EXCLUSIVE: The United Nations’ World Health Organization, which claims “impartiality and independence from external sources and authorities” in its operations, has been quietly cooperating with Syria’s murderous Assad regime in one of the ugliest aspects of its civil war: the weaponization of blood.
WHO claims to be impartial, dispensing relief from suffering according to need, and openly admits it has supplied the Assad defense ministry’s blood bank “since the beginning of the conflict,” according to a spokesperson, with more than $5.1 million worth of specialized blood storage bags and blood testing kits, intended to keep the military-administered blood supply fresh and free of contamination from HIV, Hepatitis B and C, and other blood-borne diseases.
The U.N. agency has steadfastly asserted that it maintains an arms-length relationship with the militarized Syrian national blood bank, providing supplies “through” Assad’s more palatable ministries of health and higher education (which controls some teaching hospitals). That is a legal fig-leaf: as the U.N. agency itself acknowledges, the supplies still end up with the national blood bank, just via an intermediary.
In a token nod to impartiality, a WHO spokesman says the agency “consistently demands that blood prepared by the Blood Bank be sent” to besieged opposition areas as well as government-controlled territory, but adds that. “unfortunately,” the supplies are blocked. WHO says it has lodged numerous official protests about the blockages.
On the basis of documents independently translated by Fox News, however, WHO’s claim of an arm’s length relationship with Assad’s blood bank appears to be at best a sham.
The agency has apparently taken on the role of procurement go-between for the Assad dictatorship, buying supplies that the blood bank previous bought directly from its vendor, Abbott, a global health care company headquartered in Chicago, after U.S. and European Union sanctions against Assad seemed to make the direct buyer-seller relationship untenable.
Questions from Fox News to WHO about the specific elements of that relationship, including where the U.N. agency was buying the supplies that the Syrian military’s blood bank sought, went unanswered.
Questions sent two weeks ago by Fox News to Abbott regarding its supplier relationship to the Syrian Blood Bank, the reasons why that relationship apparently came to an end, and the nature of the subsequent relationship with WHO, also went unanswered before this story was published. An Abbott spokesperson did acknowledge receipt of the questions, and in a subsequent phone call, asked for more information on the “angle” of the story associated with them.
Fox News has examined recently acquired letters sent this year directly to WHO’s top official in Syria, Elizabeth Hoff, from Major General Osama Dr. Jamil Ahmad, a top military official who is also a medical doctor, and who is head of the state-run General Establishment for Blood and Medical Industries, which includes the government’s national blood bank.
In the letters, Ahmad is asking for replacement parts for Abbott’s Architect-model blood screening machines, as well as hundreds of thousands of screening test kits for HIV and other blood-borne diseases.
The same letters indicate that WHO has been similarly helpful for years.
In a letter originally sent on January 17, 2016, Ahmad thanks Hoff personally “for your cooperation, efforts, and the humane position that you took to help us” during all of 2015, before asking for 1.2 million blood screening tests to be delivered in increments during 2016.
Another letter from Ahmad, dated March 12, 2016, extends the thank-you to WHO for help delivered since 2014, and then asks for a detailed list of spare parts for Abbott Architect blood transfusion hardware.
There is no mention in the letters of any requests from the health or higher education ministries, or any acknowledgement that the supplies will be channeled through purely civilian institutions. In actual operations rather than the public portrayal, the fig leaf disappears.
In private, the relationship between WHO and the Syrian military also looks a lot more intimate.
While the Assad regime escalated its Russian and Iranian-backed assault in June on civilians in the opposition-held centers of Aleppo, Idlib and Hama-- including deliberate bombing attacks on hospitals, blood banks and other medical facilities -- one of Syria’s top military officials at a ceremony in Damascus was hailing WHO for providing “all kinds of support to alleviate the unjust economic embargo on Syria” that was imposed over just such savage regime attacks on its own people.
The occasion was intended to commemorate World Blood Donor Day, a WHO-endorsed international campaign on June 14 to “promote and highlight the need to share life by donating blood,” and encourage national health ministries to promote voluntary blood giving. The event was covered by the official Syrian national news agency.
The Blood Day theme this year was “Blood connects us all.”
Deputy Defense Minister Mahmoud Abdal Wahab al Shawa, a Syrian lieutenant general, offered thanks to WHO while praising Ahmad’s General Establishment for Blood and Medical Industries, which includes the government’s national blood bank, for withstanding “the unjust embargo imposed on Syria.” The medical agency operates under al Shawa’s Defense Ministry.
The blood bank then bestowed a plaque on Elizabeth Hoff, offering “thank you and appreciation” for WHO’s support. (Hoff herself was not present, according to a video of the event prepared by SANA, the Assad regime’s official news agency; Dr. Wael Ismail, head of WHO’s local Trauma Service Department, attended.)
Even as Ahmad spoke, Russian and Syrian air forces were dramatically hiking their air assaults on civilians in Aleppo and other opposition centers around the country, in preparation for a major assault on Syria’s one-time biggest city that culminated in Aleppo’s encirclement and cut-off in early July.
