Syria – where medicine is a weapon of war

Doctors describe “intimidation, torture and the targeted killing of doctors… in retribution for treating the wounded”, writes the doctor and writer/filmmaker Saleyha Ahsan.

Hand in Hand for Syria, a UK-registered charity, says that 14 doctors were killed in November 2012 alone. The resultant lack of doctors in Free Syrian Army held areas and limited international humanitarian support are contributing to the UNHCR statistic of 60,000 dead since the revolution started in March 2011. One doctor in the IRC report described 36 doctors working in Aleppo, when previously they had 5,000.

Dr Rola, a British Syrian doctor working with HIH, is part of a growing Syrian medical network risking their lives to bring aid to the neglected areas. HIH was formed from within the Syrian diaspora a year ago in response to a deteriorating humanitarian crisis in the region.

We first met at a Royal Society of Medicine event in London early last year. I had been speaking about healthcare in Libya during the conflict. She remains frustrated at not being able to attract support from international agencies and funders, who had so willingly supported the Libyan uprising.

Rola spoke about a refugee camp in north Syria, swelling in numbers and in appalling conditions. Just before Christmas, I went with her to Atmeh to see for myself.

That’s why I do what I do, because you just can’t stand and watch. Dr Rola, Hand in Hand for Syria

White tents stretched as far as the eye could see. Three days of pouring rain had created a wet landscape of small lakes and tiny streams coursing in between tents. Barefoot children played in freezing muddy water. This is now home to 130,000 internally displaced Syrians, who had fled regime airstrikes on their villages. Many had nothing left to return to.

Rola greeted health workers at the medical centre, sited in a Portakabin, asking after a badly injured woman transferred to a Turkish hospital. She had lit a candle in her tent – there is no electricity. The tent caught light, quickly becoming a fireball. Her two children died in the blaze and she suffered 70 per cent burns. Stories like this are not uncommon.

The north is now in the hands of the Free Syrian Army but the risk from Assad’s airstrikes remains. We looked skywards at every rumble. And it is in such areas that there is a marked absence of UN and international humanitarian agencies. They aren’t here because they lack authorisation from Damascus to provide cross-border assistance in FSA areas, such as Atmeh.

Aiding resentment

Fabrice Weissman, Medecin Sans Frontier’s operations advisor explains in an article featuring in Le Monde last week that international aid is being distributed only to government-held areas, with agencies coordinating through the Syrian Arab Red Crescent Society. For those suffering as a consequence, this practice is causing great resentment towards the international community.

Rola articulates the sentiment. “The world will look back at this in years to come and all who just stood and watched will have blood on their hands. That’s why I do what I do, because you can’t just stand and watch.”

Three weeks later and we are back in London. She has just got off the phone to a fellow Syrian doctor in Damascus, who had described a lack of awareness of essential needs from aid agencies in their dealings with him.

“I am struck with an overwhelming sense of anger…at the humiliation the Syrian people are suffering, at how so very cheap our lives seem to be to almost everybody,” she says.

MSF has, however, worked in secret locations since last summer but not on a permanent basis, operating very much under the radar because of the high security risks involved. Being a doctor in Syria is now considered a high-risk occupation and many have left the country. Medicine has become a weapon of war.

Constant struggle

“We can’t take a day off because there is so much to do and we all feel a personal responsibility to keep going and a huge amount of guilt if we rest.” Rola is the accidental humanitarian worker.

Sixteen months ago, she was a specialist registrar working in an NHS teaching hospital, building a career. Now she has been thrust into the world of medical relief and coordinating aid delivery in a conflict zone. The learning curve has been steep.

“We are doing the work of governments, of ministries, we are overwhelmed.” The bulk of the humanitarian work in areas outwith Assad’s control is being done by grassroots NGOs, like HIH who remain largely unsupported by the wealthier, larger INGOs and funders, like the Department for International Development.

HIH have supported obstetrician Dr Aisha, secretly working from home, in Atmeh. For three months she was been delivering babies at home in the dark on the kitchen table. They are building a delivery suite under her house.

We had to move on from crying in front of the television. Dr Rola, Hand in Hand for Syria

In the early days of the revolution, Rola, like many others had watched events on the news. “We had to move on from crying in front of the television.”

The crisis has had a very personal impact on Rola’s family. A number of her relatives have been killed and many injured. Her father, also a doctor, helped coordinate medical logistics from inside Syria in the early days of the uprising.

Despite her anger, she is persistent. Rola knows an alliance between grassroots NGOs, who have access on the ground, and international organisations, with their expertise and money, has to emerge if lives are to be saved.

She is not alone in this sentiment. MSF’s Weissman says that “traditional international aid would be more than welcome to support the efforts of this local [NGO] network.” He appreciates that it will need diplomatic courage from UN agencies, the European Union, the US, Russia and China, to achieve this.

The IRC recommends that humanitarian aid should increase in order to limit a regional humanitarian crisis that could last years. Until then there exists sense of abandonment felt by Rola and fellow Syrians embroiled in this bloody uprising.