In Syria, doctors are dying before they can save lives

Health care is being hampered by those involved in the conflict because of the Assad regime’s willingness to target doctors and hospitals.

People in Syria have become proficient in gazing at the sky. It’s not clouds or stars they are looking out for but government fighter jets. One recent afternoon, we were standing outside a field hospital in northern Syria, close to an area captured by the Free Syrian Army. The momentary shimmer of silver as a wing caught the sun pinpointed a plane in the vast blue sky. A finger tracked it while the rest of us squinted into the sun. Up there, a pilot was looking for his target.
 
“It’s doing a wider circle so maybe it’s not coming for us,” one of the doctors explained. Nonetheless, we were hurried inside.
 
Crowds attract air strikes and so do hospitals. I have recently returned from working with the NGO Hand in Hand for Syria, as its work was being filmed for a BBC Panorama. It proved to be one of the most challenging medical environments I have ever worked in.
 
The Independent International Commission of Inquiry on Syria (ICIS) recently published a report that concluded that health care is being hampered by those involved in the conflict because of the Assad regime’s willingness to target doctors and hospitals. It described such practices as a “weapon of war”.
 
A hospital to which I had earlier transferred a gunshot patient was hit by an air strike in which six people were killed – one of them a doctor. Ali, a medical student working there, lived next door to the hospital. His family was building a bunker because of the persistent air strikes.
 
The ICIS report also contains harrowing accounts of torture taking place within medical facilities. It describes testimonies of alarming patient treatment, including children being subjected to torture that exploits pre-existing injuries at al-Mezzeh military hospital in Damascus.
 
An open letter published in the Lancet on 21 September, signed by 55 prominent doctors from 25 countries, outlines the “deliberate and systemic” targeting of medical personnel and facilities without respect for staff’s professional neutrality.
 
Dr Omar Arnous, who is 33, was arrested on 6 October 2012 after he ignored warnings from government forces to stop treating the war wounded in Rural Damascus province. He remains in detention, his exact whereabouts unknown.
 
The Lancet letter states that 469 health workers are being detained. Up to 15,000 doctors have fled the country, leaving a hugely reduced health-care infrastructure in place to deal with medical conditions that range from complex war trauma to deteriorating chronic illnesses.
 
The letter explains that 37 per cent of Syrian hospitals have been destroyed, and has prompted support via Twitter from both David Cameron and William Hague. Pledges have been made to raise the issue at the UN General Assembly.
 
A repeated tactic in Syria, breathtaking in its cruelty, is to target health-care workers as they enter an area following an air strike.
 
Dr Isa Abdur Rahman, a British medical volunteer working at a field hospital in Idlib province, was killed in May as he ran out of a hospital to retrieve casualties. He was hit by a second, waiting strike.
 
Chemical weapons are central to the intervention debate but other lethal weapons are being used by the regime in civilian urban areas.
 
A few weeks ago, a nearby school was hit by a napalm-like bomb causing mass casualties. Forty students were severely burned, three of them fatally.
 
I first came to Syria in December 2o12 to meet medical professionals working in defiance of the obstacles placed in front of them. A week before my arrival, a missile had hit outside the perimeter of our hospital, killing one person. After that, we slept fully clothed, prepared to evacuate in the middle of the night should there be another air strike.
 
Nine months later, the pressure of working in possibly the world’s most dangerous places for a doctor is taking its toll. Health-care workers and the injured are protected entities under international humanitarian law – but in Syria they are deemed highvalue targets.
 
As we tended to our burns patients, with limited resources and personnel, four members of staff collapsed and needed attention. Traumatised and exhausted, they run a high risk of burnout.
 
The ICIS report states that “government forces have abused the vulnerable, the wounded and the sick, exploiting their need for medical aid to further military aims”, and it describes intentional attacks against hospitals as a war crime.
 
But at the moment all that makes little difference to those in the direct line of fire.
 
Saleyha Ahsan is a practising accident and emergency doctor at a hospital in London
Smoke rises from buildings in Syria's eastern town of Deir Ezzor on August 13, 2013 following an airstrike by government forces. Image: Getty

This article first appeared in the 30 September 2013 issue of the New Statesman, The Tory Game of Thrones

Photo: Getty
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French voters face a choice: Thatcherism or fascism

Today's Morning Call. 

