Syria: Siege on East Ghouta Leaves Medical Care in Complete Collapse

Syria 2016 © MSF

MSF calls for an immediate ceasefire to help sick and wounded

March 7, 2018, update—Medical facilities supported by MSF in East Ghouta have reported receiving more than 4,800 wounded and more than 1,000 dead over the two-week period from February 18 to March 4. This is an underestimate, as it does not include information from all medical facilities supported by MSF in the area, or from medical facilities not supported by MSF. Fifteen out of 20 facilities supported by MSF in East Ghouta have been hit by bombing or shelling during the recent escalation.

MSF urgently repeats its call for an immediate ceasefire to be implemented and for medical supplies to be allowed into the besieged area to treat the sick and wounded. It remains critical for the warring parties and their backers to ensure that civilian areas, including medical facilities, are not hit before, during, and after any pause in fighting.

Brussels, New York, February 24, 2018Casualties in Syria’s besieged East Ghouta enclave are soaring as a week of relentless bombing and shelling continues, and the capacity to provide health care is in its final throes, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, calling for an immediate ceasefire in order to treat the sick and wounded.

Hospitals and clinics supported by MSF have seen more than 520 dead and treated 2,500 wounded after days of intense bombing and shelling between February 18 and February 23, among them many women and children. Over the same period, 13 medical facilities fully or partially supported by MSF have been struck by bombs or shells. According to information from nine MSF-supported facilities that managed to report figures from yesterday, February 23, women and children represented 58 percent of the wounded and 48 percent of the deceased.

These figures are certainly an underestimate, as the number of facilities able to provide reports is decreasing and MSF only has information from facilities it supports.

On the third day of the offensive, MSF-supported medics called for increased medical supplies. Now, after six days of incessant bombardment, they report that even with the supplies they would have no capacity to keep treating the wounded.  They now call for the bombing simply to stop.

As the war in Syria has increased in intensity, the frequent calls by MSF and others to respect International Humanitarian Law (IHL) – the rules of war – have demonstrably fallen on deaf ears. In addition to demanding respect for IHL, MSF is calling for an immediate pause of the shelling and bombing by the government of Syria and armed opposition groups in East Ghouta, in order for medics to carry out their work. Supporters of the belligerents must also use their influence to alleviate this extreme situation. With high numbers of medical facilities hit and damaged or destroyed, with roads for transferring patients either impassable because of rubble or from fear of bombing, with medical supplies limited or entirely lacking, and with extraordinary numbers of patients and exhausted medics, a humanitarian response is urgently required.

MSF insists on the following:

  • Pause the bombing and shelling to allow a reorganization of the medical response;
  • Allow medical evacuation of the most critical patients;
  • Allow independent humanitarian medical organizations to enter the area to provide hands-on assistance;
  • Provide a massive resupply of life-saving medicines and medical supplies;
  • Ensure before, during, and after any pause in fighting that civilian areas on both sides, including medical facilities, are not struck.

MSF calls on individual member states of the United Nations that are militarily engaged in Syria or are supporting warring parties in Syria to acknowledge their complicity in the unfolding medical catastrophe and to urgently exert their influence to alleviate the crisis.

Medics in East Ghouta, who were already pushed to the brink, have been working now for six days straight, without a break, with no realistic hope of adequately treating their patients in such extreme circumstances.

“As a nurse who has worked through extremely grim conflicts, I am devastated to hear doctors and nurses in East Ghouta saying they have 100 wounded patients and no hospital because it has just been reduced to rubble by bombing,” said Meinie Nicolai, General Director of MSF.

“There is a level of desperation and exhaustion that comes from working round the clock, finding no time to sleep, no time to eat, permanently surrounded by bombing, and simply being in the middle of absolute distress. Adrenaline can only keep you going for so long. If doctors and nurses collapse, humanity collapses. We must be determined to not let that happen.”

Testimonies: Medical Response in Eastern Ghouta Reaches Its Limits

"Our medical point was bombed. We relocated to another place. That place also got bombed. That second time, the rescuers and others around the area rushed in to extract people from under the rubble, and that’s when a second bombing happened on that same spot, just when the people were all gathered there. We had around 100 people wounded and no working facility."

—Male medical assistant working in a health clinic, February 23

"If you count the hundreds of bodies, the ones alive and the ones dead, the body parts—there is nothing we can do for them. Even if we had enough supplies, there’s nothing we can do to respond to such a huge number of people. It’s not so much medical supplies that we need from you, but your help to stop the bombing.

"We cannot transfer any patients out of our hospital. Any person in the streets, on foot or in a car, will surely die. We are even unable to refer patients who need intensive care to the intensive care unit (ICU) that is five kilometers away. We are obliged to keep them here, and here we do not have respiratory masks. We are resorting to the use of manual ventilators, and so each patient permanently needs somebody to operate that ventilator. With so many patients coming, it's impossible—we are losing so many patients because of the shortages we have. Patients would have a chance if we could refer them five kilometers away to the ICU, but with the intensity of the bombing we can’t."

—Female doctor, manager of a major field hospital, February 24

"Our hospital is full, and we already got hit twice. When the patients started overflowing, we reassigned another location normally used as an outpatient clinic close to us. We are now using it just to have enough space to give whatever care we can to the patients. We are 250 people [including staff and patients] and we have nothing to eat."

—Male doctor working in a field hospital, February 24

"It’s getting very difficult to refer patients. Any time an ambulance leaves the facility, it gets bombed. The only way we have to refer patients is via tunnels."

—Male doctor working in a field hospital, February 24

Read More: In Eastern Ghouta, “The Past Week Has Been Catastrophic”

At the start of the recent escalation in fighting, MSF was providing a full package of regular support to 10 health facilities in East Ghouta, and had been increasingly active in supplying other facilities with emergency medical donations. Even facilities that had not asked for MSF support for years were requesting help. MSF has provided emergency donations to most hospitals and clinics in the area from its fast-depleting stocks, but it is unable to supply some key surgical items that are simply unavailable in East Ghouta. No MSF staff members are present in supported facilities.

Elsewhere, MSF directly operates five health facilities and three mobile clinic teams in northern Syria and has partnerships with five facilities. MSF also provides distance support to roughly 50 health facilities in areas of Syria where teams cannot be directly present, including in East Ghouta. Some of these are regularly supported and others receive emergency medical donations at times of dire need.

MSF's activities in Syria do not include areas controlled by the Islamic State group since no assurances on safety and impartiality have been obtained from its leadership. MSF has also been denied authorization to operate in government-controlled areas. To ensure its independence, MSF does not accept any government funding for its work in Syria.