Syria: Unacceptable humanitarian failure
By Dr Joanne Liu, International President, Médecins Sans Frontières
11 March 2015
As Syria enters its fifth year of conflict, the war continues to be defined by brutal violence that does not distinguish
between civilians and combatants. Hundreds of thousands of people have been killed, and half the population has fled
either within Syria or into neighbouring countries. Syrian cities are besieged and cut off from any outside assistance.
People are trapped between the ever shifting frontlines as government troops and myriad armed opposition forces wage
battle.
Natacha Buhler/MSF
Dr. Joanne Liu, International President. October 2013
Thousands of doctors, nurses, pharmacists and paramedics have been killed, kidnapped, or displaced by violence, leaving
a massive gap in medical expertise and experience. Of an estimated 2,500 doctors working in Aleppo at the beginning of
the conflict, fewer than 100 remain in the hospitals still operating in the city.
The Syrian people’s cries for help fill social media, but it seems they have become the background murmur of the Syrian
war. With millions of people in need of assistance, Médecins Sans Frontières (MSF) should be running some of the largest
medical programs in its 44-year history. Why isn’t it?
When the conflict began, MSF started providing supplies to networks of Syrian medical personnel treating the wounded. We
were unable to obtain authorization from the government to work inside the country. But by directly engaging opposition
groups, we managed to negotiate access to areas they held in the north, and began providing direct, cross-border aid to
the population.
By 2013, we were running six hospitals in opposition-held areas, providing thousands of consultations, deliveries, and
surgical interventions. Negotiations with the numerous armed groups, while challenging, allowed us to send international
medical teams to work side-by-side with Syrian colleagues. We had to repeatedly negotiate agreements with different
local commanders to ensure respect for our presence, for the safety of our teams, and for non-interference with our
medical activities. The groups changed frequently, and we renegotiated agreements with commanders from Jeish el
Mujahideen, Islamic Front, Jahbat Al Nusra, different factions of the Free Syrian Army, and ISIS (later renamed Islamic
State - IS), among others.
However, we were never able to provide direct assistance to the majority of the Syrian people caught up in the heart of
the conflict. Violence and insecurity, attacks on health facilities and medical workers, and the absence of government
authorization to work in Syria have been some of the main obstacles to extending medical activities. Yet, however
unsatisfied we were with our limitations, we were still doing more than what we can do today.
In mid-2013, when fighters with ISIS (renamed Islamic State in 2014) arrived in areas where MSF had been running most of
its hospitals, agreements were reached with their commanders that they would not interfere with the medical management
of the hospitals and that MSF medical structures and staff would be respected. However, on January 2, 2014, ISIS
abducted 13 MSF staff members. Among them were eight Syrian colleagues who were released after a few hours. The
remaining five international staff members were held captive for up to five months. The abduction precipitated the
withdrawal of our international teams and the closure of MSF health facilities in ISIS-held areas.
Local leaders of the newly renamed IS have repeatedly requested that MSF resume its medical assistance in their areas of
control. But we cannot consider this, given that IS targeted our teams and broke an agreement they had committed to.
Necessary guarantees have not been obtained from IS leadership that MSF patients and staff will not be taken or harmed.
MSF still operates three hospitals run by MSF Syrian staff, one in Atmeh and two in Aleppo, in addition to three other
health structures in northern Syria. But assistance is limited.
MSF
Since August 2013, MSF runs mobile clinics to provide general health care services and mother and child care services to
IDPs and host communities on the Syrian side of the border with Iraq. In parallel, MSF supports a mass vaccination as
well as routine polio campaign.
Aerial bombardments in Aleppo have killed and wounded thousands, and have destroyed houses and infrastructure. In
eastern Aleppo, access to healthcare is now virtually impossible due to lack of supplies and qualified medical staff.
MSF teams have observed an increase in medical complications, such as a rise in obstetric complications, miscarriages
and preterm births. Difficulties to provide post-operative care and shortages of antibiotics are resulting in infections
and an increased mortality rate among surgical patients.
While we have been forced to reduce direct medical activities in Syria, we have continued to support Syrian medical
networks in their tireless quest to treat patients. Donating medicines and medical material is essential for Syrian
medical staff working in besieged areas and active conflict zones. Medical supplies are dispatched along dangerous roads
dotted with checkpoints. The probability of confiscation of materials, arrest, or even death, is high. This form of
support certainly falls far short of what is needed. Many of the supported facilities still lack equipment and are short
staffed, and we are unable to provide direct assistance to meet the needs.
A medical director in a besieged area near Damascus told us that his makeshift hospital received 128 wounded patients
after a severe bombing of a crowded market. His team managed to save 60 people, but 68 patients died. His team used almost all their remaining stock of medical
supplies on that single day.
MSF teams are today working in some of the most complex war zones, from Afghanistan to South Sudan to Yemen. An MSF
trauma centre I recently visited in northern Afghanistan illustrates the sort of assistance MSF should be able to
provide to the population in Syria.
In an 80-bed trauma centre run by MSF in the northern Afghan city of Kunduz, wounded combatants lie in beds next to
former enemies or alongside civilians, all in need of medical care. Afghan colleagues and international staff working in
the hospital are accepted by all groups in this contested part of the country. Safe working conditions and medical
non-interference have been negotiated with all stake-holders and actors, including the Afghan government, Taliban
leadership (Islamic Emirate of Afghanistan), and with American-led ISAF forces
While a large scale international humanitarian effort is desperately needed in Syria, it will not happen until the
parties to the conflict engage with aid organizations and identify practical steps to permit them to operate safely and
effectively. All armed parties to this conflict must allow humanitarian access to civilians, as they are obliged to do
under international humanitarian law.
The people of Syria have suffered unimaginably over the last four years. The continued obstruction of humanitarian aid
greatly compounds their misery. The people of Syria are being denied the most fundamental assistance and the world
cannot continue to look away. We can and must do more for them.
ENDS