Syria: tales of life, death, and dignityBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1691 (Published 07 March 2012) Cite this as: BMJ 2012;344:e1691
- Samer Jabbour, senior lecturer, Faculty of Health Sciences, American University of Beirut
It is a year since the revolution in Syria erupted on 15 March 2011. Is the subject of health still relevant for discussion, as deaths approach 9000, tens of thousands of people have been arrested, and thousands remain detained? Do the notions we use as health professionals of care, determinants, equity, and rights retain a meaning in the context of shelling of residential areas, sniper shooting of demonstrators, execution of activists, and restrictions on access to basic living needs? Can a health sector stand with the ongoing destruction of the fabric of society? Not claiming to know the answers to these questions, I offer a few snapshots of real life stories that, perhaps, can begin to provide some answers. Because the current crisis didn’t start a year ago, the stories start much earlier too.
February 1976: The 10 year old boy stands up straight like other kids in the yard of his primary school at the end of a long day. He does not have enough clothes on and feels cold. His left ear hurts. He gets frozen blood when he tries to clean it. He cannot move because everyone is saluting the flag and the “leader father.” (All children are, by default, part of “talaa’eh el Baath,” inculcated with Baath principles and love for the “leader father.” The late Hafez Assad brought this idea from North Korea after a visit to Kim Il-Sung.) The boy would have recurrent ear infections for years to come.
March 1981: Two tenth graders develop a journal which they call “Maabad” (temple, meaning of knowledge). It includes only mild social critique and no political messages. Members of the Revolutionary Youth Union (Baath affiliates in secondary school) made it clear that this should have included some mention of President Assad. The second issue would not see the light of day.
October 1984: During an anatomy lesson, Khouloud (name changed) sits next to a “mizally” (Baath paramilitary youth who provided the regime with services such as security monitoring and intimidation of the public. As a reward, mizallys were admitted to top university schools, including medicine, even if their high school grades didn’t qualify them. They were part of the powerful National Union of Syrian Students, the Baath affiliate at the university level). She wonders whether the mizally has blood on his hands other than from the corpse. She would see him carry the Kalashnikov guarding the entrance to the school and the not so hidden gun in his belt years after the regime enjoyed absolute control of the country. The mizally didn’t manage to graduate, even with a generous “wasta”(influence or connections). Nasr (also a pseudonym), on the other hand, graduates in 1984 but cannot get security clearance to enrol in university residency training because of his suspected connections to opposition groups.
March 1992: Walking into a “referendum” (not elections) station to renew another seven year term for Hafez Assad, the minister of health is given a ballot paper with yes/no options and a pen. He, theatrically setting a precedent that thousands would later follow, throws away the pen, makes a cut in his hand, and circles “yes” with his blood. I think of the tens of thousands of people whose blood was spilt to get to this referendum. For his loyalty, the minister stays in office for 17 years.
December 1996: Yassin Al Haj Saleh, a medical student, is released from prison. He had been arrested in 1980 for belonging to an opposition pro-democracy party. In 1982 he is given a quick “trial” without witnesses or defence and sentenced to 15 years’ imprisonment. When his time is up, the security forces ask for his cooperation as a condition of release. He refuses and is sent for an additional year to the infamous Tadmur prison where thousands had been executed and where imprisoned doctors, without access to care, make incision instruments out of chicken bones to treat fellow prisoners. He returns to medical school upon release, graduating in 2000. At 40 and stripped of his civil rights, he turns to political writing. He is now a leading analyst for the revolution. He is in hiding but they got to his brother Firas, who was imprisoned, and cousin Khalid, killed execution-style near Raqqa (north east).
July 2000: The European media shyly cheer that a British trained doctor has assumed power in Syria. Many Syrians wonder whether a man who inherits this family and regime can bring the needed change.
March/June 2004: I need security clearance to get married (my bride is a foreigner), which takes three months, and another to have a wedding party, as would any gathering of people. Both require bribes. We pay them.
February/March 2011: There is celebration as President Mubarak of Egypt steps down. We dare hope, but not really believe, that this is also possible at home. A month later, 15 children write “your turn is coming, doctor” on street walls in Daraa (south). In security custody, the children are subjected to torture, their hands burnt with cigarette stubs, and their nails taken out. The senior officer talks obscenely to the parents and tells them to forget about their kids. Men throw their head covers on the floor: “We will show you.” The revolution starts and spreads.
December 2011: He was called “the doctor of the revolution.” A third year orthopaedics resident in al-Mouwasat Hospital (Damascus), he went underground when the revolution started and co-founded the Physicians’ Coordinating Committee in Damascus. He treated many victims of regime brutality in makeshift field hospitals and was thus on the list of the most wanted, dead or alive. The body of Ibrahim Nahel Othman, known by his pseudonym Khaled al-Hakim (the “immortal doctor”), is pictured lying on the ground covered with blood near the Turkish border. He was 26.
January 2012: Residents of Idleb (north west) storm the National Hospital to locate relatives after a bombing. They find 62 bodies in the hospital morgue, including those of political activists with evidence of torture. This barely makes international news; it’s just one number among many.
February 2012: Abir (another pseudonym) is 19. She is seeking urgent care for an injury she suffered in Homs. She, her young husband, and her 9 month old baby lived in a district that was subjected to shelling, sniper attacks, and severe shortages of basic amenities. They managed to withstand 10 full days of horror before finally escaping to another neighbourhood, supposedly for refuge. On February 12, a bomb hit their new place soon after a helicopter hovered above. A blast shattered the left side of her face and ripped off her eye. Her family was quick to carry her and leave the building. A second bomb shortly after would have wiped out the whole family. Abir was treated in a field hospital before being transported to Amal Hospital. On 22 February, the same day as the UN’s Human Rights Council releases its damning report of crimes against humanity committed by the regime, she and most other patients are evacuated from the hospital because of gunfire, the cutting off of electricity, and lack of food. She can’t make it to the only remaining hospital, El-Berr, on the other side of town because of snipers and roadblocks. Her chest tube is taken out and the family brings her across the border. Her remaining eye has no glimmer. She is thinking of her baby left behind.
In the first weeks of the Syrian revolution, and in light of the quick fall of the dictators in Tunisia and Egypt, many, including health professionals, had started to think about what the post-Assad future would be like. These hopes have now been shattered, as have the lives of tens of thousands of families. But even as we are now promised “at least” another year of Assad brutality, demonstrations continue in many spots. In response to the new constitution that allows the current president to remain in power until 2028, activists propose an alternative constitution with the first subject: “The Syrian people cannot be humiliated.” In recent weeks, activists in my alma mater, Aleppo University, and elsewhere in and around the city have joined in full force, giving life again to a city that had been too quiet for too long.
As Syrians make the unthinkable sacrifices to live in dignity as free citizens, the world looks on in incompetence. What to do, after all, about Syria? First, we weep.
Cite this as: BMJ 2012;344:e1691
Provenance and peer review: Commissioned, not externally peer reviewed.