In War-Torn Syria, Public Healthcare Reduced to Rubble
Two years ago, Dr. Majed Aboali trudged across 35 kilometers of Syrian desert, climbing down canyon slopes, through their crevices toward the Jordanian border.
It was late spring of 2014. His wife and infant son were already waiting for him in Turkey, having fled Syria with the help of a friend who had smuggled them past military checkpoints.
That route was not an option for Dr. Aboali. His once thriving dental practice in Duma was forced underground to a basement during the civil war. The Syrian Army was after medical professionals. His name was one of many on an Army list that identified medical professionals suspected of treating rebels.
His route was more treacherous. He met eight smugglers along the way who helped him navigate through the dusty terrain. By the end of the following year, five of them would be dead, casualties of President Bashar al-Assad’s retaliation against rebel groups. Once across the Turkish-Syrian border, Aboali was reunited with his family in Gaziantep, where they live today.
Dr. Aboali never considered leaving, even after 1300 people were killed three years ago by a sarin gas attack orchestrated by al-Assad’s military in his hometown of East Ghouta. The United Nations would condemn the incident as the deadliest use of chemical weapons since the Iraq-Iran war.
“My wife and I had made the decision that we would live and die in East Ghouta,” he said.
Dr. Aboali’s reluctant decision to eventually flee shows how desperate the situation has become in Syria. According to Physicians for Human Rights, air strikes — 287 of them conducted by government forces — have reduced 327 medical facilities to rubble, resulting in a mass exodus of medical professionals. As the country’s public healthcare system continues to disintegrate, thousands of Syrians are exposed to deadly illnesses, adding to what human rights organizations decry as further war crimes against al-Assad and his ally, Russia.
“They’re attacking hospitals in order to prevent opposition fighters from being treated,” said Elise Baker, program coordinator at Physicians for Human Rights. “If you kill a doctor, you’re killing the 50 people they would have treated. But it’s really the civilians who are suffering.”
The World Health Organization estimates that 80,000 doctors have fled Syria and at least 700 have been killed since the beginning of the civil war.
“The regime has put a high priority on targeting those who have treated protesters who were shot or tortured,” said Neil Sammonds, a Syria for Amnesty International researcher. “Many of them have disappeared because of their work.”
As spokesperson for the Syrian American Medical Society, a non-profit organization that helps provide medical care in the country, Dr. Aboali was a person of interest to the Syrian government. He helped establish a network of basement clinics throughout Syria’s northern region. Although they are harder to detect from the sky, they aren’t immune to air strikes. His own underground clinic in Duma was shelled in October of last year.
“When your son is sick and there are no doctors to diagnose him, people will flee,” said Dr. Aboali. “People feel like they are losing their doctors.”
Large cities are also feeling the strain of the attacks. Only 10 of the 33 hospitals are in working condition in Aleppo, the nation’s most populated city. For every 7,000 patients, there is only one doctor who can treat them with an ever dwindling inventory of medical equipment.
“We have many examples of authorities not only targeting medical facilities, but also detaining professionals who wanted to treat people or bring medicine into a besieged area,” Sammonds said. “Just for carrying out their medical obligations, they are seen by the regime as the opposition.”
“There’s a huge deficit of medicine in Syria”
George Khabbazeh, 28, lives inside a narrowing pocket of neutral ground in the city of Aleppo: Kurds are fighting their way south into the city, government forces in the west are exchanging mortar rounds with rebel fighters in the east and ISIS emerges in areas where rebels have retreated. Here, all aspects of life have become paralyzed by the surrounding frontlines. Access to food, water, electricity and the medicine that his 56-year-old mother needs to treat her glaucoma has been cut off.
“My mom has a chronic disease so she has to take her medication every day,” said Khabbazeh during a Skype conversation made possible by one hour’s worth of fuel inside his rusty generator. “There’s a huge deficit of medicine in Syria. A lot of diseases will spread, especially in the summer when the mosquitos are out.”
Before the war, his mother Hasna Khabbazeh, a retired government employee, used to purchase each bottle of Cosopt and Brimogan for $20. But with most pharmacies reduced to rubble, the price of medicine has skyrocketed in the ones that remain open. The closest pharmacy is a few blocks away in the government-controlled portion of the city. When her medicine is in stock, the drops cost $100 a bottle.
“Like anything else in times of war, there’s a black market for everything, even medicine. But the medicine my mom needs is so scarce that we can’t find it anywhere,” Khabbazeh said.
Hasna has resorted to counting on her relatives outside of Syria for help. Twice a year, her younger sister would travel across military checkpoints and ISIS-controlled roads to bring the medicine from Lebanon. But she hasn’t come for more than a year because the violence has escalated. Hasna’s supply is dwindling and she has completely lost vision in one eye. She has two more bottles of medicine, enough for two months.
But Hasna’s situation is a microcosm of the drug shortage in Syria’s once thriving pharmaceutical industry that produced 90 percent of the medicine inside its borders before the war.
“Most of the pharmaceutical companies that were producing in Syria have either been destroyed or have closed their businesses,” said Dr. Sahloul, founder and president of Syrian American Medical Society. Every few months, he travels from Jordan in an ambulance across the rubble of bombed out roads, some rigged with mines, to deliver medical supplies to basement clinics.
Without proper supplies, amputations have become a common way to treat shrapnel injuries that would have otherwise been treated surgically and with anesthesia. The Syrian American Medical Society estimates that nearly 200,000 Syrians have died from chronic illnesses, such as diabetes and cancer, in the past three years.
