Q&A: Providing health care in the trenches of Syria's war

By Amy Lieberman 06 December 2016

Part of the Dr. Hasan Al-Araj Hospital that were damaged by air strikes in Hama, Syria. Photo by: UOSSM

Aid and medical workers are searching for ways to reach the many people in need of emergency and general health care amidst a deteriorating humanitarian situation in Aleppo, Syria.

The city’s eastern, rebel-controlled half has been besieged for nearly a month as government-allied forces try to retake ground, leaving nearly a quarter of a million civilians trapped. The last operating hospital there was destroyed in an airstrike in November -- part of a broader pattern of government attacks against medical facilities in opposition-held areas.

Union of Medical Care and Relief Organizations, a coalition of Syrian humanitarian and medical groups, is one of the few medical organizations still providing services in Syria, where an estimated 11.5 million people require medical care. UOSSM runs more than 15 primary health care centers and mobile health clinics across the country, in addition to supporting hospitals with medical supplies and needs. It has documented 545 attacks on 250 medical facilities throughout Syria since March 2011.

UOSSM faces enormous operational challenges. Some of its staff are among the more than 200,000 people living under siege in east Aleppo, where the number of doctors has dwindled from 30 in October to the low 20s, says Khaula Sawah, CEO of UOSSM USA.

Outside health workers haven’t been able to access the East for more than a month, she told Devex. Across Syria, medical personnel often lack supplies, including the expensive full-face masks that are typically necessary to treat victims of chemical attacks.

Access to east Aleppo has confounded both Syrian-based and international organizations alike. The International Committee of the Red Cross still has a team in west Aleppo, where they keep a warehouse stocked with food and medical supplies, says Ingy Sedky, a spokesperson based in Damascus. Their team has been waiting, ready, to go into east Aleppo and help facilitate medical evacuations for the last several months as ceasefire deals have repeatedly fallen through. On Monday, China and Russia vetoed a proposed U.N. Security Council cease-fire for seven days.

Sawah spoke with Devex about field capacity for her colleagues in Syria and how the progression of the nearly six-year-old conflict has shaped the way medical work is delivered.

How have ongoing security risks pushed you to change the way you operate in Syria?

I don’t know if there is a simple, easy answer. We have been talking a lot with our operational staff and security director to try to figure out what plans we need. We always communicate on WhatsApp. Our staff is trained to work under very difficult conditions, but this is unprecedented. Despite whatever training and capacity you have built, you can't stand up to a missile.

If the international community does not come to a political resolution and protect the people, we, as humanitarian workers, cannot do anything. The best we can do is get funding from donors and see what we can do with our access, within the safety limits, to provide services.

There’s something I heard from the ground when I went inside Syria and met people working under harsh conditions. I said, “What is it that is keeping you going? I am there 24 hours and it is horrible, not something normal, and you can easily develop PTSD.” They say, “We have to do something. We can’t just stand still. We can be the next ones who are going to lose ourselves, our wives, our children.”

We have also been providing not only regular training, but specialized, medical training since early 2013. From the very beginning, we knew the importance of pairing [medical professionals] with this training and knowing how to handle such [things as] chemical weapons. We have different specialized courses, some specialized in war zones, and we have some that are tailored to physicians … as well as training for midwives. We are doing intensive training on chemical weapons to learn about the symptoms and how to deal with the chlorine, and some administrative training. We have trained over 9,000 personnel since 2013 and have had people coming from all over.

You have done work with a fortified hospital in Syria, which was recently destroyed in rural Hama. How was that work developed?

What happened in the suburbs of Hama was we had gotten pooled funds from the U.N. Office of Humanitarian Affairs and other funds to have a fortified hospital, the cave hospital. We are not the only NGO supporting that hospital, there were a couple of other organizations, but that hospital was [previously] targeted several times and damaged. So basically in the mountains at about 50 feet below they were working on the [cave] hospital. It took several months to establish and get all the medical supplies and equipment and put it in the cave. This year it was targeted several times and eventually missiles came through it from above the mountain to below. It was powerful enough to destroy the cave hospital.

After that, it was like, “What else do we do now. There is no safe haven.” What can we do prevent missiles, if they are using ballistic missiles, and using all kinds of chlorine attacks in Aleppo. There is nothing you can do.

What is your capacity like right now in Syria?

It has been challenging, recently. For primary [health care facilities] in Syria, we used to have 12 and they were on the increase. But we had a couple we had to shut down, relocate and change a few of them to mobile clinics based on the area and needs. We provide also services in the Hama area and also in the suburbs of Homs.

We are facing a lot of challenges to get supplies as needed for providing the best of care. There are some areas where we cannot get medications. Always the preference is to give supplies versus cash, but there are many times we can’t do that. You could say funding is one major challenge, but we also don’t have sufficient access and sometimes we have no access.

Right now, we are trying to understand the issues with donors [who think] if they give us money, [our facilities] are going to be destroyed. It’s hard to seek funds when you have this disconnect and hard to organize amongst the different organizations if you don’t know how to explain you have no access.

Increasingly, in 2015, we started to switch some of our primary healthcare centers to mobile clinics. … We had done it in Hama, in the suburbs of Aleppo and then we shut down the Raqqa clinic. When we shut the [health centers] down usually, if we have the funds, we switch to mobile clinics. We try to do something else, but sometimes we have to relocate totally.

With all of our staff, including doctors and administrative workers, my understanding is we are close to 1,000 right now in Syria. All of staff are local, and what we have found is when you hire from the local population itself you empower them. We have five medical organizations working in Syria right now and these are Syrian organizations. Other organizations, [such as Médecins Sans Frontières], all work through us. They don’t work directly on the ground. They cannot. The Syrian crisis is unique in that it has not allowed foreigners, doctors even to go inside.

* Update, Dec 15, 2016: This article has been updated to reflect that while Médecins Sans Frontières collaborates with UOSSM, it works based on agreements directly made with hospitals, not through UOSSM or other intermediates.

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About the author

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Amy Liebermanamylieberman

Amy Lieberman is a reporter for Devex, based out of New York, where she covers global development around the city and out of the United Nations. She has previously worked as a freelancer, reporting on the environment, social justice issues, immigration and development. Her coverage has appeared in The Guardian, The Atlantic, Slate and The Los Angeles Times, among other outlets. She received her M.A. in politics and government from Columbia Journalism School in 2014.


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