MSF Director In Syria: People Are Under Siege. Medication Cannot Reach Them.

Emergency surgery and medical activities continue in one of the remaining parts of MSF's hospital in Kunduz in the immediate aftermath of the bombing 03 October 2015. MSF was forced to cease all its activities and evacuate the damaged hospital 04 October following the apparent targeted attack on its staff, patients and facility.

The Syrian War will be entering its 7th year in 2018. Thousands have been killed, cities have been destroyed, and many people have been displaced from their homes with no end in sight for the violence. In just the past two weeks, over 1 000 people have been killed in East Ghouta, a rebel-held area in Damascus which has been under attack from government forces. Médecins Sans Frontières (MSF) – Doctors Without Borders – has been helping with providing health facilities. The Daily Vox team spoke to Jonathan Whittall, a directo of analysis at MSF, who has been involved in MSF’s response to the Syrian war for the past six years.

Supplied by MSF

How has MSF been involved in Syria?

MSF has been involved in Syria since the beginning of the war. When we started to work in the country, we tried to gain official access. We started a process of negotiations with the government to allow MSF to work. We were never successful in getting the permission from the government to work inside of Syria so the project teams established support programmes with doctors working in often extreme conditions and areas that were under control of the opposition. These medical networks we’ve been supporting over the past six years have been providing a lifeline to the population who have been caught up in the conflict and are often outside the reach of the health system inside Syria.

How have you been involved as the director of analysis?

My involvement in Syria has been initially to understand the medical needs, to develop ideas on how to better work inside of Syria, and over time to support the projects we have working in the country. MSF’s involvement has been frustrating because we haven’t been able to do as much as we would like to do. Our usual modus operandi has been to work hands-on with the patients. We don’t work well from a distance so our ability to operate has been hampered by the restrictions we face from the Syrian government and the security situation in the country.

If we look today at East Ghouta which is under seige and there is a complete breakdown in the ability to provide healthcare population. And we’re talking about war situation, it’s not only bombs and bullets that’s needs to be addressed but it’s also maternity cases and children. People continue to get sick and even more in situations where they are living under siege. The medical needs are immense and the ability of the medical community to address those needs is extremely limited by a lack of supplies. MSF provides some support in gaining access to those supplies. It’s also difficult for people to get out so today for example in East Ghouta, people under siege are unable to leave the area. The fighting is ongoing and intensive. The ability to organise the medical system is hugely constrained by the intensity of the violence and the fact that there is not a single respite in the level of violence. What we’re seeing is a total war which is devastating to the population.

I have seen people under siege. I’ve been to areas that are under siege and I’ve seen the toll it takes on people’s lives. I’ve seen the hospitals where they have tried to organise themselves in basements and makeshift structures to be able to treat the wounded with very little supplies and infrastructure with bombings which are often indiscriminate. Often the health facilities are hit. I saw a similar situation six years this time when it’s winter. And it’s cold and damp, and there’s little to no food. The sick and wounded have very little options to move around due to the fighting. People can’t move from one building to another and sometimes can’t even reach the health
facilities. The wounded and sick are sometimes trapped and the ones that are left to move are doctors and nurses who are then caught in the violence and are injured themselves. If you imagine an emergency room under normal circumstances, it’s a very busy environment in the hospital. If you put that in a war situation with limited staff and supplies and severe injuries, the medical staff get extremely exhausted and desperate.

What is the situation like in East Ghouta at the moment?

In the first week of the intensification of fighting, there were 3 700 wounded that entered into MSF support facilities. That’s a huge number in a week. The intensity of the violence was extreme. The facility we’re supporting saw 700 dead which is also a huge number. Now, it’s a week after the violence started, we’ve reached 4 800 wounded coming into these facilities and the number of dead is over 1 000. If you imagine a population that is unable to move, that is unable to escape the violence, that can’t move from areas without being hit by shelling, by bombing, and when they are sick or wounded they are facing hospitals that are overwhelmed, and with supplies that are running out.

A week ago we called on the UN Security Council or rather the parties to the conflict to have a ceasefire basically to allow for the reorganisation of medical supplies, to allow wounded to get out, to allow supplies to get in and we called on all the different backers to the conflict to put pressure on the warring groups to allow for this to happen. The Security Council called for the ceasefire but we’ve seen no change on the ground. It’s a crisis that needs to be addressed but we see a complete failure from all the members of the UN Security Council. This is not one member or the other, this is a collective failure of the Security Council to create the conditions for this happen. Part of the reason for this is that the Security Council are protecting that space to be able to fight their own so-called terrorists where it’s Mosul, Syria, or Gaza. What we see today in Ghouta is the result of a collective failure and a horrific total war on the ground.

The ones that are suffering the most are those caught in the middle. We have the major parties in the conflict is the government and those that back the government as well as the opposition and those that back the opposition. There are groups operating on a local level. There are regional backers to the different groups as well as international groups. So we see multiple levels of complicity in Syria on all sides from the local to the international.

What response should South Africans be giving?

What we see unfolding in Syria should not seem far away from South Africa in a sense that we are uniquely placed in South Africa to understand the inequality and the reality of injustices. What’s happening in Syria, Mosul, and Palestine are all issues that should collectively touch the consciousness of South Africans. We have a role to play as South Africans, as humans, but South Africans with a unique view towards oppression and inequality to have our voices heard on these kinds of situations. I think there is a tendency in South Africa to think of these situations as far removed from our own daily realities but I think this is something that should touch our collective consciousness.

I have witnessed through my work situations such as what we see in Ghouta today and what you
realise in such situations that the bombing of civilians injures everyone the
same, whether it’s bombs being dropped by the Syrian government, the Iraqi government, the Americans, the Russians; the kind of violence that civilians are subjected to in situations like Mosul, Gaza, Aleppo, and now Ghouta is unacceptable. It’s very striking to realise that at the end of the day what we’re dealing with is trapped populations and the rest of it is narratives and spin to justify the actions of the different parties. But when you’re faced with a patient in front of you in a trauma hospital that’s been injured in a bombing or shelling or by snipers, it’s a sad reality of the kind of tactics that are being used against civilian populations.

Find out what MSF are doing in East Ghouta and more about the situation in Syria.

Interview has been edited for clarity and brevity.

Editor’s note: the interview has been amended for clarity.

Featured image Chris Huby via MSF