Tragedy beyond words in Syria rebel enclave

Would you live but suffer, or die and be spared?

When words become insufficient to describe the events unfolding before our eyes in the Syrian community of East Ghouta, we realize the extent of our hopelessness.

This suburb is the last rebel stronghold near Damascus, and it has been under siege since 2013 as the Syrian government, Russia and other allies try to oust the rebels. In the past 10 days alone, there has been a ground offensive, a huge bombing campaign, people with symptoms of chemical gas exposure, and a United Nations call for a cease-fire.

Those are the facts. UNICEF summed up the rest in one sentence: “No words will do justice to the children killed, their mothers, their fathers and their loved ones.” As medical workers and first responders, we now realize that we should also issue a statement and inform the world about the state of health and well-being, or lack thereof, in besieged East Ghouta. The truth is, we, too, have run out of words.

White Helmet volunteers, exhausted beyond measure, have been working around the clock, haunted by traumatic imagery of children trapped underneath the rubble. This has not stopped them from carrying out their rescue missions for the civil defense group. One volunteer was killed. Another was performing a rescue mission when he realized it was his own dead mother he was pulling out of the rubble. No words.

The Syrian American Medical Society reports 28 medical facilities have been targeted since Feb. 19, with eight still out of service. SAMS supports five of the targets and lost three workers last week. That makes nine SAMS staff killed so far this year. No words.

Overall, since the Syrian government and its allies intensified their offensive to recapture East Ghouta early last week, over 540 people have been killed and thousands wounded. More than half have been women and children. No words.

Nearly 400,000 people remain trapped, left to face a barrage of air- strikes, barrel bombs and surface-tosurface missiles. No words.

Our mental health professionals are struggling to find diagnoses that accurately capture the symptoms they are witnessing. Post-traumatic stress disorder, a diagnosis that may be given after witnessing a traumatic event, grossly fails to capture the extent of the pain experienced today. There is nothing “post-trauma” in East Ghouta.

There is no “post-trauma” when our trauma — living under incessant bombardment and at risk of starvation — is our daily reality. There is nothing “posttrauma” when our children tell us the only way they can get money for food is to allow themselves to be sexually exploited. There is nothing “post-trauma” when we are forced to deliver therapies that are not designed for this chronic level of horror and calamity, with no access to psychiatric medication.

What diagnosis and treatment should our mental health staff give to 5-year old Ahmad? He told our doctors this week that life and death had become the same, that people disappear and get killed without warning, and that he is praying for death — because anything would be easier than living with this type of fear. What diagnosis and treatment should our doctors give his mother, who does not know whether she should pray that her son remains alive, so they can be together, or dies so he can be spared suffering? No words.

The international community that expressed outrage at the bombardment of Aleppo is now watching the same atrocities all over again in East Ghouta. This time, it is worse; the past week has been one of the deadliest since the war began more than seven years ago.

And yes, while words are insufficient to describe this dire situation, our silence is not an option. It is time for us to regain our voice, push to end the systematic aerial attacks on civilian infrastructure, and fight for the people of East Ghouta who have been experiencing horrors beyond imagination.

Laila Soudi is the project lead for the Stanford Refugee Research Project at Stanford University. Dr. Ahmad Tarakji is president of the Syrian American Medical Society. Raed Saleh, head of the White Helmets, recently visited East Ghouta and is still in Syria.