It was It was just over a year ago when I received a flood of Skype and Viber notifications from doctors in Syria, desperately begging for help from abroad as they struggled to deal with an overwhelming influx of patients gasping for breath and collapsing at hospital doors, writes Dr. Zaher Sahloul.
The scale of the disaster in Ghouta did not truly sink in until I saw the images streaming in on YouTube and Arabic news channels. These are the images that throttle the soul— children, dead, lying in rows among hundreds, their angelic faces a chilling contrast to the monstrosity that claimed their lives. Nothing in medical school prepares you for this.
Syrian doctors had been preparing for the worst for three years, treating victims of sniper attacks, shelling, barrel bombing, and even small scale chemical weapon attacks—with shamefully limited resources—all while living under fire since the democratic protests of 2011. The Syrian American Medical Society, my group, has been working to help them.
Ghouta’s fate seemed to have been written for it long before last year’s attack. It is a strategic area outside Damascus, then under the control of the moderate nationalist rebels. Before the crisis, it had a vibrant population of 2 million people, now depleted to about 800,000, due to relentless shelling and a suffocating siege by the regime. Local folklore says Ghouta is the site of the Armageddon, where an army of believers face the forces of evil before Judgment Day.
The doctors all told a similar story— a large number of panicking patients, extremely distressed women and children arriving by foot or carried by motorcycles and cars, collapsing on the floors of the emergency rooms, foaming from the mouth, coughing, convulsing, and gasping for air. All had pinpoint pupils, a sign of exposure to an organophosphoric agent, or nerve gas.
Most of the people were asleep with their windows open when the first shells struck. Many died in their beds. Some awoke to witness Judgement Day. In the hours of confusion and horror while shells continued to drop and explode, many rushed to their basements, attempting to protect themselves from bombs. But sarin is heavier than air and it tends to gravitate downward—many were found dead on the stairs of the lower floors of their buildings. They didn’t stand a chance.
One doctor from Ein Turma, who runs a small rural hospital for 20 patients. told me with a trembling voice that he received about 700 patients in just a few hours. In spite of the heroic efforts by him and his volunteer medical team throughout that night, 141 of his patients died, including 66 children.
Another doctor told me that many arrived with respiratory failure—suffocating slowly, foaming and convulsing. He could save only few by placing them on life support, with limited access to respirators. He chose to save the youngest, as they had longer lives to live. Doctors should not be placed in a situation where they had to play God. In Syria, where medical resources are scarce, and where the international community has largely turned a blind eye, this is happening every day.
Ghouta’s first responders weren’t spared. We had been able to get antidotes and equipment to areas where there had been chemical attacks, but not enough protective gear, which is usually only in the hands of the military. Many doctors and nurses had symptoms of exposure after a few hours of contact with their patients.
Dr. Abdel Rahman, from East Ghouta, treated a score of patients, protecting himself only with a simple mask. He developed blurry vision, tightness in his chest and a severe headache. His eyes began tearing and his breathing became heavier. When he told his colleagues that he was unable to continue working, and that he needed help, they injected him with atropine, the only available antidote, and rushed to intubate him and place him on life support. He did not make it, joining the long list of Syrian doctors and nurses who have died or been killed on duty.
The attack was not surprising to the small circle of medical relief organisations working to address the worst humanitarian crisis in our time. But in spite of our best efforts in the months leading up to that infamous night, we had been unable to deliver the necessary protective gear to prevent exposure of medical staff to nerve agents. Smaller scale nerve gas attacks were documented in the eight months leading up to the Ghouta massacre: at least 34 attacks with sarin had been reported by August 2013.
The first report came in late December 2012, from the Old City of Homs. In early April, our doctors reported from the field that chemical weapons were deployed in civilian areas near Aleppo, Syria’s second largest city, killing at least 40 people and injuring more than 200, mostly women and children.
Blood tests in an independent laboratory from one of the affected patients in Aleppo led to a diagnosis consistent with exposure to nerve gas. Later on, the US government confirmed that sarin gas was used in that and other attacks.
The red line was crossed, everyone thought. So what is next? The answer from Washington was as cold as the corpses of children in Ghouta – that the red line meant mass casualties. In the context of the Syrian conflict, where 100 to 200 people are killed daily by more conventional means, with the current death toll nearing 200,000, a mass casualty is needed to shake our numbed consciousness.
On August 22, local medical councils compiled their numbers. More than 1,300 people had been gassed to death that night in East Ghouta and another 300 in West Ghouta. About 10,000 patients were treated for exposure. Forty percent of the victims were women and children. Those who survived had deep psychological scars. Many children lost all of their family members.
The doctors in Ghouta and the whole world waited for a meaningful reaction from the US. But the rest is well-known. Moral outrage, threatening to strike the Syrian regime, then aborting the strike as the administration, working with Russia, proceeded to eliminate Assad’s declared chemical weapon stockpile.
The days after the aborted strike witnessed intensification of shelling and bombing of Ghouta by Assad’s forces using conventional weapons. More civilians have died since then than those who were gassed to death. The administration could have used the window of moral clarity and global outrage to pressure the Assad regime to lift the siege on Ghouta, Homs and other cities and to draw another line on bombing civilians indiscriminately, But unfortunately it was another opportunity lost.
Fast forward one year. The humanitarian situation is much worse, and Ghouta is still under siege, despite the UN Security Council resolution demanding that the Syrian authorities and other fighting groups lift the siege on civilian areas. UN agencies headquartered 15 minutes away in Damascus are not allowed by the Syrian regime to deliver humanitarian goods and medical supplies to the 800,000 people in Ghouta. The survivors of the chemical massacre have been living under this siege in starvation conditions. Not even one memorial was erected for the innocent victims.
The last two dictators to gas their own people were Adolf Hitler and Saddam Hussein. We told ourselves “never again.” I still remember an email by one of the local doctors who witnessed the massacre—”It looked like the Day of Judgment.” History will judge those who would have been able to prevent the massacre and who remained silent.
Zaher Sahloul is a Syrian-American Critical Care Specialist who is the president of The Syrian American Medical Society, SAMS.