Special Reports  ::   A Special Report on the Medical Conditions in Aleppo


A Special Report on the Medical Conditions in Aleppo

Including the Violations against the Medical Cadres

Violation Documentation Center in Syria

May 2014

 

Introduction:

 

Aleppo governorate, especially the city of Aleppo, has had strict measures imposed on it by the regime on all levels, especially because it is the economic capital of Syria. These strict measures were the most apparent in the oppression of the peaceful demonstrations in Aleppo. They also impacted badly on other aspects of the revolutionary movement including the medical cadres, which were targeted as along with the medical points and hospitals providing medical care for the injured. First, the regime used indiscriminate arrest and abductions as weapons against the people; then, when things escalated in the city of Aleppo, they practiced field executions and fatal torture of detainees. These detainees included doctors, nurses and paramedics. By 2013, the medical points and hospitals became targets of the regime forces' guided missiles and barrel bombs.

VDC has also detected several violations committed against the medical cadres by the opposition armed groups in some eastern neighborhoods of Aleppo and other places, mostly by the Islamic State of Iraq and Sham (ISIS/Daash)

 

Methodology

This report draws from interviews conducted [1] via Skype with many specialized doctors, nurses, paramedics and supervisors in the medical points and field hospitals that have been secretly established in the eastern neighborhoods of Aleppo. Most of the interviewees preferred to remain anonymous and not to mention the locations of the medical points at which they are working, for fear of persecution by the regime forces, or of their families getting detained. (Most of them are using pseudonyms at work because their families are still in areas controlled by the regime forces such as the western neighborhoods of Aleppo.

 

First: The Deliberate Attack of Medical Cadres and Utilities

A - The Medical Cadres:

1 - By the Regime Forces:

Since the beginning of the protests in Aleppo, doctors have been ill-treated by the security forces and the regime’s militia or ‘Shabiha’. These mistreatments have included beatings, threats and detention, often leading to death under torture. Why? Because the regime considers it a crime for any doctor to help and relieve the injured – a crime punishable by detention and sometimes death.

Dr. Abu Muhammad, a general surgeon, says:

"I was a general surgeon in Aleppo Academic Hospital and al-Kindi Hospital. Whether because we have partaken in anti-government demonstrations or helped the injured, we have been exposed to many harasments by security personnel. In April 2012, an orthopedic doctor working in Aleppo Academic Hospital was arrested; when we asked for his release, military security personnel came to the hospital and threatened us with weapons, and Shabiha came and beat us.. In that same month security forces stormed an operation room in Aleppo Academic Hospital where an operation was being performed on a twenty-year-old university student, in order to beat him even though he had already been hit by the regime forces in a demonstration".

 

VDC has documented the detention of more than 53 doctors and medical staff in Aleppo. The majority of them are still under arrest, while some others have been forcibly disappeared including:

 

1-Dr. Muhammad Bashir Arab, 31 years old, was arrested on 2 November 2011. Some witnesses have confirmed that he is in Sednaya Military Prison and he is believed to have appeared before the Military Field Court.

2-Dr. Mahmoud Issa was arrested on 26 June 2012 in front of his house in Aleppo’s Martini Neighborhood. He was at one time reported to be detained by Air Security Branch in Aleppo, after which his fate became unknown.

3-Dr. Abu Ibrahim was arrested on 1 December 2012 while heading in his ambulance to help injured casualty. His fate remains unknown.

Violations, detentions and offensives were not only committed against doctors but also against their families and relatives. This has sometimes been an attempt to force the doctors to give themselves up to security branches, and sometimes in retaliation against doctors who have treated and helped civilians targeted and injured by the regime. In this respect Dr. Osama Darweesh, a general surgeon, described for VDC the experience undergone by two of his brothers when the regime forces arrested them in retaliation:

My brother, a doctor for urinary diseases called Dr. Yaser Darweesh, was arrested by the Air Security Branch in an ambush set up especially to catch him. Someone had called him to say that a casualty at Gurduba Square needed help, but when he got there some Air Security personnel were waiting for him. Thus he was arrested in July 2011, charged with having relieved the injured in Idlib countryside. His detention lasted for six and a half months, during which he lost 30kg.

