HOMS – This city in western Syria is nearing 500 days under siege, with no supply route in or out. Medical equipment and supplies are nearly impossible to find. There are no alternatives for the medicine, be it for chronic illness or for wounds sustained during daily shellings of the city. There are few medical personnel on the scene.
In Old Homs, a critical wound becomes more terrifying than death itself. A doctor might need to amputate a limb to save a patient’s life. In more critical cases, the lack of medical facilities means the only option for patients is death.
During clashes between the Free Syrian Army and government soldiers, the designated points for providing medical assistance in besieged neighborhoods fill up, mainly with wounded civilians. Emergency medical points are covered with pools of blood, in the small spaces unequipped to handle large numbers of injured.
Often, a medic in the field does not have time to immediately attend to a patient’s wounds. His sole focus is to get the injured person and himself out of the line of fire and to safety. There are few ambulances and stretchers, so the mode of transportation could be a small cart previously used to sell food.
Only simple injuries can be treated at the designated medical assistance points.
Patients with critical cases are transferred to the central hospital, which is barely functioning. Another arduous journey begins, in which patients take underground tunnels and travel through trenches in attempts to avoid regime fire. Too often, the injured die before arrival.
And then, there is one hospital inside the besieged neighborhoods – but it has just two beds. Patients often wait hours to see a doctor, and some die waiting. A stench tells of a lack of proper sterilization, and the small, damp space is below ground, devoid of sunlight, but relatively safe from shelling.
Usually, three doctors from different specializations are at the cellar field hospital. Some have graduated from medical school, while others did not have the luxury of completing their studies. Instead, they have learned on the job at field hospitals over the course of the revolt. Many doctors started off as medics, and then became practicing nurses who were able to administer first aid, extract surface-deep shrapnel, stitch up wounds and stop bleeding. Most Homs doctors either fled at the beginning of the fighting or left for fear of arrest for treating civilians and rebels; only the dedicated few remain.
In many cases, a specialized surgeon is needed. Doctors without that training now perform surgery and try to consult with specialized physicians over the Internet.
Sometimes they perform emergency blood transfusion without any prior experience. Yet the patient’s life is in his hands only.
Abu Obeida began as media activist and medic in one of the field hospitals. “When you’re under siege, you have to learn to do everything yourself: you cook, wash dishes and clothes, take photos and put out media reports, administer aid and nurse the wounded,” he said. “There is no other solution.”
Mohammad is a medical student who did not get the chance to finish his studies. He constantly checks in on the wounded at the cellar hospital. He said he believes that the recovery of patients hinges on their psychological state and on their being transported outside of Homs for treatment.
“Hope is the only cure now,” he said. “These patients can’t be treated with our limited medical capabilities. A temporary solution to their ailments is administered to keep them alive for now. We have to give them hope that they will recover, that they will be able to walk again and resume their lives.”
Abu Abdu is one of the doctors who treated patients suffering from alleged Sarin gas attacks in Khaldiyeh neighborhood. He recounted a day when, he said, the regime dropped the poisonous gas.
“We didn’t know what happened that night. We were in shock,” he said. “Dozens of patients were suffering from asphyxiation and physical convulsions. They all arrived at the center at the same time with symptoms of being exposed to poisonous gas. We had no time to think; every moment that passed without doing anything meant more casualties. That was the first time I handled such cases. It was a long and difficult night. We tried to limit the loss of life with what we had available.”
Some doctors have lost their lives while on the job, including Bilal, who died three months ago, and Abu Obeida, who died one month ago. Both were killed while accompanying rebel fighting groups.
Abu Yasser, another Homs doctor, was shot when he was making house calls to check up on patients who had undergone surgery.
Medical personnel said they had been regularly harassed by government security forces, through kidnapping and by the shelling of medical centers. The regime considers transporting medicine and medical equipment to civilians and rebels within liberated areas to be an act of terrorism punishable by death or death under torture.
Activists in Homs have continuously pleaded with the international humanitarian organizations to intervene and evacuate the injured. Supplies, inevitably, are bound to run out.
This article was translated from Arabic by Naziha Baassiri.
Early detection and accessible help are essential in the fight against domestic violence. Hairdressers in the Dutch province of North Brabant are now being trained to identify when their customers are facing abuse at home.
TILBURG — The three hairdressers in the bare training room of the hairdressing company John Beerens Hair Studio are absolutely sure: they have never seen signs of domestic violence among their customers in this city in the Netherlands. "Or is that naïve?"
When, a moment later, statistics appear on the screen — one in 20 adults deals with domestic violence, as well as one or two children per class — they realize: this happens so often, they must have victims in their chairs.
All three have been in the business for years and have a loyal clientele. Sometimes they have customers crying in the chair because of a divorce. According to Irma Geraerts, 45, who has her own salon in Reusel, a village in the North Brabant region, they're part-time psychologists. "A therapist whose hair I cut explained to me that we have an advantage because we touch people. We are literally close. The fact that we stand behind people and make eye contact via the mirror also helps."
