Bringing life-saving healthcare and humanitarian relief to populations in warzones around the world has long been a primary focus for Médecins Sans Frontières/Doctors Without Borders (MSF). Doing so while maintaining the safety of both our staff and patients has become a growing and ever more challenging concern.
Nowhere is this more evident than in Syria today, where hospitals, schools and even bread lines have been targeted and where the laws governing conduct in war have been repeatedly flaunted by the warring factions. Despite the risks and security threats, MSF is running six hospitals and surgical facilities and delivering relief supplies to tens of thousands of internally displaced people uprooted by the conflict inside Syria.
Tasked with assisting our field teams to review their own security analyses and to develop recommendations for MSF to better manage emerging risks, I recently carried out a three-week assessment mission to Syria and the surrounding countries.
Prior to my visit to Syria's Aleppo province I had heard reports of attacks on hospitals and even on displaced people living in camps, so it was with added determination and mixed emotions that I crossed the no man's land into Syria proper.
My first stop was a so-called transit camp where more than 8,000 souls live in tattered tents in a dusty, barren, open-air facility. The word "transit" is a misnomer, for those living there lacked connections, passports and bribe money, leaving them unable to exercise their right to flee to safety and claim refugee status by crossing into Turkey. They also could not return to their homes, where the indiscriminate fighting and targeting of civilian spaces continues unabated.
Relief supplies for the camp's population have been dwindling -- meals are down to two a day, and the organization running the health clinic had failed to find new doctors to attend to the sick. On the positive side, MSF had improved sanitation and provided a clean, chlorinated water supply which has helped avert serious outbreaks of waterborne diseases. Camp residents were making the journey to our nearby hospital for medical attention.
It was the residents' emotional needs which struck me most. Trapped in this camp, unable to flee, they feared spending a second winter in such difficult conditions -- when the dusty earth turns to mud for months, and the temperature drops too low for extra blankets to provide adequate protection against the cold.
Camp residents could also not shake their newly acquired fear of planes -- which had been flying over the camp menacingly for months in a kind of psychological warfare aimed at terrorizing the unprotected people below. In a final touch of cruelty, every so often the planes would fire their machine guns. The bullets would tear effortlessly through the tattered canvas tents and occasionally maim and kill families huddling below.
At our nearby hospital, the surgery, maternity and inpatient wards were overflowing with patients -- many of whom had travelled great distances and taken significant personal risks to make it to our sanctuary of care. Roadblocks, snipers and frequent attacks on hospitals had made seeking medical care a dangerous act.
Many were too afraid to remain on the wards after their operations, for fear they could be detained or disappeared. Unfortunately this meant that post-operative infection rates were very high and some patients were dying as a result of preventable infections.
A string of mortar rounds fired at and around this MSF facility forced our medical teams to evacuate and temporarily closed our operating theatres. We erected protective walls around the entire hospital and got back to work. The shrapnel and bullet marks scarring the hospital's outer walls point to the effectiveness of this strategy, which both protected our patients and staff and allowed us to continue working with a modicum of serenity.
Clearly the trickle of aid getting into Syria needs to be turned into a torrent and our governments need to fund and encourage cross-border assistance.
But aid alone is not enough. Kidnappings and attacks on health workers have driven out many well-meaning humanitarian organizations, have collapsed the health system, and have taken a huge toll on the Syrian medical community.
The international community can and must hold both the armed opposition groups and the Syrian government to account and pressure them to obey international humanitarian law. This law prohibits attacks on civilians and civilian spaces like hospitals and schools, and on medical aid workers. Ironically parties to the conflict have a duty to help enable and assist humanitarians and medical action. In Syria today the opposite is being played out in a reckless and deadly manner.
The scale of the destruction and the enormity of the populations' needs is overwhelming. Imagine four-million people uprooted by war and struggling to survive. I came away in awe of the perseverance, dignity and fortitude of the Syrian people. Despite the odds they are struggling to feed their families, earn a living and keep themselves safe from the brutal and escalating civil war being waged all around them.
They were also wondering why the international community for the most part seems to have abandoned them in their hour of need. It was a fairly straightforward question, the answer to which I am still struggling to find.
This is the final blog in a three-part series called Focus on Syria, about my thoughts and observations after travelling to Syria and the surrounding region earlier this year.
“We came here because of the shelling and the helicopter attacks,” says Saleha Mustafa, a Syrian woman displaced from her home. She's photographed here in a transit camp next to the Turkish border. Anna Surinyach / Médecins Sans Frontières/Doctors Without Borders (MSF).
A building in Eastern Aleppo City, heavily damaged after months of intense fighting. Photo: MSF/Monique Doux.
This transit camp more than doubled in size in less than six months. There were 4,000 displaced Syrians living here in November 2012. By April 2013, there were around 10,000. Photo: MSF/Anna Surinyach.
Children attend classes in a makeshift school inside a transit camp in Aleppo province. Photo: MSF/Anna Surinyach
Access to healthcare is urgently needed in Syria. This patient is being transferred to a Médecins Sans Frontières/Doctors Without Borders (MSF) hospital in Aleppo, Syria. Photo: MSF/Anna Surinyach
More than 600 children have been born in this Médecins Sans Frontières/Doctors Without Borders hospital in Aleppo. Photo: MSF/Anna Surinyach
This is the exterior of a Médecins Sans Frontières/Doctors Without Borders hospital in Aleppo province. The hospital is focused on obstetric care and surgery. Photo: MSF/Anna Surinyach
More than 400 surgeries and 15,000 consultations have been performed here. Photo: MSF/Anna Surinyach.
Life in transit camps is difficult, but many Syrians cannot return to their homes because of indiscriminate fighting and targeting of civilian spaces. Photo: MSF/Anna Surinyach
Syrians waiting in line for hours on the eastern side of Aleppo City. But even breadlines like this have been attacked. Photo: Monique Doux / Médecins Sans Frontières/Doctors Without Borders.Photo: MSF/Anna Surinyach
Hospitals are not immune either. This is Dar al Shifah hospital in the Eastern part of Aleppo city, after several months of intense fighting. MSF/Monique Doux.
A Syrian man in a transit camp. Photo: MSF/Anna Surinyach
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