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

Hamzah al Zobi
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Meet the Syrians using education to escape the refugee camps

On the bus to university with Syrian refugees in Jordan. 

The bus to Zarqa University leaves Jordan’s largest refugee camp at 7am sharp. The journey is one of the day’s highlights for the Syrian students who ride this route - a chance to plan weekend get-togethers, bemoan heavy course loads and even enjoy the occasional school-bus style sing-along. It’s also their daily ticket out of Za’atari camp and a means of escaping the dreary realities of refugee life.

“We are the lucky ones. Most had to give up their dreams of higher education” says 19-year-old Reema Nasser Al Hamad, whose family fled to Jordan five years ago when bombs destroyed her home in Dara’a, Syria. She shudders to think of the alternatives: aimless days spent sitting in a crowded caravan, or early marriage. “After the war, students in Syria lost their cities, their opportunities and their futures, so many of the girls just married when they got here. There’s a huge difference between the lives of those who study and those who don’t.”

Despite missing two years of school, Reema (pictured below) was able to pass her exams before securing a Saudi-funded scholarship to study Pharmacy at Zaraq’ University. “In Syria, I’d planned to do medicine and be a doctor because I always had high grades. There are fewer choices for us here but I’m happy to be studying at all,” she says. Hamza al Zobi, who’s studying Pharmacy on an the EU-funded EDU-Syria programnme, says young Syrians are hungry to learn. “We all have friends and relatives who didn’t get this chance and we feel so upset for them. If they’re not well educated, how can they go back and do the right thing for our country?”

More than a quarter of 18-24 year olds in Syria were enrolled in higher education when the war broke out. “Based on data provided by UNHCR we assess that around 20,000 young Syrians in Jordan would qualify for vocational education and higher education,” says Job Arts, Programme Manager Education and Youth, EU Delegation to Jordan, which is supporting some 1800 Syrians and disadvantaged Jordanians on degree courses in Jordan.

“While the number of places for Syrian students to pursue their education has increased dramatically over the past few years, there are still many more interested students than spaces available for study,” says Sarah Dryden-Peterson, non-resident Fellow at the Center for Universal Education at the Brookings Institution. “Without these possibilities, young Syrians will lose the kind of hope that is essential to productive futures.”

According to the Jordan Response Platform for the Syria Crisis, 1,250 Syrian youth were in higher education in Jordan in 2016. Building on commitments made by the international community at the London Conference on Syria last year, the Jordanian government hopes to secure funding to increase access to tertiary education and vocational training at the upcoming conference in Brussels this April.

“Jordan views higher education from a strategic point of view, specifically in terms of providing the Syrian youth with the education, skill and knowledge that will allow the opportunity to be part of rebuilding their country once the current situation comes to an end,” says Feda Gharaibeh, Director, Humanitarian Relief Coordination Unit at the Jordanian Ministry of Planning & International Cooperation.

Reema plans to return to Syria when the war is over. “After graduation a lot of students want to go to Europe. That would be fine for me too if it’s just to do a masters or doctorate, but then I want to go back to Syria and use what I’ve learnt to help my people.” Now four semesters into her course, she is making good progress but says adapting to the Jordanian education system was a challenge. “It’s really difficult for us. Classes are taught in English and the teaching style is different. They also have a lot more exams here.”

Only the brightest stand a chance of securing a scholarship but many young Syrians have seen their grades plummet after missing years of schooling. For, some, it’s too late to catch up. Accountancy student Ibrahim Mohammed, 23, came to Jordan in 2013 with his younger brother Khalil, now 19, who works in a print shop. “He stopped studying when he was 14. He didn’t even have a chance to get his high school certificate,” says Ibrahim.

Attempts to bridge the gap through open and distance learning programmes aren’t always effective. “It’s not a tool that is frequently used in the education environment in the Middle East,” explains Arts. Refugee students' access to electricity, internet connections, computers and space to study can be in short supply. Moreover, many students seek the escapism that a university education offers. “In our dialogue with parents and students, we often hear the phrase ‘being normal again’,” Arts adds.

Hamzah tries to help fellow students achieve this in his role as representative for the Syrian community at Zarqa University. He and Reema are part of a team that offers advice to new students and support for those from poorer families living in the camps. “There are 900 Syrian students here and each one has a different story of suffering,” says Hamzah, who organises group trips to restaurants and fairgrounds, helping to create a sense of regular student life. “It makes us forget what we are,” explains Reema.

During term time, she prefers to stay with her uncle in Mafraq, a city nearby. It’s hard to study in Za’atari. As soon as the power comes on at 5pm, her brothers switch on the TV, making it difficult to concentrate in the cramped caravan they share. There’s nowhere else to go; the camp is dangerous at night, particularly for young women. It’s even more crowded since the arrival of her baby sister. Reema remembers how her mother sobbed when she learned of the pregnancy, worried about bringing another child into the makeshift world of the camp.

But in five years a lot has changed. “In Syria, I had never left my village; now I feel there is another world to know,” says Reema. Like many Syrian students, she worries about life after university, particularly if they stay in Jordan where employment opportunities remain restricted for Syrian refugees. “It seems like work is forbidden to us Syrians and without a job we can’t take control of our lives. We’re studying hard but with no prospects,” says Hamzah. Few can see beyond graduation. “The future is opaque for us,” he adds, “We’re just living day by day.”

To date, the Jordanian government has issued some 39,000 works permits out of the 200,000 it pledged to make available for Syrians during the London Conference last February. However, with these opportunities built around low-income roles, primarily in the construction, agriculture, and textile manufacture sectors, the way for Syrian university graduates in Jordan still seems barred.

“Jordan is a small country with limited job opportunities,” says Ghaith Rababah Head of Projects & International Cooperation Unit (PICU) at the Ministry of Higher Education & Scientific Research. “Maybe the market will be better able to absorb educated Syrians at a later stage.”

In the meantime, higher education offers young Syrians a semblance of the security and stability their lives otherwise lack, Rababah continues. Given the opportunity to “use their talents for something good”, he adds, young people placed in difficult situations are less likely to fall prey to extremist ideologies and be “tricked into committing terrorist acts".