A doctor's letter from the besieged Syrian city of Homs

A Syrian surgeon describes his struggles to treat the wounded in Homs and calls on the international community to intervene.

I am a doctor working under siege in Homs, performing surgical operations in a basic hospital set up in an underground basement. The conditions in this field hospital are very bad, and it is especially hard to keep the hospital sterile. We have only basic surgical equipment and expired anaesthetic medication to treat the wounded. Patients who need blood transfusions are given blood directly from donors, and it is transfused without medical screening.

It has been five hundred days since a siege was imposed on Homs by Assad’s forces. Over 500,000 people have fled or died, but 3,000 people are still living here. Among the 400 families still here, most of the remaining family members are women, children and old people, and the injured who cannot move. These thousands of women, children, elderly and wounded survivors of this war are being denied access to the basic necessities of life.

For the past year and a half, this has been our life here: we have to drink from polluted wells and wash in sewage water. Food is restricted to lentils and bulgur wheat, and has been for months. There is no flour or milk or any kind of meat because of this siege.

We eat leaves and rotten rice. We have had no electricity for 500 days. We don't even have baby milk due to the siege. I see babies’ mothers who cannot breastfeed them due to stress and malnutrition: infants who should be healthy are starving and dying.

As for my job as a surgeon, we must transport patients through gaps in the walls across the neighbourhood because there are snipers outside. People move between neighbourhoods through underground tunnels. Many of the injured have died because it has been impossible to reach them. Our small medical facilities are frequently targeted, which has forced us to move our operations many times. 

Of the patients we see and treat, many initially improve after surgery but then die a slow death during recovery because of poor nutrition and the lack of serums to keep them hydrated. Those who do survive often experience poor wound healing as a result of medical shortages. 

Homs, my city, was one of the first places in Syria that hosted a UN delegation before the siege. The people of Homs gave them their best hospitality. My people stood in the streets risking their lives, all to get their voice heard. They are still waiting, five hundred days later.

We need to get this important message out and call upon the world’s media, the UN, NGOs and politicians to help break this slow killer, this inhuman siege. If you keep Assad in place, do not bother about withdrawing chemical weapons because at least, given the alternatives I see, it is a merciful way to die.

Please help us. Get us the deliveries of food and medicine that we need to survive, this is our basic human right. Does anyone hear the screams of women and children or feel the pain of the injured? Your brothers and sisters in the besieged neighbourhoods of Homs are right now screaming for your help. I hear them all the time. Isn't there any reply?

Dr Mosab is a surgeon in Homs. We have not used his full name to protect his identity.

 

The Syrian flag flying next to destruction in the Baba Amr neighbourhood of Homs in May 2012. Photo: Getty.
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Scarred lands: visiting the villages Boko Haram left behind reveals the toxic legacy of terrorism

The progress and challenges of Nigerian communities rebuilding after Boko Haram’s insurgency begins to wane.

“Sometimes it’s when I go to bed that what happened comes back to me.” Two years ago, Boko Haram militants stormed into 23-year-old John Amida’s home late at night in a village in Gwoza, Borno State, northeast Nigeria. Shielding his eyes with his hands from the torchlight saved his life. He shows me the mark in the centre of his forearm where the bullet aimed for his head went instead.

“All my friends were either killed or abducted,” he says. “I don’t try to forget what happened because it’s not possible; it’s with you even when it is not in your mind. The best thing is just to keep on living every day.”

After a broadly effective 18-month military campaign, Boko Haram remains a deadly yet waning force. Many communities once occupied by Boko Haram are now liberated. In Adamawa, just south of Borno, over 630,000 people previously displaced by Boko Haram have returned home.

With them, over 170,000 internally displaced people (IDPs) now live in camps, or – like John and his family – in host communities. He and his family live in a home vacated and lent to them by a local. All over Adamawa, IDPs live in homes shared with residents or given to them temporarily in exchange for help, crops or token sums of rent.

Adamawa is a serene, largely rural, mountainous state. Even deep into the dry season, driving through the roads that cut between its vast countryside, its land is incredibly scenic. But within local communities, in more rural, isolated villages north of the state’s capital, Yola, the picture is more complicated.

Gombi, a small town a few hours’ drive from Yola, was recaptured from Boko Haram in late 2014. Much of what was destroyed in the insurgency – shops and small businesses – have been rebuilt or replaced. The local government buildings have been largely restored. The impact is still visible but, according to locals, decreasingly so.

But in less urban areas, like in Garaha, a village in Adamawa, rebuilt homes sit next to broken, abandoned houses, churches, mosques and buildings blackened by the fires that damaged them. Local government officials say the damage across Adamawa by the insurgency has set the state’s development back by a decade. Funding for rebuilding the state, which local governments complain is insufficient, is concentrated on urban areas.

According to Chief Suleimanu, a traditional ruler in Garaha, mental health issues are widespread but few are financially able to access support. While some people have been able to move on, others are still dealing with the consequences.

“Many couples and families have separated,” he tells me, detailing how in some couples one partner feels attached to their home while the other can’t face returning, or feel there is little to return to.

“The same with the children, some of the young people have gone to bigger cities like Kano or Abuja because of a lack of opportunities.”

Many returnees, who left camps in Cameroon to come back to Adamawa, are from families who have lived in their villages for generations. Their ancestral roots anchor them to their homes because their farmland is their main source of income. Non-agriculture-based industries provide few jobs. For many people, fleeing their homes meant abandoning their livelihoods.

As of 2015, 52 per cent of people in Nigeria lived in rural areas. Their relative isolation is a blessing and a curse. Larger rural spaces provide them with adequate land to cultivate their crops – but it also leaves them exposed.

During Boko Haram attacks on Garaha through to early 2015, there was minimal protection from security forces who often take hours to arrive.

For many people living in rural Adamawa, life is getting harder and easier at the same time. Armed herdsmen, mainly from the Fulani ethnicity have become a greater threat across Nigeria, partly due to tensions between land ownership and cattle grazing.

According to locals, killings by herdsmen have increased this year. But villages are addressing their vulnerability. Armed vigilantes, some of which formed due to the lack of military protection against Boko Haram, are increasing. The police services are often too far away or too under-resourced to protect them. But some vigilantes now have more weapons and vehicles due to help from state services and locals. It is not an ideal solution but it has made places like Garaha safer.

With this new-found relative safety, villagers have begun farming again. With cash grants and donated tools from charities like Tearfund, it has been easier for thousands of people to begin cultivating land. In many villages there are small, lively recreation centres where young people play snooker and watch sport. Many of their places of worship have been rebuilt.

But the situation is grimmer in communities where such charities are not present.  Without resources, state or non-government help, rebuilding is a real challenge.

Adamawa is a state maxing on its credit of hospitality, relative safety and appreciation of agriculture. A recession in Nigeria and a severe food crisis in the northeast have added pressures on returnees and IDPs. Liberated communities will need more help and attention before they truly feel free.

Emmanuel Akinwotu is a journalist based between Lagos and London who writes about Africa, migration, and specialises in Nigeria.