At the Zaatari Refugee Camp in Jordan, Nadia Raja, a mother of five from Daraa, lives in a sparse tent with only a few sleeping mats inside, set on rocky ground. The tent has no electricity, is infiltrated with the flies that infest the entire camp, and is beset by 105-degree heat. One of the children is sick with fever and is too weak to even swat the flies away. Her remaining children are slowly succumbing to illness, as well.
“They have fever,” Raja told PBS. “They are suffering from the hot weather. They are suffering from the polluted water — because there is not clean water — and from the situation in general from the camps. It’s too hot in the camp.”
“We have no electricity, there’s no television and we don’t know what’s going on,” continued Raja. “We are just hoping that God has the best for us.”
Raja is far from alone in her suffering. Severe disruptions in the health system in Syria — including the targeting of hospitals, doctors and patients — have left the nation vulnerable to a medical disaster, according to the World Health Organization. The WHO has indicated that water-borne communicable disease outbreaks — specifically hepatitis, typhoid, cholera and dysentery — are inevitable.
With up to 70 percent of the nation’s health workforce gone for fear of their personal safety, at least 35 percent of all public hospitals are out of service. Nearly 4.25 million Syrians live as exiles in overcrowded, unsanitary conditions with little guaranteed access to safe drinking water or electricity, increasing the possibility of escalated outbreak.
“All the risk factors that enhance the transmission of communicable diseases in emergencies are present in the current crisis in Syria and its neighbouring countries,” said Dr Jaouad Mahjour, director of the department for communicable diseases at the WHO’s regional office for the Eastern Mediterranean, in a press release.
The WHO has indicated that measles have reappeared in Syria due to problems with the national vaccination campaign. Cases of tuberculosis and cutaneous leishmaniasis — a parasitic disease that causes skin sores — have appeared among displaced Syrians in Jordan, Lebanon, Iraq and Turkey.
“Jordan had previously reported zero cases of measles for three years, and was planning to officially declare that it was measles-free,” said Mahjour to BBC News.
A nation without doctors
A report from Doctors Without Borders, however, illustrates the gravity of the situation.
“Accounts from doctors and patients revealed that hospitals were being scrutinised by the security forces, and that people were being arrested and tortured inside them,” said a Doctors Without Borders report. “Doctors risked being labelled as ‘enemies of the regime’ for treating the injured, which could lead to their arrest, imprisonment, torture or even death. People injured in protests stopped going to public hospitals for fear of being tortured, arrested, or refused care, and were essentially forced to entrust their health to clandestine networks of medical workers.”
“In Deraa, Homs, Hama, and Damascus, medical care was still provided, out of public view,” the report continued. “Makeshift hospitals were set up inside homes near where protests were taking place. Health centres treating the injured would provide false official diagnoses in order hide that they were treating wounded. The major concern for doctors working in these underground networks was their safety.”
As the two-year-old civil war wages on, both sides see hospitals as a war strategy. The Syrian government openly bombs hospitals and labels doctors “enemies of the state” for treating the injured, according to the Doctors Without Borders report. The rebels began labeling their facilities “Free Syrian Army hospitals,” which increased the risk of attack. Underground, makeshift facilities have sprung up in caves, private homes and farms, but these facilities are regularly targeted in air raids, according to Doctors Without Borders.
The lack of experienced medical practitioners have led to inexperienced workers attempting to make do.
“Dentists are performing minor surgeries, pharmacists are treating patients and young people are volunteering to work as nurses,” the report said.
The realities faced by the doctors that remain were described by “Dr. K,” whose experiences were shared by Doctors Without Borders.
“A missile landed about 50 metres from the hospital; the windows were blown out,” the doctor said, according to the report. “The army had been targeting the hospital. this is the only functioning hospital in this city, and it also serves 15 other towns and villages – a population of 200,000 rely on this facility. We’re able to work and there are enough doctors, but there’s a lack of drugs and medical supplies. our stocks have run out. right now we need X-ray films, external fixators…. we can’t do lab analysis here anymore so people have to go elsewhere.
“The army’s positioned about 20 km away from here – they took over the city twice last year. When they came, I had to leave because they arrest doctors who treat the wounded. For them, doctors are as good as terrorists. they came into the hospital and took a patient right from the ward. Why do I keep on with this? Because if I leave, nobody else will care for the sick. I’ve had multiple threats but I’ve managed to escape so far because I’ve had friends who warned me.”
The brutality of war
According to the United Nations, the Syrian civil war has reached “new levels of brutality.”
The Independent International Commission of Inquiry on the Syrian Arab Republic has reported that forces loyal to Syrian President Bashar Assad “have committed murder, torture, rape, forcible displacement, enforced disappearance and other inhumane acts. Many of these crimes were perpetrated as part of widespread or systematic attacks against civilian populations and constitute crimes against humanity. War crimes and gross violations of international human rights law – including summary execution, arbitrary arrest and detention, unlawful attack, attacking protected objects, and pillaging and destruction of property – have also been committed.”
“There are reasonable grounds to believe that chemical agents have been used as weapons. The precise agents, delivery systems or perpetrators could not be identified,” the commission’s report continued. “The parties to the conflict are using dangerous rhetoric that enflames sectarian tensions and risks inciting mass, indiscriminate violence, particularly against vulnerable communities. War crimes and crimes against humanity have become a daily reality in Syria where the harrowing accounts of victims have seared themselves on our conscience.”
The commission report included reports of children taken hostage and forced to watch torture or act as combatants. It also documented gender-based violence, such as rape and forced marriage. Seventeen major massacres were tracked, including an April 10 government attack in which at least 18 civilians were killed and atrocities were allegedly committed against women and children.
The report illustrates the need for peace, but the chance for a diplomatic resolution is shrinking — to the detriment of the Syrian people. The United States, the United Kingdom and France have lined up in support of the opposition, while Russia and Iran support the Syrian government. Arms transports to the region are also increasing.
“There is a human cost to the political impasse that has come to characterise the response of the international community to the war in Syria,” the commission report said. “The desperation of the parties to the conflict has resulted in new levels of cruelty and brutality, bolstered by an increase in the availability of weapons. Increased arm transfers hurt the prospect of a political settlement to the conflict, fuel the multiplication of armed actors at the national and regional levels and have devastating consequences for civilians.”