TIME Middle East

In Photos: Injured Syrian Refugees Adjust to Life With Prosthetics

One in 30 Syrian refugees in Lebanon was injured in the civil war

Some 200,000 people have died in Syria’s ongoing civil war—and there’s no end in sight. But it’s the impact on those who make it out alive and injured—often severely—that can sometimes be forgotten.

More than 3 million Syrians are registered as refugees outside their home country, the latest U.N. figures show. Turkey, Iraq and Jordan have all taken in hundreds of thousands of them, but nearly 1.2 million have crossed into Lebanon. According to an April report by Handicap International, one in 30 Syrian refugees in Lebanon had been injured, which means that tens of thousands of people there are carrying permanent scars from the war.

Irish photographer Andrew McConnell has been based in Beirut for about two and a half years. During that time he has frequently photographed along the Syrian border and covered the refugee crisis in Lebanon from its earliest stages, watching the numbers grow from a few thousand refugees largely hidden in society to a mass that is now equal to more than a fifth of Lebanon’s pre-war population, spread throughout urban areas and informal settlements.

Earlier this year, when McConnell was on contract working alongside UNHCR and a partner organization called the World Rehabilitation Fund, he met more than 20 refugees who were receiving rehabilitation treatment, including prosthetics.

McConnell was moved by stories from people like Fatima, a 15-year-old living at a tented settlement near Tripoli, who had been traveling with her brother and father to Homs in 2011 when a bomb fell on the road. The next thing Fatima knew, she was waking up in the hospital without her right leg. She became depressed after being provided with an ill-fitting prosthetic, but her mood lifted after receiving a better-fitting one from the WRF.

He also met 15-year-old Nawaf at a rehabilitation center in Tripoli, who was severely burned when a bomb hit his house near Hama. His uncle rushed him to a nearby field hospital but doctors had to amputate his right arm above the elbow. The boy later received a prosthetic arm and is learning a range of moments, and is slowly becoming more self-reliant. But, McConnell notes, “you just wonder what’s ahead for him, trying to cope with this new reality.”

But it was Hussein, a 10-year-old living in a collective shelter in Tripoli, with whom McConnell spent the most time. Hussein had been presumed dead after a bomb hit his home in Syria, but was found unconscious at the morgue the next day as bodies were being prepared for burial. The boy received two artificial limbs after doctors amputated both legs above the knee.

“At first, he was very apprehensive about this foreigner and having his picture taken and telling his story,” says McConnell. “He was deeply traumatized but I remember he had probably the most state-of-the-art prosthetics that I saw.” After spending more time with the boy and as Hussein became more accustomed to his new legs, his mood changed and he opened up a bit. “I remember pacing alongside him as he learned how to walk again.”

TIME Syria

U.N. Says Syria Refugees Top 3 Million Mark

Syrian refugees flee from Lebanon
Syrian refugees wait in the border town of Arsal, Lebanon, on Aug. 8, 2014. Bilal Jawich—Anadolu Agency/Getty Images

One of every eight Syrians has fled across the border, and 6.5 million others have been displaced within Syria since the conflict began in March 2011

(GENEVA) — The civil war in Syria has forced a record 3 million people out of the country as more than a million people fled in the past year, the U.N. refugee agency said Friday.

The tragic milestone means that about one of every eight Syrians has fled across the border, and 6.5 million others have been displaced within Syria since the conflict began in March 2011, the Geneva-based agency said. More than half of all those uprooted are children, it said.

“The Syria crisis has become the biggest humanitarian emergency of our era, yet the world is failing to meet the needs of refugees and the countries hosting them,” said U.N. High Commissioner for Refugees Antonio Guterres.

Syria had a prewar population of 23 million.

The recent surge in fighting appears to be worsening the already desperate situation for Syrian refugees, the agency said, as the extremist Islamic State group expands its control of broad areas straddling the Syria-Iraq border and terrorizes rivals and civilians in both countries.

According to the agency, many of the new arrivals in Jordan come from the northern province of Aleppo and the northeastern region of Raqqa, a stronghold of the group. An independent U.N. commission says the group is systematically carrying out widespread bombings, beheadings and mass killings that amount to crimes against humanity in both areas.

The commission investigating potential war crimes in Syria said on Wednesday that the Syrian government of President Bashar Assad likely used chlorine gas to attack civilians, who are bearing the brunt of a civil war that has killed more than 190,000 people and destabilized the region.

