Death and suffering in Eastern Ghouta, Syria: a call for action to protect civilians and health care.

Since Feb 4, 2018, Syrian forces with Russian support have bombarded Eastern Ghouta, an enclave out of government control near Damascus. This military action has killed hundreds of civilians and injured more than 1550 people as of Feb 21, 2018, in an area where about 390 000 people, most of whom are civilians, have lived under siege since October, 2013. The recent escalation is reportedly part of a Syrian Government offensive supported by its Russian and Iranian allies to retake Ghouta. In just 1 day, on Feb 20, 2018, PAX, an international peace movement, documented 110 civilians killed and hundreds injured in 131 air strikes, 44 barrel bombs, 28 surface-to-surface “elephant” missiles, five cluster bombs, and countless other artillery and rocket fire. Amnesty International sees this as continuing “war crimes on an epic scale”. The Syrian American Medical Society, which has tracked attacks on health-care facilities during the offensive, now reports that 25 hospitals and health centres have been hit, some more than once in 4 days. Several health-care facilities are destroyed or put temporarily out of service, reducing capacity by 50% at a time when patients most need care. A doctor in Eastern Ghouta said, “Hospitals are overwhelmed. Floors are overflowing with injured and blood. Those patients we discharged a couple of days ago are now back with more serious injuries...The word ‘catastrophe’ can’t describe what’s happening.” The injured are running out of places to go. Retaliatory shelling by rebel groups on Damascus neighbourhoods has also killed and maimed scores of civilians and also deserves condemnation. Physicians for Human Rights (PHR) found that “the unspeakable suffering...was deliberately planned and meticulously implemented over time”. The Syrian Government has not contested PHR’s finding but says it is attacking “terrorists”. This claim is not supported by patterns of attacks, which predominantly target civilian areas, and demonstrate a position that all civilians in opposition-held areas are legitimate targets. The people of Ghouta endured a deadly sarin chemical attack in August, 2013, in which 1466 people, including 426 children, died. This led to the US–Russia sponsored deal to remove the Syrian Government’s chemical weapons stockpile. However, killing and destruction continued by other means. Ghouta has been subjected to regular shelling and artillery strikes, including of hospitals and civilian areas. Compounding the impact of Syrian Government violations of international humanitarian law, many Ghouta civilians suffer violence by authoritarian rebel groups and are impoverished by a war economy in which corrupt Syrian Government and rebel intermediaries participate. The worsening situation for civilians under siege and bombardment has long been reported but has not led to an improvement for civilians or even a slight lessening of their suffering. The Syrian Government has allowed only minimal and intermittent aid and regularly removes urgently needed medical supplies from the very occasional convoy it permits. In December, 2017, Ghouta doctors sent a letter to WHO Director-General Tedros Adhanom Ghebreyesus, pleading for support: “Once, we were family doctors, pediatricians, specialists...now we are specialists in war trauma, chemical attacks and siege-induced starvation.” The Syrian American Medical Society estimates that more than 1000 critically ill patients now need medical evacuation. The Syrian Government has allowed only 37 as of Feb 17, 2018. Every day, patients die. Inaction in the face of unrelenting attacks on civilians represents an epic failure of world leaders. The UN Security Council has utterly failed the people of Syria. The Published Online February 23, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30527-0