COMMENTARY

Health Professionals Respond to Syria's Humanitarian Crisis

Samer Attar, MD

Disclosures

January 22, 2014

In This Article

Healthcare Under Attack

A collapsed healthcare system further complicates the situation, as 60% of public hospitals and 78% of public ambulances are damaged or out of service.[3] Local production of medicines has diminished by 90%.[9] About 15,000 physicians have left the country for their safety; 469 health workers are imprisoned; and as of April 2013, only 36 out of 5000 physicians remained in Aleppo, Syria's largest city.[10] Many medics must work in secret, makeshift locations under threat of arrest or execution if they are caught treating "the other side."

Surgeries have been performed without anesthesia.[11] Women have given birth with no access to perinatal or obstetric care. Patients with treatable conditions, such as diabetes, hypertension, asthma, and leukemia, cannot be helped, and there is virtually no assistance for victims of sexual assault and psychological trauma. Overcrowding, contaminated water, and disrupted vaccinations threaten the region with epidemics of measles, cholera, and polio.[12]

The delivery of humanitarian aid and medical care under these circumstances is dangerous. The distribution of aid through Damascus is dictated and monopolized by the Syrian government and hampered by bureaucratic obstacles. Cross-border assistance of personnel and supplies is extremely difficult and not officially authorized. Internal checkpoints can pose hostile, challenging negotiations with government forces and fragmented opposition factions. A UN convoy once encountered 50 checkpoints on the road from Damascus to Aleppo.[13] At least 32 Red Crescent workers and 11 UN staff have been killed in the line of duty helping others; another 21 UN staff remain in detention.[14]

Blocked access to besieged areas where people are starving has been lifted for chemical weapons inspectors but denied for humanitarian aid. In such places as Ghouta and Homs, sustained government blockades and bombardments have cut off thousands of people from food, adequate shelter, and basic medical care.[15] Just in the last few weeks of December 2013, indiscriminate airstrikes in the civilian neighborhoods of Aleppo killed and injured hundreds. Ill-equipped facilities were under siege and were dealing with daily massacres. Dozens of injured and dead had to be placed onto hospital floors, and with limited ambulance support, few could be reached in time to be helped.

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