Dr. Annie Sparrow:

I thank the joint committee for inviting me to speak about this important issue. I am an Australian. I trained in the area of paediatric intensive care and for the past 20 years have been working as an aid worker. I am proud to be back in Ireland because I spent many years working with Catholic Relief Services here, the American equivalent of Trócaire, to establish relationships with Irish aid organisations which are some of the most effective in the world. The Irish people are also among the most generous in the world. I am happy to explain to the committee how aid is manipulated and controlled by the Assad regime, as well as highlighting how we must we ensure this multi-billion dollar aid effort does not continue funding President Assad’s killing machine.

Few of us remember that once upon a time this conflict was a revolution. The Syrian uprising began on 15 March 2011. The regime has been in place since illegally seizing power in 1963. Hafez al-Assad established himself as President in 1971 and his family has exerted control ever since. It has a policy of civilian oppression and a poor human rights record. We saw this in 2011 when civilians who had taken to the streets were shot. Even children who wrote anti-regime graffiti were arrested and tortured. Doctors were killed for the crime of treating civilians injured in protests. On 22 March 2011 the first doctor and ambulance driver were killed while trying to save unarmed student protestors who had been shot. Shortly afterwards, the international community responded with sanctions. Initially, they were travel bans and asset freezes in respect of key individuals deemed to be responsible for the violence such as the chiefs of the military and intelligence forces. It was done initially by the United States and the European Union followed rapidly. By May 2011, sanctions had even been imposed on President Bashar al-Assad himself.

His atrocities continued. The next year a lot of effort went into a peace process led by Mr. Kofi Annan. By this stage, not only had the European Union which was Syria's principal trading partner at the time extended it to economic sanctions, many other countries had also imposed bilateral sanctions. Mr. Annan's six-point peace process failed and a massive humanitarian crisis began to unfold. Millions were forced from their homes inside Syria and there was a massive exodus of refugees.

In response to the crisis, UN agencies were mobilised. The primary UN agency involved in this work is the Office for the Coordination of Humanitarian Affairs, OCHA, which has a mandate based on UN General Assembly Resolution 46-182. It mandates it to co-ordinate an international response, mobilise funds from governments and implement measures through other UN agencies and partners. It has to do this work while respecting the principle of sovereignty. The condition imposed was that everything would operate from Damascus, that all aid would go through it and that the Syrian Government would be fully in charge of aid efforts. These aspects are the biggest problems and have led to the current situation. Seven years later we are faced with the worst crisis in modern history. It is certainly the largest and most expensive with which to deal. It is a multi-billion dollar effort for Syrian alone. There are 5.7 million refugees outside the country and an equivalent number inside it. Sadly, the atrocities continue, as evidenced by the chemical attacks last month in Duoma in the Ghouta region, after which further sanctions were imposed. There is great concern about whether the sanctions hurt the humanitarian efforts. I shall explain the matter a little. Syria not only has a terrible humanitarian crisis, it hasalso suffered a public health catastrophe. One of President Assad's claims is that the catastrophe has been caused by the sanctions imposed.

Syria has experienced two polio epidemics. In 2013 polio reappeared in Syria for the first time in 19 years, but the outbreak was covered up by the government. Unfortunately, the World Health Organization, the primary role of which is to support the efforts of the Syrian Government, has had to toe the line. It was a task force in northern Syria, operated from Turkey with the permission of the Turkish Government, that took control and successfully administered a vaccination programme. Last year there was a resurgence of vaccine derived polio and the outbreak is ongoing. We had never seen it happen in a war before. The war in Iraq lasted eight years, but polio did not emerge. I hope I have given a useful example. Well before the war in Syria broke out, vaccines were withheld from politically unsympathetic areas, leaving people extremely vulnerable. It was one of reasons people took to the streets to demonstrate in 2011. After 50 years of brutal repression, they did not take to the streets to discover all of these new ways of dying - being shot at, made to disappear, tortured, arrested, gassed with chemicals, starved to death in a siege and attacked with vacuum bombs and barrel bombs. They protested because they wanted a better life and, most importantly, for the sake of their children, which is why we all care.

The terrible consequence of the Syrian conflict is that children have suffered the worst and are most vulnerable. The Syrian Government fully controls the aid effort. It exercises control through its partners. They include the Syrian Arab Red Crescent and the national non-government organisations, NGOs, operated by President Assad's family and friends. They determine exactly where the aid goes and deliberately ensure it does not reach the regions most in need. This is entirely consistent with its targeting of civilian homes and schools. By this time last year the Assad regime had bombed well in excess of 4,000 schools. There has also been the deliberate destruction of hospitals and doctors have been killed, which weaponises healthcare and turns people's need for it into a weapon against them by violently depriving them of it.

