Translating Humanitarian Emergency into Medical Aid in Syria

Claire Glasscoe


Slide 1. At a 'Refugees Welcome' march held in London on 12/09/15 in support of refugees seeking asylum in Britain, an expatriate Syrian Doctor carries a banner depicting how he sees Syria now. This banner graphically shows why people like him are leaving Syria in large numbers ©Claire Glasscoe


The conflict in Syria is said to be complicated and few try to explain it. Yet in all my discussions over the last five years with Syrians from all walks of life and circumstance, the message could not be clearer or more consistent. The revolution is a popular uprising of people, across the entire spectrum of society who have had enough of repression and demand justice, equality and freedom for all, as represented by the freedom flag below. It is not a sectarian war, it is a resistance movement and the heart-breaking scenes of destruction and carnage we see and hear about in the news is the response of the Syrian government to resistance in its people. The disaster that is Syria now, as portrayed in the banner above carried by an expatriate Syrian surgeon in London, is man-made. One man, Bashar al-Assad decided, with all the maturity of a three-year-old having a temper tantrum that if he could not have control of Syria on his own terms then he would destroy it. The evidence of his scorched earth policy is for the entire world to see and no one stopped him. No one vested with the power to curb this infantile response was brave enough to challenge his monstrous act of fury. Having come this far the Syrian opposition movement will not give way; they would rather die on their feet than live on their knees under an oppressive regime. This website attempts to tell their diverse stories of resistance, resilience, mutual support, rebellion, active and passive involvement, hardship and extraordinary patience together with the co-construction of an alternative way of life against all the odds. This background section is therefore my understanding of the situation in Syria, the extent of the assault on civil society and my position statement framing the need for medical aid for all. It also highlights themes I am following, which can be accessed by clicking on the thumbnail images in the Home Page and offers an archive of information for those interested in pursuing specific issues further.

Slide 2. A Free Syria flag from Facebook

Syria once characterised as 'The Kingdom of Silence,' according to Robin Yassin-Kassab and Leila Al-Shami burst into a chorus of peaceful protests on 18 March 2011 and thereafter every Friday after prayers. This action was prompted by collective objection over the arrest and torture of 15 schoolboys, aged 10-15 years after they painted the words: 'The people want to topple the regime' [الشعب يريد إسقاط النظام‎ alshshaeb yurid 'iisqat alnnizam‎! 16/02/11] on Arbeen school wall in Dara'a.

The protests that followed called for freedom, dignity and democratic reforms. Instead of listening to these concerns in a reasonable way, President Bashar al Assad responded with a brutal crackdown that only made a groundswell of people more determined. Three events stand out over the following year that solidified the revolt. The first was the arrest, detention and torture of a 13-year old boy at a protest meeting on 29/04/11 – Hamza Ali al Khateeb. He died on 25/05/11 and his mutilated body returned to his family – a narrated video at his funeral revealed that he had been shot in both arms – bullets that went on to pierce his chest. His body was covered in cuts, bruises and burn marks, his jaw and kneecaps were shattered, his neck was broken and he had been castrated. Shortly after that on Friday 01/07/11 Ibrahim Qashoush, a fireman and protest poet had built up a following and was singing this song to an estimated crowd of 250,000 strong in Hama. Two days later he was found dead in the Asi-Orontes River - his throat had been cut and his vocal chords and Adam's apple had been removed. There was little doubt in anyone's mind that this was the work of pro-Assad militias making a strong statement about silencing any voice of dissent. Instead though Ibrahim Qashoush is immortalised as the 'Nightingale of the Revolution.' The third event to further galvanise the opposition happened a year later on 25/05/12 in a village called Taldou on the outskirts of Houla, near Homs. This incident took place after Friday prayers and just before a scheduled protest rally when 108 people were massacred in their homes. Victims included 49 infants and children and 34 women who were executed with a bullet at point blank range or else their throats were cut. Witness accounts identified a mixture of government security and pro-Assad militants (shabiha) as the perpetrators and it is thought their violent rampage was in retaliation for the then formed Free Syrian Army attacking a checkpoint earlier in the day.

Slide 3. Poster from Syrian Revolution Network twitter account @RevolutionSyria and Facebook banner
for Ibrahim Qashoush

The revulsion over these serial acts of sadistic criminal violence bound the Syrian people in an uprising that quickly escalated into a revolution and armed conflict, becoming increasingly entrenched as the regime sought to exert control by ever more violent means. ['Burning Country,' by Robin Yassin-Kassab & Leila Al-Shami – a significant excerpt from their book explaining how the revolution took up arms.

