An Insider's Perspective:
Syria's Calm Before the Storm

Authored By: Dr. Houssam Al-Nahhas

CBRN-TF Coordinator, Union of Medical Care and Relief Organizations

Introduction


An outside observer can clearly see the effectiveness of the Russia-Turkey cease-fire agreement in reducing the bloodshed all around Syria, which is directly reflected on the medical work where primary care services are prioritized over traumatic emergency services. This is a good impact as it will directly increase the quality of services and improve access to these services.


On the other hand, the nature of the conflict and its parties make it, according to experts, a relative one. This means that the medical sector in the opposition-controlled areas will gradually lose its readiness to deal with war-related injuries. At the same time, it means that some political and military actors will work to undermine this stability and thus turn back to the stage of large-scale military action and subsequent violations of human rights and International law.


Because it is difficult to disrupt equilibrium by conventional military action or direct targeting, the pretext of unconventional attacks becomes the most likely option.



On November 25th, an attack using a non-conventional weapon in Aleppo City was reported by broadcasting footages from hospitals that received the victims which included testimonies from eyewitnesses, victims and medical staff. The authorities in Damascus with their allies announced that the opposition is behind this attack as an evidence of their possession of chemical agents. The opposition, at the same time denied this claim and even accused the government forces of fabricating the attack to use it as an excuse to undermine the cease-fire agreement.


If I want to speak objectively here, the problem now lies not in identifying the perpetrator, but in the new old problem of the question: Is the medical and international system ready to respond?

The answer clearly is: “no."


The idea of the red line continues under different labels such as "guarantees, expensive price, finished tasks" all fall into one result: the local community, the health system, and even the international community will not be able to do anything. The recent event’s analysis, including what was live-broadcast on the Internet the same day and the follow-up in next days, shows the weaknesses in the response at all levels.

First, the Societal level. What happened was an act of aggression primarily by the regime to its opponents and by the opposition to the supporters of the Syrian regime. The victims, who were the most affected population, they were lack of both preparedness and knowledge of the basis of response to suspected exposure to chemical agents. This will, of course, lead to an increase in the severity of the injuries, as well as an increase in the number due to secondary contamination.


Second, the health sector. There are many differences between the opposition and governmental-controlled areas in terms of objectives. In the opposition-controlled areas, the focus is on providing primary, secondary and mental health care in a demanding environment characterized by high population density and limited resources. Also building governing bodies capable of leading health institutions in the absence of a legitimate government. In governmental-controlled areas, the priority is to ensure continuity of medical work and maintain the health system.

Analyzing the videos that came from the Aleppo University Hospital, which was involved in a response to a chemical attack in April 2013, shows that the response contains many fatal gaps, including inappropriate decontamination for victims before being admitted to the hospital, not taking any protective measures by medical staff. All of this would have led to an increase in the number of casualties and deaths and would have put the hospital at the risk of being out of service completely or partially.


Lastly, The international community. The international authorities and the media covered the attack only the day when it happened, and it was not followed-up as if it never occurred, even by the media affiliated to the Syrian government with the absence of effective international investigation mechanisms inside the country. Such mechanisms, if available, would be ready to cooperate with most of the active actors to hold the perpetrators accountable. And would be able to activate the proper response required to define the agent that was used and thus facilitate the task of medical teams in applying the necessary treatment protocols.

Conclusion


The debates over the OPCW's lack of access to all Syrian stockpile of chemical agent, as well as the opposition's possession of the technology required to store or produce chemical agents, remain. This predicts that Syria now is witnessing a calm before a storm. A storm that will affect those who believe in the feasibility of a fragile political process which, if collapsed, would be the beginning of a new chapter of systematic use of conventional and non-conventional weapons.


Houssam Alnahhas was born in Syria in 1988. He worked as the Local Coordinator for the CBRN Task Force of the International Union of Medical Relief and Care Organizations (UOSSM) and is now the research and information management officer for UOSSM. As such, he has extensive first-hand experience of the chemical attacks in Syria and their treatment. Dr. Alnahhas studied clinical medicine at Aleppo University, but the Syrian Civil War prevented him from completing his education. He is now studying at the Cerrahpaşa Medical School of Istanbul University. During the Syrian Crisis, he led a medical team people to treat casualties and coordinated efforts between various NGOs to direct humanitarian efforts. During his career as a doctor, Dr. Alnahhas was responsible for developing preparedness and response protocols and manuals in case of chemical attacks.Mr. Aguero, is a Commander of Peru's General Corps of Voluntary Firemen, where he has an active role in the the elaboration of Levels of Emergency Response for Hazmat incidents. He is also involved CBRN Emergency Response and Safety inspection at the Peruvian Institute of Nuclear Energy, as well as in training and consulting activities with several local and international bodies, including training workshops in Chemical Safety at OPCW. He cooperates with Peru's Armed Forces and National Police for the instructions of agents specialized in emergency response for incidents involving Hazmat material.