On areas under siege, the regime deliberately withholds humanitarian aid and refuses to allow civilians to leave them, which makes the siege illegal. The proper way to operate a siege is to allow in humanitarian aid and civilians to leave, especially women and children. The policy of denying humanitarian aid to anyone who needs it is entirely consistent with a war that the regime has practised consistently. It is responsible for fuelling this massive refugee crisis. It does this by using an incredibly effective intelligence and security apparatus, which is how one stays in power. The Assad regime has been in power for 50 years because it has relied on brute force, a strong military and a very strong intelligence force.

Let us not forget that the people in power in Syria have all been sanctioned. The first slide shows the head of the International Federation of Red Cross and Red Crescent Societies with Prime Minister Imad Khamis. The picture at the bottom of the slide shows President Assad, the Minister of Defence and the Prime Minister. Let us recall that all of them have been sanctioned. The International Federation of Red Cross and Red Crescent Societies must work very closely with the same individuals who are held entirely responsible for the Syrian conflict. Prime Minister Imad Khamis used to be the Minister for health. The Minister for Health is also on the sanctions list and has been for years. Every single government Minister in Syria has been sanctioned for participating in human rights violations - acts of violence, killing, shooting and disappearances - yet these are the same people with whom the aid agencies in Damascus are forced to work under the terms and conditions stipulated by the Syrian Government.

The second slide shows Mr. Bashar Ja'afari, the Syrian representative in the permanent mission to the United Nations. In the photo one can see him embrace Mother Agnes whose name is designed to provide reassurance and allay fears. Even though she has her own NGO, aid is withheld from those who need it the most. She has also denied that chemical attacks ever took place. She is one of the many people who have been appointed to roles to control the distribution of aid. Syria is an authoritarian state and the only way one can succeed is through maintaining close proximity to the people in power.

At the bottom of the slide one can see Mr. Faisal Mekdad, former permanent representative of Syria to the United Nations. Mr. Mekdad and Minister Walid Muallem are the most powerful people in the regime and have a direct relationship with the intelligence forces. The Ministry of Foreign Affairs dictates which agencies can enter Damascus.

Once they have agreed an agency is allowed to come in, the condition is that it must partner with the Syrian Arab Red Crescent, SARC, which is a local member of the Red Cross-Red Crescent movement and Syria's largest humanitarian agency. It is long established and staffed by thousands of dedicated volunteers. However, it is also controlled by the same intelligence forces and has been for a very long time. All of the agencies have to work through SARC, the primary aid agency that delivers aid, but they also have to apply for approval before they can recruit any staff. Through the Ministry and SARC, which is controlled by the intelligence forces, they control who comes in to Syria. We cannot get our best people to deliver an aid project when they are excluded because they are deemed to be politically unsympathetic. They control the aid agencies, the people who staff them and the programmes delivered by SARC and through the national NGOs, which is another name for Assad's family's and friends' enterprises.

Faisal Mekdad's wife, Shukria, was hired by the WHO as the consultant for assessment of the mental health needs of internally displaced persons. In the absence of any qualifications or experience she was put into this leading position by the World Health Organisation. It is a measure of the influence of the Minister for Foreign Affairs that she was put into a position for which she is unqualified. Her only qualification is that she is his wife. She is meant to assess the mental health needs for which Faisal himself as one of the chief prosecutors is responsible.

The next slide shows the major general in charge of the blood bank. As the member can see, it is part of the Ministry of Defence. Elizabeth Hoff, the country representative of WHO Syria, was awarded a shield by the Minister of Defence for her special efforts in her services. This is one of the most egregious examples of how the aid is controlled. Blood is a very important resource in war, of course. In cases where the Red Cross controls blood, we are able to donate it and receive it when we need it. In Syria, the blood bank is controlled entirely by the Ministry of Defence. Since 2013, because Abbott in the US was no longer allowed to supply the transfusion hardware and software or the screenings kits for HIV, hepatitis B and the blood-borne diseases, the Ministry of Defence approached the WHO to procure those items for it. Since then, the WHO has been buying millions of dollars' worth of transfusion equipment, screening kits, blood bags, and all of the serums and fluids. None of these is allowed to reach those in need, however. Not to Darayya five miles away, nor to Ghouta, under siege since 2013. They are not allowed to receive intravenous fluids, let alone blood. In full knowledge that the blood products are being withheld from the population that is most in need, and that their supply is controlled by an agency that is responsible for the air strikes, the trauma and barrel bombs that drenched the country in blood, they are subsidising Assad's killing machine, bypassing the sanctions and even profiting. Because they do not have to do so, they do not reimburse the WHO, of course.

