Where doctors are criminals

Where doctors are criminals
The Assad regime considers some health workers enemies of the regime. NYT talked to four of them about why they risked their lives anyway.

There was the medical student who volunteered in eastern Aleppo even after his classmates were tortured and killed as a warning. There was the pharmacist who smuggled drugs past regime checkpoints to cancer patients who needed them. There was the pediatrics medic who relied on expired medicines taken from an abandoned factory.

Each took enormous risks to provide medical care to areas in Syria aligned against Bashar al-Assad. Some were imprisoned and tortured, evidence of how the nearly 9-year-old conflict in Syria has normalized the criminalization of medical care.

Physicians for Human Rights, which has documented the collapse of Syria’s health care system, said in a recently released study that al-Assad has successfully made medical assistance given to his enemies a terrorist act.

The study is based on interviews with 21 formerly detained Syrian health care workers who have fled the country. None wished to be identified by name, fearing retribution against their families or themselves if they ever returned.

The New York Times independently interviewed three of them. It also interviewed an emergency medic of an underground hospital, the subject of “The Cave,” an acclaimed 2019 documentary, who was so overcome by bombings she abandoned her aspirations to be a pediatrician.

The Medical Student: Navigating a Deadly Dystopian Odyssey

The passport clerk said it would take five minutes to answer some questions. “It lasted about 110 days.”

MEISENHAM, Germany — The Syrian medical students were well aware of the risks when they crossed over to opposition-held districts of Aleppo in 2013. The previous year, two other students had been arrested trying to smuggle bandages and painkillers through a checkpoint. A week later the security services told other students to collect the corpses, which had holes in their foreheads, tongues and eyes from a power drill.

“That was a message for all the medical students,” said a former student who asked that his name not be used because of fear of retaliation. “‘If you do something against us, this is the result.’”

Still, he and a friend decided to go. “There were no doctors at all in eastern Aleppo. The aerial strikes were really intense. It was a catastrophe.”

Today the former student is working at a hospital in rural Germany where the hills are carpeted with vineyards. Two years after arriving he speaks fluent German and is studying for an exam that will give him status equal to a German-educated doctor. He lives with his young family in a quiet village. He told his story in a compact living room furnished with two soft brown couches and a large-screen television.

After making contact with other students already working in east Aleppo, the student and a friend crossed over, pretending to visit relatives. As a third-year medical student, he had few skills, but doctors there taught him basics like inserting an IV needle or stitching a wound.

In the beginning, medical supplies were so scarce that surgeons conducted an appendectomy on a young boy without anesthetics. “That was terrible.”

Later the situation improved as outside aid groups provided supplies and training. A British doctor taught the Syrian surgeons how to repair a severed artery — essential in a war zone. The medical students visited Turkey to learn how to treat victims of chemical warfare.

Despite their inexperience, the students admitted patients and provided emergency treatment because the doctors were always busy operating. The wounded were classified by color code: white for survival without treatment, black for hopeless, yellow or red for those in between.

Some cases haunt him. A family trying to escape Aleppo by car came under fire, killing the father and fatally wounding the two children, one cut almost in half. “The mother said to me, ‘Please don’t help me, help my children.’”

He lied to the mother that the children were fine, and the doctors treated her. She was the only survivor.

Another time a regime missile struck a marketplace and ignited cans of fuel for sale. About 10 people came in severely burned. He and other students pushed tubes down their throats to administer liquids and medicine, but as far as he knows only one person survived.

After a couple of months he crossed back to west Aleppo to take his exams. The head doctor at the hospital told him he was crazy — the student had been filmed by a French television crew. Undaunted, he passed his exams and returned to east Aleppo.

Asked why he had gone back, he told a story about a mother brought in by her children after a bombing attack in the middle of the night. She was covered in blood and classified as “black” — a hopeless case. But the doctors revived the woman with blood transfusions and liquids, as her children, aged 3 and 6, were ca hrefed asleep beside her. The children awoke, overjoyed. Cases like that, he said, “were a motivation for me to go back.”

After about another six months, around January 2014, he left east Aleppo again to take more exams. He applied for a passport, because it was getting harder to cross into Turkey and he wanted more training there.

That was a mistake.

His name was on a list at the passport office. The clerk said the student needed to answer some questions that would take five minutes. He said “it lasted about 110 days.”