The massive numbers of Syrians fleeing the civil war has stretched the resources of neighboring countries and raised fears of violence spreading in the region.

The U.N. estimates there are nearly 35,000 people awaiting registration as refugees, and hundreds of thousands who are not registered.

International Rescue Committee President David Miliband said the Syrian refugee crisis represents “3 million indictments of government brutality, opposition violence and international failure.”

“This appalling milestone needs to generate action as well as anger,” he said, calling for more aid to Syria’s overburdened neighbors and for civilians still in the country.

The refugee agency and other aid groups say an increasing number of families are arriving in other countries in shockingly poor condition, exhausted and scared and with almost no financial savings left after having been on the run for a year or more. In eastern Jordan, for example, the agency says refugees crossing the desert are forced to pay smugglers $100 per person or more to be taken to safety.

Lebanon hosts 1.14 million Syrian refugees, the single highest concentration. Turkey has 815,000 and Jordan has 608,000.

TIME Israel

Missiles from Lebanon are Landing in Israel—But Hizballah Isn’t the Suspect

Israeli security forces stand next to damage caused by Katyusha style rocket fired from Lebanon near the border between northern Israel and Lebanon, on July 11, 2014.
Israeli security forces stand next to damage caused by Katyusha style rocket fired from Lebanon near the border between northern Israel and Lebanon, on July 11, 2014. JINI/Xinhua Press/Corbis

Lebanon's most fearsome anti-Israel militant group has stayed out of the Gaza crisis. That could change if Israel overreacts to rockets coming from Lebanon

Israel has a lot of enemies in the region, so it’s not surprising that it is taking fire from multiple sides—including from southern Lebanon, the source of at least four missile launches into northern Israel in recent days. What is surprising is that none of those attacks originated from Israel’s archenemy Hizballah, the powerful Lebanese militia that dominates the country’s south.

Some 11 rockets landed in Israeli territory. No one was hurt. At least two failed to launch, according to Lebanese military accounts quoted in Lebanon’s Daily Star newspaper, and one never made it into Israel. Not far from the United Nations-monitored Blue Line that demarcates the border between Lebanon and Israel, Lebanese bomb defusers. were able to dismantle two other rockets before they could be launched. All in all, the rocket attacks appear to be the work of amateurs driven to action by the Israeli attacks on Gaza, says Lebanese political analyst Kamel Wazne, and not that of an organized militant group. “If Hizballah decided to launch a war on Israel, well, Israel already knows what that looks like,” he says. (Hizballah has not commented on the attacks.)

On Wednesday July 16, the Lebanese military announced that it had apprehended two Palestinian brothers who had admitted to launching one of the attacks, as well as a Lebanese man who was implicated in the first rocket volley on Friday. Since the attacks started Friday, the Lebanese army has engaged in a concerted effort to prevent any further cross-border attacks by increasing patrols in the area and reaching out to the U.N. peacekeepers that have been in place in south Lebanon since the 2006 war between Israel and Hizballah. Lebanon, including Hizballah, does not want to see another war with Israel, says Wazne. “There is a consensus in Lebanon that no missiles should be launched from Lebanese territory, and that these acts do not serve the Lebanese interest or the Palestinian cause.”

One of the three detained men appears to be affiliated with a radical Lebanese group, al-Jamaa al-Islamiya that has gained ground among Lebanese Sunni militants aligned with rebels fighting the forces of Syrian President Bashar Assad. Hizballah, in turn, backs Assad. The attackers, say Wazne, could have been motivated by a desire to deflect Israeli attention away from Gaza and towards Hizballah in an effort undermine the group’s support for Assad. Meanwhile Hamas, the Palestinian militant group battling Israel from Gaza, has also claimed responsibility for an attack from Lebanon, but it is not clear that it could have achieved such a feat, considering its limited presence on the ground.

All of which begs the question: why isn’t Hizballah getting involved in the Gaza conflict, which intensified on July 17 as Israel announced a ground invasion of the enclave? For a militant group whose leader, Hassan Nasrallah, uses every opportunity to decry what he calls Israel’s illegal occupation of Palestine, Hizballah has been remarkably quiet since Israel launched its operation in Gaza a week ago. Hizballah’s standard rhetoric is that it is always ready for another confrontation with Israel, but it is just as likely that the militant group is keeping a low profile in order to better focus its efforts on Syria.