The mission of the National Coalition of the Syrian Revolution and Opposition Forces, as the accepted voice of the opposition to the government in power is to 'support the Syrian people who are struggling to change their country into a democratic, inclusive and pluralistic civil state.' A statement issued and signed by commanders of the Free Syrian Army (FSA) in July 2012 reads: 'We believe in a free and democratic Syria where all Syrian citizens, regardless of their ethnicity, creed, religion or class shall enjoy equal rights and live in liberty, justice and peace.' The full FSA statement. While this declaration has been challenged by, for example those questioning the type of democracy they are fighting for [see Shadi Hamid for a discussion on Islamist versus Liberal democracy and protracted hostilities with examples of violations on all sides, the majority of the Syrian people loyal to the Revolution have been resolute in these core principles throughout the conflict. As areas were liberated from regime control they were designated as 'Free Areas' with civil councils. Daraya is thought to have been an 'exemplary model' 'Their activism provided a glimpse of a possible future – democratic, pluralist, peaceful – which would have benefitted the whole world' writes Robin Yassin-Kassab on the Tragedy of Daraya's fall in the 'The New Arab' 27/08/16. The Assad regime's aerial bombing campaign of these free areas and scorched earth policy may have stifled the protest marches and driven protestors underground, but their on-going commitment to the Revolution remains strong, as is evidenced by the enthusiastic re-emergence of peaceful protests at 104 sites across the country on the first Friday after the fragile ceasefire began on 27 February 2016.

Slide 4. Reaffirming commitment to the popular uprising in the Roman amphitheatre in Busra Alsham image posted by Kenan Rahmani on Facebook, The Creative Memory, Arts/Humanities website 04/03/16

Five years on the people of Dara'a, which was the birthplace of this popular uprising, reaffirmed their commitment to the Revolution in the Roman amphitheatre of Busra Alsham, 40km East of Dara'a.

Slide 5. Singing and dancing in the streets of Al Gouta, Damascus- image posted on Facebook, The Creative Memory, Arts/Humanities website 04/03/16

In Al Ghouta they were singing and dancing in the streets, undaunted by the horrifying injustice that took place 2½ years previously.

This region of Damascus is where the chemical weapons attacks took place on 21/08/13. Those attacks involved the use of sarin nerve gas, which reportedly killed 1347 people mostly in the capital's Eastern and Western suburbs – Zamalka and Ein Tarma in East Ghouta and Moadamyeh in West Ghouta. The Syrian American Medical Society (SAMS) describes this and other attacks before and since then in their report released in February 2016: 'A New Normal: On-going Chemical Weapons Attacks in Syria.'

The Violations Documentation Centre (VDC) recorded details of 923 fatalities on that day (948individually named by on Twitter) as a result of chemical and toxic gases and only 26 of those victims were members of an armed group. This massacre was investigated by the Human Rights Watch and the UN declared it a war crime which crossed a 'Red Line' for the US that President Obama failed to act upon. Then a deal brokered by President Putin led to Bashar al Assad signing the Chemical Weapons Convention and agreeing to give up his chemical arsenal of prohibited weapons. The extent to which this action has been accomplished is however debateable as other toxic and corrosive chemicals have been used instead, as detailed in the SAMS report and confirmed by the more recent UN Organisation for the Prohibition of Chemical Weapons (OPCW) report published on 24/08/16. This report ventured to state conclusively on page 13: paragraph 56. The Leadership Panel examined the existing information' regarding the two impact locations in Sarmin on 16 March 2015. There is sufficient information for the Leadership Panel to conclude that the incident at impact location #2 was caused by an Syrian Arab Air Force (SAAF) helicopter dropping a device which hit the house and was followed by the release of a toxic substance, which match the characteristics of chlorine, that was fatal to all (6) occupants. The remnants of the device are consistent with the construction of a barrel bomb'.

On 11/03/16 in Rastan, Homs province protestors unfolded a Free Syria flag that could be seen by a passing airplane or drone.

Slide 6. Protests in Rastan, Homs posted on on 11/03/16

While under opposition control from 2011 to 2015, the siege of Old Homs ended with 2000 armed opposition fighters and their families evacuating the city under UN supervision, effectively surrendering. Some 150 people had died of malnutrition and an acute lack of medical treatment as a direct result of the siege. The Syrian American Medical Society (SAMS) characterises the siege policy as 'Slow Death' in their document dated 23/03/15 describing life and death in besieged Syrian communities. Rastan, in Northern Homs is a town of about 120,000 civilians that has been besieged since 2012. The International Committee for the Red Cross (ICRC) and the Syrian Red Crescent were only able to reach this community for the first time in four years on 21/04/16. They delivered 60 trucks of humanitarian assistance, medical aid and water treatment materials as well as evacuating hundreds of sick and wounded. Prior to this the shortage of bread and staple food led the residents to resort to a diet of olives, leaves and grass.

