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Resham Khiani is a freelance health journalist currently based between London and her home town Gibraltar. She is passionate about women's health and believes everyone should have access to medicine and proper healthcare. She has her own blog, Innerbellissima, dedicated to building positive messages for inner and outer beauty and challenging society's views on beauty. At present she writes for www.positivehealth.com, Diabetes Health Magazine (India) and Doctors of the World UK. 

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Resham Khiani is a freelance health journalist currently based between London and her home town Gibraltar. She is passionate about women's health and believes everyone should have access to medicine and proper healthcare. She has her own blog, Innerbellissima, dedicated to building positive messages for inner and outer beauty and challenging society's views on beauty. At present she writes for www.positivehealth.com, Diabetes Health Magazine (India) and Doctors of the World UK. 

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Syria’s medical system is at breaking point

Syrian man being treated

A patient being treated for shrapnel wounds by a Doctors of the world medic © Agnes Varraine Leca

Your local hospital has been bombed and you’re sitting in a makeshift waiting room when masked men burst in and drag your doctor away for questioning.

This scenario may sound like something from a far-fetched film but it has been a nightmare reality for many Syrians.

Hospitals in Syria are regularly targeted and medical professionals caught helping the wounded are often branded as ‘traitors’ by opposing sides.

‘A colleague of mine in Homs was arrested for having written a death certificate after a man was shot in the head by a sniper,’ says Dr Ayman Jundi, a Syrian medical consultant who now lives in Britain. ‘Sometimes doctors are pulled out in the middle of surgeries and tortured’.

Syria’s once booming pharmaceutical industry, based in Aleppo, has collapsed and patients are forced to buy medications from neighbouring countries at inflated prices

The deliberate targeting of medical facilities and staff has had a huge impact on Syria’s healthcare infrastructure, with around 60 per cent of hospitals destroyed or seriously damaged since the conflict started and doctors and nurses fleeing Syria in droves. There are also major challenges in trying to get medical supplies into Syria, as UN Emergency Relief Co-ordinator Valerie Amos highlighted last week.

‘Some estimate that there are as many as 2,000 armed opposition groups in Syria,’ she said in a speech to the UN Security Council in New York. ‘Clashes among these groups are increasingly common and key humanitarian access routes have been cut off by fierce fighting.’

This has all brought the medical system to breaking point, with patients battling chronic illnesses including cancer, diabetes, and heart disease having nowhere to turn, and diseases such as tuberculosis, leishmaniasis and measles rife. There are even outbreaks of polio.

A doctor in a medical supply room in Zaatari refugee camp for Syrian refugees, Jordan.

David Brunetti

Syria’s once booming pharmaceutical industry, based in Aleppo, has also collapsed and diabetic patients are forced to buy insulin and hypoglycaemic medications from neighbouring countries at inflated prices.

Even societies with strong healthcare foundations would struggle with these challenges, so how Syria’s current decimated system is coping can only be imagined. Exactly how it can be rebuilt is already in the thoughts of Syrian doctors, some of whom remain realistic but positive.

‘It could take up to 10 years,’ says Dr Tawfik Chamaa from the Union of Syrian Medical Relief Organizations. ‘But as soon as the war settles down and security comes back then many of the Syrian doctors will return.’

Experts estimate that the current costs are $300,000 per month just to cover the treatment of casualties and injuries – a figure which doubles if you include treatment for chronic diseases – but there is no clear vision of who will handle these costs in the future. For now, aid agencies are supplying what Syria’s health ministry used to: salaries, medical teams, vaccinations and equipment.

‘We have prepared emergency medical supplies – including primary healthcare kits, surgical material, equipment for conducting caesarean section deliveries and chemical weapon decontamination stock – to treat injured civilians,’ says Leigh Daynes, Executive Director of Doctors of the World UK. ‘The only obstacle in our way is the fighting, which must cease immediately so that we can reach and treat all those in need.’

Prior to the conflict, Syria was a relatively prosperous country with an extremely effective private and public medical system: maternal mortality, for instance, fell from 482 per 100,000 live births in 1970 to 52 in 2009.

A baby is examined by a nurse.

David Brunetti

A large part of Syria’s medical system was therefore used to dealing with diseases associated with rich countries such as diabetes, high blood pressure, depression, cancer and other chronic conditions that are expensive to treat.

