More than 50 doctors and health professionals have demanded that the Syrian government and all armed groups in the country respect the neutrality of hospitals, ambulances and patients, and refrain from attacking them. The open letter warned that Syria's healthcare system is at "breaking point" and demanded that medical staff be allowed and able to treat anyone in need of care.
"The targeted attacks on medical facilities and personnel are deliberate and systematic," said the letter. "They are neither an inevitable nor acceptable consequence of armed conflict." Such attacks, it continued, are an "unconscionable betrayal" of the principle of medical neutrality, which was first enshrined in international law by the Geneva Convention of 1864 and reinforced in various human rights treaties. It obligates societies to protect medical personnel in the midst of war and obligates medical personnel to treat all individuals, regardless of background or affiliation. It recognises that ambulances, hospitals and personnel assisting the wounded are neutral and protected from aggression during armed conflict.
Syria is not the first conflict zone in which the principle of medical neutrality has been violated. From Libya, Egypt, Iran and Sri Lanka, gross violations have been documented over recent years. A report by the UN's Independent Commission of Inquiry on Syria (ICIS) described the denial of medical care there as a "weapon of war".
"By rejecting the irrefutable and universally accepted principle that those wounded in hostilities must be treated, the parties to the conflict in Syria are setting a dangerous precedent," the UN report noted. "The incidents and patterns recorded reveal that the actions of the Syrian Government from 2011 to date have been a cynical betrayal of this fundamental principle."
Dr Annie Sparrow, a critical-care paediatrician and one of the signatories of the open letter, told Middle East Monitor that there was little left in Syria for medical neutrality to exist. "The extensive damage already done has compromised the purpose of the law and medical neutrality to be effective," she said. "I can't see that it can be upheld now as the health system and personnel are so far gone that there is very little now to be upheld." There is an immense amount to be restored and rehabilitated, she added, as the attacks on medical facilities, doctors, nurses, physiotherapists, pharmacists, clinics and hospitals have been "extensive, comprehensive and systematic".
According to figures released by the World Health Organisation, 37 per cent of hospitals have been destroyed and a further 20 per cent have been damaged. In addition, the Syrian-American Medical Society said that 78 per cent of ambulances have been damaged and 50 per cent of physicians have fled the country. Indeed, an estimated 469 health workers are currently imprisoned and around 15,000 doctors have been forced to flee abroad. Recent reports suggest that there used to be 5,000 physicians in Aleppo before the conflict; only 36 remain.
Dr Sparrow, who recently launched a population-level study of the long-term impact of the abuses in Syria on civilian health, said that violations of medical neutrality are occurring at every level.
"Doctors treating civilian patients who have been deliberately shot are not only threatened but upbraided. A doctor is seen as more powerful than a soldier due to the ability to heal," she said. "Ambulances are deliberately targeted even after agreements are made to let them pass safely. They are not allowed to pass through checkpoints, or when they are, they are not allowed to take back patients. It is shocking to hear the number of ways in which medical neutrality is violated."
She added that human suffering could be considerably reduced if facilities and services were restored. However, as government forces continue to target medical facilities, many workers and patients have deemed hospitals to be unsafe places in which to seek treatment. Instead, many civilians have no option but to seek help at basic field hospitals, often just somebody's living room, run by volunteers with the most basic training. Adequate medical supplies are scarce.
"The biggest need is blood," stressed Sparrow. "One orthopaedic surgeon averages six surgeries a day so they may need as many as 30 units of blood daily. They have to donate blood themselves."
The signatories to the letter said women are giving birth in Syria with no medical assistance, horrific injuries are going untended and life-saving surgery is being carried out without anaesthetic.
As the conflict continues and more revelations reach us about the gross violations of human rights in Syria, how can the injured be treated and how can medical staff do their jobs?
"Neutrality generally requires a great deal of negotiation and hard work," said Sparrow. "In Syria, if the borders don't open soon, one can see how successful the strategy of attrition will be. It is very hard for those left, so the solution as such is opening the borders; it would at least allow aid to get in." She pointed out that people who are pro-regime are affected as much as the opposition because the state of the healthcare system in general is terrible.
The letter concluded: "As doctors and health professionals we urgently demand that medical colleagues in Syria be allowed and supported to treat patients, save lives and alleviate suffering without the fear of attacks or reprisals."
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.