Protests continued while the tentative ceasefire negotiated by the US and Russia on 27/02/16 precariously held and broke in a cycle of half-baked promises. But there were deadly repercussions, both from the more extreme Islamist groups that emerged amidst this conflict and Government led forces perhaps over the defiant message they send.

This was particularly the case in Maarat al-Nu'man, Idleb where the then named Jabhat al Nusra (JAN), an al-Qaeda affiliate confiscated Free Syria flags, emblematic of the revolution during a protest rally on 11/03/16 [reported in an interview with Commander Ahmad Alsoud by Thanassis Cambanis 29/3/16].

Slide 7. Peaceful Protest with a defiant message in Maarat al-Nu'man on the first Friday after a fragile ceasefire was announced – image by Khaled al-Essa posted on Facebook, The Creative Memory, Arts/Humanities
website 04/03/16

They then drove out FSA Division 13 after killing several of its fighters and taking several more prisoners. In an unexpected sequel to these events what followed was a backlash from hundreds of local people. Women and children audaciously drove these jihadists from their posts while men pulled down the JAN flags that had replaced the Free Syria ones. It is noteworthy that JAN shied away from shooting at the civilians here. After a stalled Sharia court ruling that JAN said they would honour, the FSA prisoners were rescued by local people who set fire to the place where they were being held.

Three weeks later a twin aerial bombing raid carried out by the Assad regime hit a marketplace in Maarat al-Nu'man along with the nearby town of Kafranbel, killing 44 civilians and injuring many more. This ceasefire violation may have been in retribution for the bold protest message on full display at the rally or possibly retaliation over Jabhat al Nusra, not included in the ceasefire deal shooting down a Syrian regime plane near Aleppo on 05/04/16 taking the pilot, who ejected alive, prisoner or a response to something else entirely. In any event, it was civilians that ultimately paid the price presumably with the regime's rationale being that anyone in a opposition-controlled area is automatically a terrorist by association.

Kafranbel English tellingly tweeted on 29/01/16 the following somewhat resigned message:

'Please do not say civil war, it is a revolution hijacked by extreme Islamists and ISIS, destroyed by Assad.'


In November 2014 The Arab Centre conducted an opinion poll about the way in which Syria is governed, for Research and Policy Studies at the Doha Institute. They polled 5,297 refugees and displaced people in Turkey, Jordan, Lebanon and within Syria along the Syrian-Turkish border with a sampling procedure that ensured proportional representation from 377 refugee centres. They were asked about the presidential elections held on 03/06/14. These were only held in regime controlled areas and so polled a limited section of the total population who were living in the area coloured red on the map, illustrated in Slide 8. There were no external monitors present at the polling stations and witness accounts testify that at checkpoints in Damascus everyone was asked to raise their right hand to show the ink on their thumb proving they had voted. Anyone who had not voted was arrested. At the polling stations the vote was not made in private, it was impossible to vote against the government, as anyone who did so would be arrested. Despite this the official turnout was 73.42% and the Ba'ath Party were returned to power with 10,319,723 (88.7%) votes compared with the only other options, National Initiative for Administration and Change in Syria NIACS with 500,279 (4.3%) votes and an Independent candidate with 372,301 (3.2%) votes. Twenty one other candidates did not meet the criteria to stand as a candidate in a presidential election.

Slide 8. Map of territories held by armed groups inside Syria on 03/10/16 by Thomas van Linge on Twitter

This election result contrasts with the views expressed by people in the Doha survey, who were not in regime-controlled areas and so could not vote. Here the vast majority (78%) thought the recent presidential elections held on 03/06/14 were not legitimate. When asked about who was in control of Syria, 28% of respondents identified Iran as one of the two most influential parties with a say in Syrian decision-making and policy formation; a surprisingly smaller proportion (22%) thought Bashar al-Assad and his family were one of the most influential and 16% thought Russia was influential, followed by the Security and Intelligence services (10%) and Hezbollah (7%). A change of regime was the preferred choice for 64%; a further 23% wanted a peaceful resolution and concord between the parties, while only 6% wanted the regime to triumph and for the Opposition to be destroyed. In considering the crucial issue of the future governance of Syria, 50% expressed their support for a civil state, 30% wanted a religious state and 18% were impartial. These opinions could be viewed as biased reporting from a select group of Sunni Muslims opposing the Syrian government and excluded from the election, yet when these views are placed in the context of Syria's demography they are not surprising at all.

