When we justify apathy and homicide in Syria

Basem Saab

doi:10.3399/bjgp13X671731

‘Eighty thousand people died in less than a minute when the nuclear bomb was dropped over Hiroshima and another 60 000 in Nagasaki: this is almost double the estimated deaths in the Syrian conflict that completed its second year.’

I overheard this discussion while having breakfast at the hospital I work in. Later on the same day, I heard on the news a foreign minister saying that it is a moral obligation of his country to send arms to one of the parties in the Syrian conflict. A few days later, a guy who saw the movie Lincoln, was surprised to know that more than 600 000 US lives perished during the 4 years of the Civil War in the 19th century. Again, a comparison was made with the number of human beings lost to the conflict in Syria. In all these arguments the debaters were justifying killing.

On the other hand, family medicine residents in Beirut struggling to help the refugees from Syria wonder if their efforts in the midst of this mad war fuelled by several regions and countries, really makes a difference. To them, in such circumstances where the war machine kills daily tens to thousands of people, it doesn’t matter if a 4-month-old child will receive diluted infant formula because his mother cannot produce breast milk and is unable to afford undiluted infant formula. They accept the smell of sweat and urine when they realise that thousands do not have water to bathe. It aches when they fail to provide packed red blood cells to transfuse a 3-year-old boy with major thalassaemia. They stand surprised to see a mother in the winter with three febrile, bare-footed children who left her husband behind in Syria and lost contact with him. This is the plight of the Syrian refugees who did not receive any of the billions of dollars pledged for them.

These anecdotes may not appeal to the mind that demands numbers, so here is some information that sheds light on the situation. These figures were presented by the UN refugee agency (UNCHR) and Médecins sans Frontières (MSF) and it is estimated that the number of refugees is around 500 000.1 A survey of 2124 families displaced to Lebanon in December 2012 revealed that 40% share the space they live in with other families in unsuitable structures. There are on average 12 persons to a room. Fifty-two per cent of the breadwinners are unemployed. Twenty-five per cent of the refugees reported not receiving any assistance from governmental or non-governmental organisations. Sixty-five per cent said they did not receive adequate assistance to cover their basic needs. With respect to chronic diseases, 52% could not receive treatment as they were unable to afford the medications that they used to receive free or at a much lower price in Syria. Two-thirds of pregnant women did not have any antenatal care.2

One positive note observed by our residents is that many refugees confirmed that they have received more aid from neighbours than organisations. One said ‘We managed to eat, thanks to our Lebanese neighbour; whenever they cook they give us a portion’.

Many organisations do not provide help if the family is not registered with the United Nations High Commissioner for Refugees. An alarming issue is that only 59% of the families surveyed were registered according to the MSF survey.2 Possible reasons for this include; fear of persecution, lack of information on how to register and where to register, as well as the lack of means to reach a registration centre. A few families reported being asked to pay to get registered.

Is the apathy of some physicians, stemming from an inability to help to the extent they want, justified? Is the analogy of comparing the losses in Syria to those inflicted by a superpower in its Civil War and later in World War II, valid? Both situations resulted in more morbidity and mortality, which looks to be the objective of many state ‘leaders’. The painting, a cry from a recent Syrian medical graduate (courtesy of Dr Ruba Allabwani), shows an orphaned refugee shielding her doll from seeing the bloodshed. I hope that state ‘leaders’ can see it.