Medical workers are bracing for a catastrophe in the Syrian province of Idlib despite an agreement by Turkey and Russia to avert a regime offensive for now.
The deal was inked on September 17 to establish a 15-20 kilometre safe zone by mid-October, lending a brief reprieve to three million beleaguered civilians who still reside in the last rebel-held area of Syria.
Since the agreement, doctors say that no medical facilities have been attacked and that fewer patients are being rushed into the emergency ward. Just a week before the accord, four hospitals in Hama and Idlib were hit. Despite the relative calm, doctors fear that the agreement won’t hold.
One practitioner who goes by the name of Ahmad Hurr – Free Ahmad in Arabic – cited the collapse of the de-escalation agreements in southern Syria and Eastern Ghouta, where civilians and rebels were besieged and bombed into submission earlier this year.
“I left my home in eastern Ghouta for Idlib [during the offensive] on April 1,” said Dr Hurr in a phone interview. “All the agreements that Russia and the regime made in the past were broken.”
Earlier this month, the UN shared the GPS coordinates of hospitals in Idlib with the regime and Russia, mostly due to resignation that medical facilities have been repeatedly targeted throughout the conflict and fears they would be targeted again.
“We share these coordinates so that there is no doubt that a hospital is a hospital,” Panos Moumtzis, UN regional humanitarian coordinator for the Syria crisis, told a briefing on September 13.
Safwat Shaikhunny, the security and safety officer in Idlib’s opposition-run health directorate, says that facilities are prepared to operate with as few doctors as possible in case of a renewed offensive. Relief teams, he also stressed, are ready to set up mobile clinics to evade airstrikes.
"Every now and then the Syrian regime and its Russian ally launch a campaign against health facilities," Mr Shaikhunny told The National over the phone. "[In these circumstances] decreasing the number of people working in the hospitals is our main objective."
For now, medical workers are more concerned about militias and gangs. Nine pharmacists and three doctors were reportedly abducted and released this year after their families paid a hefty ransom. Mr Shaikhunny says that kidnappers target medical workers since most make $1,000 to $1,500 a month, which is five to ten times the average wage in Idlib. But ransoms can reach as high as $100,000.
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Dr Mohammad Katoub, the advocacy officer for the Syrian American Medical Society (SAMS), said that seven doctors have also been forcefully disappeared within the last nine months.
Three of the doctors were reportedly snatched by Hayat Tahrir Al Sham (HTS), an Al Qaeda offshoot that controls more than 60 per cent of Idlib. The doctors are believed to have been kidnapped for their political dissent.
Dr Katoub also noted that more innovative explosive devices (IEDs) are targeting medical facilities in areas under HTS control.
“Attacks by armed groups on medical personnel and facilities have increased in northwest [Syria] compared to previous years,” he said. “This is the situation in the northwest and it’s a big concern for us because it means that [medical workers] are being attacked by all parties in the conflict now.”
Analysts worry that HTS could sabotage the current accord if it doesn’t leave the designated safe zone, a move the extremist group perceives as weakening its position in the rebel stronghold.
Several doctors fear a regime incursion if that happens. Underground hospitals, they say, would not protect civilians or medical workers from chemical weapons, which the regime has used on multiple occasions throughout the war.
“[If the regime enters Idlib] I’m going to race with millions of civilians to the sealed Turkish border,” Dr Ahmad Ghandour, a surgeon in Idlib, said. “I don’t think we’ll be safe there, but we have nowhere else to go.”
Doctors in rebel-held areas face a serious risk of reprisal if captured by the regime. Since July 2012, the government has classified practitioners who aid the opposition as terrorists. But some doctors vow to remain in Idlib no matter what happens.
"I will stay in Idlib until the end because it is my religious and moral duty to tend to civilians," Dr Hurr, the doctor from eastern Ghouta, told The National. "I will never give up my duty for the sake of saving myself."