This investigation reveals the hardships faced by cleaning ladies in hospitals across Damascus. Many work more than eight hours a day without social security registration or employment contracts, amid weak oversight by the Syrian Ministry of Social Affairs and Labor (MOSAL) of companies contracted by hospitals.
It also reveals how three private companies (Al-Assi, Al-Arour, and Alfamed) have avoided providing insurance for 85 cleaners working in four government hospitals in Damascus: Al-Mujtahid (Damascus) Hospital, Kidney Hospital, National (Al-Watani) University Hospital, and Al-Mouwasat University Hospital.
At eight in the morning, Aisha wakes with a pale face, a bent back, and a body weakened by cancer, after undergoing a double mastectomy. Yet she heads to work cleaning the outpatient clinic bathrooms, despite her overwhelming exhaustion. In her swollen hand, she grips a mop soaked in chlorine without gloves to protect her skin or a mask to shield her from the fumes.
Aisha lives in a small room inside the hospital’s kindergarten a cramped space that provides the bare minimum of shelter. Each day, she continues working in the very place she says she loves, with everything it contains.
After more than twenty years on the job, Aisha has no formal employment contract, no health insurance, and does not even receive the minimum wage an amount that barely covers the basic cost of living.
85 female workers distributed across 4 public hospitals
Systematic Evasion
Aisha, now completing her twentieth year working as a cleaner, knows she is entitled to be registered with social security. She has previously worked for several companies and is currently employed by Al-Arour. She sums up her situation succinctly: “I know I’m supposed to be registered, but I’m weak.”
Like dozens of other cleaners in Damascus hospitals, Aisha works for private cleaning companies, without social security registration or health insurance to protect their rights in case of illness or retirement. As a result, they are left with no safety net, whether at the first sign of sickness or on their last day of work.
The women workers’ accounts contradict statements by Hayyan Assi, executive director of Al-Assi Company, who said: “Every month we submit a list of daily workers to the hospital. Although the workers do not sign contracts, we guarantee their social security rights for committed workers.”
The executive director later contradicted his own statement in a right-of-reply sent to the investigation, explaining: “At some sites, contracting follows a daily billing system, which does not fall under fixed annual contracts requiring traditional monthly payroll records. Therefore, the administrative procedures differ from contracts that require monthly reporting.”
In contrast, Radwan Saleh, project manager at Al-Arour Company at Al-Mouwasat University Hospital, acknowledged that not all of the company's workers are registered with social security. “We only register workers who have worked with the company for a certain period even if they are transferred between hospitals,” he said. “Some workers refuse registration so that deductions are not taken from their monthly salary.”
This admission comes despite Al-Arour being a newly established company that began operating in 2025, according to Saleh.
To verify the employment status of the eight women interviewed for this investigation, a review of social security and labour records found no social insurance registration for Alfamed the company employing three of the women workers even though it is officially registered with the Ministry of Internal Trade and Consumer Protection under registration number 100010.
Records also show that Al-Assi’s insurance contract expired onNovember 15, 2025. The contract for Al-Arour registered with the Ministry of Trade under number 103248 was recorded on December 9, 2025, shortly after Al-Assi’s contract had ended.
Syrian Insurance Law
Syrian Labour Law No. 17 of 2010, Article 47, and the Social Insurance Law of 1959, Article 16, require employers to register all workers with social insurance.
Suha Dioub, Director of Insurance Affairs at the General Organization for Social Insurance, says these companies operate under a contracting system that requires them to submit monthly lists of workers for each hospital. She notes, however, that none of these companies has submitted such lists for the hospitals where they operate.
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Documents for social insurance records related to a cleaning company
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Job Classification Loopholes
Companies list Aisha and her colleagues as “daily workers” a label that may appear merely administrative but conflicts with Syrian labour law. Lawyer Alaa Shaheen explains: “Daily work means being paid each day and falls within the framework of temporary employment under the labour code.”
However, the problem, according to Shaheen, lies in the absence of clear legal provisions regulating this category, creating a grey area that can be exploited at workers’ expense. She notes that paying wages monthly rather than daily changes the legal classification of the employment relationship: in practice, workers move from being classified as daily labourers to permanent employees, which carries legal obligations employers cannot avoid.
Aisha earns a monthly wage of 700,000 Syrian pounds (about $60) for eight hours of work each day, sometimes with extra evening shifts. “First of all, I trust in God, and I’m not afraid of anyone not a boss or a supervisor. I have no one: no father, no mother, no child,” she says.
Some workers earn one million Syrian pounds a month (around $86) for working twelve hours a day, roughly one and a half shifts. This violates Article 111 of Syrian Labour Law, which stipulates that overtime must be paid at the hourly rate plus 25 percent during the day and 50 percent at night.
Yet the workers interviewed said they receive no additional pay for overtime. Al-Assi and Al-Arour companies, meanwhile, report that wages amount to 750,000 Syrian pounds. The Al-Arour project manager clarified that this 750,000-pound salary covers official working hours from 8 am to 3 pm, while overtime is calculated separately.
Suha Dioub confirmed that some companies commit violations, including registering workers with salaries lower than their actual wages to reduce insurance contributions, or failing to register them altogether even though the employer’s share of contributions amounts to 17 percent of the contract value paid by the hospital.
Aisha laughs but her laugh reveals more than it hides. Years of neglect have left her teeth badly decayed, and treatment would cost several times her monthly salary. Deep lines crease her face, carrying years of silence. Behind that smile lies a long story of exhaustion, with details yet untold. “When the regime fell,” Aisha says, “I worked two months for free at the kindergarten. I refused to go back to my family.”