Doctors from the Syrian American Medical Society, which provides help in the beleaguered and besieged areas, noted that two air assaults by Syria’s Ministry of Defense took place on the day of Ahmad’s speech: one on the health directorate building in the city of Idlib and the other on a hospital in Aleppo .
In fact, Assad’s regime has used blood for years as a weapon of war to divide Syrians -- into those allies who receive blood and live, and those perceived opponents who don’t, and die.
As far back as 2011, Amnesty International extensively documented Assad’s use of medical facilities and blood banks as focal points of violence and repression, including the regime’s decision to monopolize blood distribution through the militarized blood bank.
That centralization gave the regime bank control over who obtained the life-saving supplies, as well as providing opportunities to torture and kill wounded civilians of uncertain political loyalties who turned up for transfusions.
Since Assad’s aim was to destroy opposition to his dictatorship, the regime decided to consider any doctor or medic who treated an injured protester as a terrorist, who could face detention, torture and often death.
Full-out regimes attacks on blood banks in opposition areas followed in early 2012. On July 2, 2012, the Syrian government passed anti-terrorism laws that effectively made it a crime to provide medical care to anyone suspected of being part of the opposition.
Attacks on blood banks and hospitals where donated blood is stored and used, as well as the related medical facilities that treat the wounded, have occurred ever since, as noted in several U.N. human rights reports, and these evident war crimes are a special feature of the most recent wave of ramped-up Russian and Syrian air assaults against Aleppo and other opposition-held areas.
Doctors from the Syrian American Medical Society, or SAMS, which provides help in the beleaguered areas, reported 42 attacks on hospitals and other medical facilities in July alone, three of which were targeted assaults on blood banks. Internal WHO documents examined by Fox News itemize at least five assaults against blood banks, hospitals and treatment centers from air attacks in just a few days in the last week of September.
Overall, since the peaceful uprising was first met with violence by the Syrian government in March 2011, through the end of June 2016, Physicians for Human Rights counted 382 attacks on 289 hospitals, ambulances and clinics. The overwhelming majority –344 -- of these attacks, the humanitarian group says, were committed by Syrian Ministry of Defense forces with air support from Russia.
In this same time period, the group says, 757 doctors and other medical personnel have been either killed on duty, assassinated or arrested and tortured to death, of which Assad‘s regime was responsible for 703 of deaths.
After years of such concentrated assaults, there are now only five hospitals left in eastern Aleppo, served by 29 doctors, for 300,000 civilians, as the city has been under full siege by the Syrian government since July.
The strategy has been gruesomely effective. While casualties mount, doctors in opposition areas have had to improvise blood transfusion and other medical procedures, sometimes transfusing patients including children directly from their own blood. Because these doctors cannot match blood types, some patients have died from adverse transfusion reactions.
Few doctors now have the ability to screen for HIV, Hepatitis B or C, or syphilis, or to separate blood into packed cells, platelets, plasma and other blood factors. None of those tests or treatments are available for the roughly 1.3 million people living under siege, according to the non-government organization Siegewatch.
Meantime, the vicious bombing of civilian areas has raised the demand for blood, at the same time as the supply and quality is shrinking. A doctor in eastern Aleppo told Fox News that while the toll from bombing of the area has raised demand for blood from 50 to 70 bags per day, supplies are “maybe 20 to 30 bags.”
Blood is being stored in food refrigerators, and can be kept only four or five days, he said. With proper bags and equipment, it could last “two or three weeks.” Malnutrition is further limiting the reserves of blood donors.
The Syrian government has also impeded patients with urgent medical needs from leaving besieged areas, among them conjoined twins who died mysteriously in August in government hands shortly after their delayed evacuation from besieged Eastern Ghouta.
Desperately besieged and bombarded eastern Aleppo illustrates how WHO works. It has contributed 36 tons of life-saving medical supplies for its residents. But none of it has gotten through. Instead, WHO has stockpiled these supplies in the Assad-controlled Western part of the city for distribution “once access is granted,” as a WHO spokesperson put it.
By contrast, 56 tons of medical supplies have already been distributed in the Assad-controlled territories.
WHO publicly offers detailed descriptions of the ways it sanitizes itself from Assad’s militarized blood bank, and instead relies on the civilian health and higher education ministries to tell it what supplies to provide, and -- using blood bank data -- how the supplies are distributed.
“The responsible directorates in the Ministry of Health and the Ministry of Higher Education prepare monthly distribution plans that set out the total number of blood bags required by health care facilities (including public and non-government organization-managed hospitals) for the coming month,” a WHO spokesman told Fox News. “The national blood bank (through our partners: the Ministry of Higher Education, the Ministry of Health, NGOs) provides WHO with quarterly distribution data on the blood bags that were tested and distributed.”
“WHO staff regularly visit health care facilities and interview staff and patients about the availability of blood transfusion services and the source of blood supplies,” he added. “This information is triangulated against the data provided by the national blood bank.”
