Local manufacturing of medical supplies in northwest Syria
Each year, Airbel Middle East scopes one area that we feel could make a significant contribution to the humanitarian sector. The goal is to better understand the challenges, and identify whether there are areas in which we could develop solutions that have the potential to be transformative. This year, we’re focusing on local manufacturing because of the critical need identified for personal protective equipment (PPE) and other medical devices in response to the COVID-19 pandemic.
COVID-19 in northwest Syria
After 9 years of conflict, Syria is facing the COVID-19 pandemic with a health care system in ruins, and millions of people displaced by conflict. Deliberate attacks on health facilities — 85 in 2019 in Idlib alone — left the health system overstretched even before the pandemic, with only 105 ICU beds and 30 adult ventilators available for 4 million people in northwest Syria. Meanwhile, more than 3 million people were forced to flee their homes, with many living in crowded settlements with no running water, making it nearly impossible to implement preventative measures against COVID-19 like social distancing or handwashing. Limited access into northwest Syria kept the virus at bay until the first positive case was identified in July 2020, but then cases increased rapidly. Worryingly, about 30% of positive cases in northwest Syria are healthcare workers — compared with a rate of 10–20% among healthcare workers in the U.S. and U.K., and 2.68% in neighboring Lebanon.
Since the start of the pandemic, countries globally have faced enormous challenges procuring vital personal protective equipment (PPE) like gowns, masks, and gloves, which are used by frontline workers to prevent the spread of infection. To protect their supplies, many countries imposed export bans. The availability of PPE to export is limited in neighboring countries like Turkey, which is the entry point for most aid into northwest Syria. In response, our colleagues working in health supply chains tried to find PPE within northwest Syria, but these often didn’t meet the standards needed to keep health workers safe — for instance, gowns would tear easily, or were not waterproof.
Hand in hand with the healthcare emergency is an economic collapse. Currency devaluation and displacement have intensified the crisis in the region. In 2020, 9.3 million Syrians were going hungry and 42% more were facing food insecurity compared with the previous year.
In response to COVID-19, IRC’s economic recovery team in northwest Syria identified people struggling without a means of supporting themselves, and in 2020 worked with them to produce 429,000 free cloth face masks for the community. In doing so, they not only created masks to help prevent the spread of infection, but the IRC also provided vital income to 207 Syrians, at a time when many people lost their jobs and means to support their families because of COVID-19 and displacement. While this was a successful emergency response and generated income for some of the most vulnerable people in northwest Syria at a crucial time, it was not an efficient procurement model in the long run, and nor did it solve the more technical PPE needs of frontline workers.
This mask-making project got the northwest Syria team and Airbel thinking about:
- How might we secure high quality PPE and medical supplies that meet health workers’ specifications in a context with limited supply?
- How might we use the opportunity to concurrently promote livelihood opportunities for people (our clients) and support economic recovery in NW Syria?
How can we meet PPE needs and support economic recovery?
With some initial scoping, we identified three challenges: 1) a shortage of quality PPE in northwest Syria, 2) a lack of meaningful and dignified work opportunities for people to support their families, and 3) supply chain inefficiencies globally during the pandemic.
To us, these three challenges seemed interconnected. Humanitarian supply chains and logistics are often the most expensive part of humanitarian response, at an estimated 60–80% of aid costs, or 10–15 billion USD per year. As many aid supplies are procured elsewhere, this affects the local economy where emergency response is taking place. For instance, if more PPE was procured from manufacturers locally rather than imported, this would increase local production and create more jobs in northwest Syria.
We were particularly inspired by innovations like open source communities of practice, the maker movement, and technologies from sewing machines to 3D printing, that have been used to make humanitarian supply chains cheaper. In the small pilots where these have been tested, they have demonstrated significant savings. Responding to the 2015 Nepal earthquake, Field Ready’s local manufacturing of medical and other aid supplies showed cost savings of up to 90%, and was considerably faster compared to conventional humanitarian supply chains.
Despite these efficiencies and the potential benefits of localized supply chains on the local economy, we have yet to see transformative change in humanitarian supply chains. In the longer term, we hope to change this by developing a local supply chain model that’s scaleable. That’s a long way off, but our very first step towards that is to prove the concept: to support local manufacturers in northwest Syria to produce high quality PPE that meets health sector specifications. We hope to show that this would have the triple impact of 1) offering improved life-saving PPE to frontline health workers, 2) supporting small and medium-sized businesses in northwest Syria, and 3) increasing procurement efficiencies by leveraging local decentralized supply chains.
We’ve started by embarking on an initial design phase. Our goals were to determine what PPE products might be feasible to manufacture locally, based on the demand of our health partners. We were also learning more about available materials and local manufacturers, and identifying the safest location to do this in. Based on this information, we worked with our partner, Open Source Medical Supplies (which originated in MIT’s D-Lab) to identify potential viable product designs suited to the health team’s needs and the context. At the same time we also sought to learn more about quality control and quality assurance protocols, which would be vital to generating a model for local manufacturing in emergencies.
At the start, Airbel didn’t even know that surgical PPE was being made in northwest Syria. In this exploratory phase, we started off by trying to understand what local manufacturers are making, and to what extent it is purchased by those equipping hospitals? So far we’ve learned that some local manufacturers are making PPE items, but these are not being purchased by IRC’s health team due to low or inconsistent quality, long lead times, or not meeting the specifications and standards needed by healthcare workers. In some cases, for instance, locally made gowns have been too short. We’re now trying to understand the problems that manufacturers in northwest Syria face and how we could support these small and medium-sized businesses, and the barriers for supply chain teams to procure PPE locally. We also want to better understand market dynamics and the potential impact of this project, to ensure our intervention does not negatively distort local markets.
Given the active conflict and access limitations in northwest Syria, it is undoubtedly a difficult context in which to prove a concept. For example, there are restrictions on cross-border movements of certain products (like hand sanitizer ingredients). The IRC and other organizations typically procure from suppliers who are certified by a third party, ensuring quality standards are met, but third party certification is not possible in Syria.
At the same time though, we are able to do this work thanks to the expertise and insights of our colleagues in northwest Syria, and technical specialists in health supply chains, quality assurance, economic recovery and livelihoods, raw materials procurement, and market strategy.
As we design and begin to test our approach for local manufacturing of PPE in northwest Syria, in the back of our minds we’re also thinking about scale from the beginning and designing with an awareness of what would be needed if this works. What if we could transform how PPE and other products are procured by supply chain teams in many of the 40+ countries IRC works in? How might this change the aid sector as a whole? The billions of dollars annually spent on procurement, if spent locally, could potentially help create livelihood opportunities for people affected by crises.
We’re just at the beginning of meeting PPE needs in northwest Syria and what we hope will be a multi-year journey to scale and system transformation, localizing manufacturing and decentralizing humanitarian supply chains. We’ll keep you updated on where this goes. In the meantime, if you’re interested in learning more, partnering with us, or funding this project, please reach out!
