Saturday, 4 June 2016

Syrian Conflict: A War Against Health Service

Since the beginning of the of the Syria civil war in 2011, 326 medical facilities have being bombed and around 670 medical personnel have been killed. Despite the International Rules of War, which clear states that medical personnel, units and transports must be respected and protected in all circumstances, attacks against hospitals have become well spread by the Regime and its allies in Syria, leaving the status of collateral damage and assuming a position of strategy of war.



Even before the war, great part of the Syrian people already had difficulty with access to Health service. The inadequate usage of capacity, uneven distribute of human resources, overall inequity, lack of skilled staff and leadership and qualified nurses and allied health professionals conspired to turn improvements in the quality of the care into a challenge to the country.

With the crises, great part of the already small amount of well qualified Syrians, manage to escape the war, settling as refugees in nearby countries, among them, engineers, teachers, and health professionals. Due to the war and especially the airstrikes, vital infrastructure inside Syria has been compromised or destroyed, resulting in a lack of energy, food and water sources, sanitation service and shelter.

The Situation Inside Hospitals

"The most basic things are not available – anaesthetics, painkillers, medication for chronic diseases such as heart disease, diabetes and high blood pressure. We have no anti-inflammatory injections, cough syrups or anti-diarrhoea medicine. We replaced medical plasters with paper. We have to use items many times without sterilization. We are not able to store blood – a suitable donor has to be found during an operation. When things do become available the prices are high and they are usually close to their expiry date and have lost their effectiveness by the time we get them.”- Hanan, nurse in a hospital in Homs.

Due to the lack of professionals and resources, the access to health care has become even more restricted and the lacks of maintenance of the medical equipments and shortages of drugs and medical supplies have deeply affected the quality of the service.

Stock of medication has already exhausted and with the drug production and distribution facilities inside Syria shutting down, the only way to bring supplies into the country is through the unofficial routes, coming from neighboring countries.

With the difficulty to find even basic medication, displaced families are not being able to get children vaccinated, resulting in many of them suffering from measles, meningitis and polio (once eradicated in 2014, it is again on the rise), diseases that can easily be prevented if the medication is available.

With the destruction of power plants, power cuts are frequent forcing hospitals to run on generator power, but obtaining fuel is difficult. In some cases, doctors are forced to operate without electricity.

Although many Syrians are willing to donate blood, due to the lack of power in the region, most hospitals are not equipped with refrigerators turning it impossible to keep a blood bag bank.

In consequence of the situation faced, the number of routine operations has been diminished and patients with chronic diseases were forced to interrupt their treatment to give room to more urgent cases as those with life-threatening injuries receive higher priority.

Targeting Hospitals

Despite the rules of International Law ensuring security of hospitals, the same is not noticed in practice, hospitals are being deliberately target since the beginning of the conflict in Syria. It is estimated that around 326 medical facilities have being bombed so far, mainly in rebel held areas.

Russia alone had already bombed 24 hospitals in the past eight months in the provinces of Aleppo, Idlib, Latakia and Daraa, including one run by Doctors Without Borders in Maarat al-Numan, Idlib. This week, once again a hospital was target by Russia in Idlib.

The doctor who treats my enemy must be my enemy

Far from a simple mistake, bombing hospitals had become a strategy of war since the Syrian government considers hospitals running in rebel held areas as legitimate military facilities under a counter-terrorism law but due to the lack of paper trail, it is just hard to produce any proof that Syrian and Russian governments are ordering their pilots to target hospitals.

If attacking hospitals and clinics was not enough, “double tapping” is also becoming a common strategy used by the Regime and its allies, which consist in bombing a hospital and bombing it for the second time after first responders have arrived on the scene to take care of people injured in the first attack.
Al Quds, hospital supported by Doctors Without Borders in Aleppo, targeted in airstrikes
All these evidences don’t leave room for doubts whether these attacks are intentional or not. It is clear that they are trying to kill the maximum number of hospital workers and patients as possible.

Bombing hospitals and killing its personnel decrease the capability of the health service in areas held by the opposition, intimidating doctors and patients, leaving the population with a feeling of vulnerability and giving them a sense of insecurity under opposition protection, forcing them to flee the area.

Undiscriminating Attack Against Doctors

Kill a doctor and you kill thousands

Decades ago, humanitarian groups were viewed as impartial, enjoying a certain level of protection even in war zones, it is not the case anymore. The Syria conflict doesn’t represent a threat to civilians only but also to doctors and all hospital workers, with them being target repeatedly.

In April, Mohammed al-Kos the only remained doctor in the besieged city of Zabadani was killed by a sniper alongside a member of a rescue team. In the same month, al-Quds a hospital supported by Doctors Without Border in the city of Aleppo was also bombed to the ground, killing Dr. Mohammed Wassim Moaz one of the few pediatrician and the last qualified who continued to work in the city. Three days after the attack in al Quds hospital, Al-Marjah Primary Healthcare Center, a pediatric and gynaecological clinic was also attacked, killing two doctors.

Doctors also risk being labeled as “enemies of the regime” and arrested for treating the injured in areas not held by the regime, cases of doctors being imprisoned and tortured to death were reported since the beginning of the revolution.

Dr Abbas Khan for example, a British orthopaedic surgeon who traveled to Syria to treat civilians was arrested and killed in 2013 in an “unknown prison or place of detention” in Damascus without any legal justification.

Rebuilding is an Act of Resistance

In a desperate attempt to continue operating, hospitals had been set up in homes, farms, caves and even underground. Most hospitals being rebuilt in Syria is now fortified, bunkers practically, and part of its activities happens in the basements of the actual hospitals.

Despite the danger and risks, there is no other choice but to build the hospitals back, knowing that they will be probably hit a second time, or even a third one. As the rest of the World watches these international crimes against humanity from the sidelines, without any government support, the Syrian people are left to rebuild hospitals out of donations.

As long as the Regime bombs hospitals to the ground, Syrian people will continue to rebuild them as it is not only a humanitarian necessity but an act of Resistance, reminding the World of the nonviolent activism that gave voice to the Syrian Revolution in its beginning, and that will continue to exist as long as the Syrian people resist.

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