For a few days in October, a tiny, starving baby became the face of the war in Syria. Images of one-month-old Sahhar Dofdaa, from Syria's opposition-held Eastern Ghouta, showed her fragile, less than 2-kilo body, with sunken eyes and bones protruding beneath her thin gray skin. The news of her passing highlighted how the conflict contributes to preventable deaths, especially among women and children, the population's most vulnerable members.
When Syrian doctor Khaled Almilaji saw the photos of Sahar, he thought she wasn't just suffering from malnutrition, as had been originally reported, but probably also had a chronic or congenital disease. The baby girl had been treated by a local doctor, but Almilaji believes if she had been able to access a dedicated hospital for women and children, she might have lived. "[Her disease] could have been alleviated by good medical care," he says.
That is what Almilaji hopes to provide with Avicenna Women and Children's Hospital, a facility currently being built in rebel-held Idlib province. The hospital will offer the reproductive and maternity care that is sorely lacking in a country where healthcare services have had to pivot to focus on trauma. And it will do all of this across two floors set deep underground, out of the reach of Syrian airstrikes.
They prefer to give birth at home.
Since the start of the Syrian conflict, 485 medical facilities have been hit by military airstrikes, resulting in the deaths of 841 healthcare workers, a clear breach of the Geneva Convention, which classifies the targeting of hospitals and healthcare workers as a war crime. At least 64% of these attacks were perpetrated by the Syrian military, with the rest carried out by Russian forces, non-state groups or unidentified attackers.
The constant bombardment and the destruction of fundamental health services leave many people suffering serious complications or dying as a result of illnesses that could otherwise be successfully treated. Even giving birth in Syria can be life-threatening.
"Women don't feel safe to stay in hospitals, which are attacked on a regular basis. They prefer to give birth at home without proper medical attendance, which is increasing complications for both mother and child," says Almilaji. "That's why providing a secure women and children's hospital is essential."
Tortured for treated the injured
Avicenna hospital is the latest project by the Sustainable International Medical Relief Organization (SIMRO), an NGO that Almilaji formed five years ago to protect patients and doctors from aerial attacks by moving healthcare facilities underground.
Almilaji, who is doing his postgraduate studies at the University of Toronto and in December was awarded the Meritorious Service Medal by Canada's governor general for his humanitarian work in Syria, is no stranger to providing medical care under makeshift conditions.
He was at home in Aleppo in 2011 when government forces fired on peaceful protests against Syrian President Bashar al-Assad, igniting a war that to date has resulted in at least 400,000 civilian deaths.
"When the Syrian regime started to attack protesters with gunfire, injured protesters couldn't go to the hospital because the secret police and intelligence [officers] would be there to arrest them," says Almilaji. The government was preventing injured protesters from receiving medical care as a deterrent, he says, the idea being that if protesters were seen bleeding to death in the street, other people would be less likely to join the demonstrations.
Driven to help, Almilaji joined other physicians who were traveling to the cities of Hama and Homs to treat injured protesters in secret field hospitals. When the Syrian government learned about the secret medical facilities, it responded by arresting the doctors.
On Sept. 7, 2011, Almilaji was treating protesters in Damascus when government intelligence officers arrested him and three of his colleagues for treating injured civilians. For six months, they were held in prison and tortured. Almilaji says he was beaten with bars and cables and electrocuted. "They hung me by my hands from the ceiling for 24 hours with no food, no water," he says.
In early March of 2012, he was released from prison with a warning that if he was caught treating injured protesters again he would be made to "vanish." He fled to Turkey, where he founded SIMRO so that he could continue to provide medical care by building fortified hospitals in Syria's conflict zones.
The organization runs through a network of field officers on the ground in Syria and Turkey, with funding from international donors. Almilaji tries to go back to Syria as often as he can. He last snuck into the country in 2015 to check on a few medical projects and the building of an underground hospital in Hama.
Too big to hide
Avicenna Women and Children's Hospital is being built in partnership with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and international donors including Refugee Protection International. An ongoing crowdfunding campaign contributes resources as well.
The Syrian government started building the hospital before the conflict, and by the time opposition forces took control of Idlib, the facility already included two "huge" underground floors, says Almilaji.
The eight above-ground floors have been fortified to provide a protective barrier that should stop bombs dropped by Syrian warplanes from reaching the underground floors where the new hospital is located. But there's no way to protect the hospital from Russian airstrikes, which use high-explosive ammunition, such as bunker-buster bombs that are far more destructive than Syria's barrel bombs.
"Nothing can stop them," says Almilaji.
All over Syria, hospitals have tried to hide from airstrikes by disappearing into caves and devising code-name systems in an effort to disguise their coordinates. But with Avicenna, Almilaji and his team decided to make themselves more visible, not less so, by handing the hospital's coordinates over to the Russian and Syrian authorities.
"They won't be able to say that they didn't know the hospital was there. And our doctors know that if they are attacked, the world will know about it."
"This is a huge hospital and we couldn't hide that there was a lot of work going on here," says Almilaji. So they asked various U.N. agencies to share the coordinates of the hospital with all parties involved in the conflict: the Syrians, the Russians, and the U.S.military. "They have all been told that there is a hospital there that is being supported by the United Nations and that we are doing purely humanitarian work," says Almilaji.
The hope is that by making the coordinates public and by involving the U.N., it will be impossible for Russia or Syria to attack the hospital. "They won't be able to say that they didn't know the hospital was there," Almilaji says. "And our doctors know that if they are attacked, the world will know about it."
As well as providing a safe place to get medical care, Avicenna has partnered with Brown University, in the U.S., and the University of Toronto to provide continuous training for at least 350 doctors, nurses and administrative staff in Syria. [Almilaji studied at Brown University before being barred from reentry to the U.S. last year because of President Trump's travel ban on Syrian citizens.]
Using a telehealth communications system, supervisors and consultants from Brown University will be able to provide real-time consultations, mentoring and technical support to Avicenna's medical staff. A certification program — to reinstate the residency program for would-be doctors after the original program was halted in conflict areas at the start of the war — is also in the works.
Almilaji hopes that most of the medical personnel at the hospital will be Syrian doctors and specialists who were forced to flee regime-controlled areas. "Avicenna will provide a safe environment that will attract this category [of doctors] to come back to Idlib from Turkey, where there are hundreds near the borders in Gaziantep, Antakya, Urfa, and Mersin," he says.
By the time Avicenna opens in April 2018, Almilaji estimates that $850,000 will have been spent on fortifying the hospital's structure. The project will rely on continuous donations to keep the hospital running, including paying for medical personnel and buying medical equipment. But Almilaji is determined to make it work.
"We will show that people who struggle for freedom can also establish a unique health system, even in a war zone," he says.
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