GAZIANTEP, Turkey – I had just finished an interview with a Syrian rebel commander in his home in southern Turkey when his mother discreetly ushered me into the women’s quarters. With a sense of urgency, she lifted up her granddaughter’s dress.
The nine-year-old girl had been severely burnt when an airstrike in Syria hit an oil tanker, killing her younger sister and leaving her torso, arms and legs permanently scarred. Painful scabs and burn contractures limited the movement of one of her arms. Months after the horrific episode, disbelief lined her face. Her eyes remained frozen.
The family crossed into Turkey to get her emergency medical treatment, but had to return when they couldn’t afford the high rents. So they stayed in their home in eastern Syria, even after the so-called Islamic State took control of the area in August 2014, before finally managing to escape to Turkey a few weeks before I met them earlier this year.
Yet they were unable to get her a proper medical assessment in southern Turkey, so her family borrowed some money, and the young girl accompanied some relatives on a boat to Europe. She has since reached Germany, where she is receiving treatment.
Syrian civilians have borne a heavy toll from the rapid dismantling of the healthcare system in Syria, and the deliberate targeting of medical facilities. Among them are many children who have been wounded and traumatized by war, their dazed, bloodied faces shown in footage of the aftermath of airstrikes.
Since the beginning of the Syrian conflict, U.S.-based medical nonprofit Physicians for Human Rights (PHR) has documented 373 attacks on 265 medical facilities, and the deaths of 750 medical personnel.
This year, attacks on hospitals and the blocking of emergency supplies, including medicine, have intensified. July was a particularly gruesome month for medical staff and patients in Syria.
In the last week of July, the Syrian regime or its Russian allies attacked six hospitals in and around the northwestern city of Aleppo, in what PHR called “the worst attacks on medical facilities in the region since the Syrian conflict began in 2011.” Government forces had bombed five out of these six facilities at least once before, the group said.
The attacks included “three strikes on hospitals in Aleppo’s [then] besieged eastern half within a 24-hour period, which killed patients and further deprived nearly 300,000 people trapped in eastern Aleppo of lifesaving medical care,” PHR said in a statement.
“Each of these assaults constitutes a war crime,” PHR’s director of programs Widney Brown said.
The Syrian healthcare system has also suffered a gradual process of deterioration during the war.
Getting medical aid inside opposition-held areas of Syria has been problematic throughout the conflict, despite several United Nations Security Council (UNSC) Resolutions – 2139, 2165, 2191, 2254 and 2258 – calling for unobstructed humanitarian access to civilians during conflict.
An estimated 600,000 people were living in the 19 areas officially classified as “besieged” before the recent takeover of opposition-held areas of Aleppo, home to another estimated 300,000 people.
Living in besieged areas often stifles access to the most basic of medical supplies. Even when humanitarian aid is allowed in, the Syrian government is confiscating “surgical kits, trauma kits, even basic health kits, scissors out of midwives’ suitcases” from the deliveries, a top adviser to the U.N. on humanitarian issues in Syria, Jan Egeland, noted in May of this year, calling such moves “incredible.”
Many Syrians who would have otherwise remained inside the country have been forced to flee in search of medical treatment.
Even before the recent uptick in attacks on medical facilities, many families whom I met during visits to Syria in 2014 and 2015 were selling off everything they owned in the hope of getting proper treatment for their children or other relatives injured by airstrikes or snipers’ bullets. For most of these families, the hope of getting medical aid was tied to reaching Europe.
Many families who managed to reach Turkey, Lebanon or Jordan struggled to obtain adequate medical care and continued their journeys onward.
A Syrian photographer who drove me into opposition-held Aleppo during several trips in 2014 and early 2015 endured a particularly distressing situation when his daughter required long-term medical care that was not available in the area.
The young girl had sustained serious nerve damage when a Syrian military sniper’s bullet ripped through her arm while on her way to school, and the injury was not healing.
After repeated attempts to get her further treatment in Syria and Turkey, the March 2015 closing of the Turkish border was the last straw. He was now unable to make a living, as his work required crossing back and forth over the border. So the photographer sold his car, camera and everything he owned to take her to Europe.
The father and daughter used smugglers to take a boat and eventually reached Finland, where she is receiving treatment.
Yet her father had to leave behind his three younger children and wife in Aleppo, where they remain with other relatives. His invaluable work of documenting the conflict and the situation for Syrians inside the country also came to an abrupt halt.
Emergency treatment is just a part of the massive need for medical care inside Syria. Serious injuries often require years of treatment, and chronic diseases have also posed serious issues for civilians inside Syria.
A 2013 study from the U.S. may provide an indication of the huge resources needed for rehabilitation in Syria. That study showed that the U.S. government spent an average of about $2 million per soldier on long-term treatment of conflict-related injuries in Iraq and Afghanistan. Even though U.S. healthcare costs are among the highest in the world, just a fraction of these costs would be impossible for Syrian families – who often have several members with conflict-related injuries – to bear.
Further, in many parts of Syria, the appropriate facilities to deal with long-term medical care no longer exist. With Syrian and Russian forces targeting hospitals as a strategy of war, increasing numbers of civilians are likely to flee the country, simply to gain access to lifesaving treatment.