On March 25, an orthopedic surgeon named Ali Darwish was operating on a patient in a suburb of Hama, Syria, when two barrel bombs were dropped at the entrance of the underground hospital where he was working. Soon, a strong smell of chlorine spread throughout the hospital. The underground rooms, built to protect patients and medical personnel from aerial attacks, became de facto gas chambers.
As patients and staff workers fled, Dr. Darwish refused to leave his patient on the operating table. Without even minimal protective equipment, Dr. Darwish collapsed. By the time he was taken out of the hospital it was too late. He died shortly afterward from severe lung injury. Thirteen other medical personnel, along with 18 patients, were severely hurt in that attack.
Since the beginning of Syria’s conflict in 2011, more than 14,000 people have been subjected to chemical weapons attacks, and more than 1,500 have died as a result, according to research by my group, the Syrian American Medical Society.
In the early hours of Tuesday, just 10 days after Dr. Darwish was killed, the Syrian government dropped barrel bombs on the town of Khan Sheikoun in Idlib Province. Some of those appear to have released a toxic nerve gas, killing dozens of people and injuring hundreds. The Syrian forces then bombed clinics treating the survivors. (The town’s hospital had been severely damaged two days earlier.)
Horrific as this is, none of it should be surprising.
Serious concerns about the use of chemical weapons against civilians in Syria were raised as early as 2012. At the time, Syria had one of the world’s largest chemical weapons stockpiles. The international community focused its resources on preventing armed rebel groups from getting this stockpile, and failed to protect the Syrian people from being the victims of those poisons.
The United Nations Security Council has passed three resolutions about chemical weapons in Syria since 2013. Some have hailed these resolutions as great successes. They are not. Civilians and health care workers continue to be killed by chemical weapons dropped from the sky.
Despite efforts to bring attention to the Syrian government’s crimes against humanity, on Aug. 21, 2013, the Syrian military, emboldened by the international community’s lack of action, carried out a horrifying sarin attack in besieged East Ghouta, killing some 1,300 people. In response, the Security Council passed Resolution 2118, which set plans for the destruction of Syria’s chemical weapons.
Nonetheless, attacks continued. One thing changed, though: Syrian regime forces started using barrel bombs to deliver poison gases.
Security Council Resolution 2209 was passed on March 6, 2015, condemning the use of chlorine gas as a weapon. Ten days later, barrel bombs filled with chlorine were dropped on the towns of Sarmin and Qaminas in Idlib. One of the bombs hit the house of the Taleb family, who, unaware of the chemical agent, hid where they thought they would be safe: the basement. Chlorine, however, is heavier than air, making basements extremely dangerous in such an attack. All six members of the Taleb family, including three children under the age of 3, suffocated.
Between March 16 and June 9, 2015, my group documented 43 chlorine attacks in Idlib, with more than 717 Syrians affected by exposure and nine deaths from suffocation.
Parallel to the use of chemical weapons, attacks on hospitals increased in 2015 and 2016, necessitating new approaches to protect vulnerable patients and medical personnel. According to Physicians for Human Rights, 400 attacks on health care facilities in Syria have been documented since the beginning of the conflict.
Hospitals and clinics started moving certain units, like operating rooms and intensive care units, underground. This technique limited the direct damage from bombing, but made patients and doctors even more vulnerable to the effects of gas attacks.
Days after the chlorine attack on Dr. Darwish’s hospital, several areas in Hama Province were hit by barrel bombs containing chlorine and other chemical agents similar to sarin gas based on the symptoms seen in patients: pinpoint pupils, convulsions, irritability, nausea, vomiting and shortness of breath.
Doctors in my group on the ground in Syria have been reviewing the symptoms of the affected patients and medical personnel from the recent attacks. We are worried that a new phosphorus chemical agent is being used in chemical weapons, in addition to the identifiable chlorine. Some of the patients have exhibited symptoms similar to the effects of a nerve gas: pinpoint pupils, foaming at the mouth and the loss of consciousness, slow heart rate, slow breathing, vomiting and muscles spasms.
In these unimaginable situations, doctors often face a terrible decision: Should I run for my life or stay with my patients? As doctors, we have one duty: saving lives, even under the worst and most dangerous conditions.
Dr. Darwish and many medical personnel and emergency workers have been killed in line of duty. They are heroes, and their stories are a testament to the courage and dedication of Syrian health workers. How many more stories must we hear before decisive, meaningful action is taken to end these crimes?
The world has done little to protect civilians and health workers crying out for action and attention. We, as civilized communities, must rethink how to match our values, principles and stated goals with our actions.
Over the past six years, humanitarian organizations have relentlessly pursued comprehensive documentation of war crimes. They have trained our staff to collect and catalog samples of fabric, water, skin and dirt. They have taken countless photographs and collected testimonies of many victims. Despite countless resolutions, international meetings and documentation, attacks on the people of Syria continue with impunity.
Humanitarian groups may offer to send antidotes and personal protective equipment to health workers in Syria. These are needed items — but they are not enough. The constant violation of humanitarian law in Syria, the undermining of the United Nations as a diplomatic platform, and the starving and gassing of people in order to negotiate a political outcome are not acceptable. It is time that the international community stands up and says enough. We want protection. We want accountability. We want action.
Ahmad Tarakji is the president of the Syrian American Medical Society and a cardiothoracic surgeon.