Then my second brother, a dentist called Ammar Darweesh, was also arrested at the end of January 2014 at the checkpoint near al-Razi Hospital. He was taken to the State Security Branch in Aleppo charged with "being the brother of Dr Osama Darweesh" (i.e. me), for the regime forces were well aware that I was working in opposition-controlled areas. Although he had never taken part in any revolutionary activities, Ammar was exposed to severe torture which deteriorated his health condition greatly as he is diabetic. He was eventually released on 16 April 2014."

Many doctors were tortured to death in security branches; others were killed by the regime’s ‘Shabiha’ militiamen. VDC has documented more than eight members of medical cadres who were tortured to death in the regime’s detention centers including:

 

1-Dr. Sakher Hallak, a 44 year- old doctor specializing in nutrition, was arrested on 28 May 2012 by the regime forces. His body was found on a highway in Aleppo three days after his detention, bearing the marks of severe torture.

2-Dr. Shirzad Haj Rasheed, a 25 year-old doctor and a member in the Syrian Kurdish Unity Party, as kidnapped by ‘Shabiha’ militiamen on 10 February 2012. The next day, his body was found bearing evidence of torture.

3-Dr. Qadri Muhammad Izzeddin, a 40 year-old doctor in Aleppo Central Prison until he had dissented from the regime, was arrested on 3 November and taken to one of their security branches where he was tortured to death.

 

4-Dr. Muhammad Nour Maktabi, a doctor for chest diseases and a graduate in Islamic Law/Sharia, was arrested at his clinic in Seif al-Dawlah neighborhood on Monday 18 June 2012. Five months later, on 16 November 2012, his body was found among many other bodies in the morgue refrigerator of Aleppo Academic Hospital. He had been tortured to death in Air Security Branch.

5-Dr.Basel Mazen Aslan, the paramedic Hazem Batikh, and Dr. Musaab Omar Bard were arrested at night at a checkpoint at 3000 Square in al-Hamadanieh neighborhood as they were heading to help an injured. Their charred corpses were found a few days later bearing traces of torture.

Dr. Nidal.M, 23 years, said to VDC about this horrific incident:

"I, Dr. Basel Aslan, Dr. Musaab Bard, and paramedic Hazem Bateekh formed Nour al-Hayat/ Glimmer of Life relief team at the beginning of 2012. People used to call upon us to help the injured. Accordingly, we went to the house of the injured directly with our first aid kits, once satisfied we weren’t being set up for an ambush. If the casualty needed a surgical operation we call a surgeon to assist with an operation in the casualty’s house. On 17 June 2012, Basel, Musaab and Hazem were arrested at night at a checkpoint of the regime forces near 3000 Square in al-Hamadaniyah neighborhood while they were on their way to help an injured. They were taken to the Air Force Branch in Jamieat al-Zahraa district. On Sunday 24 June 2012, we found their bodies completely burned with traces of torture all over them. On 18 June 2012 Doctor Nour Maktabi, a founder of the medical activity in Aleppo during the revolution, was arrested by security forces from his clinic in Seif al-Dawleh neighborhood and tortured to death. Security forces also arrested paramedic Hassan Haboush in 2012, and he is still under arrest. After all these detentions, and considering how checkpoints have been set up in every district of Aleppo the safety of doctors became a serious concern. Given their need to carry medical equipment, it had become very difficult and dangerous for them to move about. After that, certain areas of Aleppo were liberated and the medical revolutionary activity was moved there."

 

Arrest and fatal torture have not been the only violations those who work in the medical field, for to prevent doctors from practicing their humane profession is to prevent them from making a living during tough times that are tough in Syria, and particularly Aleppo. This too has forced most of the medical cadres to flee to elsewhere.

 

Some of the doctors whose profession was suspended are:

The two dentists Ayman Hinnawi and Ghyath Sali, who were arrested in June 2011 and could not go back to practicing dentistry after their release six months later. Another was Othman Haj Othman, whose profession was suspended for three months after his detention.