Iran is the only strong regional ally to the Syrian Government according to Karim Sadjadpour, at the Carnegie Endowment for International Peace. This alliance came about after the Assad family allowed Iran to ship weapons to its proxy, Hezbollah in Lebanon to defend Palestine against Israel. Indeed both Hezbollah (designated internationally as a terrorist organisation by the US, Canada, Israel, Egypt, Saudi Arabia, & the UK; the EU specify its military wing as terrorist and the UN does not designate this to be a terrorist organisation) and the Iranian elite Quds Force are reported to have both lost significant numbers of fighters in Syria despite, until recent denials of their involvement. Furthermore, Israel is said to have targeted weapons in convoys travelling from Iran inside Syria towards Lebanon on at least 5 occasions one of which was thought to be a game-changer when six prominent Hezbollah fighters were killed. Russia has two military bases inside Syria that it wants to protect - a naval base in Tartus and Hmeimim, an airbase in Latakia and wants to preserve a presence in the Mediterranean. Iran has 12 military bases inside Syria ostensibly protecting sacred Shia shrines.

The counter charge in a proxy war scenario is that Saudi Arabia, Qatar and Turkey are supporting various players in the opposition [Paul Danahar The New Middle East 2015] Egypt, previously governed by Mohamed Morsi until 03/07/13 was a strong supporter of the opposition movement in Syria until he was removed from power by a military coup. His successor, General Abdul Fattah el-Sisi is supportive of Bashar al-Assad. Interestingly, unexploded ordnance fired by both the Assad regime forces and ISIS have born registration marks: 'made in Egypt' and dated 2012, after the start of the revolution and the embargo on trade of weapons to Syria.


The ethnic composition of Syria has been summarized in a map produced by Dr Michael Izady at Columbia University for the period 1997-2016. Internal and external displacement and death of a large proportion of the population, particularly over the last two years will have affected this picture that is necessarily hard to confirm while the conflict continues. However, if these proportions reflect the ethnic mix at the beginning of the conflict then it means that the native predominant ethnic grouping is Arab Sunni Muslim (59%) followed by Gnostic Alawite (11.8%), Levantine Christian (9.3%), Sunni Muslim and Yezidis Kurds (8.9%), Druze (3.2%) and Sevener Shia Ismaili (2.1%) with the remaining 5.5% made up of seven other ethnic groups.

Dr Izady also maps the tribal composition of Syria onto its ethnic composition at this location. Syria's Bedouin tribes within the Sunni Muslim group are rarely considered in the context of the present conflict and yet historically they have always been present and make up 12-15% of the total population. In July 2015, Aron Lund at the Carnegie Endowment for International Peace interviewed Professor Dawn Chatty, recognised as a specialist in this subject and former Director of the Refugees Studies Centre at Cambridge University, UK: Her concluding remarks are as follows:

'You do not hear that much about them [the Bedouin] anymore. Even so, they are still very important in their communities and work really effectively at the local level. They run local committees that try to bring in humanitarian aid, organize the groups that pull people out of the rubble, and make sure that bakeries get flour. It is very inspiring but it's hard to write about, because no one [from the West] can go to these places and research them or report about it. But in some ways, I feel that they could be the glue to keep Syria together, when the day finally comes that Bashar al-Assad realizes he must sit down to negotiate.'

A view echoed by Hassan Hassan in his July 2012 article for the Guardian and confirmed with a tweet by Yalla Souriya on the role of a recently created tribal council in Badiya and Tadmor in supporting internally displaced people until they can return home.


Since ISIS (English acronyms ISIS/ISIL, which stands for Islamic State in Iraq and Syria/Levant or the Arabic Daesh, an acronym for: لدولة الإسلامية في العراق والشام' or 'al-dowla al-islaamiyya fii-il-i'raaq wa-ash-shaam') extended its presence from Iraq to Syria during April 2013 in an effort to establish an Islamic Caliphate the Free Syrian Army (FSA) has had to decide how it responds to an Islamist agenda. In May 2014 the FSA signed a 'Code of Honour' rejecting extremism with the following statements:

“8. The Syrian revolution is a revolution based on morals and values whose objective is to obtain freedom, justice and security for all sectors of Syrian society, with its diverse multi-ethnic and multi-sect social fabric.

9. The Syrian revolution is committed to the respect of human rights, which is also encouraged by our authentic religion.”