That intimate contact is one of the reasons why The Netherland's Child Abuse Taskforce and the Sterk Huis (Strong Home) aid organization want to make use of hairdressers to detect domestic violence. People often go to the same hairdresser for years, exchange remarkably intimate stories, and feel a strong bond of trust. A lot of experience has already been gained in Anglo-Saxon countries and thousands of hairdressers have been trained.
In front of the room, today's trainer is moving restlessly, one hand hidden in her sleeve, the other rubbing a leg. She tries to teach the hairdressers to recognize signals and open up a discussion about them through role-playing. They find it difficult: someone with a bruise could have fallen, couldn't they? How do you start a conversation? The trainer helps them: "Don't start with your feelings or judgement. Emphasize what you hear or see."
On November 25, the United Nations campaign against violence against women started for the 21st time with its tagline "Orange the World" and buildings lit up in orange to draw attention to the issue. But despite years of awareness-raising campaigns, task forces and national programs such as 'Geweld hoort nergens thuis' (Violence has no place in the home), violence rates are hardly decreasing.
According to figures from The Netherland's Central Bureau of Statistics (CBS), 5.5% of adults have been victims of domestic violence at least once in the past five years. It happens to both women and men, but when it comes to structural partner violence, women are six times more likely to be victims than men. Women are also more likely to suffer serious injuries, sometimes fatally. Of all murdered women in the Netherlands, 80% are killed by their partner or by a family member. That is why it is called femicide. Reports from social workers show that 119,000 children (3% of the total number) have experienced child abuse. In reports that ask children directly, the figure goes up to 12%.
Why are domestic violence and child abuse (which often go hand in hand) so difficult to tackle? And are there new methods that do work?
An intimate relationship
Domestic violence is an immensely complex problem, according to researchers and social workers. It hardly ever involves a single blow being dealt. "It has so many forms," says Nelleke Westerveld of the Movisie center for social development. It ranges from physical violence to psychological violence, from intimate terrorism — in which the man usually exerts far-reaching control over the woman – to stalking, sexual or honor-related violence. "Some forms of violence are clearly based on stress and risk factors, such as poverty, addiction or psychological problems," says Westerveld. "But power also plays a role. Care workers must therefore properly map out the situation, because all these forms require a specific approach. At the same time, it is not written on someone's forehead what kind of violence they are dealing with."
"You often see that people have been in a situation of violence for years, on average seven years, before they finally decide to ask for help," says Teun Haans, cluster manager at Sterk Huis, which together with the Child Abuse Taskforce organizes the training courses for hairdressers. "We also know that the longer the violence lasts, the more difficult it is to change the situation. So you have to get to it much earlier. The environment, in particular, can play a crucial role."
Research also shows that people who are close to the victim have the biggest impact. "Neighbors, teachers, sports coaches or caretakers who replace a door for the third time. They should ask themselves: what is going on here?"
Too much respect for privacy
In the southern region of North Brabant they are aiming for a broad approach: domestic violence should not be an issue that only professionals deal with, but one for society as a whole. So far, the fire brigade and the housing association's caretakers have been trained, and this month is the turn of hairdressers. Whether this training leads to more reports is yet to be investigated.
But what Haans does know is that 'Veilig Thuis Midden-Brabant' (Safe Home Central Brabant), the regional department of the national organization that reports and advises on domestic violence and child abuse, is the only organization in the Netherlands that did not receive fewer reports during the lockdowns. In the rest of the country, that number did drop. Not because the violence decreased (there is every reason to assume that it actually increased because of being locked down together), but because the police, social workers and teachers no longer visited people.
We Dutch people have the thickest front doors in Europe.
The idea for the broad approach was developed together with Experts By Experience. For years, social workers spoke about the victims. But nowadays, those who have lived experience of abuse are the new experts who are sitting at the table and contributing. "They told us over and over again: the baker, the teacher, the neighbor, they all knew, but nobody ever asked if they could do anything," says Haans. "We Dutch people have the thickest front doors in Europe. We are terrified to interfere with someone's private life."
Hairdresser in Rotterdam, Netherlands
Daniëlle (34, a self-employed accountant) is an Expert By Experience. As a child, she was neglected by her mother, who suffered from mental health issues and locked her up out of powerlessness. When she was with her father, her stepmother would beat her and drag her down the stairs if she did something wrong. "The worst part was not the blows, because I knew: those will be over soon.
The permanent fear, that was the worst." She believes in the Brabant approach: "I had totally ruined teeth because nobody taught me how to brush them, yet the dentist never noticed something else was up." According to her, bystanders often think they must save you, that they have to solve the problem, which is why they prefer to look away. "But they don't have to. It would have helped me so much if someone had pointed out to me that this was not normal, and that I did not have to blame myself."
Daniëlle experienced the power of such a gesture once. Her internship supervisor at a travel agency had noticed that she did not offer clients coffee. "I said I couldn't do that because I was sure I would drop the cup. I didn't mention it was because, as a child, I got beaten up if I dropped anything. 'What if I drop the cup?' I said. 'Then we'll just get a new one,' she replied. She not only taught me that I could serve a cup of coffee, but — more importantly — that I could change something."