 

In this regard, Dr. Othman Haj Othman says:

"I have been arrested twice by the regime forces since the beginning of the revolution. First I was arrested on the 4 November 2011 because I had joined a demonstration. I was detained for four months, during which I was exposed to the extreme kinds of torture and mistreatment. After my release on 6 March 2012 I was fired from my work at Ibn Rushd Hospital as a security measure on the part of the hospital’s executive manager because, he told me, the Air Force Intelligence had sent him a note ordering him to fire me. Only after I relentlessly sought and eventually received an "exemption" from the Labor Ministry, together with a photocopy of the court decision upholding my innocence, was I approved on 9 April 2012 to work again. I was very lucky in comparison with other doctors who were permanently suspended. These doctors including: Dr. Yaser Darweesh, Dr. Ayman Hinnawi and Dr. Ghyath al-Dalli."

 

2 - By Non-Official Parties:

There have also been violations against the medical cadres working in those areas that have increasingly been liberated by the opposition and other armed groups. These various violations have included threats, arrests, kidnappings and sometimes killings. The vast majority of these violations were committed by members of the Islamic State of Iraq and Sham (ISIS, aka ‘Daash’).

 

VDC has documented many of these violations including:

1-Dr. Osama Darweesh was kidnapped on 4 December 2012 in front of his clinic in Masakin Hanano district by four masked men speaking the dialect of Aleppo suburbs. They checked his identity, beat him and took him to an unknown destination. Dr. Osama told VDC how he had tried to resist and been shot at but not hit:

"They took me to an unknown destination and beat me severely after blindfolding my eyes, making a very strange accusation that could never justify the arrest. The accusation was that I had caused the bombardment of Dar al-Shifaa Hospital. After two hours of ill-treatment they told me it was a false claim, apologized to me and guided me to a third person who took me back to an area near my house. Before letting me go, they advised me to "forget all about what had happened, in the interests of my own safety!"

 

2- On 13 March 2013, members of al-Nusra Front arrested Dr. Othman Haj Othman, an emergency doctor in a medical point. He was taken to the Sharia Court in Aleppo, accused of "removing" their flag from the roof of the hospital he was working at. He had indeed prevented any flag or banner from being put on the roof of the hospital, maintaining the hospital’s independence and neutrality to assert its founding purpose of providing medical treatment to those in need of it. He spent a whole day at the detention center, which he described as the Air Force detention center, yet here he was neither beaten nor tortured. On the next day, he came before a legal judge who ordered his release after a debate about the accusation. Dr. Othman informed VDC that the personnel who had arrested him and raised the accusation against him have all subsequently joined ISIS/Daash.

3- At about 02:00 am, on 2 September 2013, Dr. Muhammad Abyad, a doctor in Doctors Without Borders Hospital and a son of Izaz city near Aleppo who was born in 1986, was kidnapped by three masked men from the doctors' dormitory at his work place. On the next day, 3 September 2013, his body was found near Tal Rifaat. Many activists of VDC confirmed that members of ISIS had threatened to kill him.

4- At the beginning of October 2013, members of ISIS/Daash kidnapped Dr. Hussein Sulaiman, a 29 year-old from Maskaneh town in Aleppo Countryside who was also known as Abu Rayyan and who was the manager of Tel Abyad crossing, from Raqqa. His body was delivered to Islamic Ahrar al-Sham Movement after he was tortured to death. A video that was posted on the social media networks shows him being brutally tortured and then gunned down.

5-Paramedic Qutaiba Abu Younes was kidnapped by members of ISIS/Daash. His body was found in the Eye Hospital in Aleppo on 6 Jan 2014 after the FSA had taken control of it.

6-Paramedic Nour Hawoot (Tiba) was kidnapped by masked men on 28 Nov 2013 while driving to the scene of a massacre in Qadi Asqar neighborhood with his ambulance and a team of journalists. Those masked men later turned out to be members of ISIS/Daash. Nour and his companions were taken to the Headquarters of the State in Qadi Asqar neighborhood, according to witnesses, and Nour was killed in the Eye Hospital on 6 Jan 2014 by the same persecutors.

