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