EXCLUSIVE: Senior UN Official On Syria Calls For An End To Attacks On Health Facilities As International Efforts Mount To Avert Another Humanitarian Catastrophe Over Looming Battle For Idleb

Panos Moumtzis, Assistant UN Secretary-General and Regional Humanitarian Coordinator for the Syria Crisis (since September 2017) spoke to Health Policy Watch in an exclusive interview Thursday about the escalating crisis in the Syrian conflict, the continued attacks on health care facilities and the mounting international humanitarian and diplomatic efforts to try and avert another humanitarian catastrophe in the war-torn nation. But he also warned he fears the worst might still be ahead of us over the looming battle for Idleb.

Prior to his appointment, Mr. Moumtzis served as UNHCR Regional Refugee Coordinator for the Syria Crisis (2012-2013), the Humanitarian Coordinator for Libya (2011), the Head of UNHCR Donor Relations and Resource Mobilization (2009-2010), and the Country Director for UNRWA in Damascus (2006-2009). Additionally, he has held senior humanitarian positions in the United States, Rwanda, Cote d’Ivoire, Egypt, Iraq, and Kenya.

Most recently, Mr. Moumtzis was Director of the Senior Transformative Agenda Implementation Team (STRAIT), IASC, in Geneva (2014-2017). He holds a BA in Political Science from Athens University Law School and an MA in Middle East Politics from Exeter University in the UK.

HEALTH POLICY WATCH (HPW): The latest escalation in the conflict in Syria around Idleb again dramatically shows that attacks on hospitals and other healthcare facilities seem to have become the “new normal” in the conflict. Why is this persisting given there have been so many attempts to put a lid on this designated war crime?

Panos Moumtzis, Assistant UN Secretary-General and Regional Humanitarian Coordinator for the Syria Crisis

PANOS MOUMTZIS: It’s really unacceptable to see these continuous attacks on health facilities that are taking place in Syria. In 2017, we had 70% of the world’s attacks in conflict situations on health facilities that took place in Syria. We have seen them again and again whether it was in Aleppo, in Eastern Ghouta, in many of these locations of conflict, to see health facilities, ambulances, schools, systematically being targeted. This is really a major concern for us to see this happen again and again. If proven deliberate, this constitutes a violation of International Humanitarian Law (IHL) and clearly, there is a responsibility by all sides to the conflict to make everything possible to assure restraint and protection of health facilities. If patients, a family, a child, and a mother, go to a hospital they need to know they are in a safe place and if a war takes place around them this is not a place to be bombed and sadly this is what we see happening. Just in the last ten days alone, we had four different facilities in Idleb province that were bombed and that is really unacceptable.

HPW: Do you think by providing the coordinates of key civilian facilities including hospitals to the armed combatants and to warring sides and to the Syrian and Russian air force, the opposition forces, and others, will act as a deterrent? Often that has not been the case.

MOUMTZIS: On our side as the United Nations, as humanitarian actors, we are doing everything possible we can, in order to ensure the basic rules of war are respected and implemented on the ground. One of the basic rules of war is really to make sure that hospitals are not being bombed in the middle of the conflict where it takes place. So, we have undertaken a number of steps – active diplomacy, quiet diplomacy, behind the scenes diplomacy. We are really speaking to everyone we can and we knock at every door we can, to make sure that governments with influence and governments with ability to bring change, really understand and advocate and respect the basic rule of law to ensure that health facilities, schools, civilian areas [are protected] and to use restraint within a conflict situation when they apply that. As part of that, we have shared the GPS coordinates for about 235 facilities in Idleb North-West region, about 640 coordinates throughout Syria, and we have shared them with the (UN) Humanitarian Task Force Team Co-Chairs in Geneva and this is the United States and the Russian Federation, with the request to make everything possible, that these facilities are not bombed, and that’s what we have asked of them.

[According to the World Health Organization (WHO), since the start of 2018, there have been 52 recorded attacks on health care; 40 were in Idleb governorate, 4 in Aleppo, and 8 in Hama. The WHO says there were three verified attacks on healthcare between 6-10 September:

o       On 8 September: An NGO-supported hospital in Has village in Kafr Nobol sub district, Idleb, was hit by an airstrike resulting in structural and medical equipment damages. Initial reports indicate two health staff and two civilians were injured. The hospital is reported to be temporarily out of service. The hospital provided an average of 4000 consultations, 200 admissions, 215 major surgeries, and treated 1200 trauma cases.

o       On 8 September: An NGO-supported specialized hospital in Kafr Zeita sub district, Hama, was hit by an airstrike, which resulted in structural and medical equipment damages. Initial reports showed that three ambulances were seriously damaged and there no casualties. The hospital is reported to be temporarily out of service. Monthly, the hospital was providing an average of 1590 consultations, 113 major surgeries and 230 minor surgeries.

o       On 6 September: An NGO-supported hospital in Kafr Zeita, Hama, (a de-conflicted humanitarian site) was targeted by an airstrike which resulted in major structural and equipment damage. Initial report indicated no casualties. The hospital is reported to be out of service. Monthly, the hospital provided an average of 780 consultations, 50 admissions, 15 major surgeries, and treated 200 trauma cases.

