In Syria, People Can Breathe with New Supply of Medical Oxygen

New Oxygen Plants Vital to Rebuilding Health Care System

By The Global Fund

February 15^th, 2024

The Doctor

Dr. Elie Azar’s office is in the newly-rebuilt Homs National Hospital in Homs, Syria.

Homs is an ancient city in the heart of the country, near the Orontes River – a gateway to the Mediterranean coast. It has been a center of trade and industry for centuries.

During the Syrian conflict, which began in 2011, large parts of the city were destroyed, many people were killed and thousands more fled their homes.

In Syria, People Can Breathe with New Supply of Medical Oxygen

“Homs National Hospital was a cornerstone of the health sector in Homs Governorate before the war,” said General Manager Dr. Azar. “During the war, it was destroyed.”

Today, fighting has largely ceased and more and more of the hospital is being rebuilt every day.

Currently, there are three operating rooms, an 18-bed inpatient ward and four intensive care units serving more than 220,000 people within Homs and the surrounding areas.

And the hospital has an important addition to its essential infrastructure: oxygen.

The Challenge

Access to oxygen is at the root of resilient, responsive and equitable healthcare systems. What could be more foundational to good health than breathing?

The COVID-19 pandemic made this clear in new and frightening ways. During the first, critical weeks of the pandemic, people around the world struggled to inhale.

And many could not: According to the World Health Organization (WHO), as of September 2023, less than 50% of health facilities in low- and middle-income countries – including Syria – had uninterrupted access to medical oxygen.

Pandemics, natural disasters and conflict exacerbate this problem, with deadly results.

In Syria, the Global Fund, in partnership with the International Organization for Migration (IOM) and WHO, came together through the Global Fund's Middle East Response Initiative to address this increasingly urgent – and solvable – challenge: strengthening the country's ability to provide medical oxygen.

The Patients

At any given time, there might be 10 to 25 patients at Homs National Hospital who need oxygen every day.

Muna Al Jaber came to the hospital when she felt like she smelled burning plastic.

Muna, a nurse, recognized the symptoms: “I had an allergic reaction in my chest,” she said. “I’ve been on oxygen three times per day since yesterday.”

Woroud Al Haj Hassan’s husband, Abdul Alim Assoura, caught pneumonia: “The doctor ordered him to receive oxygen...he has four or five sessions per day.”

Woroud Al Haj Hassan sits at her husband's bedside at Homs National Hospital in Syria: "Praise to God that oxygen is available, they gave it to him, and he is doing well."

Khairalla Al Tarsheh was admitted to intensive care after complications from brain surgery left him in a coma. When Khairalla regained consciousness, he moved to a hospital bed with regular access to oxygen to aid his recovery.

“We are talking about a substance we cannot do without,” said Dr. Azar. “A patient’s life might depend on a few moments’ worth of oxygen.”

And now they have it.

Oxygen is provided to young children, new mothers and older people. It is used to treat acute respiratory illnesses, such as COVID-19, critical conditions such as cardio-respiratory failure and chronic conditions such as asthma and emphysema.

It saves lives in surgical suites and eases the pain of health complications related to AIDS and tuberculosis.

"It is not possible to operate in a hospital without a sustainable source of oxygen,” said Dr. Yahia Suleiman Al Shimali, head of the Anesthesia and Resuscitation Section at Homs National Hospital. "[The generator] has made a real difference.”

Dr. Yahia Suleiman Al Shimali, head of the Anesthesia and Resuscitation Section at Homs National Hospital

The Partners

Muna, Abdul, Khairalla and others receive oxygen pumped into Homs National Hospital by a brand-new pressure swing adsorption plant: an oxygen generator procured by the Global Fund, IOM and WHO with technical assistance from Project BOXER, part of the Global Fund’s COVID-19 Response Mechanism that focuses on increasing access to medical oxygen.

The oxygen generation plant outside Homs National Hospital

Homs National Hospital's oxygen generator is equipped to fill oxygen cylinders that can be transported to other hospitals in Homs.

A high-pressure oxygen booster inside the oxygen generation plant

A nurse administers oxygen to a patient at Homs National Hospital.

Two additional generators were installed at the Dara’a National Hospital and Dummar National Hospital in Syria.

Developing measurements and technical specifications for the plant, then procuring, delivering and installing all three oxygen generators was a formidable undertaking in an uncertain, rapidly-changing environment.

Close collaboration and communication among key partners, including hospital officials and the Ministry of Health, helped overcome significant obstacles – including increased logistical challenges involved in transporting and preparing the site for the new plant.

Partners on the ground helped identify local suppliers to transport and assemble the generators and conducted post-installation assessments to check the quality of the oxygen once the generators were in place. Partners are now looking at investing in solar panels to ensure a reliable and sustainable supply of power.

Syria’s oxygen plants were procured as part of a US$1 billion effort by the Global Fund and partners to expand access, negotiate for better pricing, and provide governments with what they need to deliver oxygen to the communities they serve – an essential building block for resilient and sustainable health systems.

In 2023, that partnership expanded and evolved into the Global Oxygen Alliance: A group of more than 20 health agencies, country leaders and people from communities, working together to ensure better access to medical oxygen.

“Without a doubt, any successful endeavor is based on cooperation,” said Dr. Suleiman Al Shimali. “International humanitarian organizations [came] together in our time of urgent need. Our work cannot succeed without such synergy.”