0 Medical Genocide: Mass Violence and the Health Sector in the Syrian Conflict (2011-2019) Annsar Shahhoud Holocaust and Genocide Studies Universiteit van Amsterdam Student no. 12474088 Prof. Uğur Ümit Üngör September 2020 1 Table of Contents Abstract Introduction 1. Approaching Medical Perpetration in Mass Violence………………………….. 5 2. Methodology and Sources………...…………………………………………... 8 Chapter 1: The Authoritarian Regime’s Health Sector Goes to War 1. Introduction…………………………………………………………………….11 2. The Assad regime’s Health Sector…………………………………………….....12 1) Politicization ……………………………………………………………......12 1.1 Party, Ideology and Health Professionals……………………………......12 1.2 Oppression: Violence as a Pattern of Control…………………………...14 1.3 Party Clientelism-Patronage Network in Healthcare Sector……………...15 2) Militarism, Militarization and Health Sector……………………………….....15 3) Sectarianism and Healthcare…………………………………………………17 3. Syrian War Medicine …………………………………………………………......18 3.1 Polarization, Criminalization and Violence…………………………………...18 3.2 Militarization and Medicalization: Discourse, Facilities and Profession……......20 3.3 Fear and Security Dilemma…………………………………………………...22 4. The War on Terror and Medical Torture…………………………………………23 5. Conclusion……………………………………………………………………......23 Chapter 2: The Masquerade of Syrian Hospitals: Medical Atrocities and Mass Graves 1. Introduction………………………………………………………………………25 2. Military Hospitals…………………………………………………………………26 2.1 Brief History…………………………………………………………………26 2.2 The Route to Agony: Forgotten Names, Unforgettable Journeys…………......27 2.2.1 Discourse and Process…………………………………………….....27 2.2.2 Shattering The Last Hope: “Am I Going to Be Killed?” ………….....28 2.3 Hospitals as Spaces of Tyranny: Silent Persecution…………………………...30 2.3.1 Al Sanamayn Military Hospital: Restrains of Violence……………….32 2.3.2 The Abyss: Yousef Al Azzmeh Hospital 601………………………...33 2.3.2.1 Death Chambers: Medical Torture and Killing ……………..33 2.3.2.2 Doctor Mohammad Barakat: The Killing Master……………36 2.3.2.3 The Guards: Rescuers or Killers…………………………….36 2.3.3 Process of Death: Medical Destruction of Evidence…………………38 2.3.4 Major General Dr. Ammar Suliman: Mastermind of Medical Violence.38 3. Civil Hospitals: A Torture Archipelago. …………………………………………...40 3.1 Al Mujtahid Hospital: A Secret Detention Center……………………………..41 3.2 The Perpetrators: Dr. Ghazi Al-Ali……………………………………………42 4. Conclusion………………………………………………………………………...43 Chapter 3: Syrian Doctors in Genocide and War 1. Introduction ……………………………………………………………………...44 2. Medical Discourse, Propaganda and Scientific Myth……………………………... 45 2 3. Direct Killing and Clinicide ……………………………………………………..47 3.1 Direct Killing …………………………………………………………………...47 3.1..1 Political Murder…………………………………………………………...47 3.1.2 Medical Professionals- Soldiers……………………………………………48 3.2 Clinicide: Medical Murder……………………………………………………….49 3.2.1 Direct Medical Killing …………………………………………………….49 3.2.2 Medical Negligence: A Silent Massacre…………………………………….51 4. Medical Torture…………………………………………………………………52 4.1 Torture Doctor………………………………………………………………….52 4.1.1 Doctors and Torture Before the War in 2011……………………………….52 4.1.2 Doctors and Torture after 2011 …………………………………………….53 4.1.2.1 Doctors and Interrogation in Detention Centers ……………………….53 4.1.2.2 Medical Professionals and Torture at Hospitals…………………………56 5. Legitimization of Violence: Medical Reporting and Forensic Pathology………….58 6. Triage: Indirect Killing …………………………………………………………..60 7. Conclusion……………………………………………………………………….62 Conclusion Bibliography Appendices 3 Abstract This thesis is a study of perpetrators and perpetration in the Syrian health sector under the Assad regime during the conflict (2011-2019) based on extensive fieldwork, both offline and digital. The thesis examines a specific population of perpetrators, defined according to its members’ professional practice, the group members’ behavior and dynamics in a context of mass violence. It engages in a discussion regarding three problematic issues: the circumstances and factors of professionals’ co- optation within state violence in a civil war; the instrumentalization of medical facilities in violence and normalization of perpetration; and the types of medical violence in state violence in a context of repression and civil war. I conclude this thesis with three arguments: (1) medical violence in Syria is not an incidental or accidental phenomenon, but rather a continuity of Hafez al-Assad regime’s legacy, as well as a result of policies of instrumentalization of healthcare inherited from the French-colonial era; (2) civil war and medical mass violence are intertwined, as the civil war dynamics shaped medical violence pattern, and vice versa; and (3) Syrian doctors’ roles were highly important and influential during the war. Finally, I propose a future discussion on challenges of perpetrators and medical perpetration research in authoritarian regimes and ongoing conflicts. “Whether medicine merely provides the equipment or the name for a form of torture, whether doctor ever was a doctor or has only assumed a role, whether he designs the form of torture used, inflicts the brutality himself, assists the process by masquerade of aid, the institution of medicine like that of justice is deconstructed, unmade by being made at once an actual agent of the pain and a demonstration of effects of pain on human consciousness”- Elaine Scarry, 1987.1 1 Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (New York: Oxford University Press, 1987),44. 