November 03, 2016

Many of the people trapped under siege in eastern Aleppo are under 18 years old. The three-month-long siege and weeks of bombing and ground fighting have had a devastating impact on their health. For children in eastern Aleppo—healthy and sick alike—the situation becomes more critical by the day. Food, drinking water, and medical care are becoming increasingly scarce, while medical staff struggle to cope with huge numbers of wounded patients.  

At least 136 children have been killed and at least 468 have been wounded by airstrikes since September 22. The hospitals where they are treated are desperately overcrowded and short on staff, medical supplies, and intensive care beds. "Our outpatient departments are overwhelmed," says emergency room nurse Abu Al Motassem. "We are getting between 120 and 150 children every day. We received one child who needed to be admitted to the intensive care unit, but we were forced to keep him in the ward for some time. He wasn’t able to make it and he passed away."

Hospitals at a Breaking Point

Of the seven hospitals currently functioning in eastern Aleppo, just one specializes in treating children. There are four pediatricians—two doctors and two final-year medical students—in the besieged area, but no pediatric surgeon. This shortage of medical staff has fatal consequences, according to Al Motassem. "We had a child who required surgery for an esophageal diverticulum [a condition in which the esophageal lining bulges through the muscle wall of the esophagus], but we couldn’t find a doctor available in the whole of east Aleppo. Any pediatric surgeon could have done it, as it’s an easy operation. But there was no such surgeon, and the child died."

Some 1,500 child patients currently need specialized medical care that is not available in the besieged area of the city, but with all roads out of the city impassable, no referrals are possible. Among them are children with cancer, congenital abnormalities, and brain damage, as well as those in need of certain types of emergency care.

Many parents are afraid to move around the city amid bombing or ground fighting, so they wait at home with their sick children until it is less risky to go out. "They wait for the warplanes to leave, and when they reach the hospitals, the children are in a far worse condition," says Riyad Najjar, administrative manager of the only children’s hospital in the besieged area.

"Sometimes they have to wait all night long and, when they do arrive, it is too late or it has been too damaging for the children," says Aya, a neonatal nurse who prefers not to give her surname.

Patients in eastern Aleppo generally stay in hospitals for as short a time as possible, as they are considered dangerous—the area’s hospitals have been hit by bombs in 26 separate incidents during the three-month-long siege. The pressure on medical staff and on hospital capacity also contributes to patients spending less time in hospitals than they may need, with sometimes tragic consequences. "Premature babies can need a long period in the intensive care unit before they are ready to leave, but as the time is not available, we are losing many of them," says Najjar.

Dwindling Supplies

What's more, medicines must be rationed under the siege and some stocks are running out. "Here in the neonatal ward, and also in emergency rooms, many children die because there are no medicines available for them," says Aya.

Meanwhile, children with less-urgent medical problems are neglected. Given the hundreds of people wounded in airstrikes in recent weeks, general pediatric care is simply not a priority, say medical staff in one hospital supported by Doctors Without Borders/Médecins Sans Frontières (MSF). After so many years of war, vaccination coverage is patchy and children’s immune systems are weak, increasing the risk of outbreaks of preventable diseases like measles, meningitis, and polio. There are suspected cases of all three diseases in eastern Aleppo, but they cannot be confirmed, as samples can no longer be sent out of the city to a laboratory.

At the same time, there are shortages of many types of food, including meat, dairy products, fresh fruit and vegetables, and formula milk for babies. "Some mothers aren’t able to breastfeed, other children have lost their mothers," says Al Motassem. "People can’t find formula milk, so babies are often given normal food at home, and this leads to acute malnutrition, and the parents don’t know why." Malnourished children are more vulnerable to diseases.

Life for the children trapped in eastern Aleppo gets more risky with each day that goes by.

MSF supports eight hospitals in eastern Aleppo—only seven are currently functioning—and runs six medical facilities across northern Syria and supports more than 150 hospitals and health centers across the country, many of them in besieged areas. Despite best efforts, there are many areas, including western Aleppo, where it is currently impossible for MSF to work, but the organization continues to push to provide humanitarian and medical aid in these areas.

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