Special Report: In Syria, Medicine as a Weapon of Persecution

© Valérie Batselaere/MSF
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Syria 2012 © MSF

A Syrian patient treated by MSF

These 15 testimonies from injured people and doctors from across Syria were collected by Doctors Without Borders/Médecins Sans Frontières (MSF) staff between January 30 and February 6, 2012.

MSF is not authorized to operate inside Syria at present and thus is unable to fully verify the information collected here. However, given the recurring nature, consistency, and severity of the acts described in these testimonies, MSF has decided to make them public. For security reasons, names and locations have been withheld.

The testimonies reveal the following:

  • Casualties such as multiple fractures, gunshot wounds, and electric shocks that strongly suggest a concerted program of violence and torture;
  • The merciless persecution and repression of the injured and their caregivers;
  • The pursuit of doctors at risk of arrest and torture for treating wounded civilians;
  • The monitoring of hospitals by security forces, in order to arrest and torture the wounded;
  • The resulting need for many to seek medical care provided illegally in makeshift facilities, including private homes; and
  • The lack of even basic medical supplies, including drugs, anesthetics, blood bags, and sutures in places where patients do receive care. 

Man, 23 years old

Date of injury: November 2011

I was in the street, and usually when there is a raid on the city, they shoot randomly and indiscriminately on all people, whether it’s an old man, a child, or a woman. Any moving person was a target. I was injured in my hand. There were other people injured, too.

“They shoot randomly and indiscriminately on all people, whether it’s an old man, a child, or a woman. Any moving person was a target. I was injured in my hand.”

No, I was not taken to a hospital, because all the hospitals were surrounded with security personnel. In the hospitals now, the security cadres are more numerous than the medical personnel, and anyone is subject to arrest and even murder inside the hospital.

They took me to a house [to get treatment]. And, god bless them, a number of doctors and nurses there bandaged my hand and told me it needs an operation in a hospital. So my family decided to send me to the capital, considering that the situation in the capital is calm. I was taken under a false name and identity, and I was operated on in the hospital under a different name because I am wanted by the security apparatus.

I stayed for one day in the hospital, but in this operation, it should not have been the case that my hand needed to be cut off. Normally, even under the worst circumstances, they might remove a finger or just bandage the wound, but in this case, they cut it off from the wrist.

A gunshot wound does not necessitate amputation. In Damascus hospital? They had everything there and they could have treated my hand. But they amputated it. That is what I find strange and surprising. I’m still upset about it today.

I decided to leave the hospital after one day. I stayed in the capital for 10 days.

Man, 29 years old

Date of injury: November 2011

I was injured November 31. There was an attack by the Syrian security forces. There were tanks and there was firing by the tanks. My mission was a media one. I was supposed to film and show the truth on free channels and Al Jazeera. It was a horrific attack.

“I was detained twice and what we saw is that some of those in prison are left to have their wounds rot. Their injuries rotted and they were not taken to hospital. Some died next to me, while others were urinating blood from the internal bleeding they were suffering from.”

There was a man who was wanted by the security and they stormed his house and broke the glass. They couldn’t find him but found his father. I was filming all of this from the bedroom of a house next door. I was moving and the snipers saw me and they were trying to hit me or shoot me in the head. There were several shots on my arm. It was an explosive bullet. It destroyed three fingers and a quarter of my hand.

I was lucky because I went into a house where there was a woman delivering. They took me into the house and put me in the place of the woman. And the security were after me.

When they arrived in that house and saw the blood, the people were shouting and saying, “Why are you coming here? There is a woman having a baby!” And that is how I was saved. The security went to other locations.

But the doctors could not do much for me. I was bleeding heavily; they were tightening [a tourniquet] around the wound to try and stop the bleeding. The pain was so bad I wished I was dead. And I call on all those who care about human rights to ensure we receive at least local anesthesia, because the pain I endured was too much.

After the security left, the guys came to move us to another location. In the situation that we have in Syria, you cannot go to a hospital, because if you do, they either amputate the limb that you are suffering from or they take you to prison. I was detained twice and what we saw is that some of those in prison are left to have their wounds rot. Their injuries rotted and they were not taken to hospital. Some died next to me, while others were urinating blood from the internal bleeding they were suffering from. And no organizations or doctors or MSF are allowed to go into prison.

