Syria: War, ceasefire and the medical challenges ahead

Sunday 24/04/2016
Syrian man receiving treatment at makeshift hospital

Doctors Without Borders’ (MSF) first intervention in a conflict zone took place in Lebanon in 1976. Forty years later, more than half of the medical humanitarian organisa­tion’s work involves providing health care in conflict areas.
As armed conflict and violence continue to spread, MSF teams face increasing challenges in their attempts to provide essential medical care. In 2015, our teams lost patients and colleagues in both targeted and indiscriminate attacks that have damaged and destroyed medical facilities in countries such as Syria, Yemen and Afghanistan.
Syria has been called “the worst humanitarian crisis since World War II” and, six years into this brutal war, the humanitarian and medical toll of the violence is massive. The cessation of violence agreement brokered at the end of February delivered much-needed respite from bombing but not an end to suffering after years of war.
At least 1.6 million people are still under siege with dwindling supplies in areas such as North Homs and East Ghouta while neighbouring countries’ borders, and beyond, are closed to fleeing Syrian refugees.
With massive unmet needs inside Syria, MSF should be running some of the biggest operations in its history but our ability to work directly is heavily limited by security and access constraints.
However, MSF continues to operate medical facilities inside Syria, as well as directly supporting more than 70 medical structures throughout the country and providing ad hoc emergency medical donations to around 80 other medical facilities. Medical activities in neighbouring countries have been scaled up and additional projects have been opened but the need continues to be enormous.
2015 saw an increased number of countries engaging their military and entering the war. Russia intervened in September on the invitation of the Syrian government, with significant use of its air force, while France and the United Kingdom extended their air campaigns under the US-led coalition from Iraq to Syria in September and December.
Even if active hostilities have decreased, four of the five permanent members of the UN Security Council are involved in the Syrian conflict.
In a recent report, MSF detailed the toll of the conflict on Syrians, based on data from 70 hospitals and clinics that the organisation supports in north-western, western and central areas of the country. In total 154,647 war-wounded people and 7,009 war-dead were documented in the facilities in 2015, with women and children (defined as under the age of 15) representing 30-40% of the victims. Ninety-four aerial or shelling attacks hit MSF-supported facilities, in 12 cases leading to the destruction of the facility.
At least one MSF-supported hospital was bombed or shelled every week in 2015. Under international humanitarian law known functioning hospitals are protected spaces where the wounded and sick have the right to seek care safely and indiscriminate attacks that do not precisely and clearly identify the target as a legitimate military objective are in violation of the rules of war.
Whether the hospitals were hit in targeted or indiscriminate attacks, the protection and respect of the medical mission, facilities, staff and emergency response teams should be the norm even in extraordinary circumstances, especially in conflict, where this work is vital in saving lives.
The four permanent members of the UN Security Council that have participated and continue to participate in some form in the conflict should respect their own resolutions and assure that their own military, as well as their allies, fully implement the resolutions for which they unanimously voted.
While the cessation of hostilities means a reduction of violence and bombing, the medical humanitarian needs from six years of war remain immense. No matter how the situation develops, civilians and civilian infrastructure must be spared. Full humanitarian access to all besieged areas and unhindered movement for medical evacuations, supplies and staff is a priority.