The first night he was held with eight people in a cell measuring one meter by two meters. He was interrogated repeatedly and accused of providing treatment to rebels, but he was not tortured.

That changed after he was transferred to another facility in Aleppo, which he described as a large house, operated by state security.

For the next 96 days he was detained with 35 men in a cell about as big as his living room in Germany, or about three meters by three meters. There wasn’t room for anyone to lie down. The prisoners sat in rows, their legs wrapped around the person in front. The first three days he couldn’t sleep. The prisoners wore only their underwear and were allowed two bathroom trips daily. The guards counted down as the prisoners relieved themselves.

Occasionally prisoners were hauled out. The others could hear the screams from beatings in nearby rooms. The youngest prisoner was 14, arrested for demonstrating. The oldest was 76, a teacher who developed a foot infection after a beating and died.

Eventually the medical student’s turn came. A muscled guard made him lie down on the floor, hands bound. He was blindfolded and beaten with a braided electric cord. He said the first blow was unbearable. The beating lasted an hour.

The next day he was beaten again until he was bleeding, with broken teeth lying on the floor. The guard wanted him to confess to giving medical treatment to rebels.

After 96 days he and 50 other prisoners were loaded onto a bus with blacked-out windows. Guards told them they were en route to the desert to be shot.

“I said, ‘O.K., this is it. This is the end.’” But it turned out they were en route to Damascus, where conditions improved dramatically.

He was held in a less crowded cell with a toilet. He got a haircut and was allowed to wash and shave. The meals included eggs, vegetables and fruit.

It turned out his parents had bribed officials the equivalent of about $1,650 to win his release. After 10 days he was freed.

Despite his trauma, he went back to east Aleppo. The city by then was under constant attack, and his contacts behind the lines told him the situation was catastrophic. The student’s father tried to stop him. “He said, ‘Are you the only doctor? Please don’t go.’ I went anyway.”

After a short time in east Aleppo he left, finished his medical studies and married a doctor colleague. Demoralized by the fall of Aleppo, in 2016 they became refugees bound for Germany.

That was another odyssey, including a crossing in an overcrowded inflatable boat from Turkey to the Greek island of Chios on New Year’s Eve and the sale of his wedding ring to pay for train fare from Warsaw to Berlin.

Now he works 7 a.m. to 7 p.m. in the hospital now, but isn’t complaining. “People here are very nice.”

The Pharmacist: Smuggling Medicine More Dangerous Than Running Guns

“If they find a weapon in your car it will be easier for you than if they find bags of blood, for example, or anesthesia drugs.”

GAZIANTEP, Turkey — Soon after the Syria demonstrations began in February 2011, the regime started using lethal force against the protesters, and medical personnel were pulled in to help.

A pharmacist from Damascus began handing out basic first aid supplies because his pharmacy was in one of the suburbs where the protests first took hold.

“People came for bandages and cotton,” he said. “People tried to organize themselves. They tried to set up field hospitals, in houses, to do some managing,” he said. “Some doctors tried to do that. I knew a lot of them. A lot of them were my friends. A lot of them were arrested.”

Wary of Syria’s feared intelligence service, protesters cared for the injured in secret, fetching medical personnel to treat them in private homes or safe houses, not trusting the public hospitals where the police and intelligence agents could detain wounded patients.

The pharmacist began organizing networks of medical workers. He had experience from his student days when he had raised money to help orphans and the sick. He began collecting drugs and medical supplies from friends, relatives and organizations and getting them delivered.

By 2012 the protests had spread countrywide and escalated into an armed uprising. The regime had sealed off opposition-held areas including the eastern Ghouta suburb of Damascus, the southwest city of Dara’a and districts of the western city of Homs, preventing food and medical deliveries by enforcing a blockade.

“The regime was preventing any help for them,” the pharmacist said. “The regime claimed that those people were part of the opposition parties and militias - children, women or men, without discrimination.”

As a pharmacist, he supplied drugs to public hospitals, so he had access to drug supplies and he carried a health ministry card, which allowed him to drive through regime checkpoints unhindered.

“Sometimes I was trying to deliver very critical drugs,” he said. “We are talking about cancer, cancer affects all people, anyone can have this disease,” he went on. “In the besieged areas it was a very important intervention from my side to deliver those drugs.”