The field hospital [is normally in someone’s house, moving from one house to another]. There were no ambulances; any ambulance was targeted and shot at. And the doctors who are brave enough are also watched or arrested, or they rape his wife in order to prevent him from taking any action. Or they place them under house arrest.

Man, 28 years old, laborer

Date of injury: May 2011

I was injured on May 27. The Friday that was named for protecting the homeland.

We were a group of men in the same neighborhood who went out on a demonstration to demand the fall of the regime and our freedom. We used to always face live bullets. But on the night I was injured, we did not expect that Syrian army and security apparatus would prepare an ambush for the demonstrators. So at midnight, we were surprised to be facing direct live fire.

“When I fell on the ground, two men who unfortunately were from the Syrian army came to me and started to beat me on my head and my injured leg.”

I was injured, shot in my left thigh. I suffered from a broken and crushed bone.

When I fell on the ground, two men who unfortunately were from the Syrian army came to me and started to beat me on my head and my injured leg. They started to pull me by my arms, trying to drag me back to their barrier, which was a bit far from them as they came on foot. So when they were pulling me, a woman saw what was going on from her window on the second floor.

They got scared because when the woman started shouting, I also started shouting. She gave me strength. I started calling for the people. Then the soldiers left me and ran.

The people protected me and I was taken from the neighborhood. In our neighborhoods, we can move from one house to another without going through the main roads. We kept looking for a doctor until 4:00 a.m. Finally a nurse came. I am so thankful to him because he took a major risk to come and help.

After the initial treatment I was moved to another house for safety.

We remained in the house for four days. The next day the doctor came to see me and said I needed to go to a hospital, that I could not stay here. We initially wanted to have the operation to fix my fracture in a field clinic or where we were, but he said it was impossible because the wound was infected and there was swelling. He said you need a hospital, adding that it was my choice, but I could either stay here, and they will have to amputate my leg, or I could go to the hospital.

The doctors tried their best until finally they managed to operate on me. When they took me into the OR, the hospital security also went into the operation room. The doctor told them not to and that it was a sterilized room. I was operated on and they used the external fixator and I was smuggled out of the hospital in a way that I don’t want to mention because it is still being done. I was out, but after that the doctor was detained. Thanks to god he was later released.

Also, when we went home, my situation got worse, because they were still looking for me. We were homeless for a while moving from house to house. So there was a lot of pain and difficulty and hardship. It has lasted a long time.

Man, 23 years old

Date of injury: March 2011

I was injured on March 23, 2011. The security forces shot me in the thigh.

I was taken by the guys to a mosque. And at the mosque they told me I needed a hospital for my wound, but we cannot take you to the hospital because the situation is really bad. They said the injured can be shot at the hospital. So they took me to a house I stayed in the house until the afternoon, and after that they took me to the national hospital.

“For treatment I was given a drip until the morning. I still needed an operation, but I could not get treatment for my injury for 25 days.”

At the hospital, they told us that there had been a massacre and there were a lot of wounded there already and, therefore, they cannot do the operation for me.

We stayed in the hospital until midnight and after that we were told to leave for our own safety, in order not to be targeted. For treatment I was given a drip until the morning. I still needed an operation, but I could not get treatment for my injury for 25 days.

I finally got back to the hospital after the 25 days and underwent an operation. The second day, I left the hospital and went back home.

I still needed another operation to remove the fixator and implant skewer [the metal plate that had been inserted]. I stayed like that for around two months, and after two months, when I wanted to go back to the hospital, I could not because the situation was very tense.

It was difficult for everyone to go to hospital because they started to take the patients from the hospital. It became much worse—as the number of injured increased a lot, the security also increased too. Some people donated money for the operation in the private hospital and I underwent the operation. Then I went to a doctor; the bones were healing, but the problem was with the nerve, as it was damaged. This kind of treatment is not available in Syria. So I have remained in the same condition for the last eight or nine months.

Man, 34 years old

Date of injury: December 2011

I was injured in December, and I was detained during a demonstration against the president.

I was detained and tortured for 15 days, and on the last day, day 15, they put the picture of Bashar al-Assad in front of me and told me to kneel to the photo, saying, “kneel to Allah Bashar.” I told him I only kneel to god and I tore the picture. They went crazy when I was tearing the photo, as if I was tearing out their soul. So they took me to the colonel.

