I was in Syria on a medical mission in May when I got a call from Dr. Abdel Aziz Hassan from M-1 hospital in Aleppo, which I planned to visit that day. “They bombed M-1 hospital with two barrel bombs,” he said, his voice trembling. This was nothing new: For over three years, Bashar al Assad’s forces have targeted hospitals with missiles or barrel bombs. But this time the nightmare was playing out in front of my eyes.
According to Doctors Without Borders and other human rights organizations, the Syrian regime and some of the military groups have systematically targeted health care professionals, facilities, and ambulances. Physicians for Human Rights said government forces were responsible for 90 percent of the confirmed 150 attacks on 124 facilities between March 2011 and March 2014, which have devastated the country’s health care system. Of the more than 460 civilian health professionals killed across Syria, at least 157 were doctors, followed by 94 nurses, 84 medics, and 45 pharmacists. Approximately 41 percent of the deaths occurred during shelling and bombings, 31 percent were the result of shootings, and 13 percent were due to torture.
The crisis has forced many doctors to flee to neighboring countries. I heard of a doctor from Aleppo who decided to take the risky trip from Libya to Malta with his wife and three children by boat, trying to reach Europe, but they all died when the boat sank in the Mediterranean.
Dr. Hassan is a witty and respected middle-aged professor, trained and certified in general surgery in Manchester, England. He had been practicing and teaching general surgery at the university of Aleppo medical school for many years before the crisis. Many doctors left the eastern part of the divided city, but he and about 70 others—including 15 surgeons—stayed, risking their lives to provide care to more than two million people who were living there at the beginning of the crisis. Many civilians have been forced to leave after relentless campaign of barrel bombing, but about 400,000 remain.
Most of the wounded needed orthopedic, vascular, or trauma surgical intervention, but only one vascular surgeon remained. To make it worse, this side of Aleppo had only one functioning old CT-scanner, donated by a German charity.
Still in his surgical gear that day in May, Dr. Hassan rushed to my place, and described what happened. He was in his office when the first barrel bomb hit the roof of the hospital, one of four remaining surgical hospitals in that part of Aleppo treating trauma patients. Luckily, he survived, and no one in the hospital was killed. But an intensive care patient who had chest surgery one day before had head injuries from the flying glass.
Dr. Hassan started to evacuate the hospital, relocating patients and sending emergencies to a safer hospital, while trying to keep calm and reassure everyone. His wife called him crying from their apartment in the other side of the city, after she heard the news of the attack on local TV. “Everything was OK,” he told her, smiling. “It was another barrel bomb.” I could hear her prayers and pleas for him to stay safe. Many doctors’ and nurses’ families have relocated to Turkey or rural Aleppo for safety.
On the way to the hospital, I saw children pointing to the sky. We stopped to look and could see a small dark dot and the sound of a distant helicopter. Usually children are excited by the sight of helicopters hovering above their heads. But in Syria, helicopters drop death and mayhem, they drop barrel bombs—25 to 50 a day since December over the crowded residential neighborhoods in Aleppo. Dr. Hassan told me the helicopter was scouting for another target. Surprisingly, people were not screaming or fleeing. They have adapted, or maybe surrendered to their fate.
Typically, the high flying “dot” throws another dot. That second dot is the barrel filled with TNT. The second dot becomes larger and larger until it hits the ground and explodes. It can level a whole building—a hospital, a bakery, a school or a residential block. It takes 20-30 seconds from the time of dislodging to the explosions. All civilians can do is to run, seek shelter, and pray that the bomb missed them, their houses, and their relatives.
Barrel bombs were first mentioned in the media in August 2012, but I remember seeing their impact in Northern Latakia in April 2012. These bombs are made of 200 to 500 kilograms of explosives mixed with metal shrapnel, gasoline or sometimes chemical agents like chlorine gas. Barrel bombs are dumb and cheap bombs. Their poor accuracy and indiscriminate use in populated civilian areas can cause destruction of whole blocks of buildings and many deaths, amputations, and disabilities from flying shrapnel and crushing injuries.
Barrel bombs used by Syrian government killed more than 20,000 people between the time the conflict began in March 2011 and December 2013, with an estimated 10,000 more since. According to the Syrian Observatory for Human Rights, at least 2,000 people have been killed in Aleppo since the beginning of the year, due mostly to barrel bombing, including 283 women and 567 children. More than 6,000 barrels have been dropped on Aleppo since December.
In the aftermath of one of the attacks, on December 25, 2012, Dr. Mohammad Abu Hamza, an orthopedic surgeon volunteering in Aleppo, sent me this email along with some horrendous photos:
Today after the regime dropped 15 barrel bombs on the neighborhood, I saw headless children, yes children, other children screaming who lost their legs and arms, wounded young men thrown on the floor ... in pools of their blood and no place to accommodate them, one young man with head injury and large wounds who is convulsing, a mother screaming and crying pointing to her son begging doctors to take care of him, he is lying motionless dead on one of the hospital beds although she thinks that he is still alive, a group of men entered the Emergency Room carrying another young man who was just killed and chanting eulogies for the martyr. Suddenly a man entered the hospital screaming ’help, help.’ The helicopter threw another barrel bomb on the people gathered to evacuate the wounded.
This is not a horror movie. This is a public hospital called M-10 in the heart of Aleppo. Dr. Abu Hamza left his lucrative medical practice in Damascus after he was harassed by the infamous Syrian security “Mukhabarat” for treating demonstrators wounded by regime snipers in the early phase of the crisis. M-10 was bombed five times, the last time was only two weeks ago. I spent two days there, where I had to work in the emergency room protected by sandbags as a precaution for the next bombing.
I helped treat Abdallah, a 12-year-old boy injured while playing in the street. He survived after two urgent surgeries by the only trauma surgeon in town. Other children were not as lucky.
Doctors in Aleppo believed that the only way to stop the barrel bombings and their devastating humanitarian impact is to stop the helicopters and the jets flying over these areas. People in Syria have lost hope that the West would enforce a “No-Flight Zone” or that the United Nations would enforce its February resolution. People feel that the world has abandoned Syrians, and they are left alone to face their doom.
When we reached M-1 hospital that day in May, the neighborhood looked frightening and almost deserted.
I remember the same neighborhood in October. It was bustling with civilians, street peddlers, merchants and children in the streets. Most have since fled.
Dr. Hassan rushed to inspect the medical equipment, the ventilators, the monitors, X-ray machines and blood bank. He was looking to recover the surgical tools. Debris and broken glass were everywhere. Fuel and water storage areas were destroyed. I saw wrecked wheelchairs, broken monitors and blood on the floor. The hospital was empty, creepy and dark.
“Now what?” I asked. “As usual, we’ll clean up the debris, fix the operating and emergency room and resume working,” he said. “We can’t afford to stop our work. The people of Aleppo need us.”
The Syrian American Medical Society, my organization, is one of the few relief organizations that have been regularly sending medical supplies and equipment to Aleppo. We have been supporting doctors and nurses, paying salaries and living expenses. We are proud of that we have been able to provide U.S. -trained doctors to help their Syrian colleagues. Unfortunately, the work of UN agencies and the major International groups has been confined to the government-controlled areas.
“Send us coffins and body bags,” Dr. Hassan told me. “We ran out of them.”
Zaher Sahloul is a Syrian-American Critical Care Specialist who is the president of The Syrian American Medical Society, SAMS.