Aleppo Abandoned Human Rights a Case Study on Health Care in Syria November 2015
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Physicians for Aleppo Abandoned Human Rights A Case Study on Health Care in Syria November 2015 A medic carries a wounded child following a government airstrike on the opposition-held al-Maghair district of Aleppo. EmbargoedPhoto: Karam al-Masri/AFP/Getty DraftImages EmbargoedAbout Physicians forDraft Human Rights For nearly 30 years, Physicians for Human Rights (PHR) has used science and medicine to document and call attention to mass atrocities and severe human rights violations. PHR is a global organization founded on the idea that health professionals, with their specialized skills, ethical duties, and credible voices, are uniquely positioned to stop human rights violations. PHR’s investigations and expertise are used to advocate for persecuted health workers and medical facilities under attack, prevent torture, document mass atrocities, and hold those who violate human rights accountable. Acknowledgements This report was written by Elise Therapeutics, Inc., and professor PHR is grateful to Palantir Baker, program associate at PHR, of medicine in the Department Technologies for their continued and Michele Heisler, MD, MPA, of Medicine and Heart Institute support and the donation of their PHR volunteer medical advisor, at Cedars Sinai Medical Center; Gotham platform, through which PHR board member, professor of and Donna Shelley, MD, MPH, PHR is able to integrate, analyze, internal medicine and of health associate professor of medicine and visualize data on attacks on behavior and health education and population health, vice chair health care. Palantir’s tools have at the University of Michigan for research, and co-director of the supported the research and analysis Medical School. Section on Tobacco, Alcohol and included in this report. PHR is also Drug Use in the Department of grateful for The Carter Center’s This report benefited from review Population Health at the New York collaboration and data sharing by PHR leadership and staff, University School of Medicine. on conflict events, which help including Widney Brown, director contextualize PHR’s documentation of programs, DeDe Dunevant, PHR intern Trip Eggert assisted in within the broader context of the director of communications, and the report’s production. Syrian conflict. Donna McKay, executive director. PHR is deeply indebted to the Syrian The research protocol for this This report also benefited from doctors who were willing to share report was approved by PHR’s external review by Deborah D. their experiences with us. PHR is Ethics Review Board. Ascheim, MD, PHR board chair and also grateful to the Syrian American chief medical officer of Capricor Medical Society for the invitation to its annual conference in Gaziantep and for its continued partnership and support. Aleppo Areas of Control Map Kilis Turkey Syria Azaz M4 217 214 20 62 Nubl Reyhanli Aleppo 4 M45 60 5 M4 Idlib Source: The Carter Center Key using Palantir Technologies Government Control Kurdish Control Opposition Control Islamic State Control Table of Contents 2 Introduction 20 Conclusion 4 Background on Syria and 21 Epilogue the Conflict in Aleppo 22 Recommendations 7 Methodology and Limitations 23 Endnotes 8 Findings Physicians for HumanEmbargoed Rights phr.org Draft Introduction “You must be safe to save others … If you kill the physician or destroy Embargoed Draftthe hospital, the medicine doesn’t benefit any people.”1 Dr. D, a urologist working in a trauma hospital in Aleppo A barrel bomb falls from the sky, The doctors, nurses, medics, and other tumbling through the air toward civilians health workers in Syria’s opposition- Rescue workers cover a corpse in markets and homes. It shatters when controlled areas have been abandoned under the debris outside Dar al-Shifa it hits the ground. Shrapnel and nails by the international community and UN hospital in Aleppo. filling the barrel fly in all directions, Security Council. They cannot fathom Photo: Francisco Leong/AFP/ causing catastrophic injuries. Minutes how the world can stand passively by Getty Images later, after the first responders and and watch as a quarter of a million medics have rushed to the scene to people die, millions more are displaced, provide emergency aid, another bomb and civilian homes and workplaces are falls – targeting them. This is a double obliterated. They are left standing in tap strike. Those left standing transport their barren, makeshift hospitals with the injured and dying to a nearby nothing but sandbags protecting them hospital, where doctors race to save from the next airstrike, wondering how lives knowing at any moment they could much longer they have left to live. be bombed. When the last casualty is They know that as long as the world’s treated, it is time to count the dead. indifference continues, the odds are Doctors and first responders pick up against them. body parts and wonder whose mothers, fathers, and children the mangled limbs Welcome to Aleppo. belong to. 2 Aleppo Abandoned: A Case Study on Health Care in Syria “I never