Syrian government, rebels both blamed for destruction of health system

ANTAKYA, Turkey - Over the last three years, Syria has witnessed the complete and utterly vicious destruction of its healthcare system.

In the process, along with the tens of thousands of civilian casualties, hundreds of doctors, nurses, dentists, paramedics, and pharmacists have also lost their lives.

From the resurgence of polio after 14 years, to more than 100,000 cases of leishmaniasis, a parasitic disease caused by unsanitary conditions and fuelled by malnutrition, the undoing of the system and mass exodus of doctors has had devastating consequences. 

Those medical staff who remain continue to work in unimaginable conditions - often performing operations in makeshift underground clinics without anaesthetic or the appropriate training.

This has sadly become the norm in Syria.

According to a new report by Physicians for Human Rights (PHR), Syrian government forces are responsible for 90 percent of the systematic attacks on health care facilities in the country throughout the duration of the civil war.

In the report which PHR says is the most comprehensive look at attacks on hospitals, makeshift clinics and medical staff since the war began.

PHR mapped 150 attacks on 124 different medical facilities between March 2011 and March 31, 2014.

It found that 136 attacks were carried out by the Syrian government, compared with 10 attacks by opposition forces. There were four attacks that the group was unable to confirm who was responsible.

The report found that the majority of medical facility attacks were targeted and deliberate. On more than 90 occasions, weapons that can be used discriminately, such as missiles, rockets and guns, were used to attacks hospitals.

Looking at the specific location of attacks, at least 24 medical facilities were isolated from any other buildings nearby, further suggesting the deliberate nature of the attacks

Opposition forces guilty

But such attacks, which are a breach of International Humanitarian Law, are not only restricted to government forces.

In a report last year to the United Nations Human Rights Council, the Independent International Commission of Inquiry on the Syrian Arab Republic accused both sides of the conflict of attacking medical facilities as part of their military tactic.

“One of the most alarming features of the conflict has been the use of medical care as a tactic of war,” the report said.

“Medical personnel and hospitals have been deliberately targeted and are treated by parties to the conflict as military objectives.”

The report documented a myriad abuses by both the government and opposition.

Throughout the conflict, according to the report, medical access has been denied on sectarian grounds; official hospitals have only treated members of government forces and their supporters; doctors have been forced to take the bodies of executed armed group fighters and register them as deceased patients; and medical staff in government hospitals have feared abduction by armed groups who viewed them as loyal to the state.

A Doctors Without Borders report last year also found that the opposition had contributed to the destruction of the health care system. For example, the report found that some medical centres, set up for the opposition by the Free Syrian Army, had banned civilians from entering because it increased the risk of attack.

Leonard Rubenstein, director of the program on human rights, health and conflict at the Centre for Public Health and Human Rights at John Hopkins, welcomed the PHR report but said it was likely the number of attacks was substantially higher.

“Attacks on medical facilities and staff have been going on and no one has known where and when it has taken place. It is underreported,” he said. “Horrific as the numbers are, it’s likely that there have been far more attacks.”

Rubenstein pointed to a few key factors to explain the overwhelming number of attacks by government forces.

“The report’s findings are consistent with multiple UN independent reports that found attacking health care was policy of the government to defeat the opposition,” he said.

“One of the most horrific aspects of the Syrian government is that it considers health care a legitimate target. More currently though is that in 2012, Syria made it a crime to provide health care to the opposition. To them, these doctors and hospitals are criminal activity.

“It’s a breach of human rights and the Geneva conventions. I’ve never seen such as extreme case in targeting health care as in Syria.”

The law Rubenstein referred to, was passed in July 2012, and effectively made it a crime to provide medical care to anyone suspected of being part of the opposition. As an investigation by the Human Rights Council last September concluded:

“By attacking medical facilities, using hospitals as bases for military action, targeting medical personnel and interfering with patients receiving treatment, government forces have perpetrated a concerted policy of denying medical aid to those affiliated with or part of the armed opposition.”

Deteriorating health

The PHR report also found that as of the end of April this year, 468 medical personnel had reportedly been killed since the beginning of the conflict, including 157 doctors and 94 nurses. More than 15,000 doctors have fled their country, fearing for their lives.

Misty Buswell, Save the Children’s regional advocacy director, said the attacks on medical facilities were devastating for children and their families.

“The medical aid workers who remain in Syria are doing a heroic job, risking their lives to save others, but so many health workers have fled. This means that many children have nobody to treat them or are seen to by health workers who lack specialised training,” she said.

“We know of dentists who are working as paediatricians, of people dying because of lack of medications, children having their limbs amputated because there is no appropriate equipment of staff to treat their wounds. Every attack on medical staff or facilities is a serious violation of humanitarian law with tragic consequences for the children and civilians trapped in these conditions.”

Rubenstein added: “It seems to be getting worse. Unless some form of accountability and action is launched to stop them, this will continue.”