Doctors and healthcare professionals in Syria have faced attacks for most of the five-year civil war. If conditions of a previous ceasefire are any indication, the strikes are likely to continue despite the precarious new truce in the north.
Providing healthcare in Syria means living under the constant threat of air bombardments, a lack of basic equipment, or an inability to provide patients with chronic disease the medicines they need.
Media attention flared after an air strike on a medical facility operated by Reporter’s Without Borders and the International Committee of the Red Cross killed 30 people last month.
But for doctors and other health workers in the country, such attacks on their care centres are nothing new.
Syria’s Yamadiya hospital in north Latakia – near the Syria-Turkey border – was being bombed while the United Nations still claimed the existence of a ceasefire. The first hit came on March 23 at about 11am when nearly 40 bombs rained down on the hospital, Dr Saira Murady told Al Jazeera.
Murady attributed the attacks to Syrian government forces. It was not possible to independently verify the claim.
Yamadiya hospital was originally a small tent facility established to help internally displaced people. The hospital staff moved into a school and expanded services to accommodate the increase in war refugees.
But the bombing continued even after the staff relocated hospital operations.
Dr Abu Ali sustained a broken arm and chest wounds in one such attack. The hospital and its remaining doctors, including Murady, now work out of a nearby cave in the hope of protecting patients and themselves.
The attacks are not Murady’s only concern. The violence has meant a dwindling number of physicians with advanced training in specific medical procedures, and hospitals have been forced to rely only on the doctors who remained inside Syria.
“We get used to working under bombs, but the hard part was bringing specialists in this area,” said Murady, who began working at the hospital in 2013 as an emergency room physician.
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Dr Bachir Tajaldin visits Yamadiya hospital every two weeks after leaving the area in 2012 out of concern for his family’s safety. He linked the high number of amputations at Yamadiya hospital to the lack of specialists in vascular surgery.
“There’s no replacement for this health staff. The normal situation when you lose a doctor or a nurse, there is a new generation of the health staff that have graduated from the universities and institutes. But now the hospitals are destroyed and universities are in government-controlled areas,” said Tajaldin.
Dr Hasan al-Araj was the last cardiologist in Hama province. He worked out of a hospital built into the side of a mountain, but was killed in the second week of April when an ambulance he was riding in was bombed in an air strike, according to Syrian American Medical Society’s Lobna Hassairi.
The organisation previously functioned as a networking group for Syrian doctors in the United States, but has transformed its focus to on-the-ground efforts since the start of the civil war. The medical society now has 106 facilities in eight Syrian provinces.
Hassairi shared a quotation from Araj after his death. In a blog post, when asked what he would say to the international community about medical professionals working in Syria, Araj wrote, “We need protection.”
Mohamad Katoub is also concerned by the lack of medical specialists working in the country.
Katoub is an advocacy manager on behalf of hospitals and medical facilities in East Ghouta, near the capital Damascus. East Ghouta was the site of chemical attacks in 2013 which killed about 1,000 people.
Describing strikes on healthcare facilities as the main challenge to doctors, Katoub spoke about the difficulties of working with limited medical supplies in besieged areas.
Katoub said the chief of the intensive care unit at a hospital in East Ghouta instituted new standards after comparing supplies and equipment to the average number of patients admitted. Patients were limited to two litres of IV fluid a day, regardless of their needs.
“The doctor said no more than two litres. Even if he will die, we cannot spend more than two because the third litre will save another life,” Katoub said.
The Syrian government is deliberately maintaining the scarcity of medical supplies, according to Elise Baker, research coordinator for Syria for Physicians for Human Rights.
“The few aid deliveries that are able to get through, the Syrian government is still stripping out medical aid,” said Baker.
The group received information from field sources that the few supplies that do get through to besieged areas are often not usable. Baker’s sources reported receiving expired medicines, defective syringes, or injectable drugs without the required syringes.
Shadi Martini’s family owned a hospital in the main northern city of Aleppo, where he worked as a health administrator before the civil war started in March 2011. He is now on the board of Orient for Humanitarian Relief, an organisation that supports medical care in Syria and Turkey.
A group of doctors he works with in Idlib province was also forced to move their field operations into a cave because of the repeated bombings. If the doctors and patients manage to survive barrages, there is still the issue of a scarcity of supplies.
“Once a month they will get a direct hit, so all the time we have to bring new equipment,” Martini said.
In one month, the ambulance network Martini oversees received 13 direct hits.
Martini said doctors and healthcare workers try to keep ambulances from being targeted from above by digging large holes in fields with lots of trees, so the vehicles can take cover when they come under fire.
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