Offline: Syria—ending the state of denial

Offline: Syria—ending the state of denial

Comment Offline: Syria—ending the state of denial Richard Horton Richard Horton Yassin al-Haj Saleh’s image flickered onto the screen in Mary Dodge H...

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Offline: Syria—ending the state of denial

Richard Horton

Richard Horton

Yassin al-Haj Saleh’s image flickered onto the screen in Mary Dodge Hall at the American University of Beirut (AUB) in Lebanon last week. Yassin is a Syrian doctor and writer, now living in Turkey. He spent 16 years in prison (from 1980 to 1996) for actively promoting democracy under the rule of President Hafez al-Assad. A medical student when he was arrested, Yassin finished his studies after being released and qualified as a doctor in 2000. He was speaking at the first meeting of the Lancet–AUB Commission on Syria: Health in Conflict. “The world is a cause for Syria”, he said, “but Syria is a cause for the world”. He described how Syrians have long lived under tyranny and cruelty, enduring arrest and torture. Millions of Syrians have been displaced outside and inside the country, all under the eyes of international organisations. How, he asked, can we explain this situation? The world is in “a state of denial”. There is no lack of information. What has taken place “is not acceptable for humanity”. “We sow hatred, and hatred comes.” Violence and humiliation. Wilful ignorance of what is happening. “The problem today is not that the world is not helping us. The problem is that the world is not helping itself.” “As Syrians, we think globally. All the world is our country, and we are scattered all over the world.” Syrians have no recognised status in the countries to which they have fled. “We cannot be sure we will be here today or tomorrow.” “The world is our project.” “If you want to know something about the world, look at Syria.”

Richard Horton

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Richard Horton

Samer Jabbour, Co-Chair with Iman Nuwayhid and Jennifer Leaning, argued that the Commission was needed almost 6 years after the Syrian civil war started because the voice of health professionals and academics had been “hesitant and muted”. Few people seemed to care about the health of the Syrian people. It was time to organise, describe, inquire, write, speak, and act. If I track The Lancet’s own record on the Syrian crisis, I can point to many editorials, news reports, comments, and letters. But our peak coverage was back in 2013. Worse, during the past 5 years, we have published no research or detailed reviews or policy analyses about either what has taken place in Syria or what should take place in the future. We have published two open letters inviting a 2854

more muscular global response. The first was in 2013. Former WHO Director-General Gro Harlem Brundtland and 58 other signatories called on the Syrian Government and all armed parties to refrain from attacking health professionals and medical facilities, and to “allow access to treatment for any patient”. A second open letter was published in August this year. The Chair of the Board of Directors for Physicians for Human Rights, USA, together with 27 colleagues, again pointed to “the relentless targeting of medical facilities”. They called on President Obama “and all other Heads of State” to protect health workers and to ensure the “sustained and unhindered delivery of humanitarian aid”. But, as those present in Beirut noted last week, such advocacy has had little or no effect. * The themes of this Commission will not be surprising to anyone—the cost of war on human lives, the destruction of Syria’s health services, the failure of the international health and humanitarian system to respond effectively, the tragedy for Syrian refugees, the impact of the crisis on Syria’s long-term social and economic development, future scenarios, and what needs to be done now. Nobody present in Beirut was unaware of the proximity of the Syrian conflict. Aleppo was just 299 km away (roughly the distance from London to Manchester). Participants spoke of a “catastrophe in global sentiment”. The Commission somehow had to discover a “narrative of hope”. The Millennium Development Goals moved the world away from the idea of competing nation-states and towards the notion of interdependent peoples. The 2003 UN Commission on Human Security, chaired by Amartya Sen and Sadako Ogata, gave birth to the concept of a global identity embracing all the world’s citizens. The consequences of the Syrian crisis across Europe and much of the western world have punctured such idealism. There is now a rage against the global. The dream of a global identity among us is dying. One goal of the Commission is to help rescue that dream before it is too late. Richard Horton [email protected]

www.thelancet.com Vol 388 December 10, 2016