It's about opening the conversation, Haans explains. "That can be the start of a change." The hairdressers are also urged to do so. It is not the intention that they start calling Veilig Thuis hotline as soon as their customers have left. When Sterk Huis, the organization Haans works for, posted a call on Facebook for the hairdressers' training, it caused a commotion: were hairdressers going to 'report' their clients? Of course, that's not the intention, says Haans. "But you can let them know that they can chat and call Veilig Thuis for instance, and you can bring up the topic again the next time they get a haircut."
Fast help needed
Does this broad approach help to bring down the figures? Based on a 2020 report (The long-winded issue: can domestic violence and child abuse really be stopped?), one could make a cautiously optimistic prediction. Researcher Katinka Lünnemann and her colleagues at the Verwey-Jonker Institute followed over the course of three years 576 families who had been reported to Veilig Thuis. In one third of the families that received help, the violence eventually stopped. The violence also decreased in families that, for some reason, did not receive direct help (but were monitored), but to a lesser extent. According to Lünnemann, an explanation for the latter is that the report alone may have set something in motion: the silence is broken, "and we know that awareness is the first step towards change".
The Netherlands was shocked
At the same time, despite the help, serious and frequent violence still occurs in 50% of families: both partner violence and child abuse. And that is serious, because the longer the violence continues, the more harmful it is. Chronic stress causes changes in the brain, which makes it harder for children to learn and solve difficult problems. They are also more likely to become stressed even when performing normal tasks.
One of the problems is that, in the Netherlands, many institutions such as Veilig Thuis and the Jeugdbescherming youth protection agency do not provide any help themselves. "Victims are often directed to other organizations," says Lünnemann. "There is a lack of fast, concrete help."
This was also one of the conclusions of her research into the situation in Rotterdam. In 2018, the city was rocked by the murders of three young women, including 16-year-old Hümeyra, in close succession. The Netherlands was shocked. How could things have gone so wrong?
With the formation of Veilig Thuis in 2015 and the decentralization of youth care to the municipalities, it was precisely the intention to organize help that was closer to the people. But an extra layer was added. In Rotterdam, citizens cannot go directly to the community team; they need a referral form from, for example, Veilig Thuis. A lot of expertise was lost as a result of this organizational change," Lünnemann concluded.
The danger of the broad approach in North Brabant therefore lurks in the follow-up process, Lünnemann fears. "I hold Sterk Huis in high esteem, but we are already seeing a shortage of real assistance. So if you start training all kinds of groups in society to recognize domestic violence, there will be more reports and you have to make sure that the extra help is ready." That extra help is not there yet, confirms Haans of Sterk Huis.
The broad approach is good for raising awareness in society, that is indisputable according to Lünnemann. But the real solution lies in the recommendations she made for Rotterdam: there must be more actual help, real cooperation and, perhaps most important of all, accessible physical places where women at risk can go.
At the Schiedamsedijk in Rotterdam, such a place became available recently. Those who report to the municipal health services desk with the code phrase "I'm here for Filomena" are taken by hostess Gaby to a bright living room with pastel-colored furniture and a playpen with baby toys and plants. Only the large posters of the traveling photo exhibition on domestic violence give away that this is no ordinary living room.
Not only is this the only place in the Netherlands where victims can walk in without an appointment, but all parties — the police, a forensic doctor ("Many victims take photos of their bruises themselves, but these are not legally valid"), Veilig Thuis, a psychologist and a trauma specialist – are under one roof. This way, the case manager, together with the victim, can literally 'check all the boxes', and can complete the entire investigation in no more than seven days, instead of the usual months. "The victim does not have to tell her story over and over again," says care manager Christine Clement of Filomena, Centre for Domestic Violence and Child Abuse. "And there is no talking about the victim in her absence: she is always there."
A woman comes forward to make her first report in the presence of her friend: she tells her story for the first time. She has no injuries at the time, but her partner has attempted strangulation before. "That's when all the alarm bells go off, because that is often a signal that there is a risk of femicide," Clement says later. The woman faces intimate terrorism and reveals that she has a tracker on her phone: her partner keeps an eye on where she is. With an excuse that she had to be in this neighborhood, she got away.
there is no talking about the victim in her absence: she is always there.
The woman has an hour at most. Veilig Thuis makes a safety assessment on the spot and determines what needs to be done. "At a time like this, you can see why it's so important that everyone is here," says Clement. "Because sometimes you have to act quickly." It is decided that she will go home, as not to arouse suspicion. All contact will be through her friend because the partner checks the victim's phone. In the meantime, Filomena arranges for a place in a shelter.
Three days later, she is taken to that safe place "somewhere in the Netherlands," so that there is less chance of her partner finding her. She has a new mobile phone and gets help to cope with the effect the violence has had on her, Clements says. "And of course, she has the support of the other women in the shelter."
*With the cooperation of Monique van de Ven. For privacy reasons, some interviewees are only referred to by their first name. Their full names are known to the editors.
**This article was translated with permission of the author
If you are in an unsafe situation or are looking for help, here is an international directory with the names and links of organizations dealing with domestic abuse around the world.
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