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Thursday, November 7, 2013

Doctor Describes Humanitarian ‘Nightmare’ In Syria

Smoke rises after an air strike, Sept. 22, 2013, in a village that has been turned into a battlefield between Free Syrian Army fighters and government forces in Idlib province, northern Syria. (Narciso Contreras/AP)

Smoke rises after an air strike, Sept. 22, 2013, in a village that has been turned into a battlefield between Free Syrian Army fighters and government forces in Idlib province, northern Syria. (Narciso Contreras/AP)

A new report from the United Nations estimates that 40 percent of Syria’s population now needs humanitarian aid. And there are growing concerns about a recent polio outbreak and about the rise of hunger, in a middle class country that’s never had to deal with that issue.

Dr. Brian D’Cruz, a Virginia-based emergency physician, just returned from spending two months in Idlib province in northern Syria with Doctors Without Borders.

He describes what he saw for Here & Now’s Robin Young.

“The humanitarian system is a nightmare. Their medical system has entirely collapsed,” he said.

Interview Highlights: Dr. Brian D’Cruz

On the state of Syria’s medical system

“The humanitarian situation is a nightmare. Their medical system has entirely collapsed. People are exposed to conflict and injuries from the war, and a whole spectrum of diseases that they haven’t seen before. People with chronic diseases have essentially no access to follow-up care, and those with emergency needs have almost nowhere to go.”

On mental illness

“Besides the preexisting complaints — people with depression and schizophrenia and mental illness who couldn’t find counseling, couldn’t find medications — there were also people traumatized by the war. When we would ask children to draw for us, they would most often draw bombs and planes and collapsing buildings. It’s become so much a part of the culture that people exist in a state of constant stress.”

On local support for doctors and patients

“Where we worked, there was an extraordinarily strong sense of community. We had terrible events happen — mass casualties, where we’d get 20 or 30 patients at a time. But it was incredible to see how local people came together.”

“You had people bringing candy and cookies to children that were injured, and people who just heard what had happened would come to the hospital and offer to carry stretchers and walk people around and help get supplies for the people who needed them. In the midst of a terrible situation, it was very impressive to see the spirit of people.”

Guest

  • Dr. Brian D’Cruz, Virginia-based ER doctor.

Transcript

ROBIN YOUNG, HOST:

It's HERE AND NOW.

The U.N. estimates that 40 percent of all Syrians now need humanitarian aid. There are growing concerns about a recent polio outbreak, and about the rise of hunger. The New York Times quotes observers who say there could soon be more deaths from hunger than from fighting in Syria.

Let's take a closer look with Dr. Brian D'Cruz. He's an American ER doctor at the Inova Fairfax Hospital in Virginia, just back from spending two months in Idlib province, in northern Syria, with Doctors Without Borders. And he joins us from the NPR studios in Washington. Welcome.

DR. BRIAN D'CRUZ: Thank you very much.

YOUNG: And we have been hearing incredible reporting of places in Syria just absolutely devastated. What was it like where you were?

D'CRUZ: Well, the situation is terrible. I was working in an ER inside of a hospital that - we had built a makeshift hospital in a converted chicken farm. And it's - the humanitarian situation is a nightmare. Their medical system has entirely collapsed. People are exposed to conflict and injuries from the war, and a whole spectrum of diseases that they haven't seen before. People with chronic diseases have essentially no access to follow-up care, and those with emergency needs have almost nowhere to go.

YOUNG: What are the diseases that you're seeing, that people hadn't seen before?

D'CRUZ: Problems like malnutrition, like severe diarrhea, things that people in displaced situations have because in Syria, this type of disease had never occurred in the past. People haven't been used to living without sanitation, without plumbing, or without a regular food supply for children.

YOUNG: Yeah. Well, speak of the food because we've been hearing from Lyse Doucet, of the BBC, that food has become a new weapon; that the army is forming blockades around towns where insurgents live, and blocking any food transport in. And then in some other areas, maybe to a lesser extent, but the insurgents that are fighting the regime there are also blockading food.

D'CRUZ: Well, I can't speak for food supply, but I did treat two children with severe acute malnutrition, children who were starved to the point of looking like skeletons. One of them did, in fact, die while we were attempting to treat her. The other was an 11-month-old boy with a mild form of cerebral palsy. But because of difficulty getting proper medical care and getting appropriate formula for him, he was slowly starving to death. When he arrived, he had severe pneumonia as well. We were able to start systematic treatment. And last I heard, he's actually doing quite well.

