A grim prognosis for Syrian and Iraqi hospitals

During the recent Palestinian-Israeli conflict, Israel has been harshly criticized for its strikes on Gaza’s hospitals. Meanwhile, in the self-declared Islamic Caliphate straddling Iraq and Syria, violence surges while fewer and fewer doctors and hospitals remain functional. The deliberate targeting of hospitals and doctors in the theater of war has become a new, deadly strategy.

However, this worsening humanitarian crisis in neighboring countries garners a fraction of the outrage directed towards Israel. As war rages on, millions in Syria and Iraq will continue to die unnoticed, in battle, or from easily preventable ailments that have gone untreated. Long after the cease-fire finally sticks between Israel and Hamas, the vulnerability of patients and their doctors in Iraq and Syria will only grow.

For years now, the forces of President Bashar al-Assad have deliberately targeted hospitals and health centers across Syria in aerial bombardments. According to Physicians for Human Rights, 95 percent of all such attacks have been by the regime. The World Health Organization reports that 57 percent of Syria’s public hospitals are damaged, while 37 percent have been rendered out of service. With 40 percent of ambulances destroyed and others commandeered to transport weapons, patients in the field are being left to suffer and die.

Inside Syria’s hospitals, basic medicines – anesthetics, antibiotics, pain medicines and fluids – run critically low. Assad’s forces have deliberately destroyed Syria’s drug production plants; once almost entirely self-sufficient, Syria’s drug production has been reduced by 90 percent.

Assad’s July 2012 anti-terrorism laws criminalized medical treatment for anyone suspected of being allied with the opposition. The Violations Documentation Center estimates that 469 Syrian health care workers have been incarcerated by the Assad regime and charged with terrorism. Doctors are leaving: More than 15,000 Syrian physicians — more than half of all Syria’s certified doctors — have fled overseas, Physicians for Human Rights reported. According to The Lancet, more than 160 Syrian physicians have been killed.

Due to the lack of medical facilities and poor access to the facilities that do remain, many Syrians are dying of preventable chronic conditions — over and above the large number of casualties from the war itself. Becca Heller, director of the Iraqi Refugee Assistance Project, recently told me about one of her clients who suffers from low blood calcium and an underactive thyroid. “When the family was first referred for resettlement by UNHCR [United Nations High Commissioner for Refugees], her medicines were available and her health was stable,” Heller said. “That is no longer the case. With the nearest hospital over 20 kilometers away irregular access to a car, [she] is now bedridden, shivering, and unresponsive”

Even when patients can access hospitals, there are still risks. The Assad regime has appropriated hospitals for its own soldiers. Witnesses have testified that rooftop snipers compete for cigarettes by picking off civilians seeking medical care as target practice.

Doctors and their families are also vulnerable outside their facilities. The families of physicians who have fled have faced retributions. Patients have been intimidated into naming their doctors, often leading to their capture or execution. Orthopedists and general surgeons have been specifically targeted for execution, according to the recent Lancet Series “Health in the Arab World,” because of their expertise treating battle wounds.

None of these tales from Syria should surprise the world, since similar horrors have happened recently in Iraq. Following the U.S. invasion in 2003, 78 percent of Iraq’s health professionals in Baghdad alone had fled by 2007. Before the invasion, Iraq had approximately 34,000 physicians; by 2006, 18,000 remained. Those doctors who stayed were forced to work in difficult conditions: More than 80 percent of physicians at Iraq’s emergency hospitals report being assaulted. Many have paid the highest costs: by 2006, 2,000 Iraqi doctors had been killed.

Once renowned for its top-notch health care, Iraq has seen its health system steadily collapse. Already hobbled by sanctions before the invasion, 12 percent of all Iraqi hospitals were destroyed, 7 percent were looted, a third of family planning centers were destroyed and leading public health laboratories in Basra and Baghdad were also destroyed after the fall of Iraq. In the facilities that have survived, 65 percent of the remaining equipment is considered useless. Patients needing advanced care have to leave the country.

For example, an Iraqi mother in Baghdad testified to the Iraqi Refugee Assistance Project:

I was forced to take my son to India when he was diagnosed first time with blood leukemia as recommended by the Iraqi physician…. we returned to Iraq to complete the chemotherapy … exporting some of his chemotherapy from outside Iraq as it is not available [here]. Last time my son needed to be … isolated at the hospital, we were terrified … accordingly, we brought him home, along with his treatment and I was forced to give him all the medication. 

Another Iraqi mother in Baghdad, herself asthmatic, told of impossible dilemmas:

We do not know where to start. Is it to store water and food that's already beginning to disappear from markets? How much cooking gas should we store? And what about electricity that I depend on to run my electric nebulizer to be able to breathe? What if I use up all of our electricity and then I cannot run my nebulizer? Are there going to be emergency rooms available in case I need to get my son urgent medical attention for his seizures?  Often, I need to go to the emergency room to get some oxygen myself. What if the roads to the hospital are closed, bombed? What if we only have enough gas for one trip and I have to pick between my own breathing and my son’s seizures? What about explosions on the way to the emergency room? These are all questions I ask myself, in part to distract myself from imagining all the different ways I might be killed. 

It’s difficult to imagine after reading about these doctors and patients in present-day Syria and Iraq that in centuries past, life in Iraq and Syria was flourishing, safe, and healthy. The region bragged the highest reputation for training skilled Muslim doctors and Islamic hospitals — a heritage I feel keenly as a Muslim physician myself.

The first Islamic shelter for the sick was founded with Syrian Christians in Damascus in 707 AD under the rule of Umayyad Calipha Al-Walid. Three renowned hospitals — in Baghdad, Damascus and Cairo — employed physiologists, occulists, orthopedists, cuppers, surgeons and phlebotomists. Between the 13th and 15th centuries no fewer than six hospitals were founded in Damascus alone. Patients discharged from these facilities were provided with new clothing and a stipend to ensure their return to society was comfortable — a generosity that reflects the care and respect that Muslim society afforded to the sick.

Though these hospitals were founded in a rising Islamic civilization, they were secular, open to all patients and expressly forbade proselytization. Centuries later, the legacy of this noble heritage is now perverted by modern-day Muslims into a devastating, brutally sectarian battlefield. Daily, more and more evidence is emerging of the carefully documented crimes against humanity Assad pursues, born of a full-scale sectarian civil war. While the world focuses on Gaza, it should not ignore the terrifying new reality in Syria and Iraq: In warfare, the militarization of health care is here to stay.