Though the Syrian civil war has de-escalated in recent months, the Holy See's nuncio to the country says its problems are far from over, particularly regarding healthcare, with more people dying from a lack of proper medical care than from bombs.

“The risk in Syria is collapse,” Cardinal Mario Zenari, apostolic nuncio to Syria, told CNA Nov. 17, because “more than half of the hospitals and first aid centers are 'out of business' because of the war.”

Out of all healthcare personnel in Syria, two thirds have left since the start of the country's civil war in March 2011.

Zenari said the number of people who have died in bombings and shelling sits somewhere between 400 and 500,000. However, “those who die due to a lack of hospitals, a lack of medicines and a lack of healthcare are more numerous.”

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“This lack of healthcare creates more victims than bombs.”

Zenari, who spends the majority of his time in Damascus, is in Rome for the Nov. 16-18 conference “Addressing Global Health Inequalities,” organized by the Dicastery for Promoting Integral Human Development in collaboration with the International Confederation of Catholic Healthcare Institutions.

The goal of the conference is to launch a network connecting all 116,000 Catholic health organizations around the world through a platform of collaboration and sharing aimed at exchanging information.

Another key goal of the conference is to raise awareness about global disparities in access to healthcare.

Cardinal Parolin opened the conference outlining the Church's vision for the network they are trying to foster. Other big name speakers include Cardinal Peter Turkson, prefect of the dicastery; Sister Carol Keehan, president of the Catholic Health Association; and Beatrice Lorenzin, Italy’s Health Minister.

Zenari gave attendees an update on the humanitarian situation in Syria, sharing stories of his experience on the ground.

In his comments to CNA, the cardinal said that of all that he has seen and heard in his various visits to health centers and hospitals throughout Syria, what stands out is the young victims of the conflict.

“I remember the children,” he said, and recalled how during the liturgy for Holy Saturday in 2014 he met a 9-year-old girl named Lorina, who was crying because both of her legs had been amputated the day before after being hit by fragments of a mortar shell that exploded near her school.

He also recalled the numerous “skeleton children” who live on the outskirts of cities or who have died of hunger after being abandoned, many of whom were never registered.

Thousands of other children have faced a similar fate, and while victims of the war come in all shapes and sizes, Zenari said that for him “the children leave a big impression.”

Hospitals and schools have consistently been a target for fighters on the various sides of the war in Syria, which is well into its sixth year, and as a result many hospitals in the country have been forced to go underground, with locals placing sandbags above the structure to cushion the effect of shelling.

According to UNICEF, 2016 was the deadliest year for children in Syria, which claimed lives of 652 children, 255 of which took place in or near a school. The number is a 20 percent jump from the number of child deaths in Syria in 2015.

More than 11,500 child deaths were reported in just the first two years of the conflict, and the number has continued to climb. However, the data provided by UNICEF only includes deaths that have been formally verified; the real figures could be much higher.

With only one third of the country's doctors still around and half of the hospitals not functioning, “the situation is very, very dramatic from a humanitarian aspect,” Zenari said.  

“You think that there are more than 5 million refugees in neighboring countries, and there are more than 6 million internally displaced people,” he said. “So the numbers are impressive. The humanitarian situation is very, very serious.”

In addition to taking a massive toll on the country's healthcare services, the war has left many unemployed, meaning that of those who are actually able to reach hospitals or medical centers, many can't afford treatment.

Before the war, Syria had one of the most advanced healthcare systems in the Middle East, and was one of the leading producers of pharmaceuticals.

But now “many of these industrial pharmaceutical factories are also 'out of business' because of the war,” Zenari said, noting that since these companies produced more than 90 percent of Syria's pharmaceutical product, “it creates a national need (for) healthcare work.”

Poverty in Syria has risen to 85 percent as a result of the conflict, and many don't have access to the national healthcare system, leaving some 11 million people without the care they need, Zenari said.

With this bleak scenario as a backdrop, the nunciature in Syria last year launched a project called “Open Hospitals,” which aims to support the hospitals and medical centers that are left, and offers funding that goes toward free treatment for families and individuals in greater need.

Religion isn't taken into consideration, Zenari said, explaining that if Peter walks in with a headache, has a large family and is unemployed, he will be treated for free, and the same thing goes for Muhammad.

Open Hospitals is backed by Pope Francis and is being carried forward with the help of the Vatican's development office. It works directly with the three Catholic hospitals in Syria to provide medicine, keep facilities up to date, and offer free care to those can't afford to pay.

Present in Syria for over 100 years, these hospitals have been “taken by the neck, so to speak, by the financial problem,” Zenari said.

With money needed to pay for staff, general management, monthly bills, and the renewal of old facilities, patients continue to file in with average healthcare needs and war injuries, making the financial strain near crippling.

“When more than half of the state hospitals are out of business and we don't have Catholic hospitals that are highly regarded, who don't work at full efficiency,” the rate at which the remaining structures function is not sustainable, he said, so they decided to launch the project to ease the burden.

So far around one million euros (nearly $1.2 million) have already been raised. Zenari said he hopes there continues to be a “positive response,” and would like the project to extend beyond three years.

The project is being done “with a lot of transparency and a lot of competency,” he said, adding that the nunciature is also collaborating  with a well-known local NGO which helps them with technical training.

With some 13 million people still in need of humanitarian assistance, according to U.N. estimates, the funds raised will support a variety of causes. The first and most urgent need is healthcare, Zenari said, but noted that there is also need for food, work, and education, since one in three schools in Syria have closed.

As far as a possible resolution to the situation, the cardinal said, “we still don't see the end of the tunnel. It's still far away.”

“The situation is very complicated, the political situation is complicated,” he said. While there has been a decrease in violence, “this de-escalation doesn't work everywhere,” so the political situation “is far from being (resolved).”