Ground report: Unprecedented attacks on medical missions in Syria

“While international attention has focused on chemical weapons, our teams on the ground are seeing that above all, it is the bombing, the consequent displacement of millions of people, and the targeting and collapse of the Syrian health system that are causing the largest number of deaths,” said Dr Mego Terzian addressing the United Nations last week seeking increase in assistance to Syria. Terzian is spokesperson for Doctors Without Borders/Médecins Sans Frontières (MSF) on the Syrian crisis. In his appeal to the UN, Terzian highlighted the near-complete breakdown of medical services in Opposition-held areas and the urgent need to increase aid and assistance to Syria. While the primary focus of medical assistance is treating the war wounded, the Syrian medical networks are struggling to provide emergency care to pregnant women, the elderly, the sick and children. Their main challenge in Syria, Terzian told Firstpost, is the security management of the medical teams which are being systematically targeted. In an email interview with Firstpost, Terzian spoke about the humanitarian emergency in Syria and his worries about falling levels of international aid. Excerpts from the interview: [caption id=“attachment_868441” align=“alignleft” width=“380”] Dr Mergo Terzian, photo courtesy - MSF[/caption] In your speech to the UN on 7 June you said that humanitarian aid to Syria is failing. What has changed in the last six months? In terms of humanitarian response nothing has changed despite the growing violence and needs. The international aid system has not been functioning properly since the beginning of the crisis and the main aid actors (The International Red Cross and UN humanitarian agencies) have been organizing relief operations via the Capital. As a consequence, most of the aid is dedicated to the population living in government-controlled areas. On the other hand, very few humanitarian convoys are crossing the frontlines to assist the population living in opposition-controlled areas. And yet, it is in these latter areas that the needs are the most important. If you compare the humanitarian needs in the northern part of Syria (where the opposition is in control) with the international aid given, you will come to the conclusion that the aid is not adequate. Have you been able to visit any of the medical facilities in the last few months? Can you tell us about what the doctors are dealing with? I went to the northern part of Syria (Alepo and Idlib governorates) three weeks ago and visited two Doctors without Borders Hospitals and also some health facilities set up by Syrian doctors. If today the wounded are treated, it is thanks to the solidarity of Syrian Diaspora Doctors and the very rare international medical actors which are present in the governorates I just mentioned. Over the past few months, some health structures have been set up by Syrians but they are only dedicated to trauma case management. Patients who have medical problems- like chronic diseases; pregnant women, sick children etc have no access to healthcare. The reasons: the medical infrastructures in the northern part of Syria have either been destroyed or are not functional because of the massive departure of human resources. The few Syrian doctors remaining in the visited governorates focus their efforts on violence related trauma cases and almost nothing is done for other types of medical problems. As you mentioned in your speech, while international attention been on the chemical weapons, the largest deaths have been caused by bombings and the resulting displacement. What has been the impact of the bombing on the health care system? In Idlib or Alepo governorates, half of public health structures are damaged or destroyed and even if the health structures are physically remaining, the medical personnel is not attending to them for security reasons. In this war, the medical mission is targeted.  Medical workers in rebel controlled areas are in permanent risk of being targeted and they are considered criminals since they could potentially treat patients including combatants. What is the priority of international aid workers at this stage? In addition to providing care for the wounded, what are some of the other medical/humanitarian challenges that need immediate attention? There is almost no access for maternal and child care.  Chronic diseases like diabetes, asthma, cardio-vascular diseases and renal failure are also problematic and care of these diseases is almost nonexistent. A lot of burn cases are reported as well as a consequence of domestic accidents and no structure except MSF Hospitals are able to take care of them and perform the specialized surgery needed. Could you share with us one or two personal experiences of your medical staff in Syria to give us a glimpse into the state of medical emergency people are facing. My Syrian colleagues are quite frequently facing patients with renal failure who need dialysis, or children with Talasemia who need specialized follow up and transfusion… unfortunately my colleagues are not able to offer these patients treatment and we are obliged to transfer them, with difficulties, to neighbouring countries Which regions of Syria have been most affected? What are the main challenges in getting medical aid to people in these regions? The most affected regions are Homs, Alepo, Idlib and Deir Zor governorates . The main challenge is the extreme insecurity and the difficult access to the population in need due to daily shelling. Most of the time, medical workers are afraid to work in medical structures since they could be arrested or targeted. On top of that, patients are also sometimes afraid to go to the hospital since they can turn into potential targets. Uncontrolled armed groups and risk of kidnapping is also a problem in the zones I just mentioned. In order to understand the hurdles being faced by international aid workers to gain access and work in Syria, could you share with us MSF’s experience and challenges it is facing. Most of the experienced international aid organisations have no official authorisation from the central government to work in the country. We are blocked between humanitarian law which states that  we should respect the sovereignty of the country and not  work illegally through cross border activities in the northern part of the country (where the needs are high) and  between the same  humanitarian law which says that sovereignty should not put obstacles to assist populations in need . We preferred the second option. For a year now, we have been organizing aid operations through cross border activities without having the official permission from the central government. The authorities are aware of the locations of our hospitals but our teams are not targeted for the moment. However the main challenge remains the security management of the medical teams. It is the first time I witness such an intense targeting of medical structures and personnel in a conflict zone. What is needed of the international community, Syria’s neighbours and donors to ensure continued lifesaving assistance to the people of Syria. Political decisions should be taken in order to increase cross border and cross frontlines aid operations.