The declining state of healthcare has also put some of the youngest Syrians at risk of contracting diseases that had not plagued the country in years. Syria eradicated polio in 1995 after implementing mandatory and free immunizations, but it resurfaced in 2013. Today, 90 children are carrying the highly contagious disease, many of them suffering from paralysis. For the polio vaccine to work, it must be administered multiple times. This poses a challenge for the 7.6 million Syrians who who are continually displaced from one region to the next.
Humanitarian organizations are racing against the clock to vaccinate as many Syrians as possible before they’re infected. The poliovirus lives in the intestines of patients and can be found in raw sewage that is often pumped into the Euphrates River. As of 2012, the government has discontinued treating wastewater.
With more than 700,000 children living without access to healthcare, other vaccine-preventable diseases are also on the rise. In the first week of 2014, the World Health Organization reported 84 cases of measles and 30 cases of meningitis in children under five. Malnourished children and those who have weakened immune systems are the most susceptible to the disease.
Russian airstrikes suspected of targeting hospitals
Airstrikes in Azaz, 20 miles north of Aleppo, claimed the lives of at least 15 people when two missiles struck the Women and Children’s Hospital and nearby school building on Feb. 16. A separate attack on another hospital claimed at least seven more lives in Maarrat al- Nu’man, roughly 60 miles away from Azaz near the Turkish border the very same day. The Turkish government blamed Russia and Syria for the attacks, but neither have released a statement.
With warring parties orchestrating attacks to gain control of the country, bombings like these have become so commonplace that no one can be held accountable. In October alone, Physicians for Human Rights recorded 16 airstrikes on hospitals, making it the bloodiest month since the beginning of the war. The organization said Russia’s recent involvement had lead to the increase of bloodshed. Moscow has denied the allegations.
On Sept. 30, al-Assad enlisted the help of longtime ally Russian President Vladimir Putin to gain a tactical edge over ISIS, which has taken over large parts of the country. Putin’s allegiance has resulted in thousands of air strikes and a renewed arsenal of rocket launchers, helicopters and long-range bombers. Despite the combined military effort, the attacks have not become more accurate.
Amnesty International investigated 25 attacks that took place during the first month of Putin’s assistance. Researchers found that at least 200 civilians and a dozen fighters were killed in those airstrikes throughout the northern region of Syria. The Syrian Network for Human Rights reported the deaths of 570 civilians between Sept. 30 and Dec. 1 as a result of the Russian attacks.
U.S. State Department spokesman John Kirby released a statement about Russia’s involvement in Syria saying, “Greater than 90 percent of the strikes that we’ve seen them take to date have not been against ISIL or al-Qaida-affiliated terrorists.” The Russian Ministry of Defense has denied the accusations that their strikes have targeted rebel groups that seek to overthrow the Assad regime.
“It’s really quite ludicrous,” Sammonds said. “They say it’s all lies that they’ve hit medical facilities, that it’s part of an international conspiracy to deflect attention from U.S. forces and the Kunduz Hospital. It’s a lot of noise, without any credibility.”
Sammonds referred to the U.S.-led airstrike that struck a Doctors Without Borders’ hospital in Kunduz, Aghanistan in October. Twelve medical professionals and 10 patients were killed. Among the dead were three children. The United Sates called the attack accidental due to false intelligence. But the organization says the coordinates of the hospital were widely known. Doctors Without Borders has since called on the International Humanitarian Fact Finding Commission to investigate the incident, but they have not released their findings.
Russia’s lack of response to the latest attack in Kunduz further stoked suspicion that Putin has developed a pattern of hospital attacks. On Oct. 20, two Russian missiles struck near a field hospital in Sermin, in the northwestern region of Syria. People at a nearby school were thrown across classrooms when the first missile hit, and again 10 minutes later in the second blast. The air strike resulted in 13 civilian casualties and injured 30 more. An investigation conducted by Amnesty International revealed that there were no military targets in the vicinity of the attack.
Despite video and photographic evidence of the aftermath provided by people near the strike zone, the Russian Military Defense rejected the accusations and rebutted with satellite images of the area, which they alleged were taken a day after the supposed attacks and showed undamaged structures. Amnesty International reviewed the images and concluded that the images the Russian defense ministry provided were taken several days before the attack.
“Living in Aleppo is simply hell”
In October, people from all over the United States congregated near UN headquarters in New York City to host a “die-in.” Dozens of people donned white coats and laid on the ground in Dag Hammarskjold Plaza holding signs with numbers that represented a doctor who has died in Syria. The words beneath the numbers described the ways they died: Number 127, a medic was murdered; Number 70, a doctor was executed; Number 350, a dentistry student was tortured.
“We’re asking doctors to advocate for their colleagues in Syria,” said Dr. Sahloul. “Locally, nationally, or internationally, we’re asking organizations to do something to protect doctors.”
For, Khabbazeh, the effects of the war are even more tangible. The pressure in his mother’s good eye is beginning to build and he fears she will lose her vision completely. The family hopes to raise enough money to buy the expensive drugs she needs. But as the battle line closes in on their city, that option is disappearing.
“Living in Aleppo is simply hell,” he said. “The other day a house down the block was struck by an air strike. Luckily, there was no one home, but the house is completely destroyed.”
Both Dr. Aboali and Khabbazeh have witnessed first hand the destruction of the public healthcare system in their country. Although Dr. Aboali made it out of Syria, both join the nearly 12 million people who have been internally and externally displaced by the war.
Dr. Aboali, who now lives in Turkey with his wife and 2-year-old son, spoke at the October die-in, describing the sounds of children heaving from the gas attack in his hometown. His wish to return home one day will most likely remain unfulfilled, because his son’s safety is his first priority.
“I need to make sure my family has their daily bread, that my son has a cup of milk every night,” he said. “I don’t want to be a refugee. I want to go back to Syria, I just wish that day would come soon.”
