The Archivist: Critical Analysis of the Islamic State’s Health Department

NOTE: For prior parts in The Archivist series you can view an archive of it all here. And for his older series see: Musings of an Iraqi Brasenostril on Jihad.

Critical Analysis of the Islamic State’s Health Department
By Aymenn Jawad Al-Tamimi
 
The Islamic State’s [IS] health department (Diwan al-Siha) is probably most familiar to UK readers, who will recognize the ‘ISHS’ (Islamic State Health Service) branding as a spin-off of the ‘NHS’ (National Health Service). The ISHS was promoted in an official Raqqa province video featuring two muhajireen medical personnel, the first of whom (originally from Australia) urges Muslim medical personnel from around the world to join IS, saying: “Muslims here are really suffering from not necessarily a lack of equipment or medicine but mainly a lack of qualified medical care.” Though the video acknowledges lack of personnel, documents not officially released by IS also show that shortages of medical supplies are a significant problem. Of all departments, the IS Diwan al-Siha is arguably the least impressive, afflicted as it is by brain drain, deficiencies in supplies and lack of innovation despite the influx of muhajireen.
Lack of innovation is a matter I have touched upon before, illustrating as a case-in-point that vaccination schedules in Syria are no different from the prior status quo. In Mosul, one will find that the department of forensic medicine, which issued death certificates in the days of government control, still exists, only now it seems to be issuing death certificates under IS rule, most likely in particular in the name of its judiciary department known as the Diwan al-Qada (wa al-Mazalim). Salaries of health workers in Ninawa also continue to be paid by the Iraqi central government. This above all represents parasitic co-optation.
On the subject of manpower, numerous documents point to brain drain as the main cause of lack of qualified medical staff. For instance, in May 2015, the Diwan al-Siha, General Supervisory Committee (which can issue general directives to IS provinces and bureaucratic departments) and the Diwan al-Qada in Wilayat Ninawa issued a joint statement giving an ultimatum for doctors, pharmacists, medical and nursing professors and other health staff who had fled to return within 30 days or face confiscation of their homes as real estate under the Diwan al-Qada. The statement justifies this ultimatum on the grounds that many means of persuasion had been tried but to no avail.
It should be noted that this was not the first ultimatum issued in response to the medical brain drain problem. A similar threat of confiscation of property was issued in October 2014 by the Diwan al-Qada targeting Mosul University medical staff, board administrators and students who had left for Baghdad and Kurdistan to complete their studies, unless they returned within 10 days.
IslamicStateHealthDepartment
Despite these ultimatums, the dearth of medical personnel continues. On 19 August 2015, the pro-IS Facebook page “News Agency from Mosul” posted an obituary for the prominent dentist Dr. Samir Abdullah (photo above), who was reportedly killed in “international coalition bombing” on Mosul. The page added: “This man was one of the noble ones of Mosul who refused to leave Mosul, unlike others who abandoned their people in their time of need, fearing death, hunger or anything else…God willing on the Day of Judgment we will dispute with every doctor, engineer or even student who left Mosul in the time when solidarity and standing together in the path of turning the wheel of life were needed, but praise and thanks be to God we do not need those who abandoned us as they need us.”
On a more general level, some IS fatwas issued by the Diwan al-Eftaa’ wa al-Buhuth but not released in IS media outlets point to a shortage of female doctors. For example, fatwa no. 43 posits the following question: “What is the ruling on the presence of male doctors for women’s illnesses given that there are female doctors specialising in women’s illnesses but are few in number?” The response stipulates that the “principle is that the women should go to a female doctor to treat her and she should make an effort to look for that,” only resorting to a male doctor by necessity. In this case, part of the problem here is IS’ dogmatic insistence on preventing what it sees as sinful gender mixing in public.
Fatwa no. 37 appears to acknowledge that the quality of medical service inside IS territory may not quite match that of territories outside its rule, as travel to ‘Dar al-Kufr’ (the abode of disbelief) is permitted if a medical condition cannot be treated inside ‘Dar al-Islam’ (the abode of Islam: i.e. the Caliphate), responding to a particular question about whether one could travel to “areas of the [Assad] regime out of need.” Similarly in Mosul, a condition under which travel to non-IS areas is allowed is a certified document from the Diwan al-Siha that one’s illness cannot be treated inside Wilayat Ninawa (which, of all IS-held areas, will have the most developed health infrastructure).
Undoubtedly in response to the exodus of medical personnel and students and shortages, IS has been keen to encourage new cohorts of medical students, thus the opening of a medical college in Raqqa city, trying to elevate IS’ de facto Syrian capital to the same level as its de facto Iraqi capital of Mosul whose university already had a medical college. This month I have also found a statement from the Diwan al-Siha’s “Medical Sciences University” (this appears to be a new name for the medical college of Mosul University) encouraging applications from graduated high school students. Statement and full translation below.
Specimen A

