Dr. Abo Ezz, the sole surgeon in one of the few remaining hospitals in Syria’s most populous city of Aleppo, described over the phone how two weeks ago the hospital was struck by a missile that landed in the area. Though fortunately only minor damages were reported, this has been part of a broader trend that has made headlines in the last few months—the targeting of health care personnel, facilities, and equipment throughout Syria. This is a trend that, when analyzed, can reveal a window into the nuances of the Syrian war that are often overlooked.
Research conducted by Physicians for Human Rights (PHR)—which is slated to release a report on the subject within the upcoming weeks—found that 365 attacks have been carried out on 259 separate health facilities between March 2011 and April 2016, and that approximately 91 percent were committed by the Syrian regime and its allied forces. While experts and pundits have speculated the reasons behind these attacks, there is clear evidence that the Syrian regime and its allies systematically target medical facilities. As a United Nations commission into the region concluded: “Government forces deliberately target medical personnel … as a matter of policy.”
Numbering the Destruction in Syria’s Health Sector
738 medical professionals killed
365 attacks on 259 facilities
91% of these attacks were commited by Syrian regime and allied forces
Barrel bombs were used in at least 70 occasions to attack hospitals
75% decrease in pharmaceutical production
Source: Physicians for Human Rights
These attacks have contributed to an immense shortage of health care throughout the war-torn country, claiming the lives of more than 700 medical professionals and driving thousands more to flee. In Aleppo, reports have estimated that of the 2,000 physicians who once operated medical care in the nation’s most populous city, forty remain.
Within regime-held regions, President Bashar Al-Assad’s administration has maintained some functioning health care facilities, according to an Independent Doctors’ Association’s (IDA) spokesperson who asked to remain anonymous for safety reasons. However, these health systems became immensely politicized at the onset of the protests that began in 2011, and have continued to act as an arm of the security apparatus through the five-year conflict. With only 47 percent of public hospitals and health care centers partially operating and employing harsh pro-regime tactics, a majority of the population has been left without access to medical care.
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As dozens of factions continue vying for power in the region, a handful of groups—such as Islamic State (IS, also known by the earlier acronym ISIS) and Al-Nusra Front—have noted this lack of medical care and are attempting to promote themselves as health care providers to the public.
“Islamic State Health Services”
Reflected in its sophisticated social media campaign, Islamic State has attempted to portray itself not as a nihilist extremist group but rather as a functional state providing social services, such as health care, to the public. An examination of the “health care system” the organization has poured time and resources into provides a rare glimpse into the institutional and structural makeup of the group, and highlights its internal flaws that have been otherwise difficult to pinpoint.
Last year, the group circulated advertisements and a propaganda video for “Islamic State Health Services.” The fifteen-minute long clip touted state of the art health care facilities, including x-ray departments, an ICU, pediatrics departments, and even a medical college. The video, which features an Australian physician speaking Arabic and English, urges other medical professionals to join, emphasizes the quality of care, and notes its positive impact on “people who are truly suffering.”
Though doubts surrounding the legitimacy of the claims in the video persist, this has not been the sole health initiative and attempt by Islamic State to appear as a functioning health provider. The extremist organization established a free hospital for those in the region after seizing the Iraqi city Mosul in 2014. It also reportedly administered larger health campaigns, such as polio vaccinations and grants for cancer patients to purchase medicine.
While many living under the rule of Islamic State have turned to these outlets for medical care, it is primarily because they regard it as their only option.
While many living under the rule of Islamic State have turned to these outlets for medical care, it is primarily because they regard it as their only option. In essence, Islamic State is commandeering medical facilities and claiming them as public, yet running them as military hospitals. Additionally, reports reveal that these health initiatives and facilities have been plagued with a number of issues—such as shortages of medical personnel and equipment—mainly stemming from the mandated preferential treatment of Islamic State fighters over citizens.
For example, Islamic State-run health facilities have been cited as lacking resources, a fact made self-evident in the propaganda video when the Australian physician called on other medical professionals to join, saying “we really need your help.” Yet grimly, a number of reports have emerged detailing the group’s execution of dozens of doctors for allegedly refusing to treat its fighters.
This seemingly contradictory tactic—recruiting physicians while killing others—speaks to the Islamic State’s evident desire and need to establish an apparatus that primarily tends to the interests of its fighters. In doing so, however, the organization’s strategy of building a state while simultaneously destroying it showcases the group’s inherently flawed approach that the Regime and other opposing factions could find a means to exploit.
Covering Health Care Can Be a Double-Edged Sword
Islamic State’s effort to establish health care among other social benefits has tapped into the public’s interest and has been met with a proliferation of in-depth media coverage. However, as the spokesperson for Independent Doctors Association maintained, the Syrian regime and their allied forces have been using the narrative of extremist-run health delivery as a means to justify the targeting of hospitals.