“With me, they taped a detonator to my hand; it had TNT, which was tied to a long string linked to a battery. Then they put on the electric detonator and blew it up. I lost three fingers and two-thirds of the remaining two, along with most of the palm of my hand.”

They beat me badly, to the point that I was about to faint. They tied my hands behind my back and took me to the colonel and he said, “my son”—he didn’t really say “my son,” he cursed me, but I will put it like this because it was a very bad insult. He asked, “Don’t you know that whoever cuts the picture or lays a hand on the president, we will cut off their hands.”

I said, “As you wish, sir.” He kicked me, and I fell from the top of the stairs down to the last one. After that, they covered my eyes and spread my arms and tied them (like a crucifix), and they taped something to my hand. I didn’t know what it was but later found out that it was an electric detonator. They put up some sort of a shield and they blew it up.

Within less than a minute, I felt something warm on my feet. It was my blood. I was bleeding heavily and I lost consciousness. I woke up in hospital, I wasn’t totally conscious in the hospital, but my friends found out I was there. They kidnapped me from hospital and took me to a house, and they brought doctors who came and treated me in that house.

In detention: they curse and insult and were constantly beating us and they tie up people’s arms like [they’re on a] crucifix. Some guys were subject to the removal of their fingernails. Others were flogged, and there are others who had their backs broken. They put them on a certain board; they make the person lie on it and then the sides of the board are lifted and the back cracks.

They use many methods. With me, they taped a detonator to my hand; it had TNT, which was tied to a long string linked to a battery. Then they put on the electric detonator and blew it up. I lost three fingers and two-thirds of the remaining two, along with most of the palm of my hand.

Yes, they took me to hospital. They threw me there like I was a dog or something and they said they don’t want to deal with me. The treatment was bad. When the doctor saw my injuries, he said it was very bad and that my hand was completely deformed. Even the doctors later, they did not have the proper tools to treat this kind of wound.

For 25 days I could not sleep because of the pain, not even with taking sleeping pills. In the hospital, they only stopped the bleeding. After that, my friends found out that I was in hospital, so they kidnapped me from there. They took me out from the back door, because if the security saw me there, they would kill me. We are all targeted and until now they are looking for me and I am wanted.

Yes, there was a lot of torture in detention. We were 230 people kept in a small room. There were old men and doctors detained with us. There was a doctor there I met. I asked why he was there and he said, “just like you my son.”

Man, age unknown

Date of injuries: March 2011

My injury happened when a sniper shot me in my right thigh, crushing of the bones in my leg. I remember that on that date the ambulances were around, at a distance of 20 meters of less, and I was waving to them, but they did not respond. Days later we found out that the drivers of these vehicles are security people and not paramedics.

“I was given drugs and antibiotics, but they could not carry out the surgical operation because the injury was severe.”

Some of my students came and saw me injured on the ground and they insisted on taking me to the hospital, even though there was still heavy shooting.

I was moved by a taxi. The taxi driver who stopped for me was really brave. I stayed for one day in the hospital and managed to get first aid. They gave me two or three blood units and I regained consciousness. I was given antibiotics, and they told me, “This is what we can do for you, because your injury is severe.”

After that, one day later, I was referred to the Damascus hospital and I stayed there for one week. I was given drugs and antibiotics, but they could not carry out the surgical operation because the injury was severe and they sent me home and said “you need a conservative treatment.” I asked what that means and they said I should stay in bed for three or four months because the operation is semi-impossible. The bones were really crushed, but I was not convinced with what they told me.

The doctor was avoiding saying that this kind of operation was beyond their level or capacity, so he wanted to get rid of me. I went home and stayed home for 10 days. Some people mentioned the name of a famous doctor in Damascus and I was adamant to go to that doctor, and I paid for the treatment. This operation [internal fixation] cost me 150,000 Syrian liras [approximately $2,600], and the doctor was reassuring me that the success percentage was excellent. I was back to normal by 95 per cent, but now am suffering from the bullet that is still in my leg, and these metal bars hamper my ability to walk. After a while, I could not go back to hospital because security had a very tight grip on both public and private hospitals. They either terminate the injured or beat them up on their injury or arrest the injured. So I decided to come to MSF to continue my treatment.