IslamicStateHealthDepartment2
“Diwan al-Siha
Medical Sciences University
Caliphate on the Prophetic Methodology
No. 766
Date: 1 Dhu al-Q’ida 1436 AH [16 August 2015]

Announcement
The Central Acceptances Committee announces the opening of the door if application for preparatory study graduates in all its divisions to the universities of the Islamic State. Let it be known that application begins on 1 September 2015 until 10 September 2015, and the place of application will be in Mosul University/Students Centre. So students wishing to apply should hurry to do so.
And may God reward you best.
Islamic State
Medical Sciences University
Head of the University

Copy to:
– Diwan al-‘Ilam [Media Department]: Idha’at al-Bayan [the radio station]- to go ahead to broadcast
– Diwan al-Da’wa wa al-Masajid: Wilayat Centres- to go ahead to broadcast
– Diwan al-Ta’aleem: Wilayat Centres
Problems in equipment and medical provisions foremost come to light in documents showing the Diwan al-Siha’s attempts to introduce price controls on pharmaceutical goods and operations. For instance, in October 2014, price limits were introduced for childbirth operations in Deir az-Zor province, fixed at 15,000 Syrian pounds for Caesarean operations and 10,500 Syrian pounds for normal operations, with the child to be kept in hospital for 12 hours after birth. These regulations were introduced, according to the statement, on account of exploitation and to assist the poor.
In the same month, the Diwan al-Siha in the Mosul area instated regulations on profits pharmacies could make in selling goods, in light of increases in prices for drugs to treat chronic illnesses. The following month, controls on profits of pharmacies in Deir az-Zor province were imposed so as not to exceed 20%. Quality and central control also seems to be an issue as IS has sought to require pharmacies to obtain licenses to operate, stipulating further that medicines must not be exposed to sunlight and the requirement of a fridge to store certain medicines.
As with the issue of medical personnel, part of the problem here appears to be IS’ own making. In May 2015, a

The Archivist: 26 Unseen Islamic State Administrative Documents: Overview, Translation & Analysis

NOTE: For prior parts in The Archivist series you can view an archive of it all here. And for his older series see: Musings of an Iraqi Brasenostril on Jihad.

