manage patients, not enough oxygen to support those who need it most, and limited availability of personal protective equipment (PPE) for health workers.”
As of June 7, the U.N. reported 18,036 confirmed cases of COVID-19 and 732 fatalities in northeast Syria, but the real numbers are likely an order of magnitude higher. The U.N. report also noted 1 out of every 10 health care workers in the region has tested positive—so many it “necessitated temporary shut-down of several healthcare facilities for periods of up to 14 days.”
COVAX has allocated 912,000 doses for Syria and has delivered 256,800 doses so far, of which 17,500 doses have arrived in northeast Syria, according to the WHO. Yet there are pockets of regime control in the northeast. When Damascus permits deliveries, the aid mainly goes to those enclaves.
With COVAX hamstrung, it is time for Washington to step in. Although the United States plans to purchase half a billion doses from Pfizer, it may be more practical for the White House to allocate 6 million doses from its reserves of AstraZeneca or Johnson & Johnson vaccines. These do not require storage at ultra-low temperatures, which is hard to come by in Syria. The state of the health care system will make distribution more challenging, but the Biden administration has asked the U.S. Congress to restore more than $120 million of aid for the region that was frozen by Trump, so the U.S. government will already be ramping up its administrative capacity there.
From both a political and public health perspective, it makes far more sense to offer vaccinations to all inhabitants of northeast Syria rather than attempting to limit it to SDF veterans and their families. After all, the entire population suffered under Islamic State rule. More importantly, any effort to sort local residents into the deserving and the undeserving would sow division while amplifying incentives for corruption—a black market for vaccines would likely emerge along with one for counterfeit certifications of military service. Furthermore, the best form of protection from COVID-19 is herd immunity, which a selective vaccination campaign would never achieve.
There will still be a need to protect the supply chain from corruption. There is already extensive smuggling of crude oil from northeast Syria to areas under the Assad regime’s control. The United States should also ensure that local authorities do not discriminate against any ethnic group or community when administering the program.
Although honoring the United States’ debt to its Syrian allies has value of its own, the vaccination campaign would also demonstrate to people across the Middle East the tangible value of working with the United States rather than depending on Russia or Iran. A successful vaccination effort in northeast Syria would also resonate globally as the United States builds a coalition to pressure China for greater transparency about the pandemic’s origins while contesting Beijing’s influence within the WHO. An important precedent for a vaccination campaign in northeast Syria is the White House’s decision to send 2,500,000 doses to Taiwan, which is facing a vaccine blockade by China. After visiting Taiwan earlier this month, U.S. Sen. Tammy Duckworth commented: “How do you decide to choke off another nation in a pandemic like that? It’s inhumane.” Assad is choking off northeast Syria in precisely the same manner.
Northwest Syria—the other region of the country that remains outside of Assad’s control—may become the next victim if Russian President Vladimir Putin decides to veto the U.N. Security Council’s re-authorization of aid shipments to the region via the Turkish border. A trickle of COVAX aid is now arriving in northwest Syria, but since the initiative is under the auspices of the U.N., a Russian veto next month would shut it down. In that event, the United States should ask its European partners to lead a vaccination campaign in the northwest to complement a prospective U.S. campaign in the northeast.
The United States spends billions of dollars each year to contain the spread of HIV/AIDS worldwide. This effort, known as the United States President’s Emergency Plan for AIDS Relief, has saved millions of lives and built deep reservoirs of goodwill toward the United States. The George W. Bush administration launched the program and quickly garnered solid bipartisan support. Biden’s commitment to COVAX deserves similar support, but he should recognize the program falls far short in its ability to reach places like northeast Syria. Although its caliphate no longer exists, the Islamic State has transitioned to guerrilla operations, which the SDF continues to fight with U.S. support. The United States still needs its allies in the region—and those allies need vaccines.
