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

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Building peace in a dangerous world needs resources, not just goodwill

Conflict resolution is only the first step.

Thursday 21 September is the UN-designated International Day of Peace. At noon on this day, which has been celebrated for the last 25 years, the UN general secretary will ring the Peace Bell on the UN headquarters in New York and people of good will around the world will take part in events to mark the occasion. At the same time, spending on every conceivable type of weaponry will continue at record levels.

The first couple of decades after the end of the Cold War saw a steady reduction in conflict, but lately that trend seems to have been reversed. There are currently around 40 active armed conflicts around the world with violence and suffering at record levels. According to the 2017 Global Peace Index worldwide military spending last year amounted to a staggering $1.7 trillion and a further trillion dollars worth of economic growth was lost as a result. This compares with around 10 billion dollars spent on long term peace building.

To mark World Peace Day, International Alert, a London-based non-government agency which specialises in peace building, is this week publishing Redressing the Balance, a report contrasting the trivial amounts spent on reconciliation and the avoidance of war with the enormous and ever growing global military expenditure.  Using data from the Institute for Economics and Peace, the report’s author, Phil Vernon, argues that money spent on avoiding and mitigating the consequences of conflict is not only morally right, but cost-effective – "every dollar invested in peace building reduces the cost of conflict".

According to Vernon, "the international community has a tendency to focus on peacemaking and peacekeeping at the expense of long term peace building."  There are currently 100,000 soldiers, police and other observers serving 16 UN operations on four continents. He says what’s needed instead of just peace keeping is a much greater sustained investment, involving individuals and agencies at all levels, to address the causes of violence and to give all parties a stake in the future. Above all, although funding and expertise can come from outside, constructing a durable peace will only work if there is local ownership of the process.

The picture is not wholly depressing. Even in the direst conflicts there are examples where the international community has help to fund and train local agencies with the result that local disputes can often be settled without escalating into full blown conflicts. In countries as diverse as East Timor, Sierra Leone, Rwanda and Nepal long term commitment by the international community working with local people has helped build durable institutions in the wake of vicious civil wars. Nearer to home, there has long been recognition that peace in Ireland can only be sustained by addressing long-standing grievances, building resilient institutions and ensuring that all communities have a stake in the outcome.

At a micro level, too, there is evidence that funding and training local agencies can contribute to longer term stability. In the eastern Congo, for example, various non-government organisations have worked with local leaders, men and women from different ethnic groups to settle disputes over land ownership which have helped fuel 40 years of mayhem. In the Central African Republic training and support to local Muslim and Christian leaders has helped reduce tensions. In north east Nigeria several agencies are helping to reintegrate the hundreds of traumatised girls and young women who have escaped the clutches of Boko Haram only to find themselves rejected by their communities.

Peace building, says Vernon, is the poor cousin of other approaches to conflict resolution. In future, he concludes, it must become a core component of future international interventions. "This means a major re-think by donor governments and multilateral organisations of how they measure success… with a greater focus placed on anticipation, prevention and the long term." Or, to quote the young Pakistani winner of the Nobel Peace Prize, Malala Yousufzai: "If you want to avoid war, then instead of sending guns, send books. Instead of tanks, send pens. Instead of soldiers, send teachers."

Redressing the Balance by Phil Vernon is published on September 21.   Chris Mullin is the chairman of International Alert.