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Let us treat patients in Syria

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"We must not let considerations of military intervention destroy our ability to focus on getting them help." In an open letter published in The Lancet, Gro Harlem Brundtland and 50 other medical professionals highlight the devastating humanitarian and health impact of the Syrian crisis, calling on all parties to allow doctors inside Syria to save lives and alleviate suffering without fear of attacks or reprisals.

The conflict in Syria has led to what is arguably one of the world's worst humanitarian crises since the end of the Cold War. An estimated 100,000 people have been killed, most of them civilians, and many more have been wounded, tortured, or abused. Millions have been driven from their homes, families have been divided, and entire communities torn apart; we must not let considerations of military intervention destroy our ability to focus on getting them help.

As doctors and medical professionals from around the world, the scale of this emergency leaves us horrified. We are appalled by the lack of access to health care for affected civilians, and by the deliberate targeting of medical facilities and personnel. It is our professional, ethical, and moral duty to provide treatment and care to anyone in need. When we cannot do so personally, we are obliged to speak out in support of those risking their lives to provide life-saving assistance.

Systematic assaults on medical professionals, facilities, and patients are breaking Syria's health-care system and making it nearly impossible for civilians to receive essential medical services. According to the World Heath Organization (WHO), 37 per cent of Syrian hospitals have been destroyed and a further 20 per cent severely damaged. Makeshift clinics have become fully fledged trauma centres struggling to cope with the injured and sick. According to the Violations Documentation Centre, an estimated 469 health workers are currently imprisoned, and about 15,000 doctors have been forced to flee abroad according to the Council on Foreign Relations. Of the 5,000 physicians in Aleppo before the conflict started, only 36 remain. (Source)

The targeted attacks on medical facilities and personnel are deliberate and systematic, not an inevitable nor acceptable consequence of armed conflict. Such attacks are an unconscionable betrayal of the principle of medical neutrality.

The number of people requiring medical assistance is increasing exponentially, as a direct result of conflict and indirectly because of the deterioration of a once-sophisticated public health system and the lack of adequate curative and preventive care. Horrific injuries are going untended; women are giving birth with no medical assistance; men, women, and children are undergoing life-saving surgery without anaesthetic; and victims of sexual violence have nowhere to turn to.

The Syrian population is vulnerable to outbreaks of hepatitis, typhoid, cholera, and dysentery. The lack of medical pharmaceuticals has already exacerbated an outbreak of cutaneous leishmaniasis, a severe infectious skin disease that can cause serious disability, there has been an alarming increase in cases of acute diarrhoea, and in June aid agencies reported a measles epidemic sweeping through districts of northern Syria. In some areas, children born since the conflict started have had no vaccinations, meaning that conditions for an epidemic, which have no respect for national borders, are ripe.

With the Syrian health system at breaking point, patients battling chronic illnesses including cancer, diabetes, hypertension and heart disease, and requiring long-term medical assistance have nowhere to turn for essential medical care.

The majority of medical assistance is being delivered by Syrian medical personnel but they are struggling in the face of massive need and dangerous conditions. Governmental restrictions, coupled with inflexibility and bureaucracy in the international aid system, is making things worse. As a result, large parts of Syria are completely cut off from any form of medical assistance.

Medical professionals are required to treat anyone in need to the best of their ability. Any wounded or sick person must be allowed access to medical treatment.

As doctors and health professionals we urgently demand that medical colleagues in Syria be allowed and supported to treat patients, save lives, and alleviate suffering without the fear of attacks or reprisals.

To alleviate the effect on civilians of this conflict and of the deliberate attacks on the health-care system, and to support our medical colleagues, we call on the Syrian Government and all armed parties to refrain from attacking hospitals, ambulances, medical facilities and supplies, health professionals and patients; allow access to treatment for any patient; and hold perpetrators of such violations accountable according to internationally recognised legal standards. We call on all armed parties to respect the proper functions of medical professionals and medical neutrality by allowing medical professionals to treat anyone in need of medical care and not interfering with the proper operation of health-care facilities. Governments that support parties to this civil war should demand that all armed actors immediately halt attacks on medical personnel, facilities, patients, and medical supplies and allow medical supplies and care to reach Syrians, whether crossing front lines or across Syria's borders. We call on the UN and international donors to increase support to Syrian medical networks, in both government and opposition areas, where, since the beginning of the conflict, health professionals have been risking their lives to provide essential services in an extremely hostile environment.

We declare that we have no conflicts of interest.

Gro Harlem Brundtland, Eliza Glinka, Harald zu Hausen and Roberto Luiz d'Avila on behalf of 51 signatories.

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