“I’m upset – feeling guilty for leaving colleagues working in extreme circumstances in Syria. But I will document the violations. That is my contribution.” – Syrian refugee doctor

Physicians for Human Rights (PHR) is very fortunate to have the opportunity to meet and work with incredibly brave and talented health professionals, lawyers, and human rights activists around the world. Even in countries where human rights violations are widespread and corruption permeates every level of the government and legal system, PHR staff is consistently inspired by the courage, dedication, and brilliance of our colleagues on the ground who work tirelessly to press for transparency and accountability in their countries. Nowhere are these qualities more evident than in the Syrian health professionals and lawyers whom PHR has met through our work and trainings in the Middle East North Africa (MENA) region. Despite the personal tragedies that each of them has faced, both in Syria and as refugees in neighboring countries, they are determined to use their professional medical and legal skills not only to support immediate needs, but also to document violations to ensure accountability in an eventual post-conflict Syria.

Using the principles and methods from the Istanbul Protocol (The Manual on Effective Investigation and Documentation of Cruel, Inhuman and Degrading Treatment), and other international instruments, Syrian health professionals and lawyers are documenting the physical and psychological effects of human rights violations in order to build a credible medical body of evidence to submit to the Commission of Inquiry and to use in future justice and accountability proceedings. The work undertaken by our Syrian colleagues is difficult from both a clinical and personal perspective, but these professionals are committed, resilient, and – frankly – awe-inspiring.

However, it’s not easy to put personal feelings aside indefinitely, and I have seen a clear shift in the spirits of our colleagues over the past several months. The failure of the world to intervene to stop the violence– even in the face of chemical weapons use – has sharpened their despair. Winter is coming, and they lack the simplest of supplies, like blankets for their children. Increasingly, friends and family inside Syria are being captured and killed. Our Syrian colleagues tell us that the weeks they spend at PHR trainings are an oasis where they can focus on learning with colleagues who care deeply about the Syrian people and the future of their country. They implore PHR‘s experts to continue to mentor them as they work to document the severe human rights violations accompanying this conflict, including torture and sexual and gender-based violence. We promise to do as much as we can, and will continue to urge the international community to act in order to meet the colossal needs of the Syrian people at this time.

Despite the tremendous challenges they face, our Syrian colleagues have not lost hope. Between intense discussions and case studies last month, my colleagues and I joined in the celebration of the birth of a baby to one training participant, the promise of a visa to another who will travel to the United States to take a clinical exam, one couple’s engagement, and a birthday. We were all able to more fully appreciate these special moments given the context of the intractable catastrophe of the civil war in Syria. To say that this work is an emotional journey would be a gross understatement, but the rewards of working with such an exceptional group of people are manifest.

The health crisis in Syria has reached alarming proportions, threatening not only the Syrian population, but also its neighbors, and requires an immediate international response. While the international response to the Syria crisis has been effectively galvanized around the chemical weapon attacks and subsequent international inspections and destruction of stockpiles, a parallel potential crime against humanity has been unfolding – one that disproportionately impacts the children of Syria. Compounding an already desperate situation characterized by malnutrition, starvation, and limited access to medical services, the World Health Organization (WHO) has confirmed at least ten cases of polio. Twenty-two people, mainly babies and toddlers, have reportedly experienced acute flaccid paralysis – a typical indicator of polio – and public health workers in the region are bracing for a wider outbreak. The viral disease attacks the central nervous system, often resulting in full or partial paralysis or death. While there is no cure, polio can be prevented through immunization. The disease has been all but eradicated in most of the world, but this highly contagious disease remains rooted in the war zones of Afghanistan, Nigeria, and Pakistan. The current outbreak in Syria is the first the country has seen in 14 years.

In the Middle East, Syria was one of the earliest implementers of widespread vaccination programs for polio, and – until the conflict began in 2011 – it had one of the best polio vaccination rates in the region, seeing 95 percent of children vaccinated. Now, almost three years later, a significant number of children under the age of 5, the population most at risk for the disease, have not been vaccinated due to the collapse of medical services inside Syria.