Even returning to her family in the countryside about an hour from the capital would be an additional expense she cannot afford. Transportation costs around 30,000 Syrian pounds per day, roughly 900,000 pounds per month (about $80) around $20 more than her salary. Thus, staying is her only option not because it is easier, but because it is cheaper.
According to World Bank data for 2025, the poverty line is set at three dollars per day, which means that the 85 cleaners fall below it. Based on a monthly salary of 700,000 Syrian pounds, the daily income amounts to about 23,000 pounds roughly $1.9 well below the officially recognized minimum, effectively placing them under the extreme poverty line.
Occupational Safety Absent in Plain Sight
Aisha, who has breast cancer, begins her day with the smell of chlorine. She mixes disinfectant with chlorine in a large bucket, then bends down to lift it her back arching further than it can bear. She takes a breath and whispers, “God help me,” before carrying the container toward the bathrooms.
Aisha refuses to wear the protective apron provided for the job. “I work to live, and God is my protector,” she says. “I had a mastectomy and underwent chemotherapy. I used to wear gloves and a mask because I have allergies, but I still work with chlorine. God gives me strength. The apron is too short and I’m an older woman.”
Despite the risks surrounding Aisha’s work, the tasks carried out by some of her colleagues in operating rooms appear even more dangerous. They come into direct contact with surgical instruments, needles, and used gauze, and are required to collect garbage bags inside the operating theatres and remove coverings used during surgery. They perform this work wearing only light, ordinary gloves and simple clothing similar to surgical scrubs, along with a basic, unpadded mask.
Dr. Mohammad Hashem, Director of Occupational Health and Safety at the General Organization for Social Insurance, notes that cancer patients are treated in accordance with Decree No. 346 of 2006 on hazardous and arduous occupations. He explains that if a worker’s cancer is proven to be linked to the nature of their job, the worker is granted medical dismissal while retaining their social insurance rights. Accordingly, if Aisha’s condition were classified under the decree as “occupational cancer,” she should be granted medical dismissal that preserves her insurance entitlements and ensures her a dignified livelihood.
Regarding chronic illnesses such as thalassemia, rheumatism, and allergies, Dr. Hashem explains: “An employer may hire people with chronic conditions such as thalassemia or rheumatism, provided that the job does not conflict with their medical condition. However, the employer is not responsible if the worker had the illness prior to starting the job.”
None of the eight women interviewed was asked to provide medical documents to the cleaning companies to verify their health status a violation of Social Insurance Law No. 92 of 1959, which requires employers across all sectors to conduct periodic medical examinations for workers exposed to occupational diseases, to ensure that the job does not conflict with their medical condition.
Dr. Hashem acknowledged that during inspection tours of hospitals,
women workers were found performing their cleaning duties without
even the minimum occupational safety equipment violating
International Labour Organization Convention No. 155 of 1981,
which Syria ratified on 19 May 2009.
Article 16 of the convention states that employers must provide
sufficient protective clothing and equipment to minimize, as much
as possible, the risk of accidents or harmful health effects. In
practice, cleaners are deprived of basic protective gear, such as
thick masks and safety goggles suitable for the hazards of working
with chlorine.
Al-Assi Company confirmed that its workers receive a uniform, while placing the responsibility for providing medical protective supplies such as specialized gloves, masks, and disinfectants on the hospital administration. However, this arrangement violates Article 239 of Syrian Labour Law No. 17 of 2010, which requires employers to provide the necessary clothing and tools for their workers.
Al-Arour Company responded briefly: “Our institution complies with supplying protective equipment according to the contractual obligations and required standards. We will verify on-site the distribution and usage mechanisms at Al-Mouwasat University Hospital.”
Periodic Inspection Plans
Responding to questions addressed to the Syrian Ministry of Social Affairs and Labour within the framework of the right of reply about inspection mechanisms for companies operating in hospital cleaning services, Haifa Ismail, Director of the Labour Inspection Directorate, explained that the directorate carries out periodic inspection plans every three months. These cover various public, private, and joint sectors, as well as multiple responsibilities, including health, food, industry, and education.
Regarding how these plans are prepared, Haifa explained: “Plans are jointly developed by the inspection departments within the Social Affairs directorates across all governorates, alongside labour and social insurance inspectors, as well as representatives of employers. They are then submitted to the ministry for review and approval.”
She added that another type of visit involves labour and social insurance inspectors accompanied by a representative from the General Federation of Trade Unions and another from the employers. These visits may be triggered by complaints, follow-ups on previous warnings, or violations related to work licensing, and can ultimately result in a company’s deregistration or closure. Some complaints require on-site inspections, while others can be resolved through administrative mediation within the inspection offices.
Ismail acknowledged that labour inspectors routinely document several types of violations during their inspection rounds: failure to register workers in social security, absence of employment contracts or individual worker files containing personal data, and non-compliance with occupational health and safety measures particularly the failure to provide protective clothing.
She also noted that Circular No. 4 of 2025 temporarily suspended inspection campaigns to give private institutions time to regularize their situation and address violations while the inspection system was reorganized. She added that inspection campaigns resumed in the final quarter of 2025, including field visits across multiple provinces, accompanied by awareness sessions explaining the law to both workers and employers.
At the time of publication, cleaners continue to work in hospitals in direct contact with hazards without occupational safety guarantees or insurance rights to protect them.
Aisha’s story is repeated across many parts of Syria: cleaners survive on wages that barely buy a loaf of bread or less for those supporting large families. Faced with the risk of losing their jobs, many ignore their rights despite the dangers.
The images used in this investigation were generated using artificial intelligence (AI)
This investigation was produced as part of Nawa Project, a partnership between ARIJ and Women Who Won the War.
