A decade of destruction

Try telling Syrian mothers giving birth that the civil war there isn’t newsworthy. For some observers, the 10-year conflict has fallen off the radar. But at a hospital in the city of Afrin, those who weren’t killed after rocket fire destroyed a labor-and-delivery unit struggle to survive.

Each month about 350 mothers give birth at al-Shifaa Hospital, a facility that treats 1,000 patients a day. The June 12 attack began Saturday evening, when wards and hallways are less crowded. Yet whoever was behind it began by targeting nearby residences, sending dozens of injured to the hospital just as it came under fire.

Two missiles hit main wards, crashing in the roof of the emergency room as bloody residents from the neighborhood arrived.

“We received a large number of injured civilians, including a deceased person,” said Muhammad, a radiology technician wounded in the blasts. An upturned empty wheelchair, he said, was all that was left where he had just talked with a disabled boy, whose body was suddenly buried beneath rubble.

The attack injured about 50 people and killed 22, 11 inside the hospital. The dead include infants, young children and their mothers, medical staff, and paramedics. The rocket fire destroyed the emergency room, labor-and-delivery unit, and an outpatient clinic.

This was the second time this year rocket fire targeted the hospital, even though the United Nations includes it in its “deconfliction arrangement.” The UN shares coordinates for it plus other hospitals, schools, and the like with warring parties in a bid to protect them.

Syrians themselves throughout more than 10 years of war have been its most expendable resource. The regime of Syrian President Bashar al-Assad, after suffering defeats to the Free Syrian Army, ISIS, and other Islamic terror groups, has clawed its way back with combat support from Iran and Russia, which joined the conflict in 2015. Today Assad controls two-thirds of the country, but war itself—and Assad and his allies’ choking off of humanitarian aid—means the overwhelming toll on the civilian population has eased little.

“This would’ve been a much, much bigger disaster on a regular working day,” said Mufaddal Hamadeh, a Chicago-based oncologist and president of the Syrian American Medical Society (SAMS), the international nongovernmental organization that runs al-Shifaa. SAMS plans to rebuild the facility, but for now it’s offline.

HALF A MILLION Syrians have died in the war, which has forced more than half of its 22 million people to flee their homes. The UN Refugee Agency (UNHCR) estimates 6.7 million Syrians are displaced inside Syria, while 6.6 million are refugees spread throughout the Middle East and the world. That upheaval, arguably the world’s worst ongoing human catastrophe, constitutes Syria’s “silent war” for survival.

Earlier this year the UN special envoy indefinitely suspended peace talks in Geneva, a failed 15-month process between the Assad government and opposition groups. Since that time violent attacks and hardships, particularly in the north where Afrin is, have increased.

Three U.S. administrations have struggled to come up with a comprehensive policy on Syria. President Barack Obama by summer 2011 was calling for Assad’s ouster (and the U.S. ambassador actually met with rebel groups). But the rise of ISIS in Syria complicated the picture: The coalition fighting to defeat ISIS under Obama and later President Donald Trump put the United States in effect on the same side of the war as Assad. And U.S. forces found themselves sharing military coordinates with the Russians, and by extension Syria. U.S. troops still remain in northern Syria as part of the campaign to defeat ISIS.

Russia has taken a determined lead to block cross-border humanitarian aid to contested areas—just as aid groups say it’s needed most. A second wave of COVID-19 is sweeping the country, with the number of new cases per day doubling from April. The disease outbreak comes also as Turkey began using its dams along the Euphrates River to restrict water supply to northern Syria. Since February it’s cut water supplies for whole cities. Its flow is so low, the river has become contaminated. Health officials warn of potential cholera outbreaks and already are seeing an increase in waterborne illnesses.

If there’s one rule in the Syrian War, it’s that any rules of engagement are there to be broken. Russia quit the UN’s deconfliction arrangement a year ago, and its regime-backing forces are suspected for most attacks on hospitals and schools.

Hamadeh visited the damaged al-Shifaa in late June and met with victims’ families. “This attack was very painful because it was so unexpected,” he told me by phone from Turkey. “There was a relatively calm period over the last year, and Afrin is a Turkey-protected area. People thought they would be protected there. Now they are filled with fear again.”

Many in the area, including hospital workers, came from Ghouta after escaping the Damascus suburb where rebels took up positions early in the war. A sarin gas attack in Ghouta killed 1,400 residents in 2013, and it remained under daily government bombardments for years.

Among the SAMS staff killed at al-Shifaa, two women escaped rocket fire before. Rana Manfoukh, 44, came to Afrin from al-Maara south of Idlib, where she worked at a Doctors Without Borders hospital. She barely survived a missile attack by Russian and Syrian forces in 2016. In Afrin she cared for three nieces who’d lost their parents in the war. Now, they and six others will be in the care of Manfoukh’s brother, who is disabled with shrapnel wounds.