Proper medical services have all but collapsed as the conflict rages on, due in large part to the direct targeting of medical personnel. Not only have doctors reportedly been arrested, detained without charge, and tortured, but hospitals and medical convoys have been deliberately shelled and attacked while attempting to provide desperately needed services to patients. More than half of Syria’s public hospitals have been damaged since the outbreak of violence; nearly 40 percent are no longer functioning at all. As a result, there has been a mass exodus of healthcare professionals to neighboring Jordan, Lebanon, and Türkiye. Reports claim that in some areas, nearly 70 percent of health workers have fled the violence. The ongoing civil war – waged against the backdrop of a crumbling healthcare system, the rapid disappearance of capable healthcare professionals, and restricted access – has generated the ideal conditions for severe public health crises. Cases of measles, typhoid, and hepatitis A were already increasing before the troubling outbreak of polio was even reported. The highly-communicable nature of polio in particular has many worried of its spread both within Syria and among the startling number of Syrian refugee children in neighboring countries, leading the WHO and UNICEF to initiate a joint immunization campaign targeting millions of Syrian children. However, successfully containing and limiting the polio outbreak remains in doubt, as significant portions of the Syrian population are inaccessible due to fighting, sieges, and armed blockades.

At the same time, large segments of the Syrian population are starving to death as humanitarian aid, including bread and other food staples, is blocked from reaching the people who need it most. Some reports allege that the Assad regime is intentionally waging a “Starvation Until Submission Campaign” bent on destroying the opposition and its supporters. By establishing checkpoints at which soldiers deny the passage of food, medicine, or other essential items, entire areas are effectively besieged, leaving civilians to survive on what little food they can find; sometimes the only source of food is grass or other wild greens. The level of desperation is such that a local religious leader issued a fatwa allowing those in need to eat dog or cat – the consumption of which is otherwise forbidden under Islamic law. If these allegations regarding intentional starvation of the population are true, President Assad could be charged with war crimes or even crimes against humanity if deprivation of food is determined to be a widespread or systematic attack against civilians. Furthermore, international humanitarian law guarantees protection to both medical and other humanitarian personnel working to provide relief to populations impacted by conflict. All parties to conflict who attack personnel and service convoys or otherwise block civilian access to these services are in violation of international norms set by the Geneva and Hague Conventions.

Syrians, both inside and outside of Syria, have been imploring the global community to intervene in the conflict for more than two years now. Many were enraged that the world waited until chemical weapons use was alleged – the so-called “red line” that President Obama identified – before considering credible threats to intervene to stop mass atrocities and protect lives of civilians. While a laudable achievement, the dismantling of the Syrian chemical weapons capability does not mark an end to the suffering of the Syrian people. The international community has focused its attention on weapons that, though horrific, account for only a small percentage of the more than 100,000 deaths in Syria. Conventional weapons, and increasingly now disease, malnutrition, and starvation, are the larger threats to the people of Syria. While I was recently in the region, a Syrian doctor, who works closely with PHR, expressed his frustration with the global community and the UN Security Council: “If you are not able to completely stop war in Syria, please do not worry about chemical weapons in the hands of criminals. Death with chemical weapons is much easier than starving to death.”

The UN estimates that more than 9 million people – more than 40 percent of the Syrian population – now require humanitarian assistance. Public health threats such as polio and malnutrition represent an immediate and dramatic crisis, particularly to the country’s most vulnerable segment – its children. Access to essential services must be ensured, as food aid and medication is essential to preventing the unnecessary death of Syrian children and others displaced by the conflict.

PHR calls on all parties within Syria to guarantee safe, full, and unhindered access to humanitarian aid, including food and medical supplies, throughout Syria. The ICRC, its partners, and all humanitarian personnel must be allowed to move unimpeded to the besieged areas in order to address desperate humanitarian needs. Barring a cessation of hostilities, the deteriorating public health situation inside Syria can only be properly addressed by allowing much-needed aid to reach those forced to live in deplorable and dangerous conditions. As the international community responded to the use of chemical weapons, so too must it urgently respond to this burgeoning humanitarian and human rights crisis and prioritize bringing about an end to the relentless violent attacks on civilians and the country’s infrastructure that are essential to survival.

This post originally appeared in The Washington Post.

Rakhine state, on the western coast of Burma, is among the most dangerous places in the world to be a Muslim.

Just over a year ago, simmering tensions and small-scale clashes erupted into mass violence between Buddhist Rakhines and Muslim Rohingya, a minority of about 800,000 whose roots in Burma are several centuries old. During these rampages, Buddhist mobs stormed Muslim enclaves, setting fire to villages, destroying schools and mosques and leaving scores of Rohingya dead.

