Bob Seely is a member of the Foreign Affairs Select Committee, and is MP for the Isle of Wight.
I’m having supper with a group of 20 Syrian surgeons in Ganziantep, a southern Turkish town near the Syrian border. We’re tucking into ali nazik – tender skewered lamb in a light, sour yogurt – whist comparing notes on whose hospitals have been bombed the most by Bashar Al-Assad’s regime.
One doctor has worked in hospitals struck 25 times, another 30 times, but the winner of this dark-humoured contest is Munzar Al-Khalil, whose hospitals in Aleppo and Idlib have been hit 34 times. He himself was in the buildings on 11 of those occasions. Ten of his colleagues have been killed by Syrian and Russian strikes.
“The regime tries to return people under his control,” Dr Al-Khalil says in earnest if slightly broken English. “If people don’t want to return, he will kill all the things that give life to people: hospitals, education – anything that gives the people life of hope.”
The Syrian war, now in its seventh year, maybe the first in history when hospitals and medical facilities are the primary targets. At the beginning of the war, and after losing much of his territory to proto-democratic as well as extremist religious groups, Assad is now mopping up the final areas of resistance, thanks not only to Iranian and Russian support, but also this brutal new strategy.
The doctors’ discussion comes after a long day’s training with the David Nott, the British trauma surgeon who spends part of every year in or near war-torn countries teaching his Hostile Environment Surgical Training (HEST) course, organised by his foundation run by his equally remarkable wife, Elly. The doctors’ love for Nott is obvious. He spent time under fire with them in Aleppo, Syria’s second city. “You are British, you should be proud of Doctor David. He is our godfather,” says one emotional Syrian surgeon.
Nott’s training this morning covers subjects ranging from neurosurgery in besieged areas to a technical session on joining large and small bowels, to managing burns in an austere environment – when the surgeons are short of blood, colleagues and skin grafts.
Somewhat depressingly, Nott uses his own experience of London’s violent knife crime. This morning’s viewing consists of videos of bleeding arteries in London operating theatres and shrapnel headwounds from Aleppo’s children. Next up is a Syrian neurosurgeon from Homs, who talks about the food available to patients during the siege. He gives examples of emergency proteins to feed his patients; soaked leather, crickets and locusts. That also ended up being his diet.
Syria’s socialist, one-party state always relied on fear and intimidation, but, where towns were crudely besieged at the beginning of the war, there is now a more sophisticated template – illegal under every norm and law of warfare.
The hospital is the first target. “The hospital being bombed is a sign. When the hospital is targeted we know something else is going to happen,” explains Mounir Hakimi, a British-Syrian surgeon from the Royal Hospital, Salford, who is helping to organise the course. Where they get close enough, snipers also cover the entrance to hospitals. With one doctor for every 10,000 civilians in rebel areas, a dead doctor is also a win for the regime. Civilian centres come shortly after. The combination of bombed-damaged hospitals and casualties overwhelms the capacity to cope. Families flee. Some fighters take their wives and children to the front lines – they are safer there than in town.
Prior to the US-led airstrikes earlier this year, chemical weapons were also used as the final element. They had two advantages. First, they created mass panic, turfing out difficult-to-shift remainers. Second, such chemicals as chlorine are heavier than air, so they sink into the basements in which people hide from the bombardment – a double victory for Assad. Some 5,000 people have died from chemical attacks in these mass basement morgues. By contrast, perhaps 400,000 overall have been killed.
Ally McGovern, the Labour MP for Wirral South, and I have brought back a letter from the doctors to give to Jeremy Hunt and Penny Mordaunt. A summer and autumn of slaughter threatens as Assad’s regime, with its Kremlin and Tehran partners, seeks to dislocate the remaining pockets of opposition.
Doctors from rebel areas no longer share their locations with the United Nations. Earlier this year. a Syrian medical group discussed coordinates with the UN in a meeting attended by Russian officials. Ten days later. one underground hospital was struck by a bunker buster not in the Syrian Armoury. It can only have come from Russia. As Nott says: “two plus two equals four.”
What is most remarkable is that this strategy, backed not only by Iran but also by Moscow, a permanent member of the UN Security Council, has received so little international or legal censure. Where are the indictments for Syrian, Iranian or Russian soldiers, officials or Government leaders for what is probably the most systematic, state-sponsored breach of the Geneva conventions in history?
“Surely we are not going to watch the annihilation of Idlib and hospitals being blown up and do nothing about it?” questions Nott, half in amazement, half in gloom.
Sadly, that is likely to happen. Beyond the worthy prevention of chemical weapons usage, the ‘international community’ seems unlikely to act further. The outcomes of this strategy are plain to see. Doctors here estimate that 50 percent of children in the Idlib pocket have post-traumatic stress syndrome (PTSD) and that 75 per cent of them suffer incontinence or bed-wetting thanks to the psychological effects of the war.
“For the first three and four years of war, we were diagnosing PTSD. Now professionals focus on all psychiatric disorders amongst adults and teenagers and children: phobic disorder, panic disorder and GAD – General Anxiety Disorder. Moderate to severe depression and manic episodes are becoming more common, bipolar and psychosis too,” said Wael Al-Raas who works to coordinate aid going into Syria. Idlib’s population is slowly going mad under the pressures of war.
There is very obvious physical harm too. Earlier in the day we visit a prosthetics centre near Reyhanli. The centre has fitted 6,000 limbs to 4,300 people, 1,200 of which are under 16.
Lana, three, is having her leg – or what’s left of it – examined in a small, blue and white tiled room. She was playing in her parents’ garden in Idlib when her foot was blown off by the blast from a barrel bomb. She is frightened and looks to her mother for comfort. Upstairs is Saif, eight. He says very little, but eats a packet of crisps, head down. He lost his lower limbs below the knee when a bomb landed near a bus he was on with his mother, Amira, blowing it off the road. His brother, Abdul, and sister, Asma, were killed, and his other brother Mohammed, 19, who is also with us this morning, lost his right leg, part of the right hip as well as one kidney. In general, surgeons like as much leg stump as possible. No stump makes the prosthetic more difficult to fit and use, so Mohammed’s rehabilitation – he is training to be a cobbler- is taking longer than normal.
At a clinic for women, Shaimaa, 17, is learning to walk again. On the second day of her marriage, blast injuries left her blind and only able to walk with difficulty. There are many sad stories of husbands, and sometimes wives, divorcing once their partner has lost a limb. But rather than divorce, her husband Jaber, 24, put her on the back of his motorbike and drove across the border to Reyhanli’s rehabilitation centre. He now does the cooking – a somewhat radical course amongst conservative Syrians – but Shaimaa sits next to him in the kitchen and instructs him. This, amongst Syria’s injured and limbless, counts as a happy ending. Whether Syria has one itself after this vile war ends is more in doubt.