There’s a reason the collateral damage seems unending, said Hamadeh. “The perpetrators, whoever they are, feel safe and they feel that they can act with total impunity because they’ve seen umpteen other attacks happen and nothing is done. There is no accountability, and there is rarely an investigation.”

International law makes targeting hospitals intentionally or recklessly a war crime. Yet more than 600 hospitals have been attacked since the start of the war, according to Physicians for Human Rights. The group tracked independent investigations and local media reports showing that Syrian government or Russian forces carried out 541 of those attacks.

“We expect this to continue,” said Alexandra Matei, spokeswoman for World Vision, which partners with SAMS at al-Shifaa and runs other programs in Aleppo and Idlib provinces. Workers throughout the area are seeing increases in attacks targeting health and education infrastructure, halting some of their work, Matei said. “Nowhere is safe, I have to admit, in Syria.”

THE ESCALATION, aid organizers believe, is part of Russia’s showdown with UN Security Council counterparts—including the United States—over getting aid into Syria.

Russian officials have used their veto power on the UN Security Council to restrict cross-border delivery of humanitarian goods into areas that need it most, arguing that it infringes on Syria’s sovereignty. As Assad has retaken much of the country, the Russians want Damascus to manage all aid operations.

Yet the Assad regime throughout the war has blocked aid to so-called opposition areas, depriving critical supplies to civilian populations that largely are unaligned with rebels and terror groups. Many such areas have suffered attacks from barrel bombs and chemical agents. In some, residents rely on bread smugglers for survival.

After the UN commenced aid deliveries via four border crossings, Russia vetoed authorization measures to keep them open. Its efforts choked all transits except to one crossing last year—at Bab al-Hawa at the Turkish border. This year Moscow vowed to close it too. Russia’s UN ambassador, Vassily Nebenzia, on July 1 told reporters keeping Bab al-Hawa open was “a nonstarter.”

Hours before a July 10 deadline, Russia voted with other members of the UN Security Council to extend the aid operation for up to 12 more months. But, bowing to Russian demands, keeping the crossing open has to be renewed again in six months, at the height of winter. That compromise required high-level diplomacy from the United States. Top U.S. diplomats visited Bab al-Hawa leading up to the vote, and President Joe Biden raised the issue in a June 16 summit with Russian President Vladimir Putin. Said U.S. Ambassador to the UN Linda Thomas-Greenfield: “Without cross-border access, more Syrians will die.”

More than 1,000 trucks a month transport food, medicine (including COVID-19 vaccines), and other supplies through Bab al-Hawa. In the last year, UN officers and NGOs say they’ve seen no trucks from Damascus cross factional lines to reach the same areas.

“At the moment no vaccines, no medical supplies are coming via cross-line trucks from Damascus. What we have has come from Turkey via WHO and UNICEF,” said World Vision’s Matei.

A shipment of 52,000 coronavirus vaccines arrived in the spring, but an additional shipment promised in early June hasn’t. Much of Syria is experiencing a second wave of COVID-19 cases. World Vision has provided additional ICU beds, ventilators, and hygiene kits with basics like soap and disinfectant. But it’s not enough, said Matei: “In April we had 60 cases per month, maximum. Now we have more than 1,558. And 100 a day on many days.”

World Vision welcomed the vote to keep cross-border aid but said in a statement it was “deeply disappointed” the Security Council had not reauthorized additional transit points, given the needs. By constricting aid to one crossing, supplies get through but take longer and cost more per truck. Such delays can be the difference between life and death, particularly for children. Some believe that is what the Assad regime wants.

THE LONG WAR has tested loyalties among Assad supporters, including the country’s Christian community, which at the start of the war saw him as a protector against Islamic groups. Prolonged fighting has entrenched jihadist militias, while chemical weapons attacks by the regime—together with bombarding hospitals and residential areas—have transformed Assad into a pariah at home and abroad.

Syria operated as a police state under Hafez al-Assad, who seized power in 1970, and authoritarian rule continued under his son Bashar, who took office upon his father’s death in 2000.

As the poorer neighbor to oil-rich Arab states and neighboring Israel, Syria under the Assads became a client state of Russia and linked arms with Iranian-backed Hezbollah. In the shadow of the Iraq War, Syria also became a training ground for al-Qaeda-linked insurgents, who by 2010 were calling themselves “Islamic State.”

All would become part of the Syria powder keg when in 2011 Assad—ignoring the advice of top military advisers—ordered a violent crackdown on Arab Spring protesters who wanted an end to his dictatorship. Assad called them terrorists, and his bloody assaults on largely peaceful demonstrators pushed many to take up arms.