One victim of the violence was Ayessa, a 55-year-old woman who lived in Sittwe, the capital of Rakhine state. Her husband and brother were killed, and she was forced to flee her home for a displaced persons’ camp. She sought to leave Burma on a boat with her two young granddaughters and other relatives but was turned back by Burmese authorities. She was returned to one of the camps, where displaced Rohingya continue to be confined a year after the violence, cut off from nearly all goods and services. The September United Nations humanitarian bulletin reports that 180,000 people in camps and segregated communities in Rakhine state need life-saving assistance — nearly all are Muslim, and a majority, about 103,000, are children. Yet humanitarian agencies increasingly are obstructed from reaching those in need.

The anti-Rohingya violence has since affected other Muslims in Burma. In September, a Buddhist mob rampaged through a Muslim neighborhood of Kamein ethnicity in Thandwe, a town in Rakhine state. Among those killed was a 94-year-old grandmother. Attacks have been reported in dozens of locations across Burma. In the central town of Meiktila, for example, a mob massacred middle-school students and their teachers, among others. Survivors told investigators from Physicians for Human Rights grisly details of beatings, stabbings, decapitations and immolations while scores of police officers watched and hundreds of bystanders cheered and shouted such things as, “Kill them!” A key catalyst for the violence is the rising influence of the 969 movement, a campaign led by Buddhist monks that preaches religious purity and urges boycotts of Muslim-owned businesses.

The threat of future violence is acute against all Muslims in Burma but particularly the Rohingya. Burma’s 1982 citizenship law does not include the Rohingya among the country’s officially recognized ethnic groups, so they are essentially stateless. They are widely reviled throughout Burma as illegal immigrants. They must obtain official approval to marry and to travel, even to neighboring villages; in some areas, they are prohibited from having more than two children. Many Rohingya, including children, have been forced to work without pay for government and military authorities. Rohingya routinely face arbitrary arrest and detention, confiscation of property, and physical and sexual violence.

Perhaps most outrageous amid this violence against Rohingya and other Muslims has been the tacit support of Burmese authorities. Investigations by Physicians for Human Rights and others have found that Buddhist monks and local politicians incited and led many of the attacks. State security forces have failed or refused to stop incidents of violence and sometimes participated in it. While hundreds of Muslims have been jailed for supposedly instigating the violence, few perpetrators have been arrested. It has become evident that there is little risk in Burma to those who attack Muslims.

In the past few years, Burma has made remarkable progress on political reform. But in his final report last month as the U.N. special rapporteur on human rights in Burma, Tomás Ojea Quintana called attention to the “profound crisis” in Rakhine state and expressed concern that the de facto segregation of Burma’s Muslim communities would become permanent.

The Burmese government’s eagerness to attract foreign investment and aid provides opportunities for the international community to encourage and assist in protecting all of Burma’s peoples from crimes against humanity and ethnic cleansing. Indeed, largely in response to outside pressure, members of Burma’s government have signaled their intention to address the plight of the Rohingya; Burmese President Thein Sein visited Rakhine state last month for the first time since the violence started in 2012 and offered soothing words.

But there has been little progress toward easing the suffering of the Rohingya or protecting Muslims from further discrimination and violence. Pro-democracy leaders have been passive in the face of the anti-Muslim violence. Without greater initiative from Burma’s leaders and vigilance from its friends abroad, the mix of religious nationalism, ethnic violence and state complicity could yet reap catastrophic violence, which would be disastrous for the entire nation.

When armed forces bomb hospitals, attack ambulances, and target healthcare providers, the effect on the sick and injured is devastating. Physicians for Human Rights (PHR) promotes medical neutrality – the principle of noninterference with medical services in times of armed conflict and civil unrest. When medical neutrality is violated, PHR documents the deliberate targeting of health care systems and personnel and advocates accountability for violators. This fact sheet provides an overview of medical neutrality, the ethics and laws behind it, and PHR’s reporting on when it’s violated.

