Intended for healthcare professionals


Medical students perform operations in Syria’s depleted health system

BMJ 2013; 346 doi: (Published 14 May 2013) Cite this as: BMJ 2013;346:f3107
  1. Anne Gulland
  1. 1London

A doctor who recently returned from a trip to Syria has condemned the “destruction of the Syrian health system” and attacks on medical staff.

Zaher Sahloul, president of the Syrian American Medical Society and a doctor in Chicago, told a meeting convened to discuss attacks on health facilities in Syria about the fear under which many doctors work.

“There has been systematic destruction of the healthcare system. The situation is very bad, and doctors caught treating patients from the other side [the opposition] risk their life. Many physicians have been detained, tortured, or killed,” he told the meeting at the Center for Strategic and International Studies in Washington, DC, which was webcast to journalists around the world (

His most recent visit was to the city of Aleppo, which has a population of more than two million. “There are no CT [computed tomography] scanners, only 10 incubators, and 10 dialysis machines. They’re running out of saline intravenous solution, and oral antibiotics are not available,” he said.

The World Health Organization has said that there is a lack of essential medical supplies across the country, with insufficient stocks of insulin, oxygen, anaesthetics, serums, and intravenous fluids to meet current needs.

Basic utilities such as electricity and running water were not always available, and waste collections had broken down in areas controlled by the opposition, said Sahloul. Poor sanitation and overcrowding had led to outbreaks of hepatitis A and leishmaniasis, he said. Routine vaccinations were not being carried out in many areas, and a measles vaccination campaign was now taking place in the country, which was once free of the disease.

Sahloul, who studied with the Syrian president Bashar al-Assad, said that about 50% of doctors had fled the country, although this figure could not be verified. WHO has said that half of the doctors in the city of Homs have left. Medical students are having to carry out operations, and unqualified personnel act as nurses, he added.

The Violence Documentation Centre, a pro-opposition Syrian organisation set up to document attacks on civilians, claimed that 131 doctors had been killed since the beginning of the conflict. The centre also said that 499 doctors had been detained, 309 of whom were still in custody.

Leonard Rubenstein, a lawyer and expert in health and human rights at the Johns Hopkins Bloomberg School of Public Health, Baltimore, said that targeting health workers and health facilities had become increasingly common in conflicts over the past 30 years.

In the Kosovo conflict the Serbs burned 100 health clinics, and in Chechnya 30-40 hospitals were bombed or shelled, he said.

WHO had estimated that a third of hospitals in Syria were not functioning, he said. “There have been very explicit statements that providing healthcare to an enemy is wrong and punishable by torture and arrest. Healthcare has become an enemy act, like weapons transport,” he said.

Stephen Cornish, executive director of the charity Médecins Sans Frontières in Canada, said that there was a “lack of respect” for medical personnel and facilities. Although the plight of injured opposition fighters had been well documented, civilian patients with chronic diseases or those undergoing treatment for long term illnesses such as cancer were the “silent casualties” of the fighting, he added.

“They cannot be referred outside the country, because they’re not emergency cases, but the facilities to follow them up don’t exist. They face a slow steady death, and they could be treated,” Cornish said.

The speakers added that plans for rebuilding Syria after the conflict must begin now.

Sahloul said, “Syria is not like the Congo. Syria had a very successful healthcare system, and Syrian universities are known to produce good doctors. Assad [an ophthalmologist] is not one of them. Despite the desperation, there is a lot of excitement among the Syrian diaspora to go back and build when safety is no longer an issue.”


Cite this as: BMJ 2013;346:f3107

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