He knew an oncologist in eastern Ghouta who had chosen to stay within the besieged suburb, and he sought ways to keep supplying drugs and medical supplies to her hospital.

The pharmacist paid regime militias to take drugs and medical supplies across regime lines, and delivered supplies near tunnels in eastern Ghouta that the rebels had dug.

The dangers to people like him were clear, the pharmacist said. Under Bashar al-Assad — who was a doctor himself, specializing in ophthalmology — the Assad regime arrested medical professionals who showed any sympathy for the popular uprising.

“If they find a weapon in your car it will be easier for you than if they find bags of blood, for example, or anesthesia drugs,” he said. ” Working in medicine was a very critical issue because the regime hated us more than the people, more than the revolutionaries.”

Moreover, he said, the regime mistrusted medical professionals because they were educated and capable of independent thinking.

“They hate the educated people because we are trying to do some organizing that is not in their way,” he said. “They are trying to make all people think in the same way, what Assad needs and what Assad wants, not against him.”

Fear of arrest did not deter him, he said. “It is our choice, our life,” he said.  “As a human, we have this belief, and we have our belief in God, as a Muslim. And it is our families and our people who are being affected.”

One of the supply networks he had formed with a friend consisted of 10 doctors and medical personnel. They used basic security, operating in cells, using code names. Only the leader, his friend, knew who the other 10 members were. But it turned out one member was a regime informant.

They worked for two years, longer than many medical activists, but in July 2014, agents of the Syrian intelligence service detained the group leader, who led them to the pharmacist.

Plainclothes intelligence officers surrounded the pharmacist outside his office as he was getting into his car. He spotted his friend sitting in one of their cars. They took the pharmacist home and seized his computer, cash, and car, and ordered him to call his wife to tell her to come home.

As they hauled him away, he recalled, the couple exchanged glances. “I looked at her — it was a very sad moment,” he said.

He was interrogated and tortured with beatings for 60 days in the 215th branch of the Intelligence Service in Damascus.

“My interrogator asked me directly: ‘Where is your gun? Why are you helping terrorists?’” The interrogator dismissed his protests that he was a government-approved pharmacist supplying public hospitals. They showed him a fellow member of his network who had been arrested. The man’s back had been broken after he was bent backward in a form of torture that inmates call the German chair.

The pharmacist’s ordeal reinforced to him the Syrian government’s weaponization of medical care in war.

“My interrogator told me, ‘We hate you more than the fighters. Why? Because you will treat people, you will treat fighters,’” he said.

He was held in a cell so cramped that inmates had to take turns to rest. One sat with knees bent while another stood. Disease was rife that prisoners sometimes died in the cell.

A family of three, father, son and grandfather, died one after the other. The father died after interrogation, and the 18-year-old son, who had been arrested trying to buy bread at the local bakery, was so traumatized that started biting cellmates. “He died in the night, and the guards did not remove his body for a whole day.”

The pharmacist ended up signing blank papers and his interrogators filled in his confession, inventing details that he had stored weapons in a mountain cave, had treated fighters and knew the leaders of Al Qaeda and other militias.

If the regime had really believed such accusations his captors would never have let him out alive, he said. “They know I am not like that,” he said. Instead, they took a bribe of $10,000 from the pharmacist’s family to gain his release. A few months later he paid $2,000 for him and his wife to be smuggled out of Damascus and into Turkey.

He lives in a modern apartment block in the city of Gaziantep, not far from the Syrian border in southern Turkey, and works for a nongovernmental agency, providing humanitarian assistance to vulnerable Syrians.

The pharmacist said he remains opposed to the Assad regime and its enforcers. “We are fighting them, not with weapons but with ideas, concerns and also humanitarian work.”

The Pediatrician: War Destroyed Her Dream

“They focus on hospitals because if they destroy the hospitals, people would give up.”

For some, the war destroyed their dreams.

Amani Ballour’s ambition was to be a pediatrician. She lived in Ghouta, a large suburb east of Damascus, and was in her fifth year of a medical degree in Damascus when demonstrations began in 2011. She recalls a building sense of terror.

Police began checking student’s IDs at the university entrance and she watched in fear as fellow medical students were beaten and detained, and people were hauled off buses.

“That started very early,” she said. “Everyone in Syria saw that.”

