Cruel barriers to relief for war victims
Call to let medics save lives – politics aside Durban doctor wants to go back to help
I FIRST went to Damascus in 2012. As a South African I was welcomed, but as a representative of Doctors without Borders (Medécins Sans Frontières) I was greeted with huge suspicion.
Now, six years later, after multiple requests to provide independent medical care and endless unfulfilled promises, MSF is still unable to officially work in Syria.
The South African government invested efforts in supporting our requests, but has been unable to convince its allies in Damascus that medical care provided by independent doctors poses no threat to the Syrian state.
The denial of access to MSF illustrates the way health-care provision has itself become a battleground in the Syria war.
After numerous visits to Damascus in 2012-2013, I developed a proposal to turn a clinic run by the Syrian Arab Red Crescent (Sarc) into a facility capable of dealing with obstetric emergencies. I signed a memorandum of understanding between MSF South Africa and the Sarc in May 2013.
We assembled an international medical team to work alongside Sarc and the Ministry of Health. No one was issued a visa. Nor did we get permission in 2016 after representatives of MSF met Syrian authorities in Damascus.
Our efforts to send a cargo plane of medical supplies with an MSF team during the fighting in Aleppo was never accepted. And I received no reply to a letter I sent to the Syrian Ministry of Foreign Affairs in March 2018, again requesting MSF be allowed to work in the country.
The Syrian government has been consistent in accusing MSF of supporting terrorism. Recently, its ambassador to the UN referred to MSF as “terrorists without borders”.
This is because when our initial requests for access in 2011 were not granted, we opened medical projects openly in areas under control of the armed opposition. This was not because we supported the opposition, but we wished to work where the medical needs were the greatest, and were willing to negotiate with whoever could grant us access.
Part of how we ensure our independence is by not taking money from any governments for our work in such polarised environments as Syria.
However, what we can’t always control is how our medical actions are perceived by those with the power to either facilitate or hamper our work.
In Syria, our effort to treat patients where we could was interpreted as a direct assault on Syrian sovereignty. This is in part due to the central role that health care has played in the creation of the post-colonial Syrian state. Providing independent medical assistance can be seen as undermining the role of the state.
During the war, healthcare provision has been controlled, attacked or facilitated in accordance with the need to assert or deny power.
When an organisation like MSF steps beyond the interests of the state, and provides assistance to those deemed a threat, or more recently those the state labels a ‘“terrorist enemy”, we are often subject to the state’s outrage.
While in Syria, I was considered a threat to the Iranian and Russian-backed state for my links to MSF, but in Bahrain I was considered a threat to the Saudi and Us-backed Bahraini government.
Our impartiality and independence can often be measured against the full political spectrum of those who try to hamper our work.
In recent years, Msf-supported health facilities have been bombed by the Syrian government-led coalition, the Saudi-led coalition in Yemen and the US in Afghanistan.
The Islamic State group in Syria abducted MSF staff and held them for several months during 2014.
In an era where every state is fighting its own “terrorists”, from Nigeria and Yemen to Syria and Iraq, and where health care is often deemed a form of support to terrorists, MSF will almost always fall foul of someone’s political and military interests.
Choosing the side of the patients is always a political act – but not in the party political way that we are often accused of acting.
MSF exists because certain people are denied access to health care, through a specific policy of exclusion or through the indirect consequences of poverty which result in some communities being more vulnerable to war, natural disasters and epidemics.
It is for this reason that the provision of health care based on medical ethics is something we must defend.
We cannot afford for medicine to be subjected to the political polarisation of war. The doctor of your enemy is not your enemy.
South Africa and other states that do not fall neatly into the rising cold war-like political polarisations marking international affairs, can play a role in defending this core principle.
With a new minister in the Department of International Relations and Co-operation and possibly a temporary seat on the UN Security Council in 2019, South Africa can play a crucial, non-aligned role in defending impartial humanitarianism. South Africa can support organisations like MSF in the struggle against the use of humanitarian aid as a tool for political power plays.
Defending this basic principle of humanity will often mean taking a principled position against the centres of power on the UNSC, where member states are complicit in defending their ability to inflict unhindered harm on civilians in the name of fighting terrorists.
In Syria, MSF should be running its biggest humanitarian projects since our creation in 1971. Instead, we could only reach a limited number of people living in opposition-controlled territory.
The government can play a progressive role in helping medics to save lives everywhere in Syria – independently and impartially.
We have lost seven years in denial of access, but we continue to request it because there are still lives to save – on all sides of this war.
Whittall operates between Joburg and Beirut as the director of MSF’S analysis department. He can be found on Twitter @offyourrecord DURBAN doctor Rosanne Symons has witnessed Human Devastation Syndrome first hand – countless times. She has worked in Syria and longs to return there.
The syndrome is not yet an official medical term, but could soon be. Dr Mohammed Hamza, a neuropsychologist with the Syrian-american Medical Society, is heading a campaign to have it declared official. This is an attempt to more accurately describe the severe medical distress thousands of Syrian refugees face.
But Symons reckons no diagnosis could adequately describe such symptoms.
She recently returned from a mission in Jordan with the Syrian American Medical Society (Sams), an organisation at which she volunteers. She told the story of Ameen, who lives at the Alza’atari refugee camp in Amman.
Ameen’s wife and two daughters, one a journalist and the other a doctor, are among hundreds of thousands of Syrians who have disappeared after being captured by the Syrian regime. They are taken to prisons, tortured and starved, with most never heard from or seen again.
“I was treating Ameen’s wound and he was my last patient for the day,” says Symons. “As I said goodbye to him, I told him in Arabic that I was happy to have met him and that I loved Syria. I started to complete my notes, then heard what sounded like someone stumbling. I looked up and saw Ameen was crying,” she said.
Symons helped him sit down and, assisted by a translator, listened to his story. Ameen didn’t know whether to mourn the loss of his wife and two daughters or to be hopeful and continue searching for them.
When Symons heard his story, she also broke down. No words felt adequate, so she offered to pray with him.
“This happens every day in Syria. People don’t know where their loved ones are or if they are dead,” says Symons.
The Glenwood mother of five first went to the country in 2013 after signing up for voluntary work with the Gift of the Givers.
Hundreds of thousands of Syrians have been killed so far in the conlict, with many more injured and maimed. This will be the eighth year of war in the country.
Many towns are still besieged, says Symons. Cities have been reduced to rubble. There have been chemical attacks and multiple violations of the Geneva Convention.
“Markets and schools are targeted and there are mass displacements – more than half the population. Most of the refugees have fled to Turkey, Lebanon and Jordan,” says Symons.
After having watched, on TV, the Syrian conflict unfold, being there in person was a life-changing experience.
“I felt so grateful to be on Syrian soil having been deeply concerned about the war for almost two years. Of course it was scary at times. There were bombings and shootings. Even crossing into the country was dangerous.”
Back in the safety of her Glenwood home, and carrying out locum work at private hospitals, Symons said she had discovered her calling: humanitarian medical work.
If the borders opened, she said, she would go back to Syria in a heartbeat.
“I stay up to date with the news there and keep in touch with friends in the country. I have also started studying Arabic so that I will be able to converse better with the people.”
Her appeal to fellow South Africans is: don’t be distracted by the comlex political situation; pray for the people; support organisations which help them; and raise awareness of their suffering.
“These are people, not statistics. When we look at our past fears and prejudices, we see that they are just like you and I. They have hopes and dreams for their lives,” says Symons.
“They are pawns caught up in cruel global power games.”