WHO’s “impartiality and independence” behind a careful latticework of distribution plans and triangulation is contradicted by the direct communications in the past year from the militarized blood bank to WHO, ordering up blood-testing kits and replacement parts for screening equipment
In addition, internal WHO emails obtained by Fox News reveal a discussion among agency officials that took place over several months starting in June 2013, about a new supplier relationship with the blood bank. According to the emails, an initial approach to procure blood testing kits came from the blood bank itself to WHO’s Syria office, to replace supplies “procured directly from ABBOT [sic] under a large contract between the company and the government of Syria signed in 2009.”
Within the U.N. agency, as one email put it, there was subsequently “much discussion on WHO taking over the procurement process due to difficulties associated with the current restrictions placed on trade with Syria” -- an apparent reference to U.S. and E.U. sanctions. The agency apparently decided to proceed at least to the extent of preparing a draft memorandum of understanding (MOU) covering the supply process.
Most of the internal discussion in the emails seen by Fox News thereafter center on the issue of how to ensure hard currency cash payment from Syria for any supplies sent to the blood bank; concerns that the blood bank pay for supplies in hard currency (dollars or euros) and “up front;” whether other U.N. agencies in Syria might be able to draw on the hard currency credit; and such things as the credit rating of the Byblos Bank where the Syrian money would be deposited.
Most WHO officials involved in the email traffic examined by Fox News do not appear to focus on the kind of questions raised by WHO’s legal counsel, Gian Luca Burci, in an email from June 25, 2013, about “the political risk behind this kind of operation.”
As Burci put it, “We are prepared to go out of our way and stretch our rules and practices for a country that has become a pariah state and which has no U.N. sanctions against it only because Russia would block them in the Security Council,” even though other countries have imposed sanctions for the regime’s deliberate attacks on civilians and facilities.
“Do we know how the Syrian government is going to use the blood that we purchase on its behalf?” Burci asked. “What if it came out that it was using it for its troops and militias rather than for civilians? That is a concrete possibility, and it would be very damaging for our image.”
He said that “a final decision whether we want to accept Syria’s request, and the modalities for doing so, should be taken…taking into account all aspects and risks involved.”
Burci also noted that WHO was supposed to undertake certain procurement transactions only for “health administrations or comparable authorities of Member States, or to agencies operating under their jurisdiction.” In his view, the Syrian blood bank was not such an agency.
(Insisting that it operates through the health and higher education ministries, in other words, seems to be less a reason WHO uses to keep its distance from a government that uses blood as part of its repressive strategy, and more of a means of enabling the agency to supply the blood bank.)
Queried by Fox News about the email, Burci, who has since left the U.N., declined to answer, citing his “obligations under the Staff Regulations and Rules [of WHO] not to disclose without the authorization of the Director-General” -- Dr. Margaret Chan -- “information related to the internal working of the organization.”
Burci’s concerns got a response from his peers. In an email three weeks later, another WHO official, while continuing to deal mostly with the financial issues, thanked Burci for his input and added that “The agreement with the blood bank should include, at a minimum, a clause on the supplies being accessible by all those in need” -- something that the Assad regime had already been ferociously demonstrating for years that it had no intention of doing.
On September 19, 2013, a draft copy of the MOU between the blood bank and WHO was sent to WHO’s Syria boss, Elizabeth Hoff, for final review, according to the agency email chain examined by Fox News.
Fox News has examined a copy of a draft memorandum between WHO and the blood bank to procure an unspecified number of blood testing kits, in batches costing “no less than $300,000” each, whenever the blood bank sends a “pro forma invoice.”
There is no mention in the document of any role in the supply chain for other Syrian government ministries: but there is a specific mention in paragraph 2.1 of the fact that a “duly authorized official of the blood bank” is needed to sign each request.
Buried roughly midway through the 10 page document is a single last sentence in paragraph 4.7, which says the blood bank “shall be responsible to make sure the Products will reach all Syrians who are in need of these kits in all difficult areas inside Syria” —in other words, leaving the decision up to Assad.
The bulk of the same paragraph is devoted to ensuring that the blood bank should pay “all costs associated with the clearance, receipt, inspection upon delivery, loading, unloading, storage, insurance, transport and distribution of the Products” except where the supplier bears the cost.
The text immediately following paragraph 4.8 says that even though it is procuring the goods, WHO shall never be named as the “consignee” of shipments sent directly to the blood bank, or accept any return shipments. In other words, WHO will remain publicly invisible.
Questions from Fox News about the existence of the agreement and why it was considered necessary were ignored by WHO.
The memorandum of agreement in Fox News’ possession was not signed. But, as the letters written in 2016 show, WHO continues to comply with blood bank requests -- supporting the Ministry of Defense -- while the same MoD continues to use chemical weapons, missiles, incendiary bombs to target hospitals and ambulances, doctors and patients.
Annie Sparrow, a critical care pediatrician and public health expert, is an assistant professor of Global Health at the Arnhold Institute at the Icahn School of Medicine at Mount Sinai Hospital in New York City.