Richard Smith: Syria, now’s top sorrow

Richard SmithClimate change will soon destroy us. Global poverty is increasing. Non-communicable disease is sweeping the planet. Communicable disease is far from defeated and may re-emerge in new and terrible forms at any moment. Mothers are continuing to die in childbirth. War is now endemic, and nowhere, literally nowhere is safe. The tentacles of the pharmaceutical industry are strangling medicine. Migration of doctors and nurses is undermining already fragile health systems in developing countries. The Health and Social Care Act signals the beginning of the end for the NHS, and the response should be civil disobedience.

Students attending a conference on global health in London on Saturday were presented with a formidable array of sorrows. Would I like to be young now, I wondered. I remembered the young fuzzy haired me who was passionate about the injustice of the world in the ’60s, but we didn’t have quite the array of sorrows confronting students now. Nuclear war followed by nuclear winter was the only sorrow of the 60s that seems not to be on today’s list, but probably it should have been.

“How do you feel about being young now?” I asked several students. They smiled and each said something along the lines of “Excited but scared.” It was, of course, a stupid and unanswerable question: you are young when you are young. I felt guilty that I was glad that I wasn’t young now, but, as the saying goes it’s the job of the young to worry about the world and of the old to worry about the young.

One young doctor from talked directly about what it was like to be young now. Speaking to the young, he said: we face unprecedented problems, but we also have new tools. To change the world we must first open up, use social networks, self-express, and change values. Next, we should recognise that ordinary people, us, are trusted in a way that governments, CEOs, and authorities are not. We can use that trust to build powerful communities that can create change. He advocated smart targeting. allows people to create petitions around any topic, and he described examples of where petitions had led to important change. His hero is Molly Catchpole, a young American who organised a protest against the Bank of America introducing charges for people using their bank cards to get cash, built a community of hundreds of thousands who protested, and got the bank to abandon the charge.

(Later when us old timers were offering advice to the students, the young doctor from  told the students not to listen to professors telling them to research and learn, but rather to follow their own instincts. “Good advice,” I thought, “not to follow the advice of a failed generation like mine.”)

But as I listened to the array of sorrows I decided that the biggest sorrow right now, the one that justifies our full attention, is what’s happening in Syria. A specialist registrar in anaesthetics, part of the Syrian diaspora, told us of her firsthand experience in the country. (I’m deliberately not naming her because, although her name was on the programme, I don’t want to add even the tiniest risk to the considerable risks she faces whenever she travels to Syria, which she does regularly.)

The registrar started by showing us pictures of normal Syria, the souk in Damascus, dramatic Roman remains, and a very modern Mediterranean resort. When, she said, people see pictures of countries devastated by war they begin to think that it was always like that—but it wasn’t.

The war within Syria is becoming steadily more brutal, and the people of Syria feel abandoned. Worse, they feel that a proxy war between major powers is being fought in their land. The first time that 50 people were massacred in day it was front page news, now it doesn’t make the news in the West. At least 60 000 people have died, probably many more. Some 700 000 people are refugees, and around 4 million of the population of 20 million are displaced.

Perhaps the most shocking thing for the audience was how health services are being deliberately targeted. “Rebels” are killed while in hospitals. In one case a “rebel” was disconnected from a ventilator and thrown onto the floor. Doctors and nurses thought to be supporting “rebels” are killed, captured, and tortured. Syrian doctors, supported by Syrian doctors living outside Syria, have set up underground field hospitals. But, of course, the government eventually locates  and closes them, killing or imprisoning the staff. Some 800 medical staff have now been captured, killed, or tortured.

The registrar described the irritation of the “rebels” that all aid goes to the government and is thus distributed only to government supporters. The aid, she argues, thus becomes a weapon in the war. The charity she works with, Hand in Hand for Syria,  has to provide aid to medical staff just to keep them alive. The humanitarian and medical needs of Syrians are huge, and Hand in Hand for Syria has not nearly enough means to meet them.

But, I asked the registrar, isn’t one of the problems in Syria that the “rebels” are a very varied group that has trouble working together and includes some who are very extreme? That’s not really true, she answered.  She sees it as an excuse the rest of the world uses as an excuse for not acting. The world could, she believes, stop it tomorrow if they had the will but they don’t. Nor can she see any likelihood of the conflict ending soon.

What can you do? Here’s two easy things. You can sign a petition at calling on Ban Ki-Moon to get members states to do everything possible to stop the crimes against Syria’s children,  or you can donate to Hand in Hand for Syria.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

Competing interest. RS spoke at the meeting and was kindly and unexpectedly given a Moleskine notebook, which says on the front ACTIONS. SPEAK. LOUDER. (Why the fullstops, I wonder.)