This is making it even more challenging to care for Syrians inside the country, as well as the two million who have fled.

Prior to the conflict, Syria was a relatively prosperous country with an extremely effective private and public medical system

‘Thousands of people with chronic conditions are stranded in the region’s refugee camps,’ says Ron Waldman, President of Doctors of the World USA, who recently visited the camps. ‘Unlike children with acute illnesses that can be treated relatively easily and inexpensively in the short term, these patients need ongoing care with expensive medicines or procedures.’

So, what’s the solution?

Ultimately, the conflict must end before rebuilding can begin in earnest. Effective decisions, collaborations and planning among aid agencies and governments need to be made on how the sick and injured should be treated over the next years. More medical and financial support is also required, assuring that everybody can be properly treated and that the treatment is sustainable.

Any plans by external organizations to rebuild primary care centres and hospitals are still in the early stages and most realize that it is going to take time.

‘The planning needs to start now,’ says Ron Waldman. ‘If it does not, the carnage that we are currently witnessing could be only the tip of the iceberg – shorter life and high mortality could be prominent features of Syrian society for many years to come and may, in the long run, be as far-reaching and devastating as the war itself.’

Why do people donate to victims of natural disasters but not of wars?

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A young Syrian refugee fetching water at Zataari camp in Jordan © Sacha Petryszyn/MdMand

You’re watching TV and a fundraising appeal for Syria comes on. There are shocking images and no one can deny the serious needs of the men, women and children on the screen. But you don’t reach for your debit card at the end. Something in you has not been moved quite as much as when you saw such an appeal for the tsunami victims in 2004.

When the Indian Ocean Tsunami destroyed thousands of lives, the disaster pulled at an unprecedented number of heart strings encouraging hundreds of thousands of people to part with their hard-earned cash. Britons alone donated a staggering £392 million. Similarly, the appeal after the Haiti earthquake in 2010 raised £107 million. Compare this to when the Darfur war reached tragic heights in 2007, and just £13.6 million was collected. The recent Disasters Emergency Committee appeal for Syria raised £19 million.

It seems that when it comes to natural disasters donors give willingly, but when man-made disasters occur the purse strings are nowhere near as loose. Yet suffering is suffering, be it natural or man-made, so what’s behind people’s reservations about donating to war victims?

Dr Hanna Zagefka and her team of researchers at Royal Holloway, University of London, have revealed that one reason that tsunamis, famines and earthquakes switch on the altruism button within us is because we perceive victims as the people somehow less to blame for their circumstances.

In an experiment, Dr Zagefka’s psychology team, invented disaster scenarios: half were told a famine was caused by a drought, the other half were told 'military' action stopped food supplies. The researchers found people were much more likely to give money to the victims of the natural disasters.

So it seems that less sympathy is shown for victims of war – people are seen as somehow more responsible for their circumstance even though they were not actively involved in causing atrocities. Dr Zagefka says this type of mentality echoes the 'Just World Belief' hypothesis, a term referring to people's tendency to believe that the world is just and that people get what they deserve. Because people want to believe that the world is fair, they will look for ways to explain injustices – even by blaming the victim.

Unconsciously, this is one of the psychological and underlying factors behind donations. Researchers believe that by producing a message of 'giving a hand' and not 'give money now' could change the way charities interact with the public. Working with this valuable information could benefit charities and help them design more productive relief appeals.

Dr Zagefka explains: 'Charity appeals for humanly-caused disasters could explicitly stress that, even though an armed conflict is going on, the victims are impartial civilians who did not trigger the fighting. Similarly, appeals could stress that victims are making an effort to help themselves'.

And some argue that this approach would also be more representative of the situation on the ground.

'In part because of Live Aid’s success in 1985, many charities fell into the trend of portraying people who are suffering as passive, dependent victims. The reality on the ground is usually quite different,' says Leigh Daynes, Executive Director of Doctors of the World UK. 'People work tirelessly to rebuild their lives under the most difficult conditions; humanitarian aid provides the essentials that improve the chances of their efforts succeeding.'

But even though images of suffering and crisis ensure millions enter into emergency funds, the chasm between how people react to suffering and why they give is bigger than ever.

And the bottom line is that regardless of the cause, the humanitarian needs of people experiencing these crises – however they are caused – are often very similar. Who are we to decide who is most worthy of help? 

This article was originally posted on Doctors of the World UK.