The health crisis in Syria has reached alarming proportions, threatening not only the Syrian population, but also its neighbors, and requires an immediate international response. While the international response to the Syria crisis has been effectively galvanized around the chemical weapon attacks and subsequent international inspections and destruction of stockpiles, a parallel potential crime against humanity has been unfolding – one that disproportionately impacts the children of Syria. Compounding an already desperate situation characterized by malnutrition, starvation, and limited access to medical services, the World Health Organization (WHO) has confirmed at least ten cases of polio. Twenty-two people, mainly babies and toddlers, have reportedly experienced acute flaccid paralysis – a typical indicator of polio – and public health workers in the region are bracing for a wider outbreak. The viral disease attacks the central nervous system, often resulting in full or partial paralysis or death. While there is no cure, polio can be prevented through immunization. The disease has been all but eradicated in most of the world, but this highly contagious disease remains rooted in the war zones of Afghanistan, Nigeria, and Pakistan. The current outbreak in Syria is the first the country has seen in 14 years.
In the Middle East, Syria was one of the earliest implementers of widespread vaccination programs for polio, and – until the conflict began in 2011 – it had one of the best polio vaccination rates in the region, seeing 95 percent of children vaccinated. Now, almost three years later, a significant number of children under the age of 5, the population most at risk for the disease, have not been vaccinated due to the collapse of medical services inside Syria.
Proper medical services have all but collapsed as the conflict rages on, due in large part to the direct targeting of medical personnel. Not only have doctors reportedly been arrested, detained without charge, and tortured, but hospitals and medical convoys have been deliberately shelled and attacked while attempting to provide desperately needed services to patients. More than half of Syria’s public hospitals have been damaged since the outbreak of violence; nearly 40 percent are no longer functioning at all. As a result, there has been a mass exodus of healthcare professionals to neighboring Jordan, Lebanon, and Türkiye. Reports claim that in some areas, nearly 70 percent of health workers have fled the violence. The ongoing civil war – waged against the backdrop of a crumbling healthcare system, the rapid disappearance of capable healthcare professionals, and restricted access – has generated the ideal conditions for severe public health crises. Cases of measles, typhoid, and hepatitis A were already increasing before the troubling outbreak of polio was even reported. The highly-communicable nature of polio in particular has many worried of its spread both within Syria and among the startling number of Syrian refugee children in neighboring countries, leading the WHO and UNICEF to initiate a joint immunization campaign targeting millions of Syrian children. However, successfully containing and limiting the polio outbreak remains in doubt, as significant portions of the Syrian population are inaccessible due to fighting, sieges, and armed blockades.
At the same time, large segments of the Syrian population are starving to death as humanitarian aid, including bread and other food staples, is blocked from reaching the people who need it most. Some reports allege that the Assad regime is intentionally waging a “Starvation Until Submission Campaign” bent on destroying the opposition and its supporters. By establishing checkpoints at which soldiers deny the passage of food, medicine, or other essential items, entire areas are effectively besieged, leaving civilians to survive on what little food they can find; sometimes the only source of food is grass or other wild greens. The level of desperation is such that a local religious leader issued a fatwa allowing those in need to eat dog or cat – the consumption of which is otherwise forbidden under Islamic law. If these allegations regarding intentional starvation of the population are true, President Assad could be charged with war crimes or even crimes against humanity if deprivation of food is determined to be a widespread or systematic attack against civilians. Furthermore, international humanitarian law guarantees protection to both medical and other humanitarian personnel working to provide relief to populations impacted by conflict. All parties to conflict who attack personnel and service convoys or otherwise block civilian access to these services are in violation of international norms set by the Geneva and Hague Conventions.
Syrians, both inside and outside of Syria, have been imploring the global community to intervene in the conflict for more than two years now. Many were enraged that the world waited until chemical weapons use was alleged – the so-called “red line” that President Obama identified – before considering credible threats to intervene to stop mass atrocities and protect lives of civilians. While a laudable achievement, the dismantling of the Syrian chemical weapons capability does not mark an end to the suffering of the Syrian people. The international community has focused its attention on weapons that, though horrific, account for only a small percentage of the more than 100,000 deaths in Syria. Conventional weapons, and increasingly now disease, malnutrition, and starvation, are the larger threats to the people of Syria. While I was recently in the region, a Syrian doctor, who works closely with PHR, expressed his frustration with the global community and the UN Security Council: “If you are not able to completely stop war in Syria, please do not worry about chemical weapons in the hands of criminals. Death with chemical weapons is much easier than starving to death.”
The UN estimates that more than 9 million people – more than 40 percent of the Syrian population – now require humanitarian assistance. Public health threats such as polio and malnutrition represent an immediate and dramatic crisis, particularly to the country’s most vulnerable segment – its children. Access to essential services must be ensured, as food aid and medication is essential to preventing the unnecessary death of Syrian children and others displaced by the conflict.
PHR calls on all parties within Syria to guarantee safe, full, and unhindered access to humanitarian aid, including food and medical supplies, throughout Syria. The ICRC, its partners, and all humanitarian personnel must be allowed to move unimpeded to the besieged areas in order to address desperate humanitarian needs. Barring a cessation of hostilities, the deteriorating public health situation inside Syria can only be properly addressed by allowing much-needed aid to reach those forced to live in deplorable and dangerous conditions. As the international community responded to the use of chemical weapons, so too must it urgently respond to this burgeoning humanitarian and human rights crisis and prioritize bringing about an end to the relentless violent attacks on civilians and the country’s infrastructure that are essential to survival.