On a scorching summer afternoon in August of 1988, Zaher Sahloul stood proudly among his fellow medical students at the University of Damascus and swore to uphold the Hippocratic Oath, a commitment he has faithfully honored for the past twenty-five years. On that same day, at that same medical school graduation ceremony, Bashar al-Assad took the same oath, promising to devote his life to defending society’s most vulnerable from “harm and injustice” as a physician. Twenty-five years later, Dr. Assad, who famously told a Vogue reporter he became an ophthalmologist because “there is very little blood,” is overseeing a public health disaster of historic proportions—one that threatens to exponentially enlarge the death toll in Syria’s civil war, which has already surpassed 120,000, according to the Syrian Observatory for Human Rights. His classmate Sahloul now heads the Syrian-American Medical Society (SAMS), one of many humanitarian organizations struggling to meet the staggering demand for medical aid within Syria.
As the conflict in Syria continues its devastating downward spiral, the country’s healthcare system is being systematically dismantled. According to the World Health Organization, 37 percent of Syria’s hospitals have been shut down since the beginning of the war, and another 20 percent have been damaged. In Aleppo, Syria’s largest city, there were 5,000 doctors prior to the war. Today, only thirty-six physicians are left to serve the city’s population of 2.3 million. Aleppo was also the hub of Syria’s domestic pharmaceutical industry, which fulfilled 90 percent of the country’s medical needs before the war. Now decimated, this industry is meeting less than half of the demand, leading to widespread shortages of critical medications.
This healthcare crisis is not an accidental byproduct of the conflict. Over the past two and a half years, the targeting of hospitals and medical personnel by the Syrian regime has been extensively documented by various human rights organizations. Two years ago, Amnesty International published a thirty-nine-page report that described the Syrian government’s pattern of arresting and torturing medical professionals suspected of treating wounded protesters. More recently, the UN Office of the High Commissioner for Human Rights published the damning results of its investigation in a report titled “Assault on Medical Care in Syria.” UN investigators came to the conclusion that “government forces deny medical care to those from opposition-controlled and affiliated areas as a matter of policy.” According to this report, “The policy is implemented through attacks on medical units, by endangering hospitals, targeting medical personnel, and interfering with patients receiving treatment.”
One doesn’t have to dig deep to find a regional precedent for wholesale disruption of a modern healthcare system. A recent study published in the peer-reviewed PLoS Medicine journal pegged the overall death toll due to the US-led invasion and occupation of Iraq at nearly half a million. While about 60 percent of those deaths were violent, the rest were preventable fatalities attributed to a breakdown of health-related infrastructure. That accounts for about 200,000 deaths, which is almost twice the current violent death toll in Syria. It’s worth noting that in Iraq, there was no systematic targeting of the healthcare system as a war tactic such as we are currently seeing in Syria. For this reason, doctors fear that the public health catastrophe in Syria will soon dwarf what happened in Iraq, leaving hundreds of thousands of civilians dead—and they’ve been sounding the alarm for months. In an August editorial, The Lancet called for action to halt the “slow and now accelerating asphyxiation of an entire population.” A few weeks later, the respected medical journal published an open letter signed by dozens of leading physicians pleading for medical workers to be given access to conflict zones within Syria. These calls have not been heeded, and the neglect is already allowing the crisis to metastasize, as evidenced by recent confirmation of a polio outbreak that threatens an estimated 500,000 unvaccinated Syrian children.
This terrifying development underscores an important point that has been overlooked in the wake of the UN-sanctioned agreement to destroy Syria’s chemical weapons stockpiles: the humanitarian situation is still disastrous, and in the continued absence of assertive international action, it will undoubtedly get significantly worse. The air of self-congratulation—complete with the awarding of a Nobel Peace Prize—that has pervaded the Syria discourse after the chemical weapons agreement has obscured this. Though it is certainly a positive development that Assad’s enormous stockpile of chemical weapons is being dismantled, on the humanitarian front this agreement accomplishes very little. Chemical weapons account for less than 2 percent of the death toll in the conflict. Dealing with this single issue does not absolve the international community of the responsibility to address other, more pressing, aspects of the crisis.
Dr. Bassel Atassi, a Syrian-American oncologist originally from Homs, has witnessed this neglected side of the humanitarian catastrophe firsthand during his time volunteering in refugee medical clinics affiliated with SAMS.
“There is a lack of even the most basic care,” Atassi says. “Cancer patients need to undergo a wide range of multidisciplinary procedures. They need blood tests, surgeries, radiation, chemo…none of that is accessible.” Atassi says he recently spoke with a cancer patient currently residing in one of the besieged neighborhoods of Homs whose only option was to travel the dangerous road to Damascus to get the necessary treatment. “She will either die from her untreated cancer, or she will have to risk getting killed by the snipers, getting kidnapped at the checkpoints, or getting caught in the crossfire on the road. This is an impossible choice.” Atassi warns that the hundreds of thousands of Syrians suffering from chronic conditions, including cancer, diabetes, asthma and heart disease, are at significant risk if the international community does not step up its involvement. “With organizations like SAMS, we do what we can, and we are receiving support,” he says. “But there is a tremendous need. What we are doing, it’s like a drop in the ocean compared to what is needed.”
In the wake of the polio outbreak, there have been widespread calls for a “vaccination cease-fire.” Such a piecemeal approach to the systemic public health crisis is not a real solution. Containing the polio outbreak should be part of a comprehensive plan to prevent the deaths of hundreds of thousands of Syrians. A recent report published by Oxfam concluded that several of the countries fueling the armed conflict, notably Russia and Qatar, are contributing the smallest share of humanitarian aid, despite flooding the country with billions of dollars worth of military aid.
The perpetually gridlocked UN Security Council, which has only passed one binding resolution on Syria since the beginning of the conflict, must move to prevent Assad’s continued assault on medicine as a weapon of war. This weapon is more potent than any other in his arsenal, including chemical weapons. Surely, if the use of chemical weapons to kill hundreds of civilians is a “moral obscenity” that cannot go unpunished, as Secretary of State John Kerry declared in the wake of the August sarin attack, then murdering tens of thousands by denying them access to healthcare must also warrant an emphatic international response.