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When healthcare is used as a ‘weapon of war’

Two years into the Syrian conflict, Doctors Without Borders charge that the Syrian government continues to target doctors and patients in an attempt to combat the rebels

On the second anniversary of the Syrian conflict, two Greek doctors with Medecins Sans Frontieres describe the conditions of working in makeshift hospitals in rebel-controlled areas of the country and the experience of treating mass victims of aerial bombardments

Syrian and local children in  Amman, Jordan, highlight the plight of those suffering in Syria the night before the second anniversary of the start of the conflict  (Reuters) Syrian and local children in Amman, Jordan, highlight the plight of those suffering in Syria the night before the second anniversary of the start of the conflict (Reuters) The first victims of the Syrian conflict were patients, says Dimitris Giannousis, a Medecins Sans Frontieres surgeon who recently completed a 45-day stretch in a makeshift hospital in a rebel-controlled area of northern Syria.

The second, he says, were doctors.

Two years to the day after the 15 March 2011 nationwide demonstrations following arrests in the southern city of Deraa led to a rapidly escalating civil war, Giannousis and his Doctors Without Borders (MSF) colleagues in Greece describe the situation in Syria today as a humanitarian tragedy.

With doctors attempting to treat the victims of the conflict being arrested from the outset, the country’s once extensive healthcare system has essentially collapsed. More than half of state hospitals have been destroyed, and those still operational are limited to government-controlled areas where the distribution of aid and medical supplies is often scarce.

“The problem is that hospitals in Syria are targets,” says Giannousis,

Non-governmental medical organisations like MSF and the International Red Cross have been banned by the Bashar al-Assad government. Houses, fields and even caves have had to pass for hospitals in rebel-controlled areas.

The result is 70,000 Syrians are estimated to have been killed and a million have fled to neighbouring countries, according to the UNHCR. The internal displacement of people is thought to be more than two million.

Such has been the failure of international bodies to negotiate with Damascus that the EU is set is set to discuss lifting its arms embargo to allow supplying rebels. French President Francois Hollande told journalists at the Brussels summit meeting on Friday, “We cannot allow a people to be massacred as it is being today.”

Aerial bombardments

It was in this context that Giannousis recently spent more than seven weeks in one of MSF’s three makeshift hospitals in rebel-controlled areas of northern Syria.

The exact location of the hospitals is not disclosed by MSF for security reasons but Giannousis confirmed they are in the Aleppo and Idlib regions.

“It was effectively two houses combined, 12km from an airbase and one of the fronts of the conflict. We could see the attacks from the balcony,” he said.
He described the experience of two incidences of mass injuries to civilians from aerial bombardments.

“The first was on 31 December, 14.5km from the hospital. It brought us 20 injuries and unfortunately three dead,” he recalled. “It was extremely difficult for the team. We had to decide who we were going to operate on, who should wait.”

As well as seeing thousands of patients, the team carried out 86 operations - 14 of them following very injuries sustained by aerial bombardments – and delivered numerous births while I was there,” Giannousis said.

“Safety was our biggest issue. There was a wall of earth that protected us from attack but not from a direct hit.”

The second major incident, Giannousis said, was even more difficult to handle.

“It was on 23 January and it was even worse because the aerial bombardment happened just 3km from the hospital. We had the misfortune of seeing it happening. An aircraft approached and dropped a bomb on a populated area of civilians. According to witnesses, it could have been in a vacuum bomb.”

Syrian rebels have often accused government forces of using so-called vacuum bombs, which use a fuel-air explosive to spread maximum damage.

“Some 25 people with multiple wounds came to us, amongst them children, and unfortunately numerous dead,” he said.

This is another important role of MSF, Giannousis added, to make eye-witness accounts of events that often go unreported or are denied by authorities.


It was on 23 January and it was even worse because the aerial bombardment happened just 3km from the hospital. We had the misfortune of seeing it happening. An aircraft approached and dropped a bomb on a populated area of civilians. According to witnesses, it could have been in a vacuum bomb.

– Dimitris Gianoussis, MSF surgeon in Syria


Apostolos Veizis, MSF Greece’s chief medical representative, repeats that doctors and patients were the first victims of the conflict.

“Government authorities would enter hospitals and arrest doctors treating patients deemed to be enemies of the government. It got the point where medical centres, hospitals and ambulances became targets for the government,” he says. “It was healthcare being used as a weapon of war.”

The makeshift hospitals, he added, are often staffed by people with limited or no medical training – “dentists doing microsurgery”.

“And, yes, we have witnessed military attacks on civilians going about their business. We have seen victims who were queuing to buy bread,” he said.

But he stresses that MSF and other NGO international organisations have made a difference.

“There have been more than 13,000 surgical interventions, more than 20,000 cases of emergency first aid given out, 368 births handled by MSF doctors, and 176 tonnes of medical aid distributed,” he said.

“But these are only in the rebel-controlled areas. We are in constant negotiations with Damascus in order to have access to government-controlled areas too. At this moment the Syrian authorities are not allowing NGO’s in. There is only a very limited distribution of medicines to organisations that the Syrian government approves.”

Inside Greece

And, of course, there is a knock-on effect beyond Syria’s borders – mostly in neighbouring territories such as Iraq, Jordan and Turkey, but also in Greece as Syrian refugees attempt to enter the European Union.

MSF’s director general in Greece, Willem de Jonge, recently spent time in the Evros region in the north of the country visiting the migrant detention facilities there.

Syrians, he says, are now second behind only Afghanis in the most common migrants entering Greece through its northern borders and the Aegean islands close to Turkey.

“I saw many Syrian families separated, children and women in different cells from their fathers and husbands,” said De Jonge. “For me there should be a distinction between an economic migrant coming from northern Africa to refugees fleeing a conflict like Syria.

They have a clear case for asylum or refugee status, he stressed, but are instead detained in inadequate facilities – “behind bars”.

Despite existing legislation requiring migrants detained entering Greece to be assessed for country of origin and medical condition, no screening process is carried out, De Jonge charged.

“We are seeing that their medical condition actually deteriorates within the detention centres,” he said.

“I saw a mother of two children that were younger than 10. She had been in the cell for two weeks and all she asked for was to go back to Turkey. This is something we are noticing more and more because of the lack of support, because of the system here. She kept repeating it.”
 


Syria: Two years of conflict από msfgreece

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