The underlying fear is that Eastern Ghouta, followed by opposition-controlled Idlib, will follow in the footsteps of Aleppo, write experts from the Syrian American Medical Society and the Syria Public Health Network.
THE SYRIAN GOVERNMENT and its allies’ operation in East Ghouta uses a strategy similar to that implemented in other major Syrian cities such as Homs and Aleppo. This strategy includes months of siege, deliberate blockade of humanitarian aid, refusal to evacuate critical patients, constant aerial bombardment and the use of chemical weapons. It is aimed at breaking every remnant of resistance in these areas, to force unconditional surrender to government forces.
The “starve and displace” or “starve and surrender” war tactics eventually led to the forced evacuation of residents of East Aleppo without any plan for their return. The underlying fear is that civilians in Eastern Ghouta, and ultimately the 2 million people in opposition-controlled Idlib, will suffer the same fate.
The systematic and irreversible displacement of local populations is reminiscent of tactics used during World War II, but never before on such a large scale as in Syria. This strategy also reflects the tragic irony of the situation in Syria – a humanitarian crisis masked by a regime promoting an ever so stable country ready for peace and reconstruction of post-war Syria. This image is far from the truth.
In late 2016, the international community watched as the opposition-held neighborhoods of east Aleppo were besieged and systematically shelled until opposition groups surrendered the city to the Syrian government. Between June and December 2016, nearly 3,500 civilians were killed, and Syrian and Russian aerial bombardments targeted civilian structures including hospitals and open-air markets, according to the Syrian American Medical Society (SAMS). All seven major hospitals were bombed out of service (at a rate of one every 17 hours, at its peak), including underground units. At the height of violence, only 29 doctors were left to treat the quarter million people in East Aleppo.
A few weeks before the collapse of the city in December 2016, Russia vetoed a U.N. Security Council cease-fire resolution. Moscow later designated two humanitarian exit corridors for civilians, but this did not ensure the safety of medical evacuations, nor did it allow for U.N. convoys to enter. Evacuations of nearly 15,000 people began without the oversight of U.N. officials.
During the evacuation, which included that of four other besieged cities throughout Syria, a bomb killed about 100 evacuees waiting to board the buses, which led to severe delays and ultimately halted evacuations. Others died in subzero temperatures waiting to be evacuated. Most feared that their escape would lead to their deaths.
Present: Eastern Ghouta
In August 2013, the Syrian government carried out a sarin gas attack in East Ghouta that killed at least 1,000 people. Shortly after, it besieged the area, which is just a 30-minute drive from downtown Damascus. Since then, nearly 400,000 residents have faced a severe shortage of food and medical supplies, wartime inflation, bombardment and scarce access to healthcare.
U.N. and Russia-led peace talks in Geneva and Astana have failed to stop the hostilities and allow aid to reach civilians. The U.N. Security Council resolution for a cease-fire did not hold (a suspected chlorine attackoccurred shortly after).
Russia subsequently imposed a five-hour cease-fire for three days and proposed five humanitarian corridors, but these too failed to guarantee civilian protection or to allow for U.N. monitoring. What’s more, this is not sufficient time for any aid convoy to make a delivery. Humanitarian aid deliveries last month reached only 0.1 percent of the population in need.
Targeting of healthcare facilities has reduced their capacity by nearly 50 percent. As the crisis continues, the elderly, sick and disabled are forcibly displaced, creating a desperate refugee population.
It is therefore no surprise that the plan is to push for a full-scale evacuation of rebel groups to Idlib, according to Dr. Richard Sullivan, King’s College London.
Idlib is already home to some 2 million displaced Syrians who fled violence in Aleppo and other areas. Although air attacks are still intermittent, there is justified concern that Idlib will become the next target of the Syrian government’s attacks, causing waves of forced displacement to Turkey and other surrounding countries. However, access to Turkey is becoming increasingly difficult, and with the fall of most opposition-held areas, there is limited space for internal displacement.
After displacement from Aleppo last year and the recent influx of IDPs from towns in northwestern Syria, it’s clear that the World Health Organization and U.N. agencies are unable to meet these humanitarian needs, leaving many Syrian and international NGOs working through Syrian subsidiaries already picking up the slack. More than 300,000 recent IDPs are without secure shelter or sustainable water resources.
Humanitarian and medical support to Idlib is conducted through cross-border humanitarian operations under the mandate of the U.N. The resolution that was first passed in 2014 needs annual renewal. In 2017, extensive pressure was exerted on Russia to prevent it vetoing renewal of the resolution. If the resolution is not renewed in 2018, the already undersupported healthcare system in Idlib will collapse with the increasing numbers of IDPs.
International systems created post-WWII to minimize violence against civilians in situations of war have failed. The U.N. Security Council must be held accountable for its inability to enforce resolutions or to interfere to protect civilians over the past seven years.
Health professionals must come together in the face of the current and likely future escalation of violence against civilians and advocate for the cessation of attacks on healthcare facilities, personnel and civilians, the unobstructed delivery of medical and humanitarian aid to civilians, and the evacuation of the most critically ill patients in compliance with international humanitarian law.
Engaging with the U.K. political system at a parliamentary level as well as national medical and health bodies is vital to ensure ongoing debate and calls for urgent action. Academic initiatives to enhance the medical knowledge of professionals affected by war are needed.
There is a dire need for the WHO to reform its operation so that any programs are implemented equally throughout Syria. The U.N. Office for the Coordination of Humanitarian Affairs and donor countries need to mandate such a change, otherwise continued discrepancy in the provision of health will become the norm.