Tasnim News, an Iranian news outlet closely followed in the Middle East, reported earlier this year that the Syrian Air Force targeted a field hospital belonging to Islamic State. A number of pro-government media outlets and journalists have similarly framed the rhetoric of these attacks by labeling field hospitals as belonging to militant organizations.
However, data pointing to the people actually operating these hospitals is murky. In the absence of centralized care in regions that have been abandoned by the regime, a number of facilities are being run by groups of physicians whose primary aim is to provide care to patients rather than instill an agenda through care.
“They are just doctors, not humanitarian activists,” the spokesperson for Independent Doctors Association asserted.
“They are just doctors, not humanitarian activists,” the spokesperson for Independent Doctors Association asserted.
The spokesperson said their delivery of care is facilitated by the Free Medical Association, one of three such bodies in Aleppo that emerged after the regime left the region in 2012. These three coordinating groups, outlined in the PHR report “Aleppo Abandoned,” organize care among the remaining facilities in the city. They are funded and given supplies from a number of external players, such as Doctors Without Borders and the Syrian American Medical Society, where Dr. Abo Ezz works.
While the regime and its allied forces continue to cloak their targeted attacks on medical facilities in the narrative of impeding the militant factions vying for power, on-the-ground reports combined with research depict the reality that the attacks are mostly impacting the general Syrian public.
The Implications for Health Care
While health care is just one of a multitude of social benefits governments across the world provide its citizens, it composes one of the highest percentages of federal spending on a global scale. Studies have also demonstrated how the ability to provide health care to citizens lends legitimacy to governing bodies.
PHR Investigations Associate Matthew Parsons told TCF in an interview that prior to the war, the health care system in Syria was regarded as one of the best in the region. The system, though clouded in some criticism, lauded some of the best care for non-communicable diseases in the Middle East. However, the health care system has degraded in the past five years, reflecting the severe destruction of both the city and its people that the war has caused.
Caption: Before (left) and after (right) pictures of a Médecins Sans Frontières hospital in the Idlib province of Northern Syria. The after picture was taken February 15, 2016 following a series of missile attacks on the hospital that left at least 11 people, including five medical professionals, dead in the 30-bed health facility. Source: Médecins Sans Frontières.
The toll on humanity as a result of the targeting of medical facilities has been dire. Parsons lamented that in addition to the immediate perceivable effects, these systematic attacks will have long-term implications for public health in Syria and beyond. The outbreak of polio in the region—and its documented potential to spread to neighboring countries—after it was virtually eliminated in the area in the 1990s depicts the extent of these attacks.
“We are now seeing a level of destruction that will leave an already battered city in ruins,” Dr. Abo Ezz wrote in a recent opinion article for the New York Times, adding, “We are running out of coffins to bury our friends, family and colleagues.”
Maya is working with Jason Renker and the rest of the editorial team on preparing policy content for TCF’s various digital platforms. She recently graduated from the University of Wisconsin–Madison, where she studied international studies and global security. She has worked as a reporting and social media intern for Wisconsin Health News and as a copy chief for The Daily Cardinal.
Syrians Suffer from War on Health Care
Dr. Abo Ezz, the sole surgeon in one of the few remaining hospitals in Syria’s most populous city of Aleppo, described over the phone how two weeks ago the hospital was struck by a missile that landed in the area. Though fortunately only minor damages were reported, this has been part of a broader trend that has made headlines in the last few months—the targeting of health care personnel, facilities, and equipment throughout Syria. This is a trend that, when analyzed, can reveal a window into the nuances of the Syrian war that are often overlooked.
Research conducted by Physicians for Human Rights (PHR)—which is slated to release a report on the subject within the upcoming weeks—found that 365 attacks have been carried out on 259 separate health facilities between March 2011 and April 2016, and that approximately 91 percent were committed by the Syrian regime and its allied forces. While experts and pundits have speculated the reasons behind these attacks, there is clear evidence that the Syrian regime and its allies systematically target medical facilities. As a United Nations commission into the region concluded: “Government forces deliberately target medical personnel … as a matter of policy.”
These attacks have contributed to an immense shortage of health care throughout the war-torn country, claiming the lives of more than 700 medical professionals and driving thousands more to flee. In Aleppo, reports have estimated that of the 2,000 physicians who once operated medical care in the nation’s most populous city, forty remain.
Within regime-held regions, President Bashar Al-Assad’s administration has maintained some functioning health care facilities, according to an Independent Doctors’ Association’s (IDA) spokesperson who asked to remain anonymous for safety reasons. However, these health systems became immensely politicized at the onset of the protests that began in 2011, and have continued to act as an arm of the security apparatus through the five-year conflict. With only 47 percent of public hospitals and health care centers partially operating and employing harsh pro-regime tactics, a majority of the population has been left without access to medical care.
Sign up for updates.
As dozens of factions continue vying for power in the region, a handful of groups—such as Islamic State (IS, also known by the earlier acronym ISIS) and Al-Nusra Front—have noted this lack of medical care and are attempting to promote themselves as health care providers to the public.
