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’.

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

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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.

‘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.’

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