With international humanitarian access and staff limited by the Assad government, liberated areas see not only deteriorating conditions but also new roles for Syrians outside and inside the country confronting the consequences.
Healthcare professionals in Syria caring for the war-wounded are deliberately targeted, says the International Rescue Committee's in its recently published Commission on Syrian Refugees report.
Doctors describe 'intimidation, torture and the targeted killing of doctors… in retribution for treating the wounded'. Hand in Hand for Syria (HIH), a UK registered charity, says that 14 doctors were killed in November 2012 alone. One doctor described 36 doctors working in Aleppo, when previously they had 5,000. The resulting lack of doctors in Free Syrian Army held areas - and limited international humanitarian support - are contributing to the UNHCR statistic of 60,000 dead since the revolution started in March 2011.
Dr Rola, a British-Syrian doctor working with HIH, is part of a growing Syrian diaspora risking their lives to bring aid to the neglected areas. HIH was formed by members of the Syrian disapora a year ago in response to a deteriorating humanitarian crisis in the region. We first met at a Royal Society of Medicine event in London early last year. I had been speaking about healthcare in Libya during the conflict. She remains frustrated at being unable to attract support from international agencies and funders, who had so willingly supported the Libyan uprising. She spoke about a refugee camp forming in north Syria, swelling in numbers and in appalling conditions. On her last visit there, just before Christmas, I went with her to Atmeh.
White tents stretched as far as the eye could see. Three days of pouring rain had created a wet landscape of small lakes and tiny streams coursing in between tents. Barefoot children played in the freezing muddy water. This is now home to 130,000 internally displaced Syrian, who fled Bashir Assad’s shelling and airstrikes on their villages. Many had nothing left to return to.
Rola greeted health workers at the medical centre, sited in a portacabin. She asked after a badly injured woman transferred to an Intensive Treatment Unit (ITU) in a Turkish hospital. She had lit a candle in her tent for light – there is no electricity. The tent caught light, quickly becoming a fireball. Her two children died in the blaze and she suffered 70% burns. Stories like this are not uncommon.
The north is now in the hands of the Free Syrian Army but the risk from Assad’s airstrikes remains. We looked skywards at every rumble. And it is in such areas that there is a marked absence of UN and international humanitarian agencies because they lack authorisation from Damascus to provide cross-border assistance in FSA areas, such as Atmeh.
Fabrice Weissman, Medecin Sans Frontier’s operations advisor, explains in an article featuring in Le Monde last week thatinternational aid is being distributed only to government-held areas, with agencies coordinating through the Syrian Arab Red Crescent Society. This practice is causing great resentment towards the international community by those suffering as a consequence.
Rola articulates the sentiment, noting that, “the world will look back at this in years to come and all who just stood and watched will have blood on their hands. That’s why I do what I do, because you can’t just stand and watch.”
Three weeks later and we are back in London. She has just gotten off the phone with a fellow Syrian doctor in Damascus.
“I am struck with an overwhelming sense of anger…at the humiliation the Syrian people are suffering, at how so very cheap our lives seem to be to almost everybody”, she says. The doctor was describing the realities in front of him, coupled with a lack of international support from aid agencies.
MSF has however worked in secret locations since last summer but not on a permanent basis, operating very much under the radar because of the high security risks involved. Health workers and facilities have repeatedly been targeted by Assad’s forces. Being a doctor in Syria is now considered a high-risk occupation and many have left the country. Medicine has become a weapon of war.
“We can't take a day off because there is so much to do and we all feel a personal responsibility to keep going and a huge amount of guilt if we rest”. Rola is an accidental humanitarian worker in conflict zones; sixteen months ago, she was a specialist registrar working in an NHS teaching hospital, building a career. Now she has been thrust into the world of medical relief, global health policy and coordinating aid delivery in a conflict zone.
The learning curve has been steep. “We are doing the work of governments, of ministries, we are overwhelmed.’ The bulk of the humanitarian work in the areas outside Assad’s control is being done by grassroots NGOs, like HIH, who remain largely unsupported by the wealthier, larger international NGOs and funders, such as DFID.
The crisis has had a very personal impact on Rola’s family. Her father, also a doctor, helped coordinate medical logistics from inside Syria in the early days of the uprising. He is now involved politically with the Syrian National Council. A number of her relatives have been killed and many injured. ‘Most of Syria is covered in snow, my family are freezing cold and yet they are the lucky ones - the ones with a roof over their heads.’
Despite her anger, she is practical and persistent and understands the urgency better than most. She knows an alliance between grassroots NGOS, who have access on the ground, and international organisations, with their expertise and money, has to emerge if lives are to be saved. MSF’s Weissman echoes the sentiment, saying, “traditional international aid would be more than welcome to support the efforts of this local [NGO] network”, but goes on to specify that diplomatic courage is required by UN agencies and supporting states such as the European Union, the US, Russia and China, in order to achieve this.
The IRC recommends that humanitarian aid should increase in order to limit a regional humanitarian crisis that could last years. Until that moment arrives there exists an understandable sense of abandonment felt by Rola and fellow Syrians embroiled in this bloody uprising.
In the early days of the revolution, Rola, like many others, watched events on the news, but “we had to move on from crying in front of the television”.