Health care workers in Syria were significantly more likely to be detained, die in detention facilities, or be forcibly disappeared if they had provided medical care to injured protesters compared to health care workers arrested for political reasons, a report from Physicians for Human Rights (PHR) published today found.
The findings underscore a government strategy to target health care workers from the earliest months of the conflict, when peaceful demonstrators calling for rights and democracy in Syria were met with brutal violence and cruelty.
Based on a new data set compiling information on 1,685 detentions of 1,644 health care workers from 2011 to 2012, the report analyzes patterns in the Syrian government’s detention, enforced disappearance, and abuse of health care workers during the early years of the Syrian uprising. The analysis also found that non-physician health care workers were less likely to be released from detention and more likely to die in detention or be forcibly disappeared compared to physicians who were detained.
“The Survivors, the Dead, and the Disappeared: Detention of Health Care Workers in Syria, 2011-2012” sheds new light on the Assad regime’s brutal and widespread crackdown on health care workers for treating perceived opponents of the government, even during the period of peaceful mass protests in the country. The report finds:
- Health care workers detained for providing medical care to injured demonstrators had 91 percent lower odds of release, 400 percent higher odds of dying in detention, and 550 percent higher odds of being forcibly disappeared compared to health care workers who were arrested for political activities.
- Physicians, who likely had more resources and connections to navigate detention, had 143 percent higher odds of release, 48 percent lower odds of dying in detention, and 52 percent lower odds of being forcibly disappeared compared to non-physician health care workers, such as nurses, pharmacists, and medical students.
The United Nations estimates that at least 100,000 Syrians have been forcibly disappeared and tens of thousands of civilians have died in detention facilities after being forcibly disappeared during the decade-long conflict in Syria. Forcible disappearance is defined as the secret abduction or imprisonment of a person, followed by a refusal to acknowledge the person’s fate and whereabouts, with the intent of placing the victim outside the protection of the law. In its recommendations, PHR strongly supports an emerging UN mechanism on the missing in Syria, urging that families of the missing and survivors of detention and torture play a leading role.
PHR publishes this report as the Syrian government is actively seeking to normalize diplomatic relations with its neighboring states and the broader international community. In the light of the report’s revelations, PHR calls on governments to use this critical window of opportunity to compel all parties to the Syrian conflict to negotiate the release of detainees and to demand transparency from the Syrian government about the status of people who have died in detention. In any negotiations with the Syrian government, PHR calls on the international community to ensure that survivor-led plans for peace and accountability take precedence in decision-making.
“Syrian health care workers endured unthinkable brutality in detention facilities, with interrogators saying they were being tortured for providing medical care to injured protestors. This report confirms that those detained for treating wounded demonstrators often faced worse outcomes than detained health care workers who were political dissidents, which is profoundly disturbing evidence of the Syrian government’s war on health workers,” said Houssam Al-Nahhas, MD, MPH, report co-author, Syrian physician, and detention survivor, who served as PHR’s Middle East and North Africa researcher (November 2020 – August 2021). “Even during the time of peaceful mass protests prior to armed opposition, the Syrian government was detaining, torturing, killing, and forcibly disappearing hundreds of health care workers across the country. Our study makes it even more clear that any future discussions with the Syrian government must demand the release of all people unjustly detained as well as total transparency about the fates of the many missing to this day.”
The report is primarily based on a data set containing 1,685 community-generated records of the detention of health care workers in Syria between January 2011 and December 2012. The data set was developed by cleaning, recoding, and merging three independent data sets provided to PHR by the Open Society Justice Initiative, the Syrian Network for Human Rights, and the Violations Documentation Center. PHR researchers also conducted in-depth interviews with four members of a medical team that operated in Aleppo in 2012 and a desk review of open-source documentation to create a timeline and verify accounts presented in the case study.
Given the Syrian government’s decades-long failure to allow access to, publish information about, or even acknowledge the existence of its sprawling detention apparatus, the study is unable to generalize about the scope or scale of the government’s detention, enforced disappearance, and persecution of health care workers in Syria. The extreme security risks for and extensive stigma against survivors and their family members posed additional limitations to the research, which are noted in the study (see “Methodology” section). Additionally, only 18 percent of cases in the data set (299 of the total 1,685 detentions) included notes indicating the reason for detention. Despite these caveats, the report provides an unprecedented look at the Syrian government’s use of detention, torture, and disappearance both to punish health care workers and to reduce access to health services for peaceful protesters across the country.