It’s not that Hizballah couldn’t handle two fronts at once, says Wazne, who has close contacts in Hizballah’s leadership. He believes the group is keeping a close eye on the events in Gaza, but as long as Israel does not attack Lebanon, it sees no need to get involved. The real risk, he cautions, is if Israel overreacts to the missiles being lobbed over the Lebanese border. Israel has met every incoming rocket with a barrage of its own into south Lebanon, but so far there has been no casualties or damages on either side. Lebanese Foreign Affairs minister Gebran Bassil threatened to lodge a complaint with the U.N. Security Council over Israel’s excessive response against Lebanon. “Someone is trying to use Lebanon as a launching pad to respond to Israel over events in Gaza. This is not the policy of the state, and it is taking measures against these sporadic groups.” he told reporters Tuesday. “But that doesn’t mean Israel can attack Lebanon.”

If it does, notes Wazne, Hizballah will be ready.

TIME Syria

Report Details Hardships Facing Syria’s Refugee Mothers

Syrian Refugees; Lebanon; North Lebanon; refugees
Sanaa, 26, washes clothes in a borrowed washing machine at a shelter in Saida, Lebanon, on March 4, 2014. Lynsey Addario—UNHCR

Some 145,000 refugee households are headed by women

A new U.N. report grimly details the daily plight of thousands of Syrian refugee mothers who have fled civil war and now toil as their household’s primary breadwinner.

Four-fifths of the 2.8 million Syrians who have fled their war-torn homeland since March 2011 are women and children, says the U.N., leading to some 145,000 refugee households headed solely by women. The survey, based on three months of interviews with 135 women in Egypt, Jordan and Lebanon, provides a snapshot of the complexities they endure while trying to feed and protect their children, find enough work to make rent and retain any semblance of the lives they enjoyed before war broke out.

They represent women who once managed their homes, even as their husbands usually handled physical and financial security, but who now lead households in unfamiliar and often insecure communities. Lebanon, a nation of 4 million, has taken in more than a million people. At least 600,000 have entered Jordan, with most gravitating toward urban areas, an influx that has crushed certain infrastructure. In addition, some 137,000 have made it to Egypt.

António Guterres, the U.N. High Commissioner for Refugees, said “escaping their ruined homeland was only the first step in a journey of grinding hardship” and called their treatment “shameful” as the crisis worsens. “They have run out of money, face daily threats to their safety and are being treated as outcasts,” he added, “for no other crime than losing their men to a vicious war.”

Typically, their first challenge was simply finding a roof. Many make do with overcrowded or makeshift housing, due to few options and difficulties in securing a stable and sufficient income. Only one-fifth of those interviewed had paid work, and many others said they relied on cash assistance from aid groups or generosity from others in their community.

Paying rent is among their top stressors, as is feeding loved ones. With an average of 5.6 people per household, some mothers said their families ate less as a whole or individuals held back so others could eat more. “Rent is more important than food,” one woman who lived with her seven children in Amman told the U.N. “We don’t remember what meat or fruit tastes like,” echoed another, who kept a home of nine people in Giza, Egypt.

The vast majority of women interviewed relied on food vouchers from the U.N. World Food Programme, but very few complained that their households were going hungry.

Among a number of other issues reported were an inability to afford proper medical care, regular instances of verbal harassment and even offers of free accommodation in exchange for sexual favors. A significant portion said they left their homes much less often than they did in Syria.

The U.N. expects these problems to worsen, as it estimates the total number of Syrian refugees will reach 3.6 million by year’s end, unless aid agencies, donors and host governments renew their commitments of support.

TIME Middle East

U.N. Says 1 Million Syrian Refugees Are in Lebanon

The influx of Syrians, who now account for one-fourth of Lebanon's population, has immensely strained the nation’s political, economic and health care systems, reduced the quality of its infrastructure and pushed some schools past capacity

The Syrian civil war marked a grim milestone on Wednesday as the number of people who have fled into Lebanon and registered as refugees surpassed one million, according to the United Nations Refugees Agency.

The spiraling conflict that began in March 2011 has killed at least 150,000 people and uprooted more than nine million others. An estimated 1.6 million of them are spread between Turkey, Jordan, Iraq and Egypt. But it is fragile Lebanon that has by far taken the brunt.

One-quarter of the country’s residents are now Syrian, according to the U.N. There were almost 18,000 refugees in Lebanon in April 2012, about 13 months after the demonstrations, but that swelled to nearly 356,000 as the revolution turned into civil war. Now the organization registers 2,500 refugees each day.

