Based on available COI, the general situation with regard to the elements mentioned above is assessed as follows:
[Main COI reference: Damascus, 3.2]
Food insecurity is widespread across Syria due to high fuel and food prices, loss of livelihoods and reduced food production. However, the greatest difficulties are in non-government controlled areas of the country.
Food is widely available in Damascus, albeit at high prices. The driving factors for food insecurity in Damascus City are the high concentration of IDPs, limited employment opportunities and households with highly eroded livelihood coping strategies. Nevertheless, in general, there is no shortage of basic food items in Damascus City and all items can be found - at different qualities and prices.
People’s income often does not match the expenses, because there has been a drastic increase in food prices due to a drop in the value of the Syrian pound. Low-income groups in the city can still afford to purchase basic food items but they have to prioritise and rationalise their food purchases. Many families have to rely on their extended family and networks, or financial support from friends or relatives abroad to afford to feed their families.
Housing and shelter
[Main COI reference: Damascus, 3.3]
The conflict in Syria has severely affected the housing sector. A significant share of residential units was partially damaged or fully destroyed, housing investment disrupted, quality of living space deteriorated and land and property rights severely challenged. The conflict has caused an increase in rural to urban migration. In areas with relative security and consistency of services there have been large influxes, which resulted in a significant concentration of population (IDPs and hosts) in urban areas. During the conflict years from 2011-2018, Damascus City became a principal area of refuge for rural populations. The city experienced a housing crisis due to increased costs, unemployment and shortages in basic services. Many IDPs fled to informal settlements in the city with high population density.
The World Bank’s 2017 ‘Housing Deprivation Index’ for Syria indicated that the national average of damaged or destroyed housing is 28 %. Damascus City ranked at around the same as the national average. Damage concentrated in the southern (Yarmouk) and eastern districts, extending towards Eastern Ghouta. In particular, the districts Jobar and to a lesser extent Al Masani, on the edge of Damascus City, have been severely damaged. [Security 2020, 220.127.116.11]
Due to damage to housing stock and physical damages to housing infrastructure in conflict-affected areas, houses are not available for rent in most communities and only a minority can afford the rent despite living in dwellings that do not offer adequate protection from weather or are not served well by public services.
It was reported that the requirement of security clearance to rent property inside Damascus City has been lifted, however another source had noted that upon registration of the lease with the local authorities, officers from security divisions will visit the property as a new way of carrying out a security check.
Utilities, hygiene and sanitation
[Main COI reference: Damascus, 3.4]
In 2019, electricity and cooking gas were being rationed in Damascus. In April-May 2019, the country experienced a fuel crisis, which also hit Damascus City. Under the smart card rationing system for gas introduced by the GoS, each family was eligible to receive one gas cylinder every 20 days. Wealthy areas, especially where government officials reside, had enough stock but higher prices. Other neighbourhoods experienced shortages and line-ups.
The Syrian population had difficulty in access to improved drinking water since the beginning of the conflict, in addition to rising costs for water. There is a water supply network all over the Governorate of Damascus and 80 % to 90 % of the city is fully served with drinking water and sanitation. However, in the slum areas of Damascus, such as Yarmouk, Jobar, Barzeh, Al-Balad, Qaboun, Hajar Al-Aswad and al-Qadam, water supply infrastructure has been damaged from past military operations. In these areas trucks, rather than piping, tend to provide water.
[Main COI reference: Damascus, 3.5]
Article 22 of the 2012 Constitution of the Syrian Arab Republic states that:
‘1. The State shall guarantee every citizen and his family in cases of emergency, sickness, disability, orphanhood and old age;
2. The State shall protect the health of citizens and provide them with the means of prevention, treatment and medication’
Every Syrian national can access public primary services and hospitals in Damascus free of charge or at a very low charge that is affordable for low-income groups. Emergency care is also provided free of charge.
A range of medical services are offered by Primary Healthcare Centres (PHCs) in Syria: general clinical services and essential trauma care, child health clinic, nutrition management, communicable disease diagnosis and treatment, sexually-transmitted diseases, maternal and newborn health, and mental healthcare. However, not all services were systematically available. For instance, essential newborn care was only available in 15 % of PHCs, tuberculosis treatment in 32 %, psychosocial support in 34 %, and antenatal care in 81 %.