Man, 24 years old

Date of injuries: June 2011

I was injured around eight months ago. We were in a peaceful demonstration and were demanding reforms. They started firing tear gas bombs, and shrapnel hit me in the chest. It was the Syrian security who did this. Then there was shooting with live bullets so the guys carried us and took us to a mosque. I needed an operation, but I could not go to hospital because it was filled with security people. They used basic material for treatment, like bandaging and antibiotic pills. The security was surrounding all the hospitals and anyone who goes there will be detained. Now, the impact of the shrapnel hit my chest, where there is excessive tissue, but this tissue needed to be removed according to the doctor.

“I could not go to hospital because it was filled with security people. They used basic material for treatment, like bandaging and antibiotic pills.” 

I have gone without treatment for seven months. I was also detained. That happened on the twenty-seventh or twenty-eighth day of Ramadan. I went out after the Eid.

Tortured? Yes. They took me at 1:00 a.m., and they kept beating me until 4:00 a.m. We were also tied with hands apart and chained, and they used whips and kicked and insulted me.

No, there was no medical treatment in detention. We barely got food. There were 60 people in a room, some sleep standing up, others sitting down. Those who have their names called out go out, but we don’t know where to. After one or two hours they come back exhausted from the beatings and the torture. They put us in a yard and make us take off our clothes, and they spray us with water and they stand far or on top of a chair, and they electrocute the wet floor. We were all electrocuted. They also use a certain chair to crack the back of the person. Those who are injured or have broken bones are not treated. They have to endure until they are released.

Man, 29 years old

Date of injuries: Unknown

I was taking my brother’s wife to hospital. She was having a baby and my wife was also with me. And I was told not to go near that area because there are armed men there. I kept the women in that location and went to bring a car a taxi, to transport the women. As I was walking to get a car, I was shot in the calf.

“I woke up in the hospital and was told that they want to cut off my leg. Everyone in the hospital was at risk of being killed, and they even attacked the intensive care unit. I was taken outside the hospital in order not to be hurt.”

The shooting was from a tank standing behind a digging truck. The kind of bullet shot by this tank are the ones that explode in the body. I was not carrying any weapons and I had not done anything. Yes, it was the Syrian security.

I woke up in the hospital and was told that they want to cut off my leg. Everyone in the hospital was at risk of being killed, and they even attacked the intensive care unit. I was taken outside the hospital in order not to be hurt.

Security personnel were inside the hospital. The doctor talked to them and told them that even if you, the security, are injured we will treat you.

Five day later, I came back to hospital and they operated on me and put a plate in my leg, and I left the hospital. The doctors would come and see me, and they said I had an infection. The doctors were telling me if that I’m better off if I leave the country, because here the situation is worse.

I was injured the day the army stormed into the area. The whole area was full of injured and dead. It was like a massacre. Any car passing would take the injured, but the problem was with the presence of the security. There was security and a tank next to the hospital and a lot of army vehicles. The most dangerous were the snipers.

Man, 27 years old

Date of injuries: April 2011

I was injured during the demonstration. I was on a motorcycle.I saw a man who was dragging an injured person out of the crowd. They stopped me and said, "Take us with you!" There were three of us on the motorcyle with the injured person between us. They shot at us. The other guy who wasn't injured was shot. The man at the back fell off the motorcycle. It was only me and the injured man left. We fled. They kept shooting at us.

Who was shooting?

The security forces! I was pushed up against a security vehicle. We fell and they beat us up. Everybody in the vehicle got out. About fifty of them were hitting us with the butts of their guns. They were beating us, beating us . . . I had an injured leg and a bloodied face. I lost consciousness. The other guy with me, after the beating, was almost dead. He was still alive the last time I saw him. As for me, the blood was flowing from my ears, my nose, my mouth . . . they left me for dead. Some people put me in a blanket and brought me to a makeshift hospital. There, some women gave me first aid. I don't know what aid exactly . . . I stayed 13 days and then I was able to leave.

Elderly man, age unknown

Date of injuries: March 2011

We left our villages for the city. It was my first demonstration. We arrived and we were surprised. We were expecting a "normal" demonstration with water canon, tear gas, et cetera. To break us up, they fired machine guns, real bullets . . .