UNHCR
UNHCR

Lebanon’s generally open-door policy for Syrians has immensely strained the tiny country’s political and economic systems, as well as its overall stability. There’s less trade, tourism and investment. Many schools are at full capacity—520,000 of the million refugees are children, but of the 400,000 of them who are school-aged, only 90,000 are in classrooms—and its infrastructure is stretched thin.

Bombings along the border serve as a reminder that even those who leave Syria in search of safety or better opportunities aren’t guaranteed anything.

(MORE: Ordeal of a Dying Child Captures the Tragedy of Syria)

TIME Middle East

3 Dead in Lebanon in Spillover Clashes from Syria

11 more people are injured as city close to Syria's border sees fighting between opponents and supporters of Assad

Three people were killed in fighting in the northern Lebanese city of Tripoli on Friday as clashes broke out between opponents and defenders of Syria’s government.

Two men were declared dead after violet outbreaks occurred overnight between ethnic Sunnis from the city’s Bab al-Tabbaneh district and the neighborhood of Jebel Mohsen, which is dominated by ethnic Alawites, Reuters reports. An elderly civilian man was also shot dead by a sniper, and medical officials said 11 others were wounded.

The city of Tripoli is only 30 miles from the border of Syria and its ethnic divisions have been exacerbated by the civil war. Many Sunnis support Syria’s rebels, while the minority Alawites, who are from the same sect as Syrian President Bashar Assad, support the Syrian government. Each side frequently accuses the other of using the city as a base for shipping personnel and weapons in and out of Syria.

[Reuters]

TIME olympics

Topless Photos of Lebanese Olympic Skier Cause a Scandal Back Home

Lebanese skier Jacky Chamoun speaks during an interview at the ski resort of Faraya, northeast of Beirut, March 8, 2013.
Lebanese skier Jacky Chamoun speaks during an interview at the ski resort of Faraya, northeast of Beirut, March 8, 2013. Bilal Hussein—AP

Three years ago Jackie Chamoun posed as a pin-up girl; now, the behind the scenes footage has come back to haunt her as she makes her Sochi debut

Topless photos and racy video footage of Lebanese Olympic Skier Jackie Chamoun have gone viral in Lebanon, prompting a potential government inquiry just days before the Olympic veteran is due to compete in the women’s giant Slalom in Sochi. But government claims that the revealing footage may have damaged Lebanon’s “reputation” have precipitated an enormous backlash in a country that has suffered far worse than the publication of images that wouldn’t look out of place in the Sports Illustrated Swimsuit Issue.

The photos, taken three years ago at Lebanon’s Faraya ski resort as part of an annual Austrian cult calendar shoot featuring male and female Olympic ski instructors, are tame by most calendar criteria—her breasts are concealed by a strategically placed ski or a half-zipped parka. The accompanying behind-the-scenes video (NSFW, to be sure) is more revealing, if chill inducing. The 22-year-old skier-turned model, clad in little more than ski boots and thong underwear, gamely acquiesces to a photographer’s request to lounge in the snow or climb a treacherous-looking icefall. During a brief interview at the end of the 1:38 minute long video, Chamoun admits that it’s much easier being a ski racer than a model because “I’m not used to posing with no clothes on.”

The 2013 calendar was released last year, but the video only surfaced a few days ago, when the local Al-Jadeed television highlighted it in a news broadcast, calling it a “scandal.” The images took Lebanese social media by storm, and the country has spoken of little else for the past few days. Chamoun admitted on her Facebook page to posing for the photos “with other professional athletes”and apologized for offending her critics. But she also implored fans and critics alike to drop the issue so she could ski her best at Sochi. “Now that I’m at the Olympic Games … All I can ask to each of you who saw this, is to stop spreading it, it will really help me focusing on what is really important now: my trainings and race,” she wrote. The post earned her more than 13,000 Likes and an outpouring of support. “Jackie, many Lebanese people including myself would rather see a Lebanese naked beauty than what we see in our country,” wrote one fan. “You have not done anything wrong.”

Faisal Karami, Lebanon’s caretaker minister of youth and sports, was less enthusiastic. According to Lebanon’s National News Agency, he ordered the country’s Olympic committee to launch an inquiry and take all steps necessary to avoid “harming Lebanon’s reputation.” That statement elicited an even greater scandal, as Lebanese across the spectrum ridiculed the minister for his shortsighted take on what really ails Lebanon. In an editorial titled “What Reputation?” the English language Daily Star newspaper lashed out at Karami and Chamoun’s critics. “Since the beginning of 2014, there have been no fewer than six car bombs,” the editorial said. “There is a general lack of law and order, not to mention the lack of a working government. Is there a better definition of a failed state than ours? This woman, who should be a source of pride to the country, … is being blamed for something she chose to do with her free will, while the everyday concerns of citizens are being wholly and fundamentally neglected.”