None of us has any problem with a military Ministry overseeing aid. In Liberia in the ebola crisis the US military helped build the roads and infrastructure that allowed aid to be delivered. But when it is used, manipulated and controlled to deny those who need it most, that is a problem. There are other alternatives. The situation also benefits Abbott. The spotlight here is on the UN agencies including the WHO but other companies find ways to get over the sanctions and they are equally in need of scrutiny.

I wanted to show the committee the next slide because it represents to me the obscenity of the Syrian regime. This is Moaz and Nawras, who were conjoined twins born in eastern Ghouta in July 2016. I am a paediatrician and have worked in many war-torn countries including Afghanistan, Somalia, Sudan. I have also worked in First World countries such as England, Australia and America and although I have seen lots of different things, I had never seen conjoined twins. The doctors in eastern Ghouta are faced with siege, chemical attacks, outbreaks of infectious disease and trauma in addition to diabetes, cancer, kidney disease and then they were faced with these twins, these tiny little pieces of newborn humanity. After a lot of effort we managed to get the twins into Damascus and there were many international offers to take them to a centre where they could be safely separated with a multidisciplinary expert team. They were eventually allowed to be brought into Damascus with their mother who was breastfeeding them. They were joined at the chest. They could have lived their entire lives as conjoined; that they were breastfeeding tells us they were well. Then they suddenly died. The mother was not allowed to breastfeed them for five days and then they were reported dead and buried. To the best of our knowledge, this is because the Syrian regime decided to try to separate them itself. If it had succeeded, it would have been a great PR croup and if it did not succeed, they did not actually care. They did not want to allow babies that could remind the whole world that there are babies in Syria too. They could not let that out beyond their control. If they cannot let these babies survive, there is not much hope for anyone else.

I have provided a lot of resources for the committee to review. The next slide shows an illustration of the way convoys are controlled. Convoys are just a drop in the ocean of the aid effort. The current situation is that aid goes into Damascus. All agencies have to partner with SARC which is corrupted, as I have said. One of the leading figures is Tammam Mahriz, a nephew of Assef Shawkat who before his death in 2012 was the head of military intelligence. It is very sad because there are thousands of volunteers who are brave on the ground, who are doing their best to still get aid to those who need it most but they themselves are shot, executed, arrested and tortured for that same crime of trying to help those who actually need it. In addition to being already staffed by key people in the intelligence forces, after 2011, many more intelligence agents posed as volunteers from the bottom to be able to observe and inform on their colleagues. At the top, those who were experienced and qualified were dismissed and replaced by retired military officers who belonged the regime and were known for their loyalty. SARC is controlled by the agencies.

In an authoritarian regime, there are a lot of different branches of security forces. I have included an illustration of that in the supporting documents also. What happened eventually after a couple of years was that in order to exert maximum control over aid, the intelligence forces themselves had to form a co-ordinating agency in order to make sure they were all talking to each other as well as with the Ministry of Foreign Affairs and the Ministry of Health, which is charged with deleting agencies and deleting the lifesaving supplies from all the convoys.

This is all done by the department of preparedness which I describe as the "department of deletion". The department is run by Dr. Al Hajjaj al-Sharaa who is the individual in the photograph dressed in red. His agency deletes all life-saving supplies from the lists, which means that instead of a supply of adrenaline or insulin, lice shampoo and empty jerry cans will be received. Dr. al-Sharaa is one of the owners of the national non-governmental organisations, NGOs, that are approved and accredited by the Syrian Government. He is, therefore, well positioned to redirect supplies and resources to his agency, Al Cham for Health, one of the major implementing partners for the World Health Organization, the UNHCR and UNICEF to provide mobile health services. He is also one of the staff at the warehouse who ensures none of the life-saving supplies makes it onto the convoys. These staff check the list carefully. It is then sealed with a seal from the intelligence forces before leaving. One of the most recent convoys towards the end of last year reached the warehouse in Ghouta, but the warehouse was then bombed by the government to make sure nothing was used. The convoy in question included 50 dialysis sets which would have kept people alive for another week or two, but even it was bombed.

I will explain what the weaponisation of health care means. Collateral damage is usually the primary reason for the deaths of civilians in war. However, that is not the case in Syria where civilians are the target. There are various ways of pursuing a strategy of suppressing and repressing a revolution which started as a protest for basic human rights and fundamental freedoms. One way of doing so is to arrest and torture demonstrators. Military intelligence, air force security and the ministry of defence have thousands of black sites where they keep hundreds of thousands of disappeared persons, many of whom have been tortured and held for years.