Click here for to read our latest Policy Brief: Medical Neutrality and Right to Health (Türkiye)

Three medics currently jailed in Bahrain, Ibrahim Aldemestani, Dr. Ali Al-Ekri, and Hassan Salman Al-Maatouq, wrote this letter calling on the world to recognize their unjust imprisonment for upholding principles of medical neutrality. They call attention to unsanitary conditions of imprisonment and urge medics worldwide to abide by medical ethics. They end the letter by announcing their intention to form an independent body of Medics for Human Rights in Bahrain. The full handwritten letter can be found here.

The Bahraini government’s response to the early 2011 pro-democracy protests was brutal, systematic, and violent. In addition to birdshot and rubber bullets, government law enforcement attacked unarmed protestors with toxic chemical agents including tear gas. The government’s crackdown on the medical profession was especially harmful, as security forces arrested and detained doctors, raided health facilities, and obstructed patients from receiving necessary care. This fact sheet provides an overview of Bahrain’s violations of medical neutrality and its weaponized use of tear gas.

More than 35 prominent doctors and public health professionals sent this letter to President Obama and called on him to end force-feeding at Guantánamo and stop undermining medical care.

The letter highlights that some detainees remain on hunger strike and continue to be force-fed, a practice that goes against established medical ethics and has been condemned by the American Medical Association (AMA) and the World Medical Association (WMA). The signatories, who have all been leaders at major U.S. health institutions, say that participating in force-feeding compels doctors to forego their independent medical judgment.

The historic deal brokered by the United States and Russia facilitating Syria’s compliance with international chemical weapons norms has drawn wide attention from the international community. And while the work of the joint mission of the Organisation for the Prohibition of Chemical Weapons and the United Nations (OPCW-UN) is critical to enhancing global security, dismantling Syria’s chemical weapons program is overshadowing the more immediate humanitarian crisis facing the region: the ongoing and burgeoning Syrian refugee crisis.

Currently, more than 2 million individuals have fled Syria and 4.25 million have been internally displaced. Efforts to dismantle Syria’s chemical weapons program have done nothing to quell the violence within its borders or stem the tide of refugees fleeing the country. As the civil war rages on, the provision of assistance to those trapped inside Syria becomes increasingly difficult. The delivery of aid is hampered by rapidly-changing front lines as well as by blockades imposed by armed groups. Meanwhile, many continue to flee the country daily, swelling the already-large ranks of refugees and creating the world’s largest humanitarian crisis.

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) expects the number of refugees to reach 3.2 million by the end of 2013 and increase by another 2 million in 2014. By the end of 2014, OCHA predicts that more than one-third of Syria’s pre-war population of 23 million people will be either refugees or internally displaced people (IDPs). Such alarming levels of displacement have serious regional implications, particularly for Egypt, Iraq, Jordan, Lebanon, and Türkiye, the countries that currently host the majority of Syria’s refugees.

These nations are already at their limit as they work to provide shelter and services to displaced Syrians. Despite UN appeals to the international community for increased funding, host countries continue to shoulder the bulk of the burden. Both Türkiye and Jordan have spent close to $2 billion each caring for refugees with the majority of that money coming from their own coffers. Lebanon, a country of only 4 million residents, currently hosts 750,000 Syrian refugees, in addition to hundreds of thousands of Palestinians. Jordanian authorities likened the presence of Syrian refugees in Jordan to “the United States absorbing the entire population of Canada.” The influx of people in all host countries has a marked effect on local economies, health infrastructure, and education systems, thereby straining both resources and relationships.

With no end to the conflict in sight, the prospect of more refugees requiring a prolonged stay has created an unwelcoming environment for refugees in many countries. There are reports of some refugees facing indefinite detention or deportation back to Syria. Poor camp conditions, tense dynamics with local populations, and harassment from government officials have created a sense of desperation among countless Syrians. Many pay thousands of dollars to smugglers and risk their lives attempting dangerous journeys to Europe in search of asylum. However, reaching Europe does not mark the end of these refugees’ struggles, as they face overwhelmed and inconsistent asylum systems in the European Union.

PHR applauds the difficult work being done in challenging environments on behalf of refugees and the countries hosting them. But we urge the international community to recognize the need for continued support of these efforts and to not allow other issues to overshadow the ongoing displacement crisis in Syria and the region. As winter approaches, these humanitarian needs become more urgent. The international community must seize opportunities to provide assistance and security to those fleeing armed conflict – not just in Syria, but around the globe.