By Amany Qaddour, Regional Director for Syria Relief & Development (SRD), and Wouter Schaap, CARE Syria Country Director.
Dr. M works in a hospital in Syria since 2012. Photo by CARE.
On December 18, 2017, at about 10 am, Dr. M began his usual rounds. This time was peak hour for the hospital, in a region where health facilities were scarce, and this particular one was already overflowing with over 120 patients. Hundreds more were expected over the course of the day. The hospital had been providing life-saving surgeries, primary and reproductive healthcare since 2012.
Dr. M would remember what happened next for the rest of his life. A series of bombs and airstrikes – all within 20 feet of the hospital – caused the walls around him to collapse. He and the other 18 clinical staff rushed to evacuate patients to the bomb shelter they had built to guard against the airstrikes that were becoming a regular event in Syria. The clinic’s surgical unit was destroyed, along with the ambulance and the power generator.
The clinical team rushed several patients with traumatic injuries to another facility, and then went about the task of treating the people they could help with the basic equipment and resources that had survived the attack.
Dr. M worked methodically, but his thoughts were with his family - his wife and young children - who were at home nearby when the airstrikes hit. Without news, and without the ability to reach them, he struggled not to think the worst.
He later received word they were in fact safe. Dr. M would eventually move his family away for their safety.
This is just one story— one person who has worked throughout the conflict to provide the medical aid that his community needs, in the face of daily violence. Stories like this—of individual commitment and immense bravery—have been repeated throughout the country, with all of the stress, hardship, and personal risk this implies for aid workers and their families.
In 2017 alone, Physicians for Human Rights documented 38 attacks on health facilities[1]. Between the start of the conflict and the end of 2017 there had been at least 492.
In addition to airstrikes, aid workers in Syria have faced daily threats of violence, extortion and arrest. As territory changes hands, aid workers have been accused by those asserting control of providing support to their opponents. These accusations put a political target on the backs of the people who have struggled for years to keep Syria’s most vulnerable fed and cared for.
Since 2011, 294 aid workers have been killed, wounded, or kidnapped in Syria. Globally, that number is roughly 2,450. Of those, 2,174—or 89 %--are local staff, working within their own countries and communities. Attacks on local aid workers—and local aid organizations—are not often the ones that make the news headlines, but these are the people who bear the overwhelming share of the individual risk.
The hospital where Dr.M was working after the bombing of December 2017. Photo by Dr. M.
The same is true at the institutional level. In the most insecure environments, many international aid organizations use so-called “remote management,” which means directing and funding aid interventions from a safe country nearby. In Syria, the vast majority of the aid response has been managed from Turkey and Jordan, but of course the actual delivery of the goods and services that make up an aid response cannot be “remote” for all involved.
At least half of the assistance in Syria – including the hospital where Dr. M works — has been delivered by local Syrian organizations. The legal, financial, and security risk associated with delivering aid in highly insecure environments has been pushed down disproportionately onto the newest and least wealthy organizations in the aid sector.
Ultimately, the responsibility for shielding aid, and the people who deliver it, from the worst consequences of war, is the legal and moral responsibility of the parties engaged in the conflict. But in a world where armed actors are increasingly unwilling to live up to that responsibility or— worse—are actively targeting aid workers for political and military ends, there needs to be a much wider effort to help the people on the ground to mitigate and to recover from attack. Aid donors and the international organizations that design and direct the international aid response— often at arm’s reach—must recognize their own responsibility to better support local organizations and to bear more of the risk that local staff are forced to shoulder every day.
For Dr. M, this would not be the last time that airstrikes would threaten him and his patients. But in spite of the daily violence, and the prolonged separation from his wife and children, Dr. M stays because his community needs him. He stays because however bad the conditions in Syria, without his care many more people will not survive.
SRD has been providing aid in Syria since the onset of the crisis in 2011. As a Syrian-American diaspora NGO, SRD has reached over 4 million people to date through comprehensive services to those most in need in the form of health, protection, empowerment and livelihoods. SRD’s mission is to provide humanitarian relief and plant the seeds of sustainable development for the people of Syria.
CARE has been providing aid in Syria since 2013, and has reached more than 3 million people so far. Our work is focused on food security, livelihoods, shelter, water and sanitation, and psychosocial support for people in crisis. We also work in Jordan, Lebanon and Turkey with Syrian refugees and host communities. As signatories to the Charter for Change, CARE appeals to donor governments to commit more resources to build the capacities of local and national actors who operate in high-risk and hostile environments.
[1] Anatomy of a Crisis A Map of Attacks on Health Care in Syria Findings as of December 2017
Learn more about our work in Syria.