September 16, 2013

[IPPNW Co-Presidents Ira Helfand, Robert Mtonga, and Tilman Ruff,  former Co-President Sergey Kolesnikov, and a number of affiliate leaders have signed the following call for medical neutrality in Syria. Updates about the appeal can be followed on Twitter at #Doctors4Syria. The same hashtag can be used to comment on the appeal and to forward it to others.]

The conflict in Syria has led to what is arguably one of the world’s worst humanitarian crisis since the end of the Cold War. An estimated 100,000 people have been killed[1] – most of them civilians – and many more have been wounded, tortured or abused. Millions have been driven from their homes; families have been divided; and entire communities torn apart. We must not let considerations of military intervention destroy our ability to focus on getting them help.

As doctors and medical professionals from around the world, the scale of this emergency leaves us horrified. We are appalled by the lack of access to health care for affected civilians, and by the deliberate targeting of medical facilities and personnel. It is our professional, ethical and moral duty to provide treatment and care to anyone in need. When we cannot do so personally, we are obliged to speak out in support of those who are risking their lives to provide life-saving assistance.

Systematic assaults on medical professionals, facilities, and patients are breaking Syria’s health care system and making it nearly impossible for civilians to receive essential medical services. Thirty-seven percent of Syrian hospitals have been destroyed and a further twenty percent severely damaged. Makeshift clinics have become fully-fledged trauma centres struggling to cope with the injured and sick. An estimated 469 health workers are currently imprisoned[2] and around 15,000 doctors have been forced to flee abroad[3]. According to one report, there were 5,000 physicians in Aleppo before the conflict started, and only 36 remain[4].

The targeted attacks on medical facilities and personnel are deliberate and systematic, not an inevitable nor acceptable consequence of armed conflict. Such attacks are an unconscionable betrayal of the principle of medical neutrality.

The number of people requiring medical assistance is increasing exponentially, as a direct result of conflict and indirectly because of the deterioration of a once-sophisticated public health system and the lack of adequate curative and preventive care. Horrific injuries are going untended, women are giving birth with no medical assistance, men, women and children are undergoing life-saving surgery without anaesthetic and victims of sexual violence have nowhere to turn to.

The Syrian population is vulnerable to outbreaks of hepatitis, typhoid, cholera or dysentery[5]. The lack of medical pharmaceuticals has already exacerbated an outbreak of cutaneous leishmaniasis, a severe infectious skin disease that can cause serious disability, there has been an alarming increase in cases of acute diarrhoea[6], and in June aid agencies reported a measles epidemic sweeping through districts of northern Syria. In some areas, children born since the conflict started have had no vaccinations, meaning that conditions for an epidemic – which have no respect for national borders – are ripe.

With the Syrian health system at breaking point, patients battling chronic illnesses including cancer, diabetes, hypertension and heart disease and requiring long-term medical assistance have nowhere to turn for essential medical care.

The majority of medical assistance is being delivered by Syrian medical personnel but they are struggling in the face of massive need and dangerous conditions. Governmental restrictions, coupled with inflexibility and bureaucracy in the international aid system, is making things worse. As a result, large parts of Syria are completely cut off from any form of medical assistance.

Medical professionals are required to treat anyone in need to the best of their ability. Any wounded or sick person must be allowed access to medical treatment.

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.

To alleviate the impact on civilians of this conflict and of the deliberate attacks on the health care system, and to support our medical colleagues, we call on:

  • The Syrian Government and all armed parties to refrain from attacking hospitals, ambulances, medical facilities and supplies, health professionals and patients; and the Syrian government to allow access to treatment for any patient and hold perpetrators of such violations accountable according to internationally recognized legal standards;
  • All armed parties to respect the proper functions of medical professionals and medical neutrality by allowing medical professionals to treat anyone in need of medical care and not interfering with the proper operation of health care facilities;
  • Governments that support parties to this civil war should demand that all armed actors halt immediately attacks on medical personnel, facilities, patients, medical supplies and allow medical supplies and care to reach Syrians, whether crossing front lines or across Syria’s borders;
  • The UN and international donors to increase support to Syrian medical networks, in both government and opposition areas, where, since the beginning of the conflict, health professionals have been risking their lives to provide essential services in an extremely hostile environment.


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