[The Syrian Jihad, Charles Lister 2015] These statements effectively mean the FSA accepted the unenviable task of fighting the regime and the so-called Islamic State as well as the Al Qaeda affiliate formerly known as Jabhat al-Nusra, now Jabhat al Fateh al Sham. Their name change signifies a distancing from Al Qaeda but it is questionable whether this group has given up its Islamist agenda to align itself with the FSA. Hassan Hassan, Associate Fellow at Chatham House writes this summary about ISIS in The Observer 16/08/14 and Charles Lister puts forward in an article for Foreign Policy his own theory about Jabhat al Nusra's name change, alleging this is part of a plan to establish a rival Emirate for Al Qaeda in Idleb. Whether his views are well founded or not, many are sceptical about the motives of this group for changing their name on 28/07/16 to Jabhat Fateh al Sham. This move coincided with a change in the group's stated thinking and strategy as well as a public distancing from Al Qaeda immediately prior to the Battle for Aleppo. This helped seal a unified front in the counter-offensive by the combined opposition forces (Army of Conquest) launched on the 31/07/16 against the Assad regime, as the primary adversary of the Syrian people alongside ISIS.

Aleppo is Syria's second largest city, situated in the North of the country and once the heart of a successful commercial sector. Opposition forces initially liberated the Eastern part of Aleppo city in December 2012 with support from Jabhat al Nusra. Since then the Assad regime has persisted in its efforts to surround the opposition-held parts of Aleppo in order to cut off its supplies and place what is left under siege. To achieve this goal they launched a Russian backed aerial offensive, taking control of the main supply route in the north – Castello Road.

Slide 9. Map of the situation on 05/09/16 after the Battle of Aleppo broke the siege then government forces
cut the supply route to opposition held Aleppo in the south west of the city.

The civilian population of around 300,000 were then preparing for mass starvation and a relentless campaign of aerial bombardment by the Assad regime and Russia similar to elsewhere in Damascus, Homs, Moademiyah, Madaya, Zabadani, Yarmouk, Ghouta & Daraya as well as a ground offensive from Iranian, Iraqi and Hezbollah militias. The combined rebel forces of the Army of Conquest (broadly grouped by @badly_xeroxed: Jaysh al Fateh, Fateh Halab Military Operation Room (includes FSA brigades), Jabhat Ansar al Islam, Sham Liberation Army and Harakat Fajr al Sham Islamyiah) then mounted an offensive in the Battle for Aleppo that established an alternative route into East Aleppo from the south by taking the Artillery Base and Ramoussah. The role played and bold sacrifices made by the rebranded Jabhat Fateh al Sham (JFS) in the battle to defend civilians and liberate Eastern Aleppo again is not lost on these people who felt abandoned to a cruel fate by the whole world and its putative humanitarian organisations. Insistence by the US for opposition forces it backs to distance themselves from JFS will create conflicts of loyalty in the opposition camp. Subsequent to this clear victory and while the FSA had regrouped to fight a different front with ISIS on the Turkey border, a relentless backlash by ground forces allied to the regime resulted in this strategic gain being lost and East Aleppo is once again under siege.
Kurdish Rojova entered the fray in Iraq in 2012 and established an administration centre in the Kurdish regions of the northern part of the Syrian Arab Republic in August 2014. This was ostensibly to combat ISIS and to liberate the Kurdish and Yezidis people held hostage by them but they also want to claim land they believe should be theirs, independent of Iraq, Syria and Turkey, which they have succeeded in doing. So the People's Protection Units (YPG) and the Peshmerga have also been rivalling the FSA in recent battles particularly in the north, which made the task of defending Aleppo even more challenging.


A map of the territories within Syria currently acquired by different armed groups is shown above (slide 8), courtesy of Thomas van Linge on Twitter. These boundaries are extremely fluid and change from day to day so this one is dated 01/09/16. The most recent significant offensive from rebel forces in collaboration with Turkish military is entitled 'Euphrates Shield,' which aims to close the 'green' gap on the northern border so that ISIS (grey - Islamic State) controls no part of the Syrian border with Turkey. It is also a step towards creating a Safe Zone on that border. An interactive map dated 02/09/16 and an updated report on the situation in Syria by the Institute for the Study of War (ISW) detailing the recent activities of principal parties engaging in the conflict can be downloaded from the ISW website.

Slide 10. Searching through the rubble - enforced displacements through the destruction of a community in Aleppo. Image circulated on Twitter


There is grave concern among the majority of Syrians that the Assad regime through siege, surrender and relocation and Kurdish Rojova because they want to acquire statehood are changing the demography of Syria effectively carving up the country as a federal system either as an expedient measure to cut losses or as an opportunistic means of obtaining territory not previously held.

Dr Izady offers a federal option for Syria based on ethnic composition at this location. In March 2016, Anas al-Abdah the head of the Syrian National Coalition speaking for the Syrian people in opposition to the government argued for administrative decentralisation but firmly against a federal Syria

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