Francois Fillon has been handed the task of saving France from a Marine Le Pen presidency and, by extension, the European Union from collapse, after a landslide win over Alain Juppé in the second round of the centre-right Republican party primary, taking 67 per cent of the vote to Juppé's 33 per cent. 

What are his chances? With the left exhausted, divided and unpopular, it's highly likely that it will be Fillon who makes it into the second round of the contest (under the French system, unless one candidate secures more than half in the first round, the top two go to a run off). 

Le Pen is regarded as close-to-certain of winning the first round and is seen as highly likely to be defeated in the second. That the centre-right candidate looks - at least based on the polls - to be the most likely to make it into the top two alongside her puts Fillon in poll position if the polls are right.

As I explained in my profile of him, his path to victory relies on the French Left being willing to hold its nose and vote for Thatcherism - or, at least, as close as France gets to Thatcherism - in order to defeat fascism. It may be that the distinctly Anglo-Saxon whiff of his politics - "Thatcherite Victor vows sharp shock for France" is the Times splash - exerts too strong a smell for the left to ignore.

The triumph of Brexit in the United Kingdom and Donald Trump in the United States have the left and the centre nervous. The far right is sharing best practice and campaign technique across borders, boosting its chances. 

Of all forms of mistake, prophecy is the most avoidable, so I won't make one. However, there are a few factors that may lie in the way of Le Pen going the way of Trump and Brexit. Hostility towards the European project and white  racial reaction are both deeply woven into the culture and politics of the United Kingdom and the United States respectively. The similarities between Vote Leave and Trump are overstated, but both were fighting on home turf with the wind very much at their backs. 

While there's a wider discussion to be had about the French state's aggressive policy of secularism and diversity blindness and its culpability for the rise of Le Pen, as far as the coming contest is concerned, the unity of the centre against the extremes is just as much a part of French political culture as Euroscepticism is here in Britain. So it would be a far bigger scale of upheaval if Le Pen were to win, though it is still possible.

There is one other factor that Fillon may be able to rely on. He, like Le Pen, is very much a supporter of granting Vladimir Putin more breathing space and attempting to reset Russia's relationship with the West. He may face considerably less disruption from that quarter than the Democrats did in the United States. Still, his campaign would be wise to ensure they have two-step verification enabled.

A WING AND A PRAYER

Eleanor Mills bagged the first interview with the new PM in the Sunday Times, and it's widely reported in today's papers. Among the headlines: the challenge of navigating  Brexit keeps Theresa May "awake at night", but her Anglican faith helps her through. She also lifted the lid on Philip May's value round the home. Apparently he's great at accessorising. 

THE NEVERENDING STORY

John Kerr, Britain's most experienced European diplomat and crossbench peer, has said there is a "less than 50 per cent" chance that Britain will negotiate a new relationship with the EU in two years and that a transitional deal will have to be struck first, resulting in a "decade of uncertainty". The Guardian's Patrick Wintour has the story

TROUBLED WATERS OVER OIL

A cross-party coalition of MPs, including Caroline Lucas and David Lammy, are at war with their own pension fund: which is refusing to disclose if its investments include fossil fuels. Madison Marriage has the story in the FT

TRUMPED UP CHARGES?

The Ethics Council to George W Bush and Barack Obama say the Electoral College should refuse to make Donald Trump President, unless he sells his foreign businesses and puts his American ones in a genuine blind trust. Trump has said he plans for his children to run his businesses while he is in the Oval Office and has been involved in a series of stories of him discussing his overseas businesses with foreign politicians. The New York Times has detailed the extentof Trump's overseas interests. 

TODAY'S MORNING CALL...

...is brought to you by the City of London. Their policy and resources chairman Mark Boleat writes on Brexit and the City here.

CASTROFF

Fidel Castro died this weekend. If you're looking for a book on the region and its politics, I enjoyed Alex von Tunzelmann's Red Heat, which you can buy on Amazon or Hive.

BALLS OUT

Ed Balls was eliminated from Strictly Come Dancing last night, after finishing in the bottom two and being eliminated by the judges' vote.  Judge Rinder, the daytime TV star, progressed to the next round at his expense. 

AND NOW FOR SOMETHING COMPLETELY DIFFERENT

Helen reviews Glenda Jackson's King Lear.

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Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.