YOUNG: And you make a point that we might not have thought of, that hunger can be treated. But large parts of Syria were very sophisticated, and they had not seen hunger before. So what are you saying, they didn't know how to treat it?

D'CRUZ: Well, treating severe acute malnutrition is incredibly difficult because a lot of the children, if you attempt to feed them, their bodies can't keep up with the stress of growing. And they - they can have heart failure; they can die. It's a very systematic approach that has been used in other places in the world that are more prone to malnutrition. You give antibiotics. You give vitamins. You give measles vaccination, if they haven't had it. And then you start with this low-calorie, high-nutrient milk, to tank up their system; and then add other things, like a peanut paste called Plumpy'nut, or a high-energy milk to help children grow normally. But the doctors and nurses there had literally never seen malnutrition on this scale, and had no idea how to treat it. And we were very involved with teaching people, in the patients that we saw.

YOUNG: What about the role of doctors in Syria? I know you don't want to talk about how you got into the country because it's very dangerous.

D'CRUZ: Yes.

YOUNG: But doctors who are there, who are Syrian, others coming in, the New York Review of Books reported on how the regime of Bashar al-Assad views doctors as dangerous because they can heal rebel fighters. And in the last couple of years, doctors, nurses, pharmacists have been arrested, detained; paramedics tortured; ambulances targeted by snipers. Did you observe any of this view of doctors?

D'CRUZ: I did not observe any of that directly. I can say that doctors in Syria, in the area where we were working, had difficulty finding a place to work. There were very talented, very well-trained doctors and nurses and technicians, and people who had worked in very, very state-of-the-art hospitals who were having difficulty finding anywhere to work. And these are people who desperately wanted to work ,to help the community around them.

YOUNG: What about mental health? It's over two years. What are you seeing there?

D'CRUZ: Besides the pre-existing complaints - people with depression and schizophrenia and mental illness who couldn't find counseling, couldn't find medications - there were also people traumatized by the war. When we would ask children to draw for us, they would most often draw bombs and planes and collapsing buildings. It's become so much a part of the culture that people exist in a state of constant stress.

YOUNG: And we mentioned polio. The World Health Organization last month confirmed an outbreak. This is now one of the only places in the world with polio. As a doctor, what would have to happen here to stave this off?

D'CRUZ: Well, we were involved with a vaccination campaign but were able to work in one, small area and reach the people immediately around us. People - many people have not had vaccinations for the last two years. Children born during the conflict very often have not had any vaccinations at all. To prevent polio and measles and these other diseases, you need extensive vaccination campaigns to cover huge proportions of the population.

YOUNG: Yeah because - I mean, it's not just vaccinating the people, but as their surroundings degrade more and more, and if you have polio in the water or - I mean, it's just going to be so easy for it to spread.

D'CRUZ: I mean, people are much more exposed to all diseases when they're outside and huddled together, and don't have good sanitation and don't have good shelter.

YOUNG: Yeah. It's just - it seems like unrelentingly grim. Did you see any light at the end of this tunnel?

D'CRUZ: Where we worked, there was an extraordinarily strong sense of community. We had terrible events happen - mass casualties where we get 20 or 30 patients at a time. But it was incredible to see how local people came together, to try to work. You had people bringing candy and cookies to children that were injured. And people who just heard what had happened would come to the hospital and offer to carry stretchers and walk people around, and help get supplies for the people who needed them. It was, in the midst of a terrible situation, was very impressive to see the spirit of people.

YOUNG: But still, a pretty terrible situation. So what do you with this now, Brian, Dr. D'Cruz? You're back in Virginia. What do you do with this experience you've had?

D'CRUZ: Part of it is trying to help people know what happened there, and encourage humanitarian aid to reach people - because I realize where we were working, we were able to accomplish something. But it is such a small drop in an ocean of need. I'd like for people to know what the needs are there and- in the hopes that people can try to work and get more humanitarian aid to everybody involved in the war.

YOUNG: Again, the group that he traveled with, Doctors Without Borders. Dr. Brian D'Cruz, emergency room doctor, now back home in Virginia. Dr. D'Cruz, thanks so much.

D'CRUZ: Good. Thank you.

YOUNG: And you're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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