Children walk past a hole in the ground caused by strikes in the rebel-held town of Douma in Syria’s Eastern Ghouta region, on November 15, 2017. HAMZA AL-AJWEH/AFP/Getty Images
THE DESPERATE STATE of Syria’s Eastern Ghouta region made international headlines in late October when local activists released the photo of an infant girl who had starved to death. While her case received significant attention, severe malnutrition and a lack of medical supplies have killed a number of other children in the besieged suburbs outside the capital – deaths that have largely gone unreported.
Before the tragic death of one-month-old Sahar, Kinan, a 6-month-old boy with leukemia, died in August, because he received only one of five drugs needed for his treatment, a physician who works for the Union of Medical Care and Relief Organizations (UOSSM), an international organization that provides free medical aid to Syria, told Physicians for Human Rights (PHR).
“[Kinan was] followed by Sahar, Obaida and Maram, [children] who died from severe cases of malnutrition,” in the following months, according to the physician who asked to be identified as Dr. Jad Salem.
Lack of food in conflict-torn towns has severely affected the well-being of residents, Dr. Salem explained. For him, these children aren’t the first and will not be the last to die if the siege on Eastern Ghouta is not lifted immediately.
Eastern Ghouta, just outside the capital Damascus, is one of the largest remaining opposition strongholds in Syria, and the last rebel enclave around President Bashar al-Assad’s seat of power. Since 2013, the Syrian government has imposed a suffocating siege on the area, which is home to at least 350,000 people.
The blockade left families and other residents struggling every day to find basic necessities. To alleviate the suffering, local activists dug tunnels from Eastern Ghouta to Barzeh, a Damascus neighborhood that has had easy and sustained access to supplies. The tunnels enabled civilians to smuggle food and medical supplies into Eastern Ghouta, until the Syrian government destroyed them in February 2017.
“This is when the situation started to severely deteriorate,” local media activist Ammar Al Hassan, told PHR.
Besieging civilians as a tactic of war is illegal under international law, and in Syria it is made worse by the equally illegal blocking of humanitarian aid and medical supplies. Doctors and other healthcare professionals in Eastern Ghouta are operating with virtually zero support. Aid deliveries are rare and, when they arrive, they are wholly inadequate to the needs of the besieged population. Eastern Ghouta, which historically provided various types of fruits and vegetables to the Syrian capital, is now the prime example of famine and healthcare scarcity in the country.
Since the beginning of 2017, just six aid convoys reached Eastern Ghouta. Of the 29 towns in the region, only eight have received humanitarian aid, and deliveries were inadequate both in terms of quantity and variety.
Most recently, the U.N. and Syrian Red Crescent led two aid convoys of 49 trucks in the towns of Saqba, Kafarbatna and Douma in Eastern Ghouta at the end of October. The convoys contained only enough supplies for 20 percent of the 370,000 people trapped inside the area. This forced residents to divide each individual package into five or six portions to distribute food to as many people as possible.
Furthermore, many of those who received food were unable to cook it, as the convoys did not contain materials to compensate for the shortage of cooking and heating fuel in eastern Ghouta, according to Dr. Mohammad Katoub of the Syrian American Medical Society (SAMS). Lack of fuel means that civilians in the area have no means to stay warm in the coming winter months.
Doctors and healthcare workers also struggle to provide even minimal care because of a severe and protracted lack of medical supplies in all of the 39 medical centers across the besieged region. Dr. Katoub told PHR that the few convoys to reach the area contained only limited amounts of insulin, pediatric oral medications and lice and scabies treatments. The recent convoy to reach Douma contained just 50 syringes.
“They didn’t have any surgical supplies, not even those needed for a cesarean delivery,” Dr. Katoub said.
According to Dr. Salem, doctors are using surgical sutures meant for external wounds for heart surgeries. Some are making the extraordinarily difficult choice of using expired medical supplies and are attempting surgeries their facilities are not equipped for. The alternative is not to provide any care at all, he said.
“A few weeks ago, one of the local doctors performed a successful surgery on a newborn. But unfortunately the infant couldn’t escape death simply because the intensive care unit didn’t have any functioning incubators or ventilators to keep him alive,” Dr. Salem.
To make matters worse, healthcare workers now fear the imminent spread of epidemics. Without vaccines, children with already weak immune systems due to malnutrition are more susceptible to vaccine-preventable diseases. In the past year, local sources have reported an outbreak of measles.
Five years of siege combined with targeted bombings of hospitals and medical points have been traumatizing for healthcare professionals who have been working relentlessly. Many are showing symptoms of secondary trauma, and in addition to the hardship and lack of sustainable income, healthcare workers are now expressing dread.
“Doctors in Eastern Ghouta share a sense of helplessness, loss of hope, and despair for not being able to provide the help for their patients – a feeling that is affecting them beyond what words can describe,” Dr. Salem said.
PHR has consistently documented the consequences of siege. The current level of vulnerability requires not only the Syrian government but all parties to the conflict to collectively respond to the human catastrophe in Eastern Ghouta and to act immediately to ensure comprehensive and unrestricted humanitarian aid deliveries.
But the onus is not just on local actors. Responsibility also lies with the U.N., as a key coordinator of humanitarian aid, and the countries sponsoring the cease-fire talks.
Critical patients in Eastern Ghouta must be transferred to other medical centers to receive proper treatment. The most pressing medical needs of the 156 cancer patients, the 560 patients with chronic illnesses, and the 32 cases in critical need of kidney dialysis must be met.
The current crisis in Eastern Ghouta is not a case of the inevitable suffering during war. It is the result of the deliberate targeting of civilians through direct attacks on healthcare and livelihoods. We must all advocate for the urgent needs of civilians who have endured five years of blockades, bombardment and internal conflict among the divergent armed factions.
These fellow human beings must have access to food and medicine. Now.
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