7- Doctor Farouq Harah was kidnapped on 18 Sep 2013 by members of ISIS/Daash after they stormed Izaz Local Hospital.

8- Three doctors were arrested on 7 Feb 2014by members of ISIS/Daash while heading to al-Bab city during the Anti-Polio Vaccine Campaign.

 

B-The Medical Centers:

1-Before the Armed Opposition Took Control over the Eastern Neighborhoods of Aleppo

Persecution by regime forces of the medical cadres helping those injured at demonstrations has hindered their ability to treat casualties in private and public hospitals, so the treatments had to take place in secret medical points in private houses to avoid arrest or murder by the regime. Doctors also moved from one medical point to another for fear of being discovered by the regime intelligence personnel and their spies, who were everywhere in Aleppo.

 

In this regard, Dr. Othman Haj Othman says:

'When the revolution began in Aleppo, the medical points consisted of first aid kits and ambulant medical teams, the injured were moved to the nearest safe house and the communication between the medical members and teams was via Skype. We used to give the injured a first aid treatment, and when there was a need for additional treatments like an operation, we had to wait the regime forces had gone before we could take the injured to a safe hospital whose cadre cooperated with us. In some other cases, we had to give all necessary treatments our secret location."

Doctor Abu Muhammad, a general surgeon, says in this regard:

"We were not allowed to give any kind of treatment to those whom the regime forces shot or hit during a demonstration. In April 2012, a twenty-year-old university student who had been injured in a demonstration in al-Zebdieh neighborhood was hospitalized to Aleppo Academic Hospital, but the regime's ‘Shabiha’ militiamen stormed the emergency room and began hitting him on his injury. Once his treatment was complete they arrested him."

In many cases, these secret medical points were stormed, and the injured were taken along with the medical team to one of the security branches:

 

1-In January 2012 security forces stormed a medical point in a house in Salah al-Din neighborhood, and in February 2012 they stormed another medical point in a house in al-Fardos neighborhood. In both cases, the medical teams had evacuated the place before the security forces arrived.

2-On 25 May 2012, security forces stormed a medical point that was established in For Aleppo Community Headquarters and arrested Dr. Othman Haj Othman, his cadre and the casualties there.

In this regard, Dr. Othman Haj Othman says:

"On 25 May 2012 I got arrested for the second time from For Aleppo Community Headquarter and charged– according to the court papers - with "establishing a field hospital and providing medical help for the armed groups". I got arrested while treating someone who had been shot in the face during a demonstration in Bustan al-Qasr neighborhood. His wound was about 7cm deep. Dentist Muhammad Khalili, activist Muhammad Qarra Damour, the injured, his brother and his neighbor were all arrested with me as well. They took us at night to al-Jamiliah Police Station and on the next day they transferred us to the Criminal Security Branch where they put each one of us in a 120x60 cm designed for solitary confinement (except for Dr. Muhammad al-Khalili who was put in a collective cell). 4-6 people were put together in each ‘solitary’ cell, each of which contained a toilet, a broken faucet and a 30x20 cm ventilation shaft. As for the casualty, they transferred him on the next day to al-Razi Hospital where he was treated, but he was then returned to his cell and left with no medication or medical observation. During my detention, I was beaten all over my body and left without food. My detention lasted for 27 days, 22 of which were in the solitary cell."

3- In June 2012, the security forces stormed a medical point in Old Aleppo and arrested the medical team along with the injured.

 

Doctor Diaa al-Abdullah said to VDC:

"On 12 August 2011, the first massacre was committed in Aleppo following a demonstration in al-Sakhour neighborhood. Then, security forces opened fire at the demonstrators. Consequently, we set up a room in a house in Old Aleppo and equipped it with simple tools so we could treat the injured. Since then, we have been preparing such rooms each time a demonstration goes out. However, these medical points were stormed by the security forces on many occasions. For example, in April 2012, the security forces stormed a house in al-Fardos neighborhood and arrested the owner of the house, the doctor, the two paramedics and the five casulaties who were there. Also in June 2012, the security forces stormed a field hospital in Old Aleppo and arrested the five casualties and the two doctors who were there."