“Islamic State Health Services”
Reflected in its sophisticated social media campaign, Islamic State has attempted to portray itself not as a nihilist extremist group but rather as a functional state providing social services, such as health care, to the public. An examination of the “health care system” the organization has poured time and resources into provides a rare glimpse into the institutional and structural makeup of the group, and highlights its internal flaws that have been otherwise difficult to pinpoint.
Last year, the group circulated advertisements and a propaganda video for “Islamic State Health Services.” The fifteen-minute long clip touted state of the art health care facilities, including x-ray departments, an ICU, pediatrics departments, and even a medical college. The video, which features an Australian physician speaking Arabic and English, urges other medical professionals to join, emphasizes the quality of care, and notes its positive impact on “people who are truly suffering.”
Though doubts surrounding the legitimacy of the claims in the video persist, this has not been the sole health initiative and attempt by Islamic State to appear as a functioning health provider. The extremist organization established a free hospital for those in the region after seizing the Iraqi city Mosul in 2014. It also reportedly administered larger health campaigns, such as polio vaccinations and grants for cancer patients to purchase medicine.
While many living under the rule of Islamic State have turned to these outlets for medical care, it is primarily because they regard it as their only option. In essence, Islamic State is commandeering medical facilities and claiming them as public, yet running them as military hospitals. Additionally, reports reveal that these health initiatives and facilities have been plagued with a number of issues—such as shortages of medical personnel and equipment—mainly stemming from the mandated preferential treatment of Islamic State fighters over citizens.
For example, Islamic State-run health facilities have been cited as lacking resources, a fact made self-evident in the propaganda video when the Australian physician called on other medical professionals to join, saying “we really need your help.” Yet grimly, a number of reports have emerged detailing the group’s execution of dozens of doctors for allegedly refusing to treat its fighters.
This seemingly contradictory tactic—recruiting physicians while killing others—speaks to the Islamic State’s evident desire and need to establish an apparatus that primarily tends to the interests of its fighters. In doing so, however, the organization’s strategy of building a state while simultaneously destroying it showcases the group’s inherently flawed approach that the Regime and other opposing factions could find a means to exploit.
Covering Health Care Can Be a Double-Edged Sword
Islamic State’s effort to establish health care among other social benefits has tapped into the public’s interest and has been met with a proliferation of in-depth media coverage. However, as the spokesperson for Independent Doctors Association maintained, the Syrian regime and their allied forces have been using the narrative of extremist-run health delivery as a means to justify the targeting of hospitals.
Tasnim News, an Iranian news outlet closely followed in the Middle East, reported earlier this year that the Syrian Air Force targeted a field hospital belonging to Islamic State. A number of pro-government media outlets and journalists have similarly framed the rhetoric of these attacks by labeling field hospitals as belonging to militant organizations.
However, data pointing to the people actually operating these hospitals is murky. In the absence of centralized care in regions that have been abandoned by the regime, a number of facilities are being run by groups of physicians whose primary aim is to provide care to patients rather than instill an agenda through care.
“They are just doctors, not humanitarian activists,” the spokesperson for Independent Doctors Association asserted.
The spokesperson said their delivery of care is facilitated by the Free Medical Association, one of three such bodies in Aleppo that emerged after the regime left the region in 2012. These three coordinating groups, outlined in the PHR report “Aleppo Abandoned,” organize care among the remaining facilities in the city. They are funded and given supplies from a number of external players, such as Doctors Without Borders and the Syrian American Medical Society, where Dr. Abo Ezz works.
While the regime and its allied forces continue to cloak their targeted attacks on medical facilities in the narrative of impeding the militant factions vying for power, on-the-ground reports combined with research depict the reality that the attacks are mostly impacting the general Syrian public.
The Implications for Health Care
While health care is just one of a multitude of social benefits governments across the world provide its citizens, it composes one of the highest percentages of federal spending on a global scale. Studies have also demonstrated how the ability to provide health care to citizens lends legitimacy to governing bodies.
PHR Investigations Associate Matthew Parsons told TCF in an interview that prior to the war, the health care system in Syria was regarded as one of the best in the region. The system, though clouded in some criticism, lauded some of the best care for non-communicable diseases in the Middle East. However, the health care system has degraded in the past five years, reflecting the severe destruction of both the city and its people that the war has caused.
Source: Médecins Sans Frontières.
The toll on humanity as a result of the targeting of medical facilities has been dire. Parsons lamented that in addition to the immediate perceivable effects, these systematic attacks will have long-term implications for public health in Syria and beyond. The outbreak of polio in the region—and its documented potential to spread to neighboring countries—after it was virtually eliminated in the area in the 1990s depicts the extent of these attacks.
“We are now seeing a level of destruction that will leave an already battered city in ruins,” Dr. Abo Ezz wrote in a recent opinion article for the New York Times, adding, “We are running out of coffins to bury our friends, family and colleagues.”
Tags: Independent Doctors Association, Syrian Regime, Islamic State Health Services, health care, syria, islamic state, Doctors without Borders