A slim pale-faced figure in a head scarf and long coat, Ms. Ballour, 32, recounted her ordeal with the calm efficiency of a medical professional as she sat in the sparse one-room apartment she shares with her husband, a civil engineer, Hamza el Hiraki, 37.

When demonstrations broke out in her own suburb, the risk of detention grew. “They started to do the same thing,” she said, “I felt very afraid.”

Then one day, Nov. 25, 2011, her brother and brother-in-law, both mechanics who were traveling by bus on their way to fix a water pump, were detained.

“My brother did not participate in the demonstrations,” she said, “but they took their IDs and because they were from Ghouta they were arrested.”

“They disappeared from that time, nine years ago,” she said. “Till now we don’t know.”

Ms. Ballour was still traveling to the university by bus, and was already helping to treat wounded protesters in a small clinic in Ghouta.

“It was dangerous for doctors,” she said. “If you helped injured people they would arrest you, so I had to decide if I wanted to stay in Ghouta, or stay in Damascus and study. I decided to stay in Ghouta.”

People who knew she was studying pediatrics began bringing their children to her. She handled respiratory and intestinal infections and referred serious cases to specialists in Damascus.

When the regime imposed a siege on the suburb, conditions worsened. At the beginning of 2013, a woman came to her with newborn twins. They were in good health, but she had no milk. And with no milk powder available, the babies died within weeks.

The medics relied on expired medicines they found in an old pharmaceutical factory, but by 2014 even those were exhausted. “We did not think it would last that long,” she recalled of the siege. “By 2014 we had nothing. I saw a lot of children die with infections, and some died of pneumonia.”

The numbers of wounded escalated sharply when the government began aerial bombardment in 2012. When a hospital she worked in was destroyed by fire, Ms. Ballour began assisting a surgeon, Dr. Salim Namour in a hospital that was dug underground to protect against airstrikes. Their work in The Cave is now the subject of a documentary film.

They trained volunteers to assist in the operating theater, and on the wards and Ms. Ballour was able to focus on pediatric cases. Eventually the staff voted for her to become the hospital’s manager.

“He bombed it six or seven times but he could not injure anyone, he could not reach the basement,” she said, not needing to mention President Bashar al-Assad by name. Only when Russia intervened in Syria in 2015 and Russian jets joined the fight, were they able to pierce underground, she said.

“A missile entered the basement,” she said. “They destroyed a part of the hospital and they killed three of my colleagues.” Ms. Ballour had just walked out of their room into the corridor and narrowly escaped.

“They focus on hospitals because if they destroy the hospitals, people would give up,” she said.

“A doctor represents hope for the patient,” her husband, Mr. el-Hiraki chipped in.

Nothing prepared her for the devastating sarin gas attack of 2013. “This was the most difficult thing I saw. I had never seen something like that before, hundreds of dead bodies.”

When she reached the hospital that night the whole square in front of the hospital was covered in bodies. “There was no blood,” she said. We did not know what it was but people were shouting, ‘Chemical, chemical!’”

“I saw a lot of people, most of them children and they were suffocating,” she said. “Some of them were dead and some were dying.”

The patients were foaming at the mouth, had pinpoint pupils and were in seizure. As medics tried to suck out the foam, more foam kept building. They gave every patient an injection of atropine but it was not enough and they had no oxygen.

“People asked me to help their children but they were dead,” she said. With seconds to save those still alive, she brushed off a woman whose three children were her patients. “I could not even look at them. They were dead and I had to help others. There was no time and I did not sympathize with her. And when I remember that I feel bad.”

“That night 1,400 died, most of them were children,” she said.

The incident made Ms. Ballour and her surgeon colleague, Dr. Salim, targets of the Assad regime because they were important witnesses to one of the war’s worst atrocities.

They were eventually evacuated in to Idlib, the last opposition-held province in northwestern Syria. But there, they received a warning that they were on a regime hit list because of their knowledge of the sarin attack and were forced to move to Turkey.

In Ghouta medical colleagues who chose to stay behind were arrested, including a former military doctor, Dr. Motaz. He died in prison.

For Ms. Ballour, the last days of the siege, when she saw so many children killed and maimed, many of them her own patients, finally broke her. She is working on a new project for Syrian women but gave up her dreams of being a pediatrician.

“I cannot describe it, there are no words, but I could not work,” she said. “I will not be a pediatrician any more. I could not work with the children. Every child reminds me of another child.”