 

2-After the Armed Opposition Took Control over the Eastern Neighborhoods of Aleppo

a-The Facilities that have been partially destroyed by the attacks of the regime forces

All medical centers, hospitals and medical points under the control of the armed opposition groups in the eastern neighborhoods of Aleppo have been targeted by the regime forces. Some were targeted by barrel bombs:

1-al-Daqqaq Hospital has been targeted several times, the last of which was on 13 April 2014 when it was targeted with barrel bombs.

2- Dar al-Wafaa Dispensary in Masakin Hanano was targeted with barrel bombs on 8 February 2014, which caused injuries to four people.

3-al-Sakhour Hospital was targeted by barrel bombs on 7 February 2014, causing two fatalities and causing injuries to four of the medical cadre. None of the injuries were serious but the hospital stopped working for a week due to the attack and resultant need of renovation to the building.

4- Children's Vaccination Dispensary - al-Jalaa Dispensary in al-Mayser neighborhood was attacked by air forces on 28 January 2014, causing the death of a child.

5-Abeer Sasila Hospital in Tariq al-Bab neighborhood, a maternity hospital, was shelled with two barrel bombs on 23 December 2013.

6-Omar Bin AbdulAziz Hospital in al-Ma'adi neighborhood was shelled with barrel bombs on 28 September 2012, and stopped working completely for a month due its need of renovation.

7-Dar al-Shifaa Hospital in al-Sha'ar neighborhood was attacked by air force on 14 August, suffering great damage thereby.

8-al-Hamyat "Zahi Azraq" Hospital in al-Halk neighborhood was attacked by air forces at the beginning of August 2012. This attack caused great damage in the emergency section of the hospital.

The afore-listed hospitals and medical points, these being the ones that were partially destroyed, continued to provide services – albeit with varying degrees of efficiency, despite having been directly attacked by the regime forces.

 

b-The Facilities that have been completely destroyed by the attacks of the regime forces


Some hospitals went out of order because they were completely destroyed by the regime’s continuous use of barrel bombs.

 

1- The Central Hospital in Masakin Hanano was shelled with barrel bombs many times on 21 April 2014 and consequently went out of order. It was subsequently turned into just a medical point.

2-Dar al-Shifaa Hospital in al-Sha'ar neighborhood was shelled - for the seventh time - with barrel bombs on 21-11-2012, which killed several patients and medical staff, injured many more and completely destroyed the hospital, which, as a result, went out of order.

 

In this context, Dr. Othman Haj Othman said:

 

'The story of how Dar al-Shifaa Hospital has been targeted is a sad one. The hospital had been shelled six times before it was "completely destroyed" by the seventh strike on 21-11-2012. The hospital is an eight-story building with two underground stories. It has four operation rooms and nine beds for intensive care. Before al-Sha'ar neighborhood was liberated, the hospital provided all specialisms. However, it was shelled heavily after the liberation and the 6th floor operation rooms were destroyed as well as the operation section, which prevented us from receiving any cases requiring surgery. Thus it became fit for use only as a field hospital, where we worked on the ground floor and in the cellar. As for the cases that needed surgeries, we had to transfer them to other nearby hospitals: al-Hakeem, al-Zahraa, al-Bayan or al-Daqqaq hospitals.

When the hospital was targeted by barrel bombs it was completely destroyed. The shelling claimed the lives of Dr. Muhammad Kasem Agha, a sixth-year medicine student; Nurse Bushra Sheikho, the hospital guard; AbdulKader al Saleh, who was deaf and dumb; the receptionist; an epilepsy patient who was at the emergency section; and a number of pedestrians who were near the hospital. Nine of the hospital cadres were also injured. One of the two separate buildings comprising the hospital was leveled to the ground while the other building’s back section was completely destroyed and hence unusable. The hospitals near Dar al-Shifaa, like al-Daqqaq, al-Bayan and al-Hakim were also targeted at least once each."

3-Yaseen al-Jabban Hospital, a children's hospital, was opened for two months before it was shelled in July 2013 and became out of order. After that, it was moved to the Polyclinics in Masakin Hanano neighborhood.

