|The Open Letter in The Lancet|
It also calls on 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.”
The Open Letter warns that Syria’s health systems are at “breaking point.”
In an Open Letter published in The Lancet online today, the signatories from across five continents highlight the acute shortage of medical personnel, supplies and facilities afflicting the people of Syria after more than two years of conflict, with over half of Syria’s hospitals destroyed or damaged, and thousands of health workers either imprisoned, or fleeing abroad.
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, on behalf of 55 signatories. (See the list of signatories below)
The conflict in Syria has led to what is arguably one of the world's worst humanitarian crises since the end of the Cold War. An estimated 100,000 people have been killed, 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 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. According to WHO, 37% of Syrian hospitals have been destroyed and a further 20% severely damaged. Makeshift clinics have become fully fledged trauma centres struggling to cope with the injured and sick. According to the Violations Documentation Centre, an estimated 469 health workers are currently imprisoned, and about 15,000 doctors have been forced to flee abroad according to the Council on Foreign Relations. Of the 5000 physicians in Aleppo before the conflict started, only 36 remain. (Assessment Working Group for Northern Syria. Aleppo city assessment report, March 2013. http://www.irinnews.org/pdf/aleppo_assessment_report.pdf)
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, and dysentery. 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, 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 effect 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; allow access to treatment for any patient; and hold perpetrators of such violations accountable according to internationally recognised legal standards. We call on 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 immediately halt attacks on medical personnel, facilities, patients, and medical supplies and allow medical supplies and care to reach Syrians, whether crossing front lines or across Syria's borders. We call on 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.
We declare that we have no conflicts of interest.
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Supplementary appendix on behalf of the 55 signatories:
1. Dr Salim S. Abdool Karim (South Africa), President of the South African Medical Research Council and Director of the Centre for the AIDS Programme of Research in South Africa, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal.
2. Dr Peter Agre (US), Professor at Johns Hopkins’ Bloomberg School of Public Health, former Chairman of the Human Rights Committee at the National Academy of Sciences, and corecipient of the Nobel Prize in Chemistry, 2003.
3. Dr Salah Al Ansari (Saudi Arabia), Executive Director of the Islamic Medical Committee and the World Assembly of Muslim Youth.
4. Dr Neil Arya (Canada), former President of Physicians for Global Survival, founding Director of the Global Health Office at Western University, and co-editor of Peace through Health.
5. Dr. Deborah D. Ascheim (US), Chair of the Board of Directors of Physicians for Human Rights and Associate Professor and Clinical Director of Research in Department of Health, Evidence and Policy at Mount Sinai, New York.
6. Dr Holly Atkinson (US), former President of Physicians for Human Rights and Co-director of the Advancing Idealism in Medicine Program at the Icahn School of Medicine at Mount Sinai, New York.
7. Dr Roberto Luiz d'Ávila (Brazil), President of the Federal Council of Medicine, Brazil.
8. Dr Hany El Banna (Egypt/UK), Pathologist, founder of the Humanitarian Forumand ofIslamic Relief, and Chairman of the International HIV Fund.
9. Dr Ahmad Hassan Batal (Syria/Bahrain), Professor of Ophthalmology, Chairman of the Batal Eye Center, and member of the Syrian Expatriates Medical Association.
10. Prof Dominique Belpomme (France), Professor of Oncology, Director of the European Cancer and Environment Research Institute, and President of the Association pour la Recherche Thérapeutique Anti-Cancéreuse.
11. Dr Gro Harlem Brundtland (Norway), former Director-General of the World Health Organization, former Prime Minister of Norway, and member of The Elders.
12. Dr Richard Carmona (US), 17th Surgeon General of the United States.
13. Sir Iain Chalmers (UK), British health services researcher, one of the founders of the Cochrane Collaboration, and coordinator of the James Lind Initiative.
14. Dr Lincoln Chen (US), Chair of BRAC-USA.
15. Yaolong Chen (China), Editor, Testing Treatments Interactive, one of the founders of the Chinese GRADE Centre.
16. Sir Terence English (UK/South Africa), former President of the Royal College of Surgeons of England, former President of the British Medical Association. Performed Britain’s first successful heart transplant.
17. Prof Atul Gawande (US), surgeon, writer, and professor at Harvard’s School of Public Health and Harvard Medical School.
18. Dr Elizaveta Glinka (Russia), founder and President of the palliative health charity Spravedlivaya Pomosh (Fair Aid).
19. Dr Fatima Haji (Bahrain), rheumatologist and Internal Medicine Specialist at Salmaniya Medical Complex.
20. Dr Rola Hallam (Syria/UK),member of Hand in Hand for Syria medical committee and Secretary of World Anaesthesia Society, Association of anaesthetist of Great Britain and Ireland.
21. Dr Fatima Hamroush (Libya), former Minister of Health in the Libyan Transitional Government and President of Irish Libyan Emergency Aid.