The Surgeon: Electrocuted in Ankle-Deep Water

“Maybe I could have done more. This feeling of guilt never left us.”

GAZIANTEP, Turkey — Dr. Ahmed was training to be an orthopedic surgeon at a regime training hospital on the outskirts of Damascus when he became involved in coordinating first-aid points for injured protesters in 2011. With a group of 10 friends in the suburb of Dummar, Dr. Ahmed helped to move wounded protesters to a couple’s private house where he would bring his instruments and medication, and provide first aid.

They kept the medical work secret, but at the same time were actively supporting the demonstrations on social media.

“We were expressing our opinions in public on Facebook. I was using my real name,” he said. “That was to encourage people to express their opinion. So I never used a fake name which was crazy in that time.”

In August 2011, intelligence officials came to the hospital where he worked and detained him. Unknown to Dr. Ahmed, the whole group was taken into custody at the same time.

He endured a month of interrogation and torture of beatings, electric shocks and mock executions. He was beaten with rubber, wooden and steel cables, and electrocuted in ankle-deep in water.

“It was like someone threw me into a wall. I lost consciousness and then I woke up on the watery floor.”

Three times his torturers told him to prepare for his death by hanging, marching him out in the morning, and then after hours of waiting, giving him a reprieve.

Although his interrogators did not know about his secret medical work, they always took exception to his status as a doctor and his education.

“They said you studied in government schools, and it was for free, and the health service is free. So now you are receiving training from the government and receiving a salary, and now you want to bring down this government. You are a cheat,” he said.

“They always were torturing me double because I was a doctor.”

Eventually he confessed, was charged with multiple crimes including trying to overthrow the government, and released. Despite a grueling four months detention, he immediately returned to his activism.

“A lot had changed,” he said. “The Free Syrian Army had formed, the international community was with us. I felt, ‘O.K., we have hope.’ And the regime increased its violence so I felt it was our responsibility and we should not stop.”

He created a network of safe houses to treat the wounded, both civilians and those who took up arms and joined the Free Syrian Army. “We helped all of them. At that time there was no Al Qaeda or ISIS, so we felt the F.S.A. were part of us.”

He set up a safe house in a luxury villa just yards from one of the Syrian regime’s main military bases. They devised a network to ferry serious casualties to Lebanon. He returned to his post in the government hospital, working by day as a regime orthopedic surgeon and by night for the opposition. “Like Dr. Jekyll and Mr. Hyde,” he said, laughing. “Most of us had these two lives.”

At one first-aid point he amputated the arm of a Free Syrian Army fighter without equipment. He used a simple razor blade and cut the bones with garden shears. “It worked,” he said, “but a couple of hours after we finished, they said that the Army was very close to the center and we have to evacuate.” The doctors could drive out because they had passes, but they had to leave the patient. “He told us, go, and we left and we don’t know what happened to him. It was one of the most difficult moments of my life.”

In 2013, he received a warning that he was about to be arrested and fled Damascus for the rebel-held area of Idlib. It was just in time, as government officials came looking for him at the hospital the next day.

He joined a small rural hospital, and in 2014 encountered one of the most dramatic surgeries of his life. A car bomb exploded in the market and caused dozens of casualties. He treated a 10-year-old boy who had an open leg fracture, but then discovered his femoral artery was ruptured. As the blood spurted out, he told his assistant to put his hand on the wound and called a surgeon friend in Germany.

“He said ‘O.K. I will send you a YouTube link, watch it and then go to the operating theater and call me through Skype and I will tell you what to do,’” he recalled. Dr. Ahmed watched the video, and then his friend talked him through the operation, taking a piece of vein from the boy’s other leg, mending the rupture and watching the color return to the boy’s foot. “Till now, I have never felt happiness like this in my life,” he said.

He now works in Gaziantep in southern Turkey, meeting for an interview in a cafe because his wife wants no more activism in their lives.

He no longer practices medicine and describes feeling survivors’ guilt. “Maybe I could have done more. This feeling of guilt never left us,” he said. His new mission is to help train and support medical personnel in northwestern Syria, where there is a lack of doctors.

“I came here to bridge the gap as much as I can, and I think I did good work in that.”

By Carlotta Gall

Produced by Rick Gladstone and Malachy Browne.

Edited according to Orient Net

Link to the original source of NYT

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