There were snipers also. It was indescribable. I was hit in the shoulder. I was with another demonstrator who I saved. We hid in a building waiting for it to calm down. The area was shelled for two hours. I wanted to help a wounded man but he refused. People had told him that injured people were killed at the hospital. We couldn't do anything but I bandaged his wound with a bit of fabric that a woman gave me . . . The doctor in the village is pro-regime. He refuses to treat the injured. In the hospital in my village, they just gave me first aid because nobody wants to stay at the hospital. You go in one day, and the next day "they" come and get you. You make do with what you find in
the pharmacies: medicines, disinfectants, et cetera. One scene I remember in particular was a man with his face hidden, crushing an injured person with his feet.

Who?

One of "them," security, in military gear. Judging by his uniform, he was an officer. At the end, the officer finished off the injured man. I witnessed that scene with my very own eyes.  

Doctor

General surgeon who left Syria two months ago

My name was registered with the security services and I am wanted because I treated the demonstrators.

“We try to prepare these field hospitals, but they do not have the proper standards. No proper ventilation, sterilization. We are using rooms in houses. So whatever you try to have, it will not fulfill the required requirements to carry out surgical operations. But this is the utmost that we can do.”

There were three kind of cases. The first were those that could be treated in the clinic. This is mainly treatment of those injured by bullets fired by hunting rifles. This kind of rifle bullet produces a lot of shrapnel and a lot of shell wounds. Wound treatment, as well as treatment for broken bones like putting a cast on can also be done at the clinic—the simple stuff.

There are the cold cases, like a bullet lodged in someone’s leg. This, we can keep the case for two or three days before we send them to hospital. And we coordinate with the hospital to remove the foreign object from the body in a clandestine way, because if we send someone to hospital and the security finds out, they will be detained. So for the cold case, we would sustain the wound, then under a false name or medical report make arrangements for the patients to be operated on in the hospitals.

The third kind of case are the acute cases. With these, we have no other option but to take them to hospital, and it depends on luck if the patient is picked up by security or not. But all the info of the patient will be recorded by the security, like who treated him and how they were injured and all the details.

In public hospitals there is a process to go by, and through this process the patient’s name will be registered with security and those who are supporting the regime within the hospital. So you cannot really help a patient in such circumstances.

Sometimes, some doctors manage to treat simple cases and manage to let them flee without being seen or registered. But if an admission is required for the patient, then the administration of the hospital is notified, and therefore it reaches the security.

A majority of the nursing cadres in these hospitals are pro-regime. For instance, they start saying in front of a patient that they will amputate the leg because he is with the revolution. Sometimes they insult the patients and beat them, and tell them “You want freedom? This is the freedom that you want?” At other times, they decide to amputate believing that with these patients, it is not worth trying to help them or save their limbs.

In public hospitals there is equipment and drugs, but the problem is up to 95 percent of the injured do not go to the public hospitals. They are often treated in a field hospital, where the people of that neighborhood agree on a certain house to place the wounded and decide what to do with them. Of course, there is a major lack of field hospitals, but we can at least try to help or operate acute or emergency cases.

What we do is: the patient is taken to a house, then some people take the patient after they blindfold them to another location to be treated. Even the doctors do not know where these field hospitals are. They are also blindfolded and taken by the guys to treat the patients. Neither patient nor doctor knows where the field hospital is located.

We try to prepare these field hospitals, but they do not have the proper standards. No proper ventilation, sterilization. We are using rooms in houses. So whatever you try to have, it will not fulfill the required requirements to carry out surgical operations. But this is the utmost that we can do.

We need the ventilator machine, or the transport ventilator, as well as other machines to be able to use for operations in field hospitals. We have prepared ORs in houses that are sealed to be used when the situation really blows up. They are hidden rooms in houses and are covered with walls, so when there is a break-in by the security they will not find the room. [These are] to be opened for acute and major cases or when there are huge numbers of people.

Yes, violence is increasing and the number of patients is increasing as well. And the kind of weapons being used are more lethal. Now we see wounded with bullets that have exploded in the body.

I treated a young man for six bullet wounds. He was travelling with his family in the car and did not stop at the road block, so they shot at the family’s car repeatedly.

The violence varies and that is why the cases vary depending on how tense the situation is. In one case, the security went into the OR and took the patient who was under anesthesia. It was in a private hospital.

As long as I was working in a clandestine way, and nobody knew that I was helping treat the injured, there was no threat on my life. But once my name reached the security—I was not ready to jeopardize my family.

What is needed most are the echo machines, transferable operating table, mobile x-ray machine and ventilators.