expected to see doctors tortured, to see what we saw. It’s probably best that we didn’t know this would happen. Otherwise, we may not have started the revolution.”2 Dr. M, an orthopedist working for an organization supporting health care in Aleppo The conflict in Syria is well into its While the self-declared Islamic and thousands of their patients have fifth year, and as of October 2015, State (IS), also called ISIS or ISIL, has lost their lives. Health workers in Aleppo Physicians for Human Rights (PHR) has grabbed headlines with its exhibitionist understand the UN Security Council’s documented the deaths of 687 medical violence, the Syrian government failure all too well. They live with the personnel and 329 attacks on medical has systematically violated every reality of disappeared colleagues and facilities. The Syrian government is international law aimed at protecting hospital attacks every day. Yet they have responsible for nearly 90 percent of civilians. Its strategy is to bomb its not given up hope, and they continue these attacks.3 Each attack, whether the citizens into submission – destroying to ask for one simple thing: an end bombing of a hospital or the detention hospitals, markets, and mosques in to the attacks on hospitals, medical and torture of a doctor for providing order to punish the opposition and its personnel, patients, and civilians. If the health care, is a war crime. Given the supporters for their political views and international community will enforce systematic nature of these attacks make life unbearable outside of the these protections, as mandated by by Syrian government forces, these areas it controls. The Syrian government international law, Aleppo’s medical violations constitute crimes against has forced health workers to risk their workers are confident their colleagues humanity. The Syrian government’s lives to save others and left its well- who fled will return, and together they ongoing assault on health care is one established health care system – one can begin rebuilding their country’s of the most egregious the world has of the best in the region – in ruins that health care system. But first, the attacks ever seen. will take decades to rebuild. It has also must stop. compelled millions of civilians injured in International humanitarian laws (IHL) bombardment on their homes, markets, Syrian forces must immediately were negotiated more than 150 years mosques, and schools to weigh the stop attacking medical facilities and ago and have since been ratified by risks of dying from treatable conditions personnel in Syria. If they do not and 196 countries, including Syria, in an versus dying in a hospital attack while these war crimes continue, the UN attempt to protect civilians in conflict. seeking life-saving care. Security Council must implement further They prohibit parties to conflict from measures (as prescribed in Resolutions targeting non-combatants and require This report focuses on the state of 2139 6 and 21657) to ensure that the that special measures be taken to health care in eastern Aleppo city4 – the Syrian government and all other prevent harm to civilians or civilian city hit hardest by these attacks5 – and parties to the conflict end all unlawful objects. In addition to these protections, tells a story of courage and resilience in attacks on civilians and respect medical medical personnel and facilities are the face of tremendous human suffering neutrality, the principle under IHL that awarded even greater protection under and loss. PHR’s findings illustrate that health care is protected and must be the Geneva Conventions. IHL requires the unlawful attacks have significantly provided impartially. that all parties protect and ensure degraded Aleppo’s health care system; the functionality of medical facilities, more than two-thirds of the hospitals no The consequences are clear: failing to transport, and personnel; all parties longer function and roughly 95 percent stop attacks on medical professionals protect and ensure unbiased treatment of doctors have fled, been detained, or and infrastructure has resulted in and for both wounded civilians and killed. However, the remaining medical will continue to result in devastating combatants; and that medical personnel personnel have persevered and manage health outcomes for civilians living in provide impartial care to both civilians to provide health care in the midst of conflict zones. Syria’s unprecedented and wounded combatants, in keeping a horrific war, despite minimal access assault is not only disrupting emergency with medical ethics. States established to equipment and medication. They aid, but also depriving communities these laws because they agreed that have learned to rebuild hospitals after of routine health care and threatening anyone injured in a conflict – civilians their own have been bombed and their very capacity to survive. It will take and combatants alike – should have provide lifesaving care without adequate decades to rebuild Syria’s health care guaranteed access to health care in a personnel, medications, supplies, and system, but the effects go far beyond safe space.