26 Unseen Islamic State Administrative Documents: Overview, Translation & Analysis
By Aymenn Jawad Al-Tamimi
Introduction
Of all jihadist groups, the Islamic State [IS] by far has presented the most comprehensive, ostensible bureaucratic structure as part of its claimed state project, embodied foremost in a system of diwans (government departments) since the declaration of the Caliphate in June 2014. The best means to analyse the nuances of this set-up is through looking at documents issued by these departments that have not been officially released in IS’ media outlets.
Here, numerous shades emerge that go beyond simple statements such as ‘IS provides services.’ For example, one pattern in the documents from the IS takeover of parts of Iraq is that the Diwan al-Khidamat (services department) in a given city is normally composed of the same staff, workers and offices of already existing government service offices in that city. It is simply that the personnel have been compelled to return to work under threat of confiscation of their homes. For a more in-depth survey, see my recent paper in the academic journal Perspectives on Terrorism primarily based on my current archive of IS documents and other collections of mine currently totalling over 200 specimens.
This post presents 26 further documents not previously in the public domain, obtained from a businessman from a town in northeast Aleppo province that is currently a stronghold of IS. For reasons that are self-evident, this person’s exact location and identity cannot be revealed, but it may be added that this person does business across IS territory, including regular trips to Mosul and Anbar. Though not necessarily a hardline, ideological supporter of IS, he nonetheless finds the security environment amenable to doing business: a common advantage perceived by Syrians who make investments and conduct transactions in IS territory.
Islamic State vs. Jabhat al-Nusra Administration
Before proceeding to the selection of documents, one question worth pondering- first suggested to me by Aaron Zelin- is comparing the IS administration with that of Jabhat al-Nusra, Syria’s al-Qa’ida affiliate. To put it briefly, Jabhat al-Nusra’s administrative structures lack the same sense of comprehensiveness and consistency. Jabhat al-Nusra does not have the same level of contiguous territory and urban strongholds, and the extent of its presence varies considerably from one place to another. Further, Jabhat al-Nusra is not claiming yet to be a state.
The main Jabhat al-Nusra administrative bodies that can be identified are the Dar al-Qada (Judicial Body), the Maktab al-Da’wa wa al-Irshad (Da’wa and Guidance Office) and al-Idarat al-Aama lil-Khidamat (Public Administration for Services). Broadly speaking, the Dar al-Qada corresponds to IS’ Diwan al-Qada wa al-Mazalim and Diwan al-Hisba, dealing with legal matters such as real estate and enforcement of Shari’a justice (including harsher hudud punishments like stoning fornicators to death), while the Maktab al-Da’wa wa al-Irshad corresponds to IS’ Diwan al-Da’wa wa al-Masajid (Da’wa and Mosques department), and al-Idarat al-Aama lil-Khidamat to the Diwan al-Khidamat.
However, these bodies do not exist in every place where Jabhat al-Nusra has a presence, and sometimes functions are blurred. The Dar al-Qada can be clearly identified in Idlib towns controlled by Jabhat al-Nusra, such as Sarmada, Salqin and Darkush, but in at least one instance the Dar al-Qada seems to have assumed entered into the realm of provision of public services, with the undertaking of a project to reform the main road in Sarmada. Even so, evidence suggests that Jabhat al-Nusra continues to allow civilian local and service councils in Sarmada to operate and provide services such as fixing water pumping lines, contrasting with IS co-optation of such bodies in cities like Raqqa whereby they only have the Diwan al-Khidamat label now. More recently, as part of the Jaysh al-Fatah coalition that has driven the regime out of all major towns in Idlib province since the spring, Jabhat al-Nusra has agreed with the other factions in Jaysh al-Fatah on the formation of a judicial council that is supposed to be “independent in its decisions and rulings, with no right for any faction to intervene in it.” The council is also supposed to unify judiciary authority in all areas liberated at the hands of Jaysh al-Fatah. This development comes amid complaints from the Islamic Commission for the Administration of Liberated Areas (mainly linked to Ahrar al-Sham) that some members of Jabhat al-Nusra have attacked its branches in places like Kafr Nabl.
Moving toAleppo province, one will note the Dar al-Qada branch in Hureitan, which claims authority also over Kafr Hamra and Anadan. Here the Dar al-Qada is undoubtedly supported by the jihadi coalition Jabhat Ansar al-Din that has a presence in these towns (most notably the coalition’s main component Jaysh al-Muhajireen wa al-Ansar). Further up north in Azaz, the Jabhat al-Nusra presence has been limited to bases with control of one of the mosques in the town (the Mus’ab ibn Umair mosque), railing against the public school system in Azaz and offering alternative education for children.
Nevertheless, with talk of the establishment of a U.S.-Turkish safe zone stretching from Azaz to Jarabulus in the north Aleppo countryside, Jabhat al-Nusra has evacuated most of its bases in the Azaz area and is primarily operating as a small military force to provide limited reinforcements for the rebels fighting IS to the east of Azaz (these rebels being primarily the Levant Front and Ahrar al-Sham, with smaller contributions from mainly Levant Front break-offs like Thuwar al-Sham and Jaysh al-Mujahideen elements). These Jabhat al-Nusra members on the frontlines are mostly locals, while the remainder have already gone to Idlib province.
Thus it can be seen how much more complex the picture is with Jabhat al-Nusra administration. The bodies do not have a uniform presence and the group’s approach seems split between a more hardline approach embodied in the rise of the Dar al-Qada and the more traditional picture of Jabhat al-Nusra as a faction willing to work with others in administration. In 2013 what was then the Islamic State in Iraq and al-Sham (ISIS) indulged in the latter to a degree in the occasional issuing of joint statements for defensive projects and the like.
The Documents
Below, each document is translated and notes provided where applicable.
Specimen A: Activities of the services office, Manbij, Aleppo
JihadologyPostISDocuments
Manbij
Islamic State in Iraq and al-Sham
In the name of God, the Compassionate, the Merciful
By order of the wali [provincial governor] of Aleppo, the services office in the town of Manbij has placed more than 600 flags on all the entrances to the town and its surrounding. The office has also made the Manbij-Jarabulus road passable for traffic, and has opened a maintenance workshop for the sewage system in the eastern quarter, has planted trees on al-Imaan street, and has done maintenance work on the Dar al-Qada in the town. And all the expenses have been referred to the Diwan al-Wilaya.
And glory belongs to God, His Messenger and the believers but the hypocrites don’t know it.
Islamic State in Iraq and al-Sham
Abu [?] Al-Azadi
Wilayat Halab
Notes: Dating uncertain. The ‘Diwan al-Wilaya’ (Province Department) appears to be the same as the “General Administration” (al-Idarat al-Aama) for a given Islamic State province. A similar interchange of names can be observed in some documents regarding healthcare labelled ‘Diwan al-Siha’ (Health Department) and others labelled ‘al-Idarat al-Tibbiya’ (Medical Administration).
Specimen B: Prohibition on hoarding of goods, Yarmouk, Damascus
JihadologyPostISDocuments2
Islamic State
Wilayat Dimashq
Diwan al-Hisba
28 Rajab 1436 AH [17 May 2015]

In the name of God, the Compassionate, the Merciful
On