Doctor

Lab doctor

For the most recent cases, I can tell you, for instance, last week we lost two patients because there was no field hospital in that area and the injuries were gunshot wounds in the chest, so we could not treat them because they needed the proper tools and specialized people.

“Some of our people were detained. Some doctors are well known who have been in detention for months. ( . . . ) [We have seen] different forms of injuries [including] bruises due to beating, electric shock, which led to the death.”

To take these patients to the public hospitals is impossible, not just because there are doctors and nurses working for the regime in these hospitals, but due to the fact that in each hospital there is a police unit and they are on the door, and they belong to the different branches of the security apparatus and they apprehend the injured.

Some of our people were detained. Some doctors are well known who have been in detention for months.

[We have seen] different forms of injuries [including] bruises due to beating, electric shock, which led to the death. One case was electrocuted in the mouth and they kept electrocuting him until he died. I saw this. I was there standing next to the mosque.

Field hospitals: we set-up three hospitals. One hospital was attacked so we had to dismantle the others, then we switched our method and we started setting up field hospitals in the countryside. But these hospitals remained unequipped and more like emergency kits. These are all in houses and changing routinely.

A doctor now is considered more dangerous than those fighting with the [rebel group, Syrian] Free Army, and anyone caught with drugs in his possession, the charges against him are more grave than being accused with possession of weapons.

The average person is normally taken for days or up to a week, but doctors are detained for months. The doctors are also targeted not just because they treat the injured but also because they are involved with the movement. In the military hospital, those who are considered renegades from the army are tortured and killed.

Some intern doctors or medical students in their last year are helping; they receive training on basic injury treatments and are helping us with the treatment of the injured

Doctor

Doctor who worked in a hospital

Certain colleagues were caught and I was advised to leave the country.

“At the beginning the security raided several areas where we had field hospitals, so
we were not able to treat as many as possible.”

In each public hospital there is a police unit, so any patient admitted for a surgical operation will be known and will be reported. We cannot work within this context. I wasn’t able to work within these hospitals. I worked in my city, going down to the street and taking my stuff to treat cases on the street.

A colleague of mine was caught with gauze in his car and he was sentenced on charges of running a field hospital. He was in prison for a month and was tortured.

At the beginning, we used to go down to the street. Those who were shot in the head by snipers or the cases we know cannot be treated, we leave them or send them to the hospitals without their families.
At the beginning, the security raided several areas where we had field hospitals, so we were not able to treat as many as possible. Other cases, like shell wounds, are taken to the field hospital and are treated. We put them in a house and we visit them and monitor their injuries.

For cold cases, we sustain the case and then send them to a hospital. With others, we try to send them to a private hospital and arrange for their treatment.

The first time there was violence, there were no ambulances. The second time, when the ambulances came, we sent them away because they can easily take all the injured and transport them to the security station, or security personnel can come out of it. So they are not safe. We would not trust any ambulance that belongs to the public hospital. One patient was shot in his leg as he was giving first aid to a patient inside an ambulance.

Doctor

I'm a Syrian doctor. I was treating the wounded in Syria.

“The risk of being arrested is big. But despite that risk, many doctors are putting their lives in danger in order to fulfill their medical oath.”

At first, when the demonstrations started, we sent the injured to public hospitals. But then we were told that injured demonstrators were being tortured or left untreated. Many were even killed.

Doctors are working in difficult security conditions and in tough medical conditions, too.

Makeshift hospitals tend to be one or two rooms somewhere near a demonstration area. In addition to that, there's all the security pressure and difficulty in reaching certain areas. Doctors who treat the wounded are also being harassed by security forces.

Security is what worries doctors most. It's difficult. The risk of being arrested is big. But despite that risk, many doctors are putting their lives in danger in order to fulfill their medical oath. It is difficult to find sterilized medical materials. Due to our limited means and the numbers of wounded, we have to resort to rudimentary medical practices.

We are forced to use medical materials and perform medical acts that are far from the safe surgical procedures we would usually carry out. Activists and protestors don't really have any medical resources. They don't have ambulances, for example. The injured are transported by their friends and fellow protestors.

When we receive serious casualties, a patient who needs to be hospitalized, we have two options: Either we let him die, or we send him to hospital not knowing what will become of him.
Many hospitals are encircled and placed under tight control when security forces are informed that a casualty is due to arrive from a demonstration area.

