In April 2016, in my office at Save the Children International in southern Turkey, I had a meeting with Dr Hasan Al Araj, who was at that time the head of Hama health directorate in northwest Syria. He was explaining to me the need for more protection for health infrastructure and health personnel. He had pushed health actors in the humanitarian cross-border medical response in northern Syria to adopt new designs for health infrastructure that ensured fortification against airstrikes and shelling. He established a hospital in a cave in northern Hama, which was named Al Maghara (‘The Cave’) Hospital. Only two days after our meeting, Dr Al Araj was killed in an airstrike that targeted his car as he was leaving the hospital. Dr Al Araj is one of at least 930 health personnel killed in the Syrian conflict between March 2011 and June 2021.
What happened to healthcare workers in Syria should never have happened, and it should never happen again. Not being able to find a health service in the moment you need it the most, and seeing perpetrators enjoying impunity, creates deep and long-lasting psychological, social and political scars that span generations. Targeting healthcare – something that feels like a common feature of modern conflict – should not be normalized or be something that we as health professionals learn to live with and work around. Although an immensely complex task, one of the essential infrastructural components required to avoid this is better documentation and evidence of these assaults. Not only must we gather this evidence, we must use it to create greater accountability. The goal of this research was not to somehow right the wrongs of history and condemn those criminals who targeted us; it is to help humanity build the tools we need to protect future generations from the tyranny we suffered. The pain of being targeted will haunt us for the rest of our days.
I am grateful to all health actors, personnel and institutions who contributed to this study, through either interviews or access to data. In particular, I would like to thank SAMS, the WHO-led Health Cluster in Gaziantep, the UOSSM, the Early Warning and Response Network (EWARN) and the health directorates of northern Syria. The contribution of SAMS was instrumental to the production of this research. They granted me access to their primary data on AHCC in Syria and co-organized the workshop in Gaziantep.
Many thanks to Emma Ross, David L. Heymann and Rachel Thompson of the Global Health Programme at Chatham House – and to the outstanding editor André Heller Pérache – for their advice, edits and support. Grateful acknowledgment also goes to the anonymous reviewers who have enriched the findings of the research with their feedback.
Finally, this study would not have been possible without the financial support of the Asfari Foundation fellowship and the operational support of the Queen Elizabeth II Academy for Leadership in International Affairs at Chatham House.