Another way of doing so is to control health care delivery. As I stated, one week into the protests, the hospitals which were under the control of the ministries of health and higher education were informed that they would not be allowed to provide aid for anyone hurt in demonstrations. In response field hospitals were established, one of which was located in an ancient mosque in Dera'a. On 21 March 2011 medical personnel were providing care for more than 50 people in the field hospital when a student protest outside, attended by a few hundred unarmed protestors holding olive branches, was attacked by military forces, including Iranian forces. The mosque put out a call and one of the doctors responded in an ambulance. They managed to pick up one patient who had been shot by the security forces. He was thrown into the ambulance which was then hijacked by the Iranian military on its way back to the field hospital. The driver was shot and killed; the doors were opened and machine gun fire killed the doctor and critically injured the nurse. The patient was shot six more times.

The massacre that day was covered up and when one reads reports, they suggest only six people died because that is the number for which we have records. No one believed Bashar al-Assad, a doctor in training to be an ophthalmologist, would exert this level of brutality. We have since documented the direct killing of more than 900 doctors for the crime of assisting people injured by the Syrian Government. This tactic was even legislated for in July 2012 and, as a result, a person who does what my colleagues and I do is designated a criminal and a terrorist and charged as such. Hundreds of attacks on hospitals across Syria have led to a policy of building underground hospitals to provide protection from bombing. It is a testimony to a country that has not been allowed to have a civil society and the depths of relationships and networks among Syrians that they have been able to create this informal and decentralised health system which has endeavoured to meet massive needs. The needs of Syria have gone from primarily being first world needs to encompassing the whole spectrum, including outbreaks of infectious diseases such as polio, cholera, typhoid and tuberculosis to chemical attacks, which we were not trained in medical school to treat.

The map shows that the attacks take place according to area and are directed at any opposition held area or any area that has been politically antipathetic. It shows the trajectory of the attacks during they years, although it is a little difficult to see this. The slide features an analysis of attacks on hospitals since 2012. It shows intentionality and that attacks are continuous and systematic. The only time they stop is when the hospital has been destroyed and no longer needs to be attacked.

Ghouta was besieged shortly after the chemical massacre of August 2013 which was highly visible to the eyes of the world. Who can forget the images of the naked, limp bodies of recently killed children? A siege is invisible. Irish people are familiar with starvation as a weapon of war and the withholding of food and creation of famine as a political weapon. This practice was imposed on Ghouta shortly after the chemical massacre. The second picture which was taken two years ago shows my colleagues in Ghouta. They were very tired at the time and their message was to stop the killing of civilians. At the end of last year the co-ordinates of the hospitals were published to show the government where they were located. That the government subsequently bombed these hospitals shows that the destruction of hospitals in full view has been a deliberate and intentional policy. The next picture shows a patient who died in a hospital in Ghouta.

Last week the widow of one of my great colleagues called me to say Kafr Zita hospital in Hama was being targeted again. The hospital has been bombed hundreds of times and forced to move many times. Unfortunately, when the Russians entered the conflict with much better weapons than the Syrian forces, they were able to destroy hospitals much more quickly and, as members can see, their attacks are highly effective.

Members will recall the Khan Sheikhoun chemical massacre of this time last year. Khan Sheikhoun is an entirely civilian area. Government forces first dropped barrel bombs on it. People's response to barrel bombing is to take cover underground in basements and caves because this offers the best protection. Shortly afterwards, there was a sarin attack. Chemicals sink into basements and caves because they are heavier than air. Government forces first put people in a position of maximum vulnerability in order that they would then suffer horrendously. People did not want to go to hospital because they knew that they would be targeted. However, sarin does not wear off and survivors of the attack had to go to hospital. The Russians were able to track their movements, discover hospitals that had not been destroyed and target them immediately as people arrived.

Last month, in Hamouria and Douma in eastern Ghouta, government forces dropped chemicals to force people who had been living underground for weeks in an effort to protect themselves from the dedicated barrel bombs and missiles to go back on to the streets again.

They dropped chemicals to force them into the streets where they were then gunned down by machine guns in helicopters. As someone who has worked in many wars, I have never seen such brutality and obscenity. The egregious manipulation and exploitation of the aid response means that the generosity of the Irish, which is renowned, is contributing towards profiteering by the Syrian Government, the same people who are responsible for the crisis, which must be addressed. Another example can demonstrate some of the ways in which Syrian aid in the hands of the military is corrupted and misused. I would also like to provide the opportunity for questions.