Doctor 

The general problems that we are facing: 

There are two public hospitals in X. . . . But this applies equally to the whole of Syria. The wounded do not go to public hospitals. The wounded are treated in residential houses staffed. These are emergency medical stations. There are no ambulances. The ambulances are not available. They are controlled by the authorities. We use civilian vehicles. 

We are organized. In each region there is a medical team including doctors and nurses to take care of the wounded in that region. However, we cannot transport the sick from one region to another because the regions are isolated from each other. Each person is treated in his or her region, in his or her neighborhood. But serious cases are transferred to the two or three hospitals that are providing care with us in secret in X. These are not public but private hospitals. 

Of course the transfers take place in an organized way far from the military checkpoints. Because anyone could be stopped at a checkpoint. If a vehicle is transporting a wounded person, that person and the driver could be stopped and the vehicle confiscated. They could also be shot at. Even the ambulances have been shot at. 

I can give you an overview of the medical situation in general. The medical situation in general: we have field hospitals here in X, one field hospital. Here we perform general operations, not only small operations but also certain chest injuries. These are good operations, more or less important operations. They’re not always complex operations, but emergency operations of a good standard. That is the situation with respect to the hospitals. 

In addition to the hospitals, we also have what we call emergency medical stations. There are more of these than the hospitals. Each region has one or two hospitals. There are more medical stations. They are installed in houses, in rooms inside the houses, and equipped with emergency medical equipment such as gauze, cotton, serum, the essentials. 

The teams of volunteers are composed of nurses and certain doctors. The wounded person is transferred to the medical station. He is rapidly treated and released. Even the medical station is subject to searches and in danger. Actually a house which treats the wounded regularly is quickly identified by the authorities and becomes a target. This is why the medical teams are constantly transported from one house to another. 

The medical stations are mobile. They are different to the field hospitals. The items of equipment in the field hospitals are also mobile. We transport them from one area to another as much as possible.

But the situation is difficult. The hospitals were searched. When the militias enter into a neighbourhood with a field hospital, they destroy it. They destroy the equipment, confiscate it, burn the medical products, such as the cotton and the gas. It was agony. 

The security services search and destroy the hospitals so that we have nothing left to treat the wounded. This is why the medical stations are mobile. 

We also have slightly larger medical stations in which smaller operations are performed. These stations are more or less fixed. We also have the field hospitals. 

Certain [doctors] admit wounded and operate on them. These are standard operations. Today these doctors are in foreign countries. It is difficult to obtain [medical products]. They exist, they are available, either on the domestic market, or as contraband via the borders, but with difficulty. 

Sometimes we suffer from a major deficiency of medical products. Other products are more available. Some organisations support us, some influential people help us to maintain supply of medical products through the border. These are the operating rooms, but they are far from perfect . . . as you know, the operating room must be sterilized. It must be maintained in a particular way. 

It is installed in a room in the house. One room is sometimes open. One room in a region being bombarded. People enter and leave like in a mill. The conditions are not ideal, but it’s all that we have.

The supply of basic products was possible but we are going through difficult periods. At a time we suffered a major lack of products. In surrounded regions, the needs were far more urgent. We tried to get medical supplies by way of the internal market as much as possible.

It’s true, the security forces are present. The medical hospital here is a base for the security services. They received wounded from the army. They even receive wounded civilians. We don’t have a lot of stories that are coming through. People who come into this hospital are only injured soldiers, as wounded civilians don’t come to public hospitals. 

We have got hold of the pursued people. On one of them, there’s the name of three or four doctors. One of them is being pursued for having helped an injured person. In other words, every doctor helping an injured person is accused. That’s an accusation. It’s there on the official documents in our possession. There’s the name of the doctors who have been imprisoned then came out. Others have been imprisoned and then executed. 

We are people just like others. The situation is unacceptable. I got involved in this work from the first day. I can’t even imagine not being involved. I was there from the beginning with them. I was there from the first day in the demonstrations. I am one of the first to have gone into the streets, with my colleagues. 

They say that people filled the streets: everybody came down to demonstrate, doctors, engineers, defavorized social classes. Everybody participated in the movement. I am part of these neighborhoods. I am not participating only because of my duty as a doctor. My role as a doctor is to heal the wounded. This is the reality. People are still dying in the streets. We can’t leave them.