Aleppo Abandoned: A Case Study on Health Care in Syria
Less Than a Third of Aleppo’s Hospitals Functioning; 95% of Doctors Have Fled, Been Detained or Killed
New Report Shows Egregious Attacks on Health Care by Syrian Government Have Devastated Aleppo’s Medical System
The Syrian government’s assault on eastern Aleppo city, which includes 45 attacks on medical facilities in the past three years, has decimated the city’s health care system. Less than a third of the hospitals remain functioning, and the vast majority of physicians who have not been killed have fled.
A new report by Physicians for Human Rights (PHR) shows the devastating impact of the Syrian conflict on Aleppo, Syria’s most populous city and the area that has been the hardest hit in terms of attacks on medical facilities. In the past three years, Aleppo has suffered 45 attacks on health care facilities, more than two-thirds of hospitals no longer function there, and roughly 95 percent of doctors have fled, been detained or killed. Today’s ratio of doctors to residents is eight times less than what it was before the conflict began, and this extreme shortage of health professionals is exacerbating the already dire humanitarian crisis. At precisely the time when medical services are most needed – in the middle of a brutal war – the health system is being systematically destroyed.
The report, “Aleppo Abandoned: A Case Study on Health Care in Syria,” explores how medical personnel have coped during the war, managing to provide health care despite minimal access to equipment, medication, supplies and personnel. PHR chose Aleppo as a case study because as the report describes, it illustrates how a small group of dedicated and resilient health workers have chosen to remain in their city to rebuild hospitals after bombings and provide lifesaving care, despite the unrelenting attacks on their facilities and direct threats to their lives. Through the bloodshed, the city’s remaining medical community has remained resilient, demonstrating what dedicated health care workers can achieve in the face of horrific violence as they stand up for human rights and international law.
“The Syrian government is using attacks on Aleppo’s health care system as a weapon of war,” said Dr. Michele Heisler, a PHR board member who is one of the report’s investigators, and a professor at the University of Michigan Medical School. “The systematic targeting of hospitals is the biggest impediment to providing health care in Syria. The physicians I met want one thing – for the bombing to stop so they can do their work.”
The report comes at a time health care systems in Syria and beyond have been under grave attack, in blatant violation of international humanitarian laws. Though medical personnel and facilities enjoy special protections under these laws, attacks on hospitals have recently taken place in Afghanistan, Gaza, Syria and Yemen. Adding further complication to medical workers’ ability to care for those in need, Aleppo’s residents are hesitant to enter medical facilities because they are targets of violence.
While Syrian forces have been responsible for the vast majority of these attacks in their own country, Russia has recently joined Syria in its illegal assault on the health care system. PHR documented 10 attacks on Syrian health facilities by Russian war planes in the month of October.
“Typically in a war zone, hospitals are clearly marked and even provide their coordinates to the parties to the conflict as a safety precaution,” said Donna McKay, PHR's executive director. “But in the perverse logic of the Syrian conflict, those working in the medical field are actually forced to hide their identities and their facilities in the desperate hope that this will provide some measure of protection against attacks that have become shockingly commonplace.”
The report’s findings include:
- The ratio of physicians to Aleppo residents is eight times less than what it was in 2010, now numbering approximately one doctor for every 7,000 residents, compared to one doctor for every 800 residents in 2010.
- Only 10 hospitals – 30 percent of the 33 functioning hospitals in 2010 – were functioning as of August 2015. These include seven field hospitals for trauma surgery, one ophthalmology hospital, one obstetrics and gynecology hospital, and a specialized children’s hospital.
- There are no more than 80 physicians working in Aleppo throughout any given month (approximately five percent of Aleppo’s pre-war physician population) and as few as 35 working at any given time.
- The largest impediment to provision of health care in Aleppo is continued aerial bombardment, especially with barrel bombs, by the Syrian government. To date, the Syrian government has launched 45 attacks on health facilities in eastern Aleppo city. Most hospitals still functioning in Aleppo have been attacked repeatedly, one up to seven times.
- There is not a single functioning MRI machine in all of eastern Aleppo city.
- Aleppo has only one thoracic surgeon, plastic surgeon, renal surgeon, neurologist and cardiologist, as well as one or two urologists, ear, nose and throat specialists, and gynecologists (including only one female obstetrician-gynecologist), leading to significant gaps in coverage.
- There are no psychiatrists or psychologists, leaving profound unmet mental health needs.
Between July 22 and July 30, 2015, PHR investigators interviewed 24 individuals providing health care, supporting the health care system, or documenting events in Aleppo. Due to the conflict, PHR researchers could not travel to Syria, but instead met with medical personnel in Gaziantep and Kilis, in Turkey. PHR researchers interviewed staff working at each of the 10 currently functioning hospitals, the main aid and medical organizations supporting hospitals, and the leading organizations documenting violations and providing health assessments in Aleppo.
Between March 2011, when the conflict in Syria began, and October 2015, PHR has documented the deaths of 686 medical personnel and 329 attacks on medical facilities across Syria. That data is available via its online, interactive map. This year alone, there have been over 105 attacks on medical facilities, making 2015 the worst year yet for attacks on hospitals in Syria. With 16 attacks last month (10 by Russian forces, five by either Russian or Syrian forces, and one by unknown forces), October was the worst month on record. The Syrian government is responsible for nearly 90 percent of the attacks, systematically violating international laws aimed at protecting civilians. The attacks are war crimes and crimes against humanity, and the international community has failed to stop these violations.
UN Security Council Resolutions 2139 and 2165 demand an end to unlawful attacks on civilians, immediate and unhindered delivery of humanitarian assistance to those in need throughout Syria, and respect for medical neutrality (the principle that health care must be protected and be provided impartially). PHR’s report further illustrates the UN Security Council’s failure to implement these resolutions and makes the case that the longer the council shirks its responsibility of maintaining international peace and security, the greater the chance these violations will become the new normal in armed conflicts.
Managing Director at West End Strategy Team
Tel: (917) 679-0110
New York, NY - 11/18/2015
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to stop mass atrocities and severe human rights violations. Learn more here.