No easy answers to the Syrian crisis

The numbers are staggering. According to a recent United Nations report, 7 million people are in urgent need of food and medical aid. Three million are refugees in neighboring countries. The country is Syria. Despite the agreement on chemical weapon destruction, the conventional civil war is worse then ever. Conventional weapons used, especially by the government, have been indiscriminate in targeting civilians on the one hand, and cold and calculating in their precision on the other.

I met two teenage girls while doing medical rounds at a spinal cord clinic in Amman, Jordan. They were lucky to be out of Syria and receiving medical care, but unfortunately were paraplegic because of wounds to their spine. They told a tale I had heard from others. Government military snipers targeting children in the spine, not to kill but to paralyze. Using them as bait so family and friends coming to their aid themselves become easy victims.

A 10-year-old girl in Zaatari refugee camp on the border with Syria shows up with her father. Just two more people in our clinic that has quickly become chaotic as hundreds show up for medical care. She has an X-ray of her head that shows a bullet lodged in a part of her brain. Her face droops a little, but miraculously she is quite neurologically functional. Her father states that with a lull in the fighting, they were attempting to go to the market when he was shot in the leg, not to be killed but to be injured. Why? So he could witness his daughter being killed. She was shot in the head but survived, and was taken by other family to Jordan. The father was taken to a hospital in Syria, presumably to be treated for his wounds. Instead, he was tortured for three days by both the medical staff and military officials before being released to prison. He eventually was released from there after paying a bribe and made his way to Jordan to seek help.

He and his daughter were not participants in the civil war, but caught in the conflict because of where they lived. Allegations of routine torture of injured civilians in hospitals has been well documented by many Syrians and in a PBS Frontline episode. They reunited at Zaatari. Neither could smile. The father told me he no longer has a heart, except for his daughter.

The stories are shared reluctantly and only by those I have the chance to ask, through an Arabic interpreter, when time allows. Everyone, it seems, has some horrific recollection of his or her last days in Syria.

Most of the patients are women and children. Their husbands/fathers/brothers are either back in Syria or have been killed or taken away by secret police. Almost everyone has lost some family member killed, home destroyed, town or village bombed. Their appearance is deceiving; they do not look like refugees. Most are well fed, clothed and clean. The United Nations, Jordan and many charities are meeting the most pressing needs for now. Almost everyone, however, appears emotionally injured.

The government of Syria has systematically made a point to destroy medical clinics and hospitals in any rebel held cities and towns. In addition, they have attempted to kill or imprison any medical care providers in these areas. A policy especially appalling given the fact that President Assad is a physician, by training. It effectively has led to the wholesale collapse of a once functional medical care system and rendered large segments of the population without any acute or ongoing chronic medical care. Many of those leaving Syria are doing so to seek medical attention for their problems.

There is no good answer for how to end the conflict. What was once a peaceful demonstration against the Assad regime for a life of more freedom and liberty among a large swath of the Syrian population has turned increasingly into a sectarian conflict among Sunni and Shiite Muslims. As humanitarians we are good at helping those in need after the atrocities have already occurred. However, we at least need to be asking the bigger question in conflicts such as this. Does it make sense to provide aid earlier and in a more deliberate way to prevent the suffering from ever happening in the first place?

As a Christian American, I treated and worked alongside predominantly Sunni Muslim Syrians. They are not members of al-Qaida or religious zealots. They are people who wish to return to their village or town and resume their lives with their families, with some level of dignity and freedom from oppression. They are opposed to the Assad regime to achieve that end, but they are losing. And they wonder why the world is silent to their plight.

In this season of thanksgiving, appreciate where you live and those you live with, and be sure to hug them just a little bit longer. Maybe, realistically, that is all we can do. But possibly, magically, we can and should do something more.

John Sager, M.D, is a family physician in Ashland.

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