Lebanon’s online news portal, NOW, was more blunt, placing Chamoun’s pinup alongside an image of a heavily armed man in camouflage under the headline “Boobs over Bullets.” And Lebanese human rights activist and blogger Melkar El Khoury was apoplectic in a recent post: “In a country that is overburdened with debts, embezzlement and corruption, political deadlocks and terrorism, drug and human trafficking, uncontrolled spread of personal weapons, economic decay and unemployment… Jackie’s [rear end] is undermining Lebanon’s image and sending the wrong message?”

Allegations of hypocrisy aside, the “scandal” has caused a bit of head scratching among many Lebanese. Yes, many parts of Lebanon are conservative, but billboards spanning the length of the country’s highways feature cosmetic surgery and laser hair removal clinic ads that reveal almost as much as Chamoun’s photo shoot. While topless bathing is frowned upon at most beach clubs, a summer stroll down Beirut’s seaside corniche offers a wide spectrum of female dress, from ground skimming shapeless black veils to high-heels and hot pants. That tolerance for diversity, forged in the crucible of a 15-year sectarian civil war, is a fundamental part of Lebanon’s reputation as the most liberal and fun-loving country in the Middle East, no matter what crises come its way. The suggestion that an Olympic skier’s brief foray into modeling is a scandal is what undermines Lebanon’s reputation, not the act itself.

TIME Apps & Software

World’s Most Depressing App Launches in Lebanon

Shia area Choueifat district of Lebanese capital Beirut hit by a blast wounding many and killing at least two on February 3, 2014.
Shia area Choueifat district of Lebanese capital Beirut hit by a blast wounding many and killing at least two on February 3, 2014. Bilal Jawich—Anadolu Agency/Getty Images

With just a tap of the finger, bombing survivors can now tweet, "I am still alive!"

A new smartphone app in Lebanon lets citizens automatically tweet, with one convenient tap of the finger, “I am still alive! #Lebanon #Latestbombing.”

The BBC reports that the creator of the app intended to highlight the country’s deteriorating security situation with an ironic solution. The jarringly upbeat sales pitch on the app’s homepage reads, “Every time there is an explosion, we have to spend a lot of time contacting our loved ones…Not anymore!”

Sadly, the pitch resonated with 4,000 users who have downloaded the app since it launched on January 21 and used it in two subsequent bombings. People in other war ravaged regions of the world have contacted the app’s creator to request their own, localized version, according to the BBC.

No word yet on how many users have downloaded the “VIP” version, which enables politicians to tweet out prefabricated messages of condemnation.

[BBC]

TIME Syria

Syria’s Health Crisis Spirals As Doctors Flee

A man walks through a room at Dar Al Shifa Hospital, damaged in a Syrian Air force air strike the day before, in the Sha'aar neighborhood of Aleppo on Aug. 15, 2012.
A man walks through a room at Dar Al Shifa Hospital, damaged in a Syrian Air force air strike the day before, in the Sha'aar neighborhood of Aleppo on Aug. 15, 2012. Goran Tomasevic—Reuters

More than half of the country's physicians have left just when they are most needed

It was the third week of an uprising in Syria that would eventually evolve into a brutal civil war and already the wounded were showing up at the hospital in the Damascus suburb where 29-year-old Ahmed was doing rotations during his medical residency. Ahmed, who asked that only one part of his name be published because he is afraid of repercussions from Syria’s security agencies, had only just started examining a young man with bruises and a deep puncture wound on his right side when two armed security officials burst into the examining room barking questions. Who was the patient, they wanted to know, and how did he get his injuries? When it emerged that the patient had been at a protest that afternoon against the government of Syrian President Bashar Assad the officials hauled the young man outside. Ahmed could do nothing. “I was so angry at myself,” he recalls, as he chain-smokes in a café in Lebanon nearly three years later. “Why didn’t I protect him? I was terrified. I was a coward.”