22. Prof Dr Harald zur Hausen (Germany), winner of the 2008 Nobel Prize in Medicine.
23. Dr Monika Hauser (Germany), gynecologist and CEO of Medica Mondiale.
24. Dr Jules Hoffmann (France), winner of the 2011 Nobel Prize in Medicine.
25. Dr Richard Horton (UK), Editor of The Lancet.
26. Dr Unni Karunakara (India), International President of Médecins Sans Frontières/Doctors Without Borders.
27. Dr Michel Kazatchkine (France), UN Secretary General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia.
28. Dr Kerem Kinik (Turkey), President of Doctors Worldwide Turkey.
29. Dr Sergey Kolesnikov (Russia), Co-President of Russian IPPNW, Professor at Moscow State University, and Co-President of the All-Russia Social Movement For Safeguarding People.
30. Prof Dr Sebnem Korur Fincanci (Turkey), President of the Human Rights Foundation of Turkey and one of the founders of the Turkish Association of Forensic Medicine.
31. Dr Robert Lawrence (US), Professor of Environmental Health Sciences, Health Policy and International Health at John Hopkins Bloomberg School of Public Health, Founder of the Centre for a Livable Future at John Hopkins Bloomberg School of Public Health and co-founder of Physicians for Human Rights.
32. Dr Kgosi Letlape (South Africa), President of the African Medical Association and ExecutiveDirector of the Tshepang Trust.
33. Dr Mohammed G. A. Al Maadheed (Qatar), President of the Qatar Red Crescent and Vice President of the International Federation of Red Cross and Red Crescent.
34. Serigne MagueyeGueye (Senegal), fistula surgeon, Head of Urogynecology at the University of Dakar, Head of Urology at Grand Yoff General Hospital, and Editor for several major medical journals. Awarded UN Medal for Peace for work as a field trauma surgeon for AU forces in Rwanda.
35. Dr Jemilah Mahmood (Malaysia), founder and former President of the Malaysian Medical Relief Society, Board Member of DARA, recipient of the Isa Award for Service to Humanity.
36. Dr Paul McMaster (UK), surgeon working with Médecins Sans Frontières in Syria.
37. Dr Denis Mukwege (DRC), Founder and Medical Director of Panzi Hospital in South Kivu Province, DRC.
38. Dr Robert Mtonga (Zambia), Co-President of International Physicians for the Prevention of Nuclear War.
39. HE Dr Laila Negm (Egypt), Director of the Health and Humanitarian Department, League of Arab States.
40. Dr Rose Nyabanda (Kenya), Head of Radiology at Kenyatta National Hospital, Kenya.
41. Professor Sir Michael Rawlins (UK), President of the Royal Society of Medicine.
42. Dr TilmanA Ruff (Australia), Associate Professor at the Nossal Institute for Global Health, University of Melbourne, Co-President of International Physicians for the Prevention of Nuclear War.
43. Prof Hamid Rushwan (Sudan/UK), Chief Executive of Board at International Federation of Gynecology and Obstetrics.
44. Dr Eloan dos Santos Pinheiro (Brazil), former Director of the Oswaldo Cruz Foundation.
45. Dr Babulal Sethia (UK), President-Elect of the UK Royal Society of Medicine.
46. Dr Imtiaz Sooliman (South Africa), founder and Chairman of Gift of the Givers, Africa's largest relief aid organisation.
47. Dr Laila Taher Bugaighis(Libya), Deputy Director General of the Benghazi Medical Centre, Member of the RCOG of London, Senior Lecturer, founder of the National Protection Against Violence Committee, and Co-founder of the Al Tawafuk Al Watani Democratic Organization.
48. Prof Prathap Tharyan (India), Professor of Psychiatry at the Christian Medical College (Vellore, India), Coordinator of the South Asian Cochrane Network, and member of the Scientific Advisory Group of the WHO-ICTRP.
49. Dr Michael Van Rooyen (US), Professor of Medicine at Harvard Medical School, Director of the Division of International Health and Humanitarian Programs at the Department of Emergency Medicine, Brigham and Women's Hospital, and Director of the Harvard Humanitarian Initiative.
50. Dr Vasiliy Vlassov (Russia), President of the Russian Society for Evidence Based Medicine.
51. Prof Ron Waldman (US), President of Board of Directors of Doctors of the World, USA, and Editor-in-Chief of Global Health: Science and Practice
52. Prof Prathap Tharyan (India), Professor of Psychiatry at the Christian Medical College (Vellore, India), Coordinator of the South Asian Cochrane Network, and member of the Scientific Advisory Group of the WHO-ICTRP.
53. Dr Michael VanRooyen (US), Professor of Medicine at Harvard Medical School, Director of the Division of International Health and Humanitarian Programs at the Department of Emergency Medicine, Brigham and Women's Hospital, and Director of the Harvard Humanitarian Initiative.
54. Dr Vasiliy Vlassov (Russia), President of the Russian Society for Evidence-Based Medicine.
55. Prof Ron Waldman (US), President of Board of Directors of Doctors of the World-USA and Professor of Global Health, George Washington University.