“After more than a decade of atrocities, Syrians deserve justice and accountability for the mass enforced disappearance of opponents of the Syrian regime and the health care workers who provided care to the wounded according to their ethical and moral duties,” said Susannah Sirkin, director of policy at PHR. “Earlier this year, a coalition of Syrian organizations representing survivors, their families, and family members of the missing developed the ‘Truth and Justice Charter,’ which sets goals for transparency, redress, and accountability. PHR calls on the United Nations and international community to listen to survivors and fully embrace the Charter. There can be no sustainable peace or reconciliation without truth and justice, led by survivors and their families.”
The PHR report analyzes detention cases by profession, age, gender, governorate of origin, governorate of detention, reason for detention, duration of detention, and last known status. Of the health care workers known to have been detained for providing health care, only 14 percent were released; 10 percent are known to have died in detention; and 75 percent were forcibly disappeared, or taken by the government without recognition or a legal process.
Of the available cases where detention duration was noted, the median length of detention was 37 days, with a maximum of 2,778 days (7.6 years). The median length of time that elapsed between a health care worker’s detention and reported death was 137 days (about 4.5 months), with a maximum of 2,078 days (5.7 years).
The report also provides a timeline of events in Syria from 2011-2012 that highlights key events and the rapid escalation of the Syrian government’s violent crackdown on peaceful protests during the early phases of the Syrian uprising, as well as a case study about the Noor al-Hayat medical team in Aleppo.
The Noor al-Hayat group formed to provide medical care to injured protesters who were threatened with detention and death by security forces if they attempted to seek care at public hospitals. Within just one year of the group’s formation, six of the 13 members had been detained and four had died after reportedly being tortured in detention.
“This report paints a clear picture of how the Syrian regime has targeted health care workers since the first months of the popular movement in 2011 with persecution, arbitrary arrest, and enforced disappearance,” said Fadel Abdul Ghany, founder and director of the Syrian Network for Human Rights. “The international community must speak out on these cases, as we no longer hear any demands about their fate or release. States must condemn the continued violations committed against detainees and hold the Syrian regime accountable. Syrian health care workers’ heroic sacrifices have largely been forgotten. The fate of all the forcibly disappeared, including medical personnel, must be revealed to stop this never-ending cycle of suffering and mental anguish.”
PHR’s report findings, alongside extensive documentation of detention-related abuses in Syria compiled over the course of the Syrian conflict, warrant comprehensive accounting and redress for violations of domestic laws, human rights law, and international humanitarian law.
“This report confirms the Syrian government’s large-scale violence against the peaceful opposition and anyone who provides health assistance to it, in grave violation of international laws and treaties. The Syrian government uses these violations as a weapon of war, a pressure tool against its opponents, and a means of financial blackmail, regardless of humanitarian and legal considerations,” said Abdulrahman Dabbas, operations manager at the Violations Documentation Center (VDC) project at the Syrian Center for Media and Freedom of Expression (SCM), which has worked since 2011 on documenting violations of human rights law and international humanitarian law in the context of the Syrian conflict. “SCM emphasizes the importance of establishing a mixed UN mechanism to reveal the fate of the forcibly disappeared. We encourage the international community to establish a special fund to compensate victims and support them in finding the truth and reintegrating into economic life, as well as to put pressure on the Syrian government to sign the International Convention on Enforced Disappearances.”
“The Assad government continues to perpetrate atrocities against its own people with impunity. This robust data with the detention details of more than 1,600 health care workers should support criminal proceedings against those responsible for international crimes committed by the Syrian government, including Bashar al-Assad himself,” said Steve Kostas, senior legal officer at the Open Society Justice Initiative (OSJI). “OSJI represents several doctors in ongoing criminal proceedings, and we call on states to use all the tools at their disposal – whether it be pursuing universal jurisdiction prosecutions or pooling resources to form an international tribunal – to investigate and prosecute these and other atrocity crimes.”
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.