4-the Polyclinics in Masakin Hanano neighborhood, which were used as a children's hospital under the auspices of the Red Crescent, have been shelled several times. After the last shelling in March 2014 it became out of order.

 

Second: Other Abuses of Hospitals:

Hospitals have not only been targeted and shelled with barrel bombs by the regime air forces; they have also been shut down or turned into military barracks by other non-official parties.

A-Hospitals that Have Been Shut Down:

1- Hamyat Hospital "Zahi Azraq"

The regime forces shelled Al-Hamyat Hospital (Zahi Azraq) in al-Halk neighborhood, one of the largest and best equipped public hospitals. After the FSA took control of several areas in Aleppo this hospital stopped working due to the absence of its medical cadres, who abstained from going to work as a result of the insecure situation. Several nurses of the area tried to keep the hospital working for several days more, yet that lasted only for two weeks. After that, the emergency section was targeted in August 2012 and was greatly damaged. Thus, work in the hospital stopped completely and most of its equipment and tools were distributed to field hospitals. Other equipment and tools were stolen and sold by unknown individuals. As for the important expensive medicines for cancer and hepatitis, nurses took them to al-Razi Hospital.

 

2-The Children’s Hospital and The Eye Hospital:

The Children’s Hospital and The Eye Hospital are both in Kadi Askar neighborhood. One of the doctors stated to VDC: “when the Free Army took over the area, I approached Mr. Ahmad al-Abid, the Head of Aleppo Medical Department with an offer to operate the hospital, with volunteer cadres who had previously worked in the Children's Hospital and with the cooperation of Pediatrician Hassan Nirbani. After negotiating with the leaders of the Free Army, I offered guarantees that they would never interfere in the hospital. However, Dr. Saad al-Naif, who currently holds the position of Health Minister, refused the idea after consulting the Governor of Aleppo, as they thought the regime will 'regain the area soon'. They also threatened to lay off any employee who works in either of these two hospitals, which stayed vacant until ISIS/Daash turned conquered them and turned them into a headquarters for themselves."

 

B -Hospitals that Have Been Turned into Military Barracks:

Al-Kindi Hospital
Al-Kindi Hospital, located on the way to al-Maslamieh, is one of the largest and most important public hospitals in Aleppo. However, the regime forces have turned it into a military barrack in November 2012. After that, several fights took place between the regime forces and the armed opposition in order to take control over it.

 

Dr. Abu Muhammad, a general surgeon and a member of al-Kindi Hospital medical cadre, said in this regard:

"al-Kindi Hospital was transformed into a military barrack at the beginning, then a checkpoint was set-up nearby and became one of the toughest in the area. When the FSA started targeting the checkpoint, the regime set a sniper on the roof of the hospital. The security and army members proliferated in the hospital, occupying the doctors’ dormitories on the fifth and the sixth floors and preventing any of the doctors from getting in. All sections of the hospital ceased to be operated except for the kidney section which was operated by one doctor only. Hence it was very difficult for civilians to come for treatment unless their condition was critical. Five patients were shot by the sniper, as well as one of the hospital's employees named Muhammad Habbash."

 

Third: Hospitals and Medical Points in Liberated Eastern Neighborhoods of Aleppo, and the Current Medical Situation

A-The Medical Points:

As the opposition forces took over the eastern neighborhoods of Aleppo, doctors established medical points to meet the medical needs in the eastern areas as many public hospitals in the area had been closed or destroyed by the regime. They established 13 hospitals. Only two of these were equipped to treat critical cases and the casualties among the fighters, and the regime destroyed both of them.

Aside from the hospitals, there are many dispensaries that function as ‘polyclinics' with a general practitioner and a few paramedics just like the dispensary of Yusef al-Azma in Dahrat Awwad neighborhood, the dispensary of Mouhamad Raslan in Tariq al-Bab and the dispensary of Jamal Abd Al-Naser in al-Halak neighborhood. There is also a medical point with a number of nurses almost in every neighborhood, but there are no doctors at these medical points.

