 |
| 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.
* * * * *
, 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.
* * * *
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.