That scene in Ahmed’s examining room would play out hundreds of more times across Syria as regime thugs hunted hospitals for wounded protestors, and then later, for rebels fighting against Assad’s government. When the rebel forces in Douma, the suburb where Ahmed’s hospital is located, grew in number and strength they then took to roaming the hospital corridors, seeking to finish off any regime supporters who had been injured in the vicious street fighting. In July 2012, the Syrian government passed an anti-terrorism law that effectively made it a crime to provide medical care to anyone suspected of supporting the rebels. Ahmed was caught between the Hippocratic oath — a doctor’s promise to treat every patient — and the growing pressure to take sides. “The regime said ‘Why are you helping the Free Army?’ and the Free Army said ‘Why are you helping the regime?’” Once a supporter of the revolution, Ahmed has come to the conclusion that neither side will be able to save Syria. So he is giving up, abandoning his “patient”— Syria— once again, he says with a wry smile. Instead, he has opted for a life in the United States; relatives already there are helping him to emigrate. “Yes, maybe I feel guilty,” he admits. “Maybe I am a coward for leaving Syria. But as a doctor it is impossible to work there. I have to live, I have to eat.”

Ahmed is one of an estimated 15,000 doctors who have fled Syria over the past three years, according to a report released Feb. 2 by Physicians For Human Rights [PHR], representing half of the certified physicians in a country whose medical system was once the envy of the Arab world. The doctors who have fled have left behind a horrifying medical crisis. According to the World Health Organization, more than half of Syrian hospitals have been destroyed or severely damaged. Syria’s largest city, Aleppo, once boasted 6,000 doctors. According to the PHR report, only 250 remained as of July 2013, serving a population of 2,500,000. In the Damascus suburbs where Ahmed worked, a pre-war population of 1,000 doctors had been cut down to 30 by December, according to the PHR report. Nurses, technicians, ambulance drivers and medical support personnel have been forced to abandon their posts, the report says, unable to provide care in destroyed hospitals and clinics where supplies of life-giving medicine have run out. Even if the war were to end tomorrow, its medical legacy will last a generation. The U.N. estimates that more than half a million Syrians have suffered debilitating injuries that will require long-term care. Outbreaks of communicable disease are on the rise. Manageable chronic conditions, such as diabetes, kidney failure and heart disease, are escalating into life-threatening illnesses. When the war ends, Syria will need more physicians than ever before. Yet the likelihood of doctors returning from exile is slim. The longer the war lasts, the harder it will be for them to give up their new lives.

The medical staff who have fled Ahmed’s hospital have settled in France, Germany, Dubai and Saudi Arabia. Some have lucrative contracts with local hospitals; others have set up private clinics. Many are going through the arduous process of getting recertified so they can work in the United States and Europe. “Most doctors will not go back after the crisis,” says Dr. Zaher Sahloul, a Chicago-based pulmonologist and head of the Syrian American Medical Society, an organization that raises funds to provide salaries and supplies to doctors still working in Syria. “Once you set up a new practice in a safe country it is a difficult decision to go back, especially since the economic situation will be so bad.” He says that around 1,000 to 1,200 Syrian doctors are already in the process of resettling in the U.S since the conflict started. Though not all will continue in the medical field, it is a significant addition to the 7,000 Syrian doctors who were already in the U.S. prior to the war’s start. “It’s a huge brain drain,” Sahloul says. “I am not sure the Syrian medical system can recover from this.”

The shortage of doctors is taking an immense toll. Based on an assessment of mortality rates, hospital intake numbers, population and treatment rates for manageable diseases prior to the war, Sahloul estimates that some 200,000 people have died in Syria because they did not have access to routine medical care, what he calls a “secondary death toll” that is even higher than those killed by bombs and firearms. “These are the women who died in labor because there was no one to do a C-section, or the men who have a heart attack and can’t find a physician, or have complications from diabetes. People are dying of chronic diseases that three years ago would have been completely manageable.” The PHR report has found that 70,000 cancer patients and 5,000 dialysis patients have not been able to receive treatment.

Oncologist Michel Abdallah fled for Jordan last year, and is now treating refugees as an employee of an aid group. The situation in Syria, he says, “is really bad. There are situations where a dermatologist might play the role of a dentist or a surgeon. We are losing patients who could have easily survived in normal circumstances. That’s not easy to come to terms with.”

As Syria suffers, the American health system may benefit. Many Syrian doctors finished their advanced studies in the U.S. and are already licensed to work there. The U.S., with its high salaries and advanced medical care, has long been a magnet for doctors around the globe. Ahmed isn’t sure yet what he will do once he arrives in the U.S. After three years of war, he says he is tired of blood. “Real estate might be nice,” he muses. Still, he is hedging his bets. Unlike many doctors who fled, Ahmed is applying for official leave