A report for the Lancet Commission on Syria, published on Tuesday, March 14, 2017, to mark the sixth anniversary of the Syrian conflict, condemns pro-government forces’ targeted attacks on health facilities and workers. In the ‘weaponization’ of healthcare in Syria, “healthcare facilities are attacked, workers are targeted, medical neutrality is obliterated and international humanitarian laws are violated to restrict or prevent access to care as a weapon of war.”
The report warns that “Syria has become the most dangerous place on earth for healthcare providers.” Dr. Samer Jabbour, co-leader of the study and an associate professor at the American University of Beirut’s Faculty of Health Sciences, states that “targeting has become more frequent, more obvious, and more geographically widespread. To the best of our knowledge, this level of targeting health facilities has not occurred in any previous war, and the data we were able to collect overwhelmingly show intent to target, which falls under the definition of a war crime.”
The report estimates that 814 medical workers were killed between March 2011 and February 2017, and according to Physicians for Human Rights (PHR), more than 90% of these deaths were the result of Syrian government forces and their Russian allies. Dr. Jabbour also warns that this is probably a “gross underestimate” due to difficulties in collecting and corroborating evidence. There were nearly 200 attacks on healthcare facilities in 2016 alone and some medical facilities have been repeatedly bombed in apparently deliberate attempts to stop them from functioning. Kafr Zita cave hospital in Hama has been bombed 33 times since 2014, including six times in just the first three months of 2017. M10, an underground hospital in eastern Aleppo, was attacked 19 times in three years and was destroyed in October 2016.
As a result, 27% of Syrians now live in areas with no health workers whatsoever and another 31% live in areas with insufficient care. Almost half of hospitals are reportedly damaged and doctors and other medical staff have to practice improvised “siege medicine,” using the light from mobile phones to carry out operations and homemade saline since intravenous fluids are consistently confiscated from air convoys into blockaded cities. “There is now an underground factory in eastern Ghouta near Damascus producing normal saline. Denied blood bags for the collection and storage of blood, urine bags with anticoagulants added are used.” The provision of medical care to anyone injured by pro-government forces has been a criminal offence since July 2012.
The report criticizes UN agencies’ failure to hold the aggressors, who are violating international law, to account, noting that although the World Health Organization (WHO) monitors attacks, it does not go as far as recording or condemning their perpetrators. Dr. Jabbour declares that “the international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and protect health workers in situations of armed conflict.”
The international community must do more to protect healthcare in Syria. A PHR report claims that less than 1% of the population the UN was given permission to reach received aid by December 2016. Jan Egeland, UN special advisor on Syria, laments the “hopeless bureaucratic quagmire of having to seek facilitation letters, permits, security permits” to deliver aid in Syria. The PHR urges that the UN should “notify Syrian authorities of deliveries, but not wait for approval, as it already does with cross-border aid deliveries.” Equally, the war crime of depriving civilians of food and medical care must be more vociferously reported and condemned, as well protections for healthcare workers must be strengthened.
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