Regarding the children sections, there was one in Hanano Central Hospital but it was shelled and destroyed. Currently, there is a small section for children in al-Ehsan Hospital and another one in Omer Bin Abdulaziz Hospital. Still, these divisions have no intensive care units. The doctors do only the simple operations that require no intensive care, like hernia and patches. There is no treatment for most children with chronic cases like diabetes, hemophilia and epilepsy. Some centers like al-Halak, al-Fardos, Bustan al-Kasar and previously al-Sakhour, provide vaccines, but these vaccines are rare and incomplete. The incubators for the neonatal they’re available in the hospitals of al-Quds, Omer, al-Ehsan. They were also in Hanano Hospital before it was closed. The problems include shortage of medical staff, electricity and generators; each hospital needs at least two generators to power the incubators; in one case in al-Ehsan Hospital, two babies passed away because the generator was not working, according to a doctor in the hospital.

 

One of the doctors stated to VDC:

“There are sections for children in al-Ehsan and Omar Hospitals, but they lack intensive care units. We have cases of measles and presumed poliomyelitis, and on 2012 and 2013 we received cases of hepatitis that were caused by polluted water that had mixed with the sewage system. During my work at al-Daqqaq Hospital, four children passed away. The first had Cerebral Palsy and was so thin; he passed away due to lack of immunity. The second had malabsorption caused by the Celiac Disease; he passed away due to lack of immunity too. The other two were healthy and could have been saved in a better medical condition; they passed away due to the pneumonia that followed their measles.

An ambulance the regime forces targeted

 

B-The Available Medical Cadres:

Due to the persecution they suffer, the numbers of the medical cadres in the eastern neighborhoods of Aleppo are very few relative to the populations of these neighborhoods. Some specialisms don’t exist at all; for example, there is no neurologist in the eastern neighborhoods of Aleppo.

 

The doctors available are:

  1. Ten General Practitioners.
  2. Four Pediatricians.
  3. Three Orthopaedic doctors.
  4. Two Doctors for Urinary Diseases.
  5. One Doctor for Emergency Cases.
  6. One Anesthetist.
  7. One Ophthalmologist.

The unavailable specialisms are: neurosurgery, jaw surgery, and vascular and thoracic surgery. There are also no intensive care doctors. There is a doctor who is studying neurosurgery but he isn’t yet able to perform operations. There is also a third year doctor who is still studying vascular surgery, but he performs the operations as a graduate. Many urgent vascular surgery operations are performed by general surgeons.

Dr. Abu Muhammad, a general surgeon and member of the medical staff, said:

“At the beginning, the situation was so difficult and the support was at the individual level only. Later, however, things got more organized and most of the hospitals could get the following specialties: general surgery, orthopedic surgery, urinary diseases and in some hospitals there are neurosurgery and jaw surgery, depending on the availability of doctors with these specialisms. When it comes to vascular and thoracic surgery we, general surgeons, perform these.

 

C-The Available Medical Supplies and equipment:

Aside from the fact that we have acute shortages of medical supplies and equipment, much of what we did have was destroyed by indiscriminate shelling. For example, there is a Computed Tomography Device in Omar Bin Abdulaziz Hospital, but it does not work as there is no electricity and the generator’s capacity is so low. Devices for traditional X-ray Imaging and C Arm Endoscopy are all available, and there is also one Dialysis Machine in Shawqi Hilal Center, but there is a shortage of filters and distilled water so most of the operations are performed with normal water. As for MRI there isn’t a single device anywhere in Aleppo. When it comes to kidney implants, there is neither a specialized doctor nor periodic kidney tests or the required medicines. There are no artificial limbs. There is no treatment available for cancer, diabetes or epilepsy - as there is no radiology center, patients are sent to regime-controlled areas or to Turkey. Furthermore, there is no medicine for chronic diseases.

 

Dr. Othman Haj Othman said:

“There is no MRI device in Aleppo; it’s available in the City of Manbij, but one radiographic image costs 30,000 sp. Two months ago, we had one Computed Tomography Device in Omar Bin Abdulaziz Hospital, yet it didn't work due to a lack of electricity. The substitute device is in Tal Rifaat and the image cost ranges between 4,000 to 15,000 sp. Devices for traditional X-ray Imaging and C Arm Endoscopy are available.”