Moreover, the UN says on 8 September the Nabd Al Hayat hospital in Ma’arrat An Nu’man District, southern rural Idleb was also stuck. It had also been hit in February 2018.]

HPW: But some of these facilities that you have mentioned were bombed earlier this year, as well. So there seems to be a pattern of impunity by some of the warring sides here.

MOUMTZIS: Sadly, one of the hospitals that were bombed, just in the last ten days, was within the list that we had shared the coordinates. Not only that, but the same facility was bombed again in February this year. So, I think it does bring up the question of accountability. Because once the GPS coordinates are shared, no one can say we didn’t know. So, the whole point of it is to ensure accountability. And there is a possibility of responsible governments, really to do the right thing. Hospitals must be respected.

HPW: With the looming battle over Idleb, the UN is making contingency plans and projecting that close to 1 million people might flee if the hostilities escalate. On the health front, what have you done, given that in the Syrian conflict, so many aid convoys of health supplies have been intercepted by the government and have not reached the people in need from antibiotics to painkillers and surgical equipment. Is that continuing and what assurances do you have that you will have adequate supplies especially of medicines for chronic diseases?

MOUMTZIS: On our preparedness and response plan for Idleb, the best case scenario that we hope will happen is a peaceful negotiated settlement where we won’t see a massive escalation of military activities like what we have seen in other parts of the Syrian conflict. Part of this preparedness plan we always come up with a working planning figure, not that we really know will happen. At the moment, we have about 900,000 people to help – who may flee if there is an escalation in the military offensive in Idleb. Most could flee into non-government held areas in Idleb but some of them might also go into government-held areas. So within the sectors, the health sector plays a key role in ensuring that there is planning and prepositioning, in order to be able to respond to a dramatic increase in terms of health needs. Colleagues from the WHO with NGOs got together two weeks ago to look at this preparedness plan and to look at all the eventualities, all scenarios, and how to mobilize support to medical needs both in government areas but also cross-border from Turkey. This applies to all the sectors where we basically look at all modalities and see how to best help the people there.

[In a similar vein, the WHO says rapid changes in military operations and areas of control affect the access situation and needs on the ground, requiring changes in response plans. Humanitarian convoys bearing essential life-saving and life-sustaining supplies must be allowed to proceed immediately to provide medical assistance across conflict lines. All parties to the conflict must let critically ill and wounded civilians be immediately evacuated to receive life-saving treatment, and evacuated patients and accompanying family members must be able to return safely to their homes upon completing treatment without fear of reprisals.]

HPW: I noticed in one of your reports you have provided in advance for some chronically ill patients directly with medicines for up to three months. This is an innovative move, no?

MOUMTZIS: Yes, indeed when we realized that in a situation where a conflict escalates sometimes access becomes difficult and [for] a sizeable number of people their life is dependent on having these basic life-saving medicines and supplies. So we try to do everything we can to ensure continuity of medical services to people who find themselves in the middle of the war. And like every other human being they are worried about what happens if the routes are closed, if the conflict isolates the areas where they are and they no longer have access to medical supplies. So, that’s where the response is.

HPW: Do you also have sufficient prepositioned surgical and trauma kits, because that is one of the key supplies when things escalate?

MOUMTZIS: Surgical kits, trauma kits are really crucial because indeed at the height of the conflict this is where they are needed the most and for a surgeon and a health facility to have a trauma kit can save a life. Without them, there is not much that can be done. So, indeed part of this preparedness is this capacity to be able to respond. Now, a preparedness plan is completely useless if it is not supported, resourced to be able to make things happen. For the Idleb plan to help over 900,000 we have asked for $311 million dollars. Of course, we have also re-prioritized and looked at existing stocks and we’re really doing everything we can, including reaching out to donor capitals to make sure the resources are provided and the time is now.

HPW: Has the initial response been positive?

MOUMTZIS: Yes, there are I think a lot of governments which are looking at their own re-programming but also at additional resources. A number of countries are coming forward. We’re not at 100%, and we don’t have 100% of what is needed, but I think there is enough support including from cluster sector lead agencies on preparedness resource and funds I think the Idleb situation at the moment is at the top of the priority agenda for all the organizations and I know that. I attended yesterday a conversation with the UN principals and they’re all very much alert and aware and have given instructions for everything to be done to be able to respond to the humanitarian crisis and needs.

HPW: Now, already with the escalation in hostilities you’ve estimated that about 38,300 people have fled, of which about 4,500 people have come back, so we are looking at nearly 34,000 displaced already in the conflict. Are these people receiving adequate humanitarian assistance ?

MOUMTZIS: We are humanitarian actors – in particular with the direct frontline intervention by Syrian NGOs – there’s a massive mobilization for this. A lot of people fled within hours and everything is being done to support them on the ground.

