* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Outbreaks of diseases that had long been under control have spread across the land and into neighbouring countries
After four years of civil war, Syria’s conflict is spiralling further out of control with devastating consequences for its people.
While video footage of ISIS beheadings and government barrel bombs dominate the media, the collapse of the healthcare system means Syrians are now almost as likely to die of easily preventable illness: choking to death from asthma, bleeding to death during child birth, starving.
“Syria is experiencing the worst humanitarian catastrophe this century,” said Leigh Daynes, executive director of Doctors of the World UK, which supports dozens of primary healthcare clinics operating in and around Syria. “The misery is unimaginable and made worse by the willful, illegal targeting of healthcare workers and facilities.”
Over half of the population of 20 million have been forced to flee their homes, often multiple times. Within Syria, 7.6m are displaced and and another 3.6m have fled the country completely, mostly living in refugee camps in neighbouring countries causing huge stress to their healthcare systems. More than 200,000 Syrians have been killed and over one million injured and disabled. A third of these deaths and a half of these injuries occurred in 2014.
BEFORE THE WAR
Prior to the war, Syria’s healthcare system was thriving with hospital and doctor numbers comparable to other middle-income countries such as Brazil, Turkey and China. Life expectancy was 76 years. Over three quarters of the country’s disease burden was of the Western-prevelant, non-communicable type (hypertension, diabetes, and so forth); 27% of the Syrian population were obese, precisely the same proportion as in the UK.
Four years of violence waged with heavy artillery, missiles, barrel bombs, bullets and a fearsome intensity have changed all of that.
The UN estimates that 12.2m Syrians now require urgent humanitarian assistance, almost half of them children. Two and a half million children aged under-five are at risk of malnutrition. Life expectancy has dropped by two decades.
Child vaccination levels dropped from 90% pre-conflict to 50% in March 2014. As a result, outbreaks of diseases that had long been under control have spread across the land and into neighbouring countries: hepatitis, measles, leishmaniasis, multi drug-resistant tuberculosis, typhoid and even polio, which had not been seen in the Middle East for 20 years.
An estimated 1,500 women give birth in dire conditions every day. Chronic diseases that can be easily managed with access to medicines and equipment are killing people.
The mental health burden of the conflict is vast and largely untreated.
DOCTORS TARGETED
Overwhelmed by the devastation is a Syrian healthcare system shattered by the deliberate targeting of medics and medical infrastructure.
“Medical personnel are clearly targeted because they are seen as potential enemies, because they are seen as helping the opposite side,” says Doctors of the World’s Syria director Francesco Volpicella.
The NGO Physicians for Human Rights has detailed 233 attacks on 183 medical facilities, 138 with indiscriminate weapons, 32 with barrel bombs. Only 45% of Syria’s public hospitals are fully functioning. In the half of the country not controlled by government forces the majority of hospitals have been destroyed.
“This is the worst concerted attack on healthcare in living memory,” says Leonard Rubinstein, director at the Bloomberg Center for Public Health and Human Rights at Johns Hopkins University, Maryland. “In the decades I’ve been studying this issue in places like Bosnia, Chechnya, Afghanistan and the Gaza Strip, there has been nothing like what has happened in Syria.”
After bombs are dropped in civilian areas, rescue workers and paramedics sometimes faced so-called ‘secondary attacks’. Six hundred medical personnel have been killed since 2011, 145 of them tortured and executed. The majority of Syria’s doctors have fled the country.
Rubenstein and colleagues interviewed Syrian doctors for a recent report; they told of being tortured to admit working in field hospitals where opposition forces are sometimes treated.
“They knew that if they refused to admit to this the torture would get worse,” said Rubenstein. “But if they admitted it they would be killed.”
NEXT?
Three UN Security Council resolutions were passed in 2014 that called for an end to attacks on civilians and an increase in aid, but critics have argued they made little difference.
“Without action by major governments, these resolutions are little more than empty words and the situation worsens,” says Leigh Daynes.
There’s major agreement that when the war ends there will need to be a coordinated and long-term strategy to rebuild the country’s shattered healthcare system.
“We will need to be ready to help rebuild much of the healthcare system from scratch,” said Daynes. “It will be a huge job and one that won’t be able to be done without the return of Syrian doctors and healthcare workers – and for that we first need the fighting to stop.”
