One of the most brutal and most shocking features of Syria’s civil war is the way doctors and health centres have been targeted.
Throughout the war, the regime of Bashar al-Assad and its allies have attacked hospitals in rebel areas as part of a strategy to destroy popular resistance by rendering civilian life impossible.
The regime did this with siege tactics that used starvation as a weapon of war; with the widespread use of chemical weapons and the fear they spurred; and with a prison system filled with people collected through arbitrary arrest, and punctuated by deprivation, torture and mass execution.
Hospitals and clinics have been bombed so regularly that they now operate underground and in secret. Over the nearly ten years of fighting, a precarious pattern has developed: all the hospitals in areas under attack are destroyed, only for new clinics to be opened.
This happened so frequently in Aleppo province during the regime’s successful campaign, ending in 2016, to capture the area that the phrase ‘last hospital in Aleppo’ attracted its own unwelcome international comment and cache.
More recently, extensive investigative reporting has demonstrated the Russian air force’s campaign against hospitals in insurgent-held Idlib province and the surrounding areas. This investigation documented four attacks on different hospitals in the course of 12 hours, using evidence from eyewitness testimony, flight logs, and voice recordings from pilots.
Even during – and since – the investigation, Russian planes attacked more medical buildings in plain sight.
But as pervasive as this aerial campaign against medical facilities, the evidence of a new report suggests, is the Syrian regime’s grinding crackdown on doctors and other health workers, including arbitrary arrest, torture, and murder.
In Syria’s war, all concept of medical neutrality has been eagerly thrown aside.
‘My Only Crime Was That I Was a Doctor’, a report issued by the NGO Physicians for Human Rights, tabulates a war in which attacks on medical facilities and medical workers are commonplace.
It documents ‘583 attacks on health facilities’, noting ‘the Syrian government and its allies have been responsible for carrying out more than 90 percent of these attacks’.
But more than that, the report notes a pattern of attacks on doctors who treated the wounded, which has been a constant feature of the conflict from its beginnings in 2011.
The state’s brutal treatment of medical staff – like its methods of collecting information from and punishing protesters – was carried out and justified under the pretence of fighting terrorism.
State forces maintained that, just as protesters were terrorists, so too were the doctors and surgeons treating them.
Dr Youssef fell victim to this strategy early in the war. On August 21, 2011, in rural Damascus, the report states, he was arrested by plainclothes members of the state’s security services after treating a number of injuries sustained by protesters.
He was taken to al-Khatib State Security Branch, and there was interrogated and tortured with increasing intensity. He was accused of supporting a terrorist enemy through establishing an underground medical network to aid the state’s enemies.
After suffering repeated torture, Youssef was moved between regime prisons and was eventually released on bail in late 2011. In 2013, he was informed that the state wished to arrest him again, after which he fled first to Idlib province – then, as now, outside the regime’s orbit. And the next year, he finally fled the country to Turkey.
His case is not an isolated one.
The report notes that those arrested and interrogated by the regime were accused, like Youssef was, of giving material aid to terrorists. Interrogations ‘were almost always accompanied by torture’.
Syrian ‘security forces regularly beat, humiliated, and subjected [doctors] to stress positions. In some cases, they were burned, shocked with electricity, and sexually assaulted.’
The report provides more evidence of a catalogue of methods of torture used by the regime: ‘Interviewees also described Syrian guards and interrogators inflicting burns with cigarettes, electrical shock, sexual assault, and a variety of psychological stress methods, including staging mock executions’.
Those under interrogation were asked to inform on friends, family and colleagues, and the funding of their medical work.
But these interrogations were not solely about information or punishment. Interrogations provided a number of false confessions to substantiate the regime’s paranoid contention that it was assailed by a terrorist conspiracy, something justified and provided for by the Counter-terrorism Law of 2012, and the Counter-terrorism Court it established.
One doctor, Samer, was tortured into confessing to providing terrorists with medical aid, and into giving up one of his colleagues to the state.
These confessions were not just intended to increase the regime’s intelligence about its opponents, or to intimidate those doctors who treated them.
It was also part of an active campaign to reduce the capacity of medical workers to be effective and to save lives.
Doctors imprisoned by the regime were rendered unable to aid those outside the prisons. But even inside, they were made less useful. The report notes the story of one doctor, Hassan, who wanted to use his medical knowledge to help other prisoners. But authority did not help. The guards ‘would only bring them to my corner if they were dying’, the report quotes him saying. ‘I watched 14 detainees die and the only thing I could do for them was pray’.
This treatment extended to volunteers for international medical organisations, including the Red Crescent. Leila, a medical volunteer, was shot while walking to a site of what she had been told was an emergency. She arrested and beaten, then passed between regime security services before being released. While in custody, she was accused of aiding terrorists.
When the regime later overtook her neighbourhood, Leila left the country.
Attacks on medical facilities in Syria are so common that when media outside the country reports on them, journalists are accused of lying or exaggerating the numbers of attacks. The scale of the violence is so great, and the targeting so cruel, it appears almost impossible.
But as this report shows, Syria’s war has seen a war on doctors and on medicine – one intended to reinforce and make more terrible its civil conflict.
The report closes with a number of plaintive recommendations – many of them directed at parties to the violence. It is not likely any will be enacted. So long has Syria’s war gone on, and so brutally has it been waged, that violence against medical staff is unlikely to end.
And so NGOs and medical organisations search – without much chance of success – for a legal, rather than a medical, remedy.
This piece was originally published at The New Arab.