52 out of the 61 PHCs in Damascus were reported as functional and one partially functional in the same period. There are also 15 public hospitals in Damascus, 14 of which functional and 1 partially functional as of the end of December 2018.
The nearest healthcare facility (either public or private) in Damascus can generally be accessed within an average five minutes of travel time by car. 12 public hospitals were defined as accessible (easy to access for patients and health staff) and two as hard-to-access (hard to reach, due to security situation or long distance). One of the hospitals in Damascus was partially damaged. Electricity generators were reported as being available in the hospitals 24 hours/day as of 2018. Still, the number and/or efficiency of electricity generators was insufficient in 27 % of the Damascus hospitals. One hospital reported limited water sources.
Some Damascus hospitals have extended their operational capacity and, as of December 2018, the number of available beds reached 3 311 (116 %) - the highest of all governorates. The estimated caseload of functional public hospitals of Damascus (outpatient consultations and emergency cases) from January to December 2018 was over 1.5 million cases. Damascus also has the highest proportion and availability of doctors in functional public hospitals.
However, healthcare facilities in the capital are overcrowded, often with patients from outside Damascus and, due to the high demand, the system is overstretched.
There were waiting lists to receive treatment at public hospitals and high prices at private hospitals. Advanced surgery at a private hospital can cost up to 6 000 USD. The cost of a full medical check-up at a private hospital is at least 120 USD and can be afforded by only 10 - 15 % of the inhabitants of Damascus.
In addition, the availability of pharmaceutical products as well as supplies of raw material and spare parts for medical equipment in the hospitals of Damascus has been negatively affected by the destruction of local pharmaceutical factories and sanctions imposed by the US and the EU. Pharmaceutical companies use third countries, e.g. Lebanon, the United Arab Emirates, Iran, Russia and China, to get the needed medicine. Some hospitals in Damascus reported shortages in supplies and long delivery times. However, medicines which are prescribed by primary healthcare physicians are available to a great extent in pharmacies and the price is not high. Medicines to treat chronic diseases are provided free of charge by PHCs and hospitals.
Basic subsistence and employment
[Main COI reference: Damascus, 3.7]
The World Bank estimates that in the government-controlled regions approximately 2.4 million net jobs were lost from 2010 to 2015. Construction and industry were the sectors that suffered the greatest loss, followed by agriculture. However, Damascus City is one of the least affected Syrian governorates, similarly to Sweida, Tartous, and Latakia. Some economic activities in the capital were re-established since the stabilisation of the security situation. In 2018, Damascus City provided approximately 15 % of the total employment in Syria. Livelihoods in Damascus City are predominately based around business trading jobs, government office job, commercial activities, petty trading and remittances.
The capacity of the labour market in Damascus is smaller than the demand for jobs, particularly due to a high number of IDPs. University graduates in Damascus are mostly able to find employment, even if not in their field of study. Moreover, some space for a new workforce has opened because a large number of skilled labour has left the country during the conflict. Unskilled workers are reportedly also able to find a job in the city and manage a minimum standard of living, particularly if they received some vocational training. However, expenses are high in Damascus City and it is very difficult for low- and middle-income groups to make ends meet.
In addition, an increasing number of women find employment in traditionally male jobs. IDP women take part in employment increasingly due to the shortage of male workers caused by the conflict.
The salaries of government employees were between 30 000 SYP [52 EUR] and 40 000 SYP [about 69 EUR] as of mid-2019, while the average salary of employees in the private sector did not exceed 65 000 SYP [about 113 EUR]. In 2018, the highest civil servant salary in governmental institutions was 100 000 SYP [about 166 EUR] per month, while the estimate for the average monthly household expenditure in February 2019 was about 325 000 SYP [592 EUR].
Due to the conflict, the national poverty prevalence rates increased between 2010 to 2017, and more steeply after 2012. Damascus City’s poverty rate is reflective of the national average: poverty was at about 23 % in 2010 and increased to nearly 60 % in 2012 and to about 90 % in 2016 and 2017 (93.7 % nationally). However, there is still a presence of middle class and wealthy Damascenes in the city. In 2019, poverty rates in Damascus City were higher in the suburban areas, mainly in the eastern periphery coinciding with the main locations of informal settlements and rural districts.
Secondary or multiple employment is often required to meet needs. Requesting support from charitable western organisations or reliance on aid from relatives abroad were other livelihood strategies.