Syria’s Hidden Crisis (Part I)

The conflict in Syria has trapped hundreds of thousands of civilians in parts of Homs and Damascus, besieged by their own government for years. They struggle to survive, facing shortages of basic goods including food, water, and medicine while continuing to endure violent aerial attacks. Rural Homs and Damascus both contain naturally fertile agricultural areas, but the shortages in the besieged areas are man-made—intentionally caused by the Assad regime.

Since the outbreak of the Syrian conflict, the government has employed siege tactics to subdue rebellion. The government besieged the southern city of Deraa for eleven days in April 2011, in an attempt to clamp down on the peaceful protests that ultimately sparked nationwide unrest. But the government’s siege strategy evolved over time from a short-term tactic into an extreme, systematic, long-term method of collective punishment against populations that it no longer controls. This transformation in the siege strategy began in late 2012 and culminated in mid-2013. Many areas, especially in the Damascus suburbs and parts of Homs, remain cut off from the outside world ever since. Eastern Ghouta, for example, has been without electricity for almost three years.

People residing in besieged areas struggle to find essentials such as food, medicine, and fuel. Government shelling and air strikes often directly target civilian infrastructure—including schools, hospitals, bakeries—and local means of production such as crops. Basic utilities such as electricity and water are intentionally cut off and continued attacks by the Syrian government compound these hardships.

Most besieged areas are experiencing severe health crises as the various components of the siege strategy coalesce to amplify the suffering: populations weakened by malnourishment and dehydration, the lack of sanitation, the decimation of the medical community, destruction of infrastructure, supply shortages, and the steady occurrence of mass-casualty events from air strikes and bombings. The results have devastated the population. Infectious disease outbreaks including typhoid, bacillary dysentery, and hepatitis A are becoming more common. Civilians lack options for medical treatment and hundreds have died from chronic conditions or injuries that would be treatable elsewhere. Hundreds more have starved or frozen to death. These numbers continue to grow.

Medical equipment and supplies have proven to be the most difficult type of humanitarian good to bring into besieged areas. Even in opposition-controlled parts of Syria that are not under siege, government forces routinely remove medical supplies from humanitarian aid shipments. In besieged areas, getting caught smuggling medical supplies is a death sentence. The Syrian government particularly restricts surgical supplies—including anesthesia drugs, sutures, and blood transfusion materials—due to fears they may be used to treat combatants. But restrictions extend to even the most basic supplies needed to treat chronic conditions, such as asthma.

This deprivation has forced medical staff to treat patients in primitive conditions. Medics transfuse blood from makeshift blood bags; doctors perform surgeries without anesthesia; and patients are treated with unsanitary, recycled, or poor-quality locally produced materials. Often the patients outnumber available treatments and doctors must choose who lives and who dies.

The Syrian government intentionally and systematically targets medical facilities and staff. This tactic has made field hospitals incredibly dangerous places to work and visit, discouraging civilians from using them even when they require treatment. Most field hospitals must relocate—sometimes more than once—following targeted attacks by the Syrian government. The Assad regime has decimated the medical community in the besieged areas by killing, arresting, or forcing them to flee the country.

In June 2015 a cardiologist who works with the Syrian American Medical Society escaped to Turkey from the besieged area of Douma near Damascus. On one hand, his escape means fewer medical specialists in an area that desperately needs doctors, with tens of thousands of civilians still trapped inside. On the other hand, his survival after all his time, having remained behind to save countless others, is nothing short of miraculous. His shift in besieged Douma lasted for almost three years without a break.

But not all can escape and those left behind still struggle to go on under siege. Hidden from the outside world, they build rooftop gardens for food, reclaim biofuel from feces to run generators, and move field hospitals underground to hide from air strikes.

The besieged areas represent a complex moral and ethical dilemma for the international community. Located deep within the parts of Syria still controlled by the Assad government, the Syrian armed forces and affiliated militias effectively hold the besieged communities hostage. Ending these sieges necessarily involves a confrontation with the Syrian government, either military or political. But these complexities should not excuse the international community from its obligations to protect civilians from mass atrocity and to enforce international laws and norms.

The sieges imposed on civilians in Syria have metastasized for too long without decisive international action. The Geneva Conventions expressly forbids the intentional targeting and starvation of civilians and these systematic sieges rise to the level of crimes against humanity. Allowing those who flagrantly violate international laws and norms to act with impunity not only exacerbates the growing threats to international security in Syria, but also causes enduring damage to the credibility of the United Nations Security Council and undermines the foundations of international law. Without a global effort committed to ending this illegal and immoral collective punishment, the people struggling to survive in Syria and elsewhere will continue to struggle alone.

Valerie Szybala is the author of Slow Death: Life and Death in Syrian Communities under Siege and has worked as a Syria analyst, researcher, and advocate with the Syrian American Medical Society (SAMS) and the Institute for the Study of War (ISW).

Image: A man carries his belongings as he walks past damaged buildings along a street in Jobar, a suburb of Damascus, Syria July 6, 2015. Picture taken July 6, 2015. (Reuters)