By Jonathan Whittall
On one of my first visits into Syria with MSF, I arrived on a cold night in a city with no electricity and shortages of food. A community under siege hosted me while they lived in fear, huddled into basements in an attempt to escape the continuous bombing. I saw field hospitals overflowing with war-wounded. I saw bodies of men, women and children lying in the streets amid the debris — the grim reminder of government and opposition snipers taking aim in the streets.
Since the conflict started in March 2011 the Syrian healthcare services have been decimated and facilities destroyed — leaving a deadly medical void. Fifty seven percent of public hospitals have been damaged, 36% are no longer functional and 78% of public ambulances have been damaged. From the start of the conflict, denial of healthcare and targeting of medical facilities and staff has been a tactic of war. Ordinary Syrians have no option but to rely on makeshift field hospitals staffed by volunteers with little medical training. I have seen a construction worker operating as a surgeon in a kitchen converted into an operating theatre.
The conflict has evolved and so too have the undeniable needs. Millions of people face severe shortages of food, fuel, shelter and clean water, and there have been outbreaks of typhoid and leishmaniasis in opposition-controlled areas. MSF teams were only able to donate medical supplies as intense fighting meant our medical teams couldn’t reach these areas.
The public health system is under huge strain. International sanctions have frozen financial assets and transactions, making it impossible for the government to purchase medical supplies internationally. Syria used to produce the majority of its own medical supplies but most of the factories have now been destroyed. On a recent visit to Damascus I saw that some medical supplies had run out.
The humanitarian response to these immense needs is massively insufficient. Today the majority of aid in Syria is provided in the bunkers on either side of this war. Whoever provides aid immediately becomes painted with a brush of political solidarity with one side or the other. Attempting to cross the frontlines of this conflict without the acceptance of all warring parties means that you can be turned back at checkpoints as someone who has been assisting “the enemy”, or you have to run the gauntlet of bombings and snipers. For aid to reach besieged places like Homs, Deraa and the suburbs of Damascus, it would have to be able to cross frontlines.
The Syrian government and the opposition forces have the power to ensure that aid can move freely across frontlines and into areas where the most vulnerable on all sides of this conflict are trapped. They can agree to allow the passage of independent medical relief — supplies and personnel. For months now I have tried to negotiate access in government-controlled territories, but so far without success.
Faced with the inability to access Syria officially, MSF has established three unofficial field hospitals in the north. We also send — sometimes illegally — relief and medical supplies into both government and opposition-controlled territories. But given the immense humanitarian needs of the Syrian people, this is not enough.
The grounds on which Damascus suspects aid actors is created by their own policies of denying access, which encourages those who deliver aid sponsored by a geo-political agenda to hide behind the excuse of having no other option but to enter Syria illegally through the north.
Damascus holds the key to unraveling the paralysis of the aid response by allowing the free circulation of independent assistance. A negotiated agreement between all parties is urgently needed to allow life-saving relief to be delivered on the scale required in the most efficient way — across frontlines and across borders. Without such an agreement, life-saving humanitarian aid cannot be extracted from the political complexity that plagues this crisis and hinders an adequate response. Brics leaders could play a role in ending the unacceptable stalemate that currently blocks aid from reaching the most vulnerable.
Jonathan Whittall is a South African working for Médecins Sans Frontières / Doctors Without Borders in Beirut.