{"id":38402,"date":"2017-02-07T16:50:22","date_gmt":"2017-02-07T15:50:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=38402"},"modified":"2017-02-09T16:42:05","modified_gmt":"2017-02-09T15:42:05","slug":"forgetting-aleppo-fatalism-has-no-place-in-this-tragedy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/02\/07\/forgetting-aleppo-fatalism-has-no-place-in-this-tragedy\/","title":{"rendered":"Forgetting Aleppo: Fatalism has no place in this tragedy"},"content":{"rendered":"

<\/a>William Faulkner wrote, \u201cWe must be free not because we claim freedom, but because we practise it<\/em>.\u201d Such freedom cannot be better encapsulated than by the herculean health workers in the midst of the Syrian tragedy, risking and even sacrificing their lives to limit bloodshed.<\/p>\n

In this ambiguous\u00a0conflict, woven with persecution and the complexity of splinter groups, certain statistics pierce through political fog. From the period between January 2015 to December 2016, the Syrian Observatory for Human Rights<\/a>\u00a0estimated that 49 742 people were killed in the conflict\u2014of which 13 617 were civilians and 2885 children.<\/p>\n

Statistics rarely move readers. Nevertheless, pinpointing a region\u2019s plunge from civilization to barbarism is essential to potential resolution. Those at hand are a stark reminder of the incomprehensibility of globally televised inhumanity. Physicians for Human Rights (PHR) marked in 2015 the deaths of 700 medical personnel<\/a>\u2014either shot, tortured to death, or otherwise killed\u2014since the start of the conflict.\u00a0In addition, 95% of doctors in Aleppo<\/a>\u2014the Mesopotamian city marking the start of the ancient Silk Road\u2014had either been displaced, captured, or killed.<\/p>\n

At any given time, it is estimated that there are only 37 to 50 physicians working in Aleppo<\/a>, providing care to
\n300 000 people.\u00a0Many of them work temporarily, moving to and from the safety of bordering Turkey. Nevertheless, some stayed, choosing fight rather than flight. In makeshift hospitals under constant threat from airstrikes and shrapnel filled barrel bombs, workers in a multitude of healthcare professions treat patients brought in from all over the city.<\/p>\n

Dar al-Shifa Hospital after being bombed<\/figcaption><\/figure>\n

 <\/p>\n

In July 2012 something changed: the Syrian government started targeting<\/em> hospitals. This has been widely reported<\/a>.\u00a0The epicentres of pre-conflict healthcare were flattened while makeshift solutions, such as the\u00a0Dar al-Shifa Hospital in eastern Aleppo<\/a>, were aerially bombarded.\u00a0In November 2016, MSF reported an attack on<\/a> the only paediatric facility left in Aleppo. A similar attack<\/a> in July killed four\u00a0babies dependent on incubation<\/a>.\u00a0The rest were rushed to the basement, leaving behind the incubators responsible for keeping them alive. In addition to horrific mortality, the psychological trauma<\/a>, from\u00a0over three million children displaced by war, should not be forgotten.<\/p>\n

Yet care continues. An alarm based system was adopted in hospitals for when helicopters were spotted nearby. This allowed for a two minute warning before an inevitable cascade of bombs. Warplanes, however, were too fast to be caught by this warning system. Other rudimentary tactics that have been implemented, such as\u00a0the switching off of all lights during the night, were akin to those used in the Blitz of World War II; calling to mind\u00a0Dylan Thomas\u2019s famous poem \u201cDo not go gentle into that good night \/ Rage, rage against the dying of the light.\u201d<\/em><\/p>\n

Help has been forthcoming; donations of portable equipment, such as ultrasound machines, and the implementation of novel “virtual wards” allow experts to provide diagnostic and practical help to colleagues in Syria. Aid is exemplified by David Nott, the British vascular surgeon<\/a>.\u00a0In addition to travelling to Syria to operate, he also provides intraoperative tele-assistance to surgeons and established a foundation that helps run courses to better train conflict surgeons (integrating novel skills, such as the ability to safely conduct a caesarean section regardless of surgical specialty).<\/p>\n

Internal organisations like the heroic White Helmets<\/a>\u2014unarmed local volunteers of self-confessed \u201cbakers, tailors, engineers, pharmacists, students, and many more\u201d\u2014provide lifesaving medical aid and rescue support.\u00a0International humanitarianism is led by charities such as M\u00e9decins Sans Fronti\u00e8res<\/a> and Save the Children<\/a>.<\/p>\n

\u201cHow dreadful the knowledge of the truth can be when there\u2019s no help in truth,<\/em>\u201d quipped Sophocles in 429 BC.<\/p>\n

The tragedies of Sophocles are known for embracing fatalism\u2014the philosophy defined by characters being powerless to change their fate because actions are predetermined. Such cynically passive thinking is coupled with America\u2019s recent shift towards isolationist foreign policies\u2014manifesting in the inhumane suspension of refugee resettlement<\/a>.<\/p>\n

Let us embark on the opposite course. Pay attention to global events, support humanitarian aid, and demand empathic policy change. The defenceless and defenders are dying in Syria at an alarming rate. The least we can do is persist. Fatalism has no place in this tragedy.<\/p>\n

\"salil_patel3\"<\/a>Salil Patel<\/strong> is a medical student currently studying for a master’s degree in neuroscience at Keble College, University of Oxford. He was working as a spinal surgery research fellow at the Royal Devon and Exeter Hospital and is passionate about improving access to surgical care worldwide.
\n<\/strong><\/em><\/p>\n

Competing interests<\/strong>: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

William Faulkner wrote, \u201cWe must be free not because we claim freedom, but because we practise it.\u201d Such freedom cannot be better encapsulated than by the herculean health workers in […]<\/p>\n

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