4 Introduction “It is him... he is the doctor who tortured detainees with diabetes,” a former detainee at hospital 601 said when he saw a photo of Dr Ous.2 Dr. Ous is a man gives the one a wrong impression of a peaceful man and a successful doctor with principles. He is calm, modest, and decently behaved. He even criticized the regime: We hated politicians because they made neighbors kill each other and destroyed cities for personal purposes. I frequently asked myself, “why do we fight each other?” What did we gain of it? We hated political slogans.3 Dr. Hammdan is from the third generation of doctors who graduated under the Ba’ath party, and the second from Tishreen Medical School in Latakia in 1994. He was born in a middle-class family in Qardaha in 1970 and grew up fully under Hafez al-Assad’s regime. Dr. Ous viewed his life as that of a “typical” Syrian doctor: he joined the Syrian Ba’ath party at a young age and served the mandatory military services at Tishreen Military hospital in Damascus. He was trained in military medicine and specialized in anesthesiology. He practiced medicine as a civil doctor with the military for fourteen years (1996-2010). He then returned to military medicine as a reservist doctor after the eruption of the Syrian conflict in 2011. For him, it was a rational decision out of a commitment to his family, community and the state: It was my duty to family, community and the state…I don’t regret serving in the military, it has some great impact. I was an active subject to the country. As an individual, I had a positive impact on the society, it made me content… I helped in a collective meaning.4 He occasionally regretted his decision to stay and serve in the army because of- as he explained- serious mental consequences of numbness and desensitization: “I lost my connection to this world, life means nothing to me.”5 Considering himself a foremost victim of the regime’s ‘conspiracy’: “We discovered at the end that the ‘terrorists’ we were demanded to treat, were state agents sent to penetrate the opposition… The state sacrificed us.”6 The alleged conspiracy had exposed him to danger and caused enormous fear. Dr. Ous tended to rationalize the war and violence in Syria, but he persisted in calling the victims “terrorists”, denying accusations of ill-treatment and torture of detainees, or the existence of a prison at the hospital, and portraying himself as a successful doctor with principles: The truth is we provided medical care equally to loyalists and “terrorists”, they accused us a lot of killing “terrorists”. There were orders to keep them alive because they are of use in terms of information for the state. The hospital is a place where people from different backgrounds work, so you won’t implicate yourself openly. There are three reasons why did not kill the “terrorists”: the intelligence apparatus’ demands to keep them alive; the medical professional’s ethics prevented us from killing; and the doctor cannot violate a patient because the news would be revealed if the doctor killed someone openly. I was among doctors who treated oppositionists in the presence of their families in Jableh 2 Interview with Ismael via WhatsApp June 23, 2020 3 Interview with Ous via Facebook, May 7, 2020 4 Interview with Ous via Facebook, May 7, 2020 5 Interview with Ous via Facebook, May 7, 2020 & April 24, 2020. 6 Interview with Ous, May 7, 2020. 5 hospitals during the army’s ground offensive on the city. I can tell you straightforward there was strict order to keep the “terrorists” alive because they are an information bank for the regime, he will tell the names of his friends.7 Hammdan’s version of events widely conflicts with that of survivors. The former detainee I interviewed not only cast doubt on Dr. Ous’s story, but also his body responded physically to these memories when he saw the photo: “My hands are shaking…I feel as if my brain is trembling.”8 Today, Dr. Ous returned to normalcy as a civil doctor and a family man, where he lives with his wife and two children in his hometown of Qardaha. He works in a civil hospital, enjoying what he missed for years: “A freedom of civilian life away from rigid military institutions and orders.”9 This thesis will examine the phenomenon of medicalized violence during the Syrian conflict between 2011 and 2019. It outlines features of Syrian medicine under Syria’s authoritarian Ba’athist regime and its historical genesis in an attempt to understand the circumstances that led to the co-optation of medical professionals with the regime’s violence. It also identifies the extensive use of medical facilities as torture centers, and types and patterns of medical violence as a distinct category.