Calculating that he could not survive political concessions to protesters calling for change, Assad decided instead to crush them—even if it meant taking the country with him.

“Assad or we burn the country,” his military officers repeated, reported officers who later defected. “I knew that Assad would not leave until he had demolished the entire country and blood would run in the streets,” Abduljabar al-Akidi, a Syrian army colonel who later joined the opposition Free Syrian Army, told U.S. journalist Sam Dagher.

“HOW CAN WE not empathize when we see family members missing, homes destroyed? And these are my countrymen,” said Hamadeh of SAMS.

Hamadeh grew up in Syria. He attended medical school in Damascus and emigrated to the United States, where he completed his residencies.

SAMS began in 1998 as a social club for Syrian-American doctors, Hamadeh said. But soon its members connected with a teaching hospital in Syria and started training doctors long-distance. That turned into training trips and financial support for Syrian hospitals.

At the start of the war, the group’s annual budget was $75,000. By 2017 it was $42 million as it became one of the leading NGOs supporting hospitals throughout Syria and in other war-torn countries (such as Yemen).

SAMS has 2,000 healthcare employees inside Syria, and most are war victims themselves displaced from other areas. They receive salaries as a way to support and rebuild local economies. The group’s U.S.-based doctors often consult via telehealth with Syrian doctors and nurses.

Too often, said Hamadeh, his trips to Syria are to survey the group’s destroyed hospitals. But that’s not what bothers him most.

“The hardest thing to see is the lost generation, the children of this war. They have no future. I ask them, ‘What do you want to be when you grow up?’ And you know what they say? ‘Nothing.’”

Hamadeh choked and paused as he talked. “They say ‘nothing’ because there is nothing they can imagine ahead but war. It breaks my heart.”

Is peace possible?

In 10 years of war, neither a UN-sponsored peace process nor fighting to the death has brought an end to the Syrian conflict. But support for local governance might map a way forward, at least in parts of the country.

Syria’s northeast, like much of the rest of the country before the war, is a mix of ethnic and religious people. Assyrian and Greek Orthodox Christian, Kurdish, and Yazidi communities have historic roots there alongside dominant Sunni Arab Muslims.

Their uneasy coexistence has shattered on all sides—from militant groups battling to create a new Islamic state to government forces launching massive aerial assaults in return. Neighboring Turkey launched three invasions into northern Syria between 2016 and 2019. Turkish forces, aligned with some Islamic militants, continue to occupy key towns along the Euphrates River inside Syria with large swaths of territory in between.

In the midst of such turmoil, opposition leaders in the northeast have established an autonomous zone that’s “uniquely promising,” according to U.S. officials, fostering political freedoms and—potentially—peace.

The Syrian Democratic Council is the political arm that operates alongside the Syrian Democratic Forces (SDF). The council is composed of long-standing opposition figures—many of them forced by the Assad regime into exile in Europe and the United States. The leaders in Syria are Assyrian Christians, Kurdish Muslims, Arabs, and others.

The SDF leadership is multiethnic, too, leading with the Kurdish YPG, the militia that successfully fought with support from U.S. forces to defeat and dislodge ISIS in northern Syria.

A 2021 report from the U.S. Commission on International Religious Freedom (USCIRF) found the northeast zone a bright spot in the dismal Syrian landscape.

It “continued to allow Muslims, Christians, Yazidis, and others to practice openly, express, and even change their religious identities—while facing significant peril due to threats from Turkey, Turkish-allied militias, regime forces, and remnants of the Islamic State of Iraq and Syria (ISIS),” the report concludes.

“This is how you stop forever wars,” said Nadine Maenza, who chairs USCIRF. “Governance is how you hold the ground we won, so we don’t have to come back and fight for it again.”

Somehow, said Maenza, the Muslim-majority northeast with its deep Christian history has figured out how to build governance “that embeds principles of inclusivity in every level of government—in the middle of a civil war while also fighting ISIS.”

Half of the political and military leaders are women, she points out, and their co-chairs and vice co-chairs are from different ethnic or religious communities. “They aren’t doing this for show or to impress the United States, because no one is really watching.”

USCIRF commissioners are pushing the Biden administration to pay more attention to the northeast. This year the panel recommended the United States recognize the Autonomous Administration of North and East Syria (AANES) as a local legitimate government and lift sanctions from the area it governs. The move could allow AANES officials to have a formal seat at renewed peace talks. It could stabilize the economy, expand U.S. engagement in that region, and provide an incentive for other areas to follow. —M.B.

—WORLD has updated this story since its original posting. A version of this story also appears in the July 31, 2021, issue.