There are 20 ambulances, many having been shelled and destroyed. The most famous case of an ambulance being shelled was on 22 Dec 2013, when the driver Muhammad Farhat and his assistant, the pharmacist Mahmoud Ali Kousa, were martyred because regime forces struck their ambulance with a barrel bomb while they was on their way to relieve casualties.

There is usually a stretcher and simple equipment in each ambulance, but three or four casualties often need to be transferred in one ambulance. There is also acute shortage of cadres. The ambulances require technical maintenance due to a shortage of spare parts, and three ambulances were stolen on 30 Nov 2014 by members of ISIS/Daash.

 

Fourth: Forensic Medicine

Following “Al Naher Massacre” on 28-1-2013, the Forensic Medicine was founded in Aleppo. Its personnel dissect the bodies delivered to the center, in order to discover the cause and date of death. After that they send the body with a copy of an autopsy report to the funeral office, so that it can be buried according to the Islamic Law. They also seek to detect criminal offenses in cooperation with the Free Police, the Legal Council of Judiciary and The Unified Judicial Council.

A primitive form of refrigeration created in order to preserve corpses

 

Abu Jaafar Al-Khaheel, an expert in criminal science and Manager of Forensic Medicine in Aleppo, said to one of the VDC's staff in Aleppo:

“The Forensic Medicine was founded in Aleppo at the beginning of January 2013, immediately following “Alnaher Massacre” on 28-1-2013. We in Forensic Medicine document the unidentified bodies which we receive from hospitals and medical points, and also the bodies brought directly to the Forensic Medicine from sites of massacres.

 

We create a record for the unidentified body, take pictures of it and document all the features, as well as the place and the time of arrival, the cause of death, the place of injury, the time of death, the party that brought the body.... etc. We receive four or five bodies daily. In very rare cases, this figure may move up to ten. In mid-December 2013 when the shelling by barrel bombs began on the neighborhood, we began to receive new kinds of cases – we received carnage and guts, the documentation of which had to be based on a tattoo, a ring, shoes, or any other characteristics that could be used to identify the body. Things escalated and we began to receive completely charred and even smoking bodies. The number of bodies we received every day reached 38-40 body.

After the documentation, the 70% of bodies that can be identified are delivered to their families. We give each body a number in the records and then send the deceased to the funeral home to be buried according to the Islamic law. We have a room in the Forensic Medicine where we display pictures of all the unidentified bodies.

We also document the victims of criminal offenses in cooperation with the Free Police of Aleppo, the Unified Judicial Council and the legal council of the judiciary - they send us casualties and victims, and we examine them to identify the dates of the injury and recovery, the duration of the sick leave from work and the inability that may be caused by the injury.

We use very simple equipment; just speakers, simple devices and an ambulance. In the past we preserved the DNA, but the room where we preserved these things was shelled, and we don’t have the requisite preservative acid any more. In the Forensic Medicine, there are absolutely no specializations; no one is specialized in anatomy, fingerprint science, or weapons. We depend entirely on experience. We are covering all the liberated areas of Aleppo, and sometimes we go to the countryside to cover cases there".

 

Fifth: Conclusion and Summary

One of the most difficult challenges likely to confront any doctor in the current circumstances in Syria is to practice his/her profession properly – i.e. to save someone’s life or to help him/her in a no-win situation involving shortage of the tools, shortage of raw materials and high security risk amid daily killings.

VDC was able to document over (190) fatal cases that could have been prevented with the sufficient medical care that is lacking throughout the Syrian governorates outside the regime's control.

In 14-5-2014, Physicians for Human Rights issued an interactive map which shows that the regime forces, which have been responsible for 90% of the attacks that targeted 124 of the hospitals in 150 attacks, is deliberately attacking the medical system in Syria. The organization added that these attacks are crimes against humanity.

VDC demands all the parties, especially the regime, to neutralize the hospitals and the medical staff from the conflict, and to respect the laws which protect both medical staff and civilians in an internal armed conflict.

 


[1] Our colleague Nisreen Manafikhi has conducted most of the interviews with the witnesses.



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