Medics working in the chaos of Syria’s civil war are in constant danger from shells, gunfire and bombs – but they also fear arrest and death for just doing their job, writes doctor Saleyha Ahsan.
There are few things more shocking than the idea of doctors tending to the sick and injured while also under attack themselves.
An open letter published by the Lancet last week, signed by 55 prominent doctors from 25 different countries, outlines the deliberate targeting of medical personnel and facilities without respect for their professional neutrality.
Dr Omar Arnous, 33, was arrested in Damascus on 6 October 2012 after he ignored warnings from government forces to stop treating the war-wounded in rural Damascus. He remains in detention, in an unknown location.
Further examples have been published by the UN’s commission of inquiry on the Syrian Arab Republic, led by its Brazilian chairman, Paulo Pinheiro. After collecting testimonies from eye-witnesses and survivors since 2011, the report describes how doctors in Damascus were “forcibly disappeared” and tortured by regime security services after disobeying orders to deny treatment to the war wounded perceived to be opposition supporters.
A UN report describes how doctors in Damascus were ‘forcibly disappeared’ and tortured by regime security services.
There are examples also of anti-government forces activity which resulted in hospital damage and harm to medical personnel, particularly in cross-fire incidents.
In Homs, the Bab Sbaa national hospital was raided so frequently by regime forces that a nurse describes how “at one point there were no more doctors left in the hospital”. Even more disturbing are accounts of extra-judicial executions, including those of three medics working in Aleppo’s opposition-affiliated Al Zarzou hospital, whose burned bodies were found three days after their arrest.
Read more: the agony of Aleppo's children
A British medical volunteer, Dr Isa Abdur Rahman, 26, was killed in May this year while working in a field hospital in Idlib. He ran out of the hospital to retrieve casualties and was hit by the second waiting strike – a recurrent tactic of hitting healthcare workers as they enter an area following an airstrike.
The Lancet letter quotes the Violations Documentation Centre stating that 469 health workers are currently in detention. Unsurprisingly, 15,000 doctors have fled the country, leaving a significant shortfall in manpower and thus rendering the delivery of a satisfactory healthcare service impossible.
Being hit by a device dropped from a fighter jet leaves no chance of survival, no attempt to negotiate or to even fight back. Nothing.
I have recently returned from north Syria working with NGO Hand in Hand for Syria, and filmed for BBC Panorama, integrated into one of the most challenging medical environments I have ever worked in.
In the aftermath of the Ghouta chemical weapons strike, we checked dwindling atropine supplies and thought through mass casualty decontamination plans. There was an appreciation amongst staff that Assad’s regime was willing to use whatever force deemed necessary against them as they continued their work at a hospital that accepted wounded fighters.
Chemical weapons will be “made safe” – but what about other lethal weapons used by the Syrian regime in civilian urban areas? Their impact is that much more significant when coupled with poor access to adequate healthcare facilities.
Earlier this month we found ourselves in the middle of a mass casualty situation when a nearby school was hit by a napalm-like bomb. Thirty students were severely burned, three of them fatally on the spot. The students had been going to the private Iqraa Institute to supplement their fractured education as a consequence of the war.
Eye-witnesses included eight-year-old Sara, who we met two days after the attack, on a visit to the burnt-out remains of the school. Her hair was roughly cut into a short bob and she seemed self-conscious. She told us her hair had caught fire that day and had to be cut.
Eight-year-old Sara had her hair roughtly cut into a short bob. She told us her hair had caught fire that day and had to be cut.
I was so grateful she was not one among the terribly burned patients I had cared for. The impact on her psychologically may last longer than the time it takes for her hair to grow back.
The Lancet letter, which quotes a World Health Organisation report that 37 per cent of Syrian hospitals have been destroyed, prompted support via Twitter from both David Cameron and William Hague, with pledges to raise this issue at the UN General Assembly this week.
The timing for this is chillingly significant, as I receive news that a hospital I had earlier transferred a gunshot patient to was hit by an airstrike last week, killing six – one of them a doctor. A family living next door had been digging a bunker because of the persistent hits.
“We are afraid from the sky,” said a nurse, and I could well believe it. Being hit by a device dropped from a fighter jet leaves no chance of survival, no attempt to negotiate or to even fight back. Nothing.
As the international community contemplates diplomacy to secure a safe humanitarian corridor, the Syrian medics at our hospital continue as before. We slept fully clothed in our day clothes, prepared to evacuate in the middle of the night should there be an airstrike. Female doctors left their headscarves in place. Three weeks ago, a missile hit just outside the perimeter of the hospital killing one.
The UN report describes intentional attacks against hospitals as a war crime, but at the moment that makes little difference to those in the direct line of fire. Healthcare workers and the injured are protected entities within international humanitarian law but in Syria they are deemed high-value targets.
Saleyha Ahsan is a film-maker, freelance journalist and practising doctor