Surgery without anaesthesia is a miserable and brutal reality in Syria. Doctors report that demolished hospitals and humanitarian blockades have left some Syrians to suffer, awake, through amputations and Caesarean sections.

I saw similar horrors while working in a northern Syrian field hospital under air strikes in August. I operated on children who had the bone fragments of obliterated bystanders embedded in their skin. Children shot by snipers were pronounced dead in front of grieving parents. Civilians with bellies torn open from shelling held their intestines in their hands while pleading for help. Some lucky enough to have survived shrapnel wounds succumbed to gangrene and required amputations. The day before I left, a little boy whose crushed legs had been amputated asked me to bring him prosthetic limbs if I ever returned.

Only so much is possible in a besieged hospital where cellphones illuminate underground operating rooms when the power goes out. In Syria, the front lines are everywhere and many who are armed do not respect medical neutrality. Like many makeshift hospitals, the one I worked at does not display Red Crescent emblems to help prevent its discovery and destruction. It has survived so far on luck, courage and generosity.

As international attention to Syria wanes, all of these horrors are still happening. Such basic needs as nutrition, vaccinations and perinatal care cannot be adequately addressed — let alone war injuries. The World Health Organisation reported in April that 57 per cent of Syrian public hospitals had been damaged or destroyed. Local production of medicines has decreased 90 per cent, and only 36 doctors remained in Aleppo, down from about 5,000 before the conflict started.

In a September paper, ‘Assault on medical care in Syria’, the United Nations documented how hospitals have been systematically destroyed, ambulances targeted, patients tortured and medics executed. Red Crescent volunteers have been attacked while relief supplies are distributed, and at least 20 have been killed while helping others.

In an open letter in the Lancet last month, more than 50 prominent physicians from around the world described these horrific conditions and pleaded: “Let us treat patients in Syria.” Similarly, Medecins Sans Frontieres (MSF) has repeatedly asked that diplomatic efforts aim to “provide emergency assistance to the people of Syria” and to “lift the humanitarian blockade.” The International Committee of the Red Cross has called for “full access to all areas of the country”.

The Syrian government, however, still restricts entry to critical areas, denies cross-border assistance and monopolises the distribution of aid through Damascus. The Syrian military surrounds the Damascus suburb where chemical weapons were used in August, and food or medicine cannot be delivered. The government denies involvement in the chemical attack, but how can it defend starving the victims?

Armed factions also threaten humanitarian work. A 28-year-old surgeon working for MSF, Mohammad Abyad, was killed by extremists last month. Seven Red Cross/Red Crescent workers were kidnapped two weeks ago in northern Syria.

The UN Security Council recently issued a nonbinding statement urging all armed parties to stop targeting civilians and to allow immediate, unhindered humanitarian access. A nonbinding statement does not carry the weight of the council’s binding resolution on chemical weapons, so it is no surprise that attacks on civilians, schools, hospitals, bakeries and bread lines have continued — even with chemical-weapons inspectors in the country.

Moreover, it is illogical that access to besieged areas of conflict where people are starving and dying is permitted for inspectors but not for humanitarian aid. It is unreasonable that the Syrian government swiftly lifts bureaucratic obstructions for chemical-weapons personnel but enforces and intensifies them for aid groups. It is, in the words of MSF General Director Christopher Stokes, “an absurd situation”. The mission to destroy chemical weapons in Syria is a good thing, but the abhorrent crimes committed by other means and the ongoing human suffering must not be forgotten.

The diplomatic focus needs to return to that suffering. Humanitarian efforts are failing in Syria because access to those who most need help is threatened, restricted or denied. A statement urging the prioritisation of humanitarian efforts is not enough.

The international community must collaborate to support and safeguard immediate humanitarian access in Syria. The same resolve and urgency that rapidly crafted an effort to eliminate chemical weapons must be directed towards this purpose. Too many people will not survive winter waiting for proposed peace talks or political solutions.

— Washington Post

Samer Attar is an assistant professor of orthopaedic surgery at Northwestern University. The Syrian American Medical Society arranged his recent visit to and volunteer work in Syria.