HPW: The UN Secretary-General, Mr. António Guterres, the UN Special Envoy for Syria, Mr. Staffan de Mistura, yourself, and others, have already stressed that everything must be done to protect nearly 3 million civilians caught up in the middle of this conflict over Idleb between Syrian government forces and the Russian air force, versus the armed opposition, and some terror groups. How do you protect these civilians when the armed groups are in the urban areas, together with the civilians, and the government and the Russians are saying they’re going after the designated terror groups?

MOUMTZIS: The protection of civilians is our number one concern. In every conflict situation when we ask the Syrian people what do they need! is it food, is it health! the answer is always the same, it’s protection. It’s safety. For them to feel for themselves, for their loved ones, for their families, they are in a safe place. What we have seen in the Syrian conflict whether we look in (Eastern) Ghouta, whether it is Raqqa or in other areas, there is a failure of all of us, a failure of the international community to be able to really protect the civilians, and sadly we have seen scores of deaths, massive displacement. There is really a poor record of the international community to do prevention, and most importantly in this extremely complex conflict situations, to be effective to be able to ensure the protection of civilians. It shouldn’t be that we see entire neighbourhoods and cities bulldozed to zero. It shouldn’t be that we see today 6.2 million internally displaced people, 5.5 million refugees, massive destruction of entire areas of the country in the name of anti-terrorism. I think that the war on terror does not justify this extreme heavy-handed response which results in massive suffering.

HPW: And abuse of the principle of proportionality?

MOUMTZIS: Of the principle of self-restraint and proportionality and also limiting an intervention to military targets or terrorist targets and making sure that neighbourhoods where civilians live, markets, civilian infrastructure is protected, and that’s really the challenge we are facing in today’s situation.

HPW: Are you anticipating the establishment of any humanitarian corridors?

MOUMTZIS: Our position as humanitarian actors is we very much ask for respect on the principle of the freedom of movement, and the right to remain. If people want to go, whether to run away or to flee to a government-held area or to an opposition-held area, their free choice must be respected and they should be allowed to move to all directions or if they want to stay, where they are, must also be respected.

HPW: Yesterday, [12 September] the International Commission of Inquiry on Syria spoke about the kidnapping of teachers and healthcare workers by armed groups in Idleb governorate. Has similar information come across your desk?

MOUMTZIS: What I can say is in areas of opposition – particularly in Idleb – where there have been so many fighters that have gone there – are several areas, several pockets or islands where there is lawlessness, including fighting within the groups themselves. Respect for health workers, for teachers, for service providers, for humanitarian workers, is something we ask all sides to respect and safeguard and ensure they can do their jobs.

HPW: But this sort of action can also trigger an exodus of health care workers.

MOUMTZIS: It’s catastrophic for the people, because if doctors or nurses do not feel safe to go to work this has a massive impact particularly in areas where people are so volatile. And I think Idleb has been the dumping ground for every evacuation that has taken place in terms of fighters. So today there is a highly insecure area because you have so many different armed groups from the full spectrum – from the very hard line (to moderates) and that really creates a real sense of lawlessness and chaos in an area. Indeed, the safety of humanitarian workers and the ability of services providers to be able to continue to do their job is absolutely vital.

[Similarly, the WHO says: The situation in Idleb is already insecure and dangerous due to limited access to health services, improvised explosive devices, targeted assassinations, kidnappings, and poor living conditions.]

HPW: Any final points you would like to add?

MOUMTZIS: We all hope to see a peaceful solution forward in Idleb. I think, today [13 September] when I was at the task force, I was very much encouraged to hear everybody, whether it was the Russian Federation or the US, the two co-chairs, or other members to say, we’re working towards a peaceful solution, we’re working towards a best case scenario where we will not see a bloodshed.

HPW: Did you hear similar thoughts from the Iranian and Turkish representatives?

MOUMTZIS: The Turkish and Iranian representatives said the same thing, exactly. As humanitarians, what we’re afraid of is that despite 7-8 years of war and conflict in Syria, when we look at Idleb, our fear is that the worst might still be ahead of us. That the worst is still to come. So every effort must be made to avoid a bloodbath, to really move to a solution, that the protection of civilians the respect and protection of health infrastructure, humanitarian workers, and service providers, is respected and ensured.

HPW: Of course, nearly half the health infrastructure has been damaged and so many health personnel have left.

MOUMTZIS: Half or even more than half in some sectors. One more reason to make sure that the remaining ones are safeguarded and to continue to function and provide life-saving services to women, children, to civilians, who are in desperate need for them.

[The WHO says its response priorities include to: Improve access to basic and advanced health services, Reactivate public health facilities in newly accessible areas; Temporarily deploy mobile medical teams and clinics; Improve/expand emergency referral systems, adapt referrals for relocation, and integrate new health facilities; Strengthen preparedness and response levels for management of trauma and other emergency cases as well as cases of exposure to chemical agents; and Support diagnostic and treatment services through the provision of medical equipment and supplies to health facilities or mobiles teams and clinics. WHO also plans to expand the existing 22 WHO-supported national NGO-run mobile teams and 38 static points already providing essential services to displaced people; and scale-up support to trauma, secondary, and tertiary health care services through an active referral pathway to district and national referral hospitals.]


Image Credits: John Zarocostas.

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