Over the past three years, Syria’s healthcare system has disintegrated. This is a fact, substantiated by the systematic targetting of hospitals and medical professionals by Bashar Al Assad’s ­regime; the massive decline in production of essential medications by the country’s pharmaceutical industry; the spread of leishmaniasis, a parasitic skin disease; the first polio outbreak in 14 years; and, most recently, an H1N1 flu virus (swine flu) mini-epidemic that has claimed at least 19 lives.

Lengthy discussions in the international arena about Syria’s failing healthcare industry have concluded that the Assad regime is directly or indirectly to blame. And while the regime continues to perpetuate the false narrative that “terrorists” – the government’s preferred name for the legitimate Syrian opposition – are at fault for what has befallen the country and that the government is the bastion of resistance protecting Syria from terrorism, it certainly cannot deflect blame away from itself for deaths caused by infectious disease.

In fact, the swine flu mini-epidemic is a clear example of the government’s failure in its purported role of protection, even in territories it controls. This is especially true considering that the outbreak has occurred in regime-held areas, including Damascus, Hama, Latakia and Tartous. ­Realising this, the regime has opted to remain as silent as possible on the issue, and has tried to minimise the apparent risks of the disease.

According to Marwan Al Ashqar, a doctor in Hama, the first reports of swine flu in the city emerged in early January, and the first death was confirmed at the start of February. The Syrian Ministry of Health has confirmed 59 cases of swine flu, including 11 in Hama that resulted in death.

“The government’s response has been ridiculous,” said Dr Al Ashqar, who has concealed his true identity for safety purposes. “It came one-and-a-half months after the disease emerged, and said nothing more than that vaccinations were being provided at healthcare clinics, Syrian Arab Red Crescent centres and the ­National Hospital.”

In his first public remarks regarding swine flu-induced deaths late last month, the Syrian Health Minister Saad Al Nayef pointed to the fact that the disease has claimed dozens of lives in Middle Eastern countries this flu season, and those who died suffered from chronic illnesses as well.

In Mr Al Nayef’s attempt to divert attention from his government’s responsibility, he neglected the fact that the deaths could have been prevented had the Health Ministry ensured that Syria’s vulnerable population – including those with the chronic illnesses he mentioned – was vaccinated ­before the flu season kicked in.

“The right response when we have an epidemic is a large-scale population-based vaccination for influenza,” said Zaher Sahloul, the Syrian American Medical ­Society president.

“We need to make sure we vaccinate people who are vulnerable: those with diabetes, lung disease, heart disease and cancer. We need to have a system in place where doctors and nurses [can administer the vaccine], and safe situations for patients to seek vaccinations in clinics and primary care systems.”

Once cases of swine flu were confirmed, the government had a responsibility to raise awareness and protect at-risk individuals, Dr Sahloul said. Instead, public health officials avoided the problem and did not address it until the mounting death toll made it impossible to ignore.

“[Mr Al Nayef] was probably trying to remove responsibility from the Ministry of Health,” said Dr Sahloul, who believes the deaths were avoidable. “This is a pattern we have seen for a long time. They don’t report facts, and when they do come out, they under-represent the problem and over-represent their response. We saw the same with the polio epidemic.”

While it may seem ridiculous that a regime responsible for killing more than 120,000 people and displacing a third of the country’s population could worry about its reputation, Dr Sahloul said President Al Assad is aware that the spread of disease could affect the aid money delivered by organisations such as the UN and World Health Organisation.

The ministry of health is allotted a share of this money, presumably to support the healthcare industry. When avoidable deaths become prevalent, the regime may be expected to explain how the money is being spent, and those are questions it would rather not answer.

According to Dr Sahloul, whose organisation provides medical support to Syrians in need, 19 deaths is probably a severe understatement. The fact that swine flu has been reported in limited areas indicates only that the Health Ministry and the WHO are not present to document it in other areas, not that no lives have been lost to the disease in opposition-held territories.

“When you have [the] displacement of populations, no electricity, no clean water and a refugee situation, those are the perfect ingredients for epidemics of ­infectious diseases,” said Dr Sahloul, who expects that infectious disease epidemics will become common in refugee camps.

While there is uncertainty surrounding some facets of the Syrian conflict, other aspects are clearly painted in black and white. There is no disputing that deaths caused by communicable diseases like swine flu could have been avoided if only the Assad regime had taken the necessary health precautions, especially in areas it controls. And as Dr Sahloul put it, what we have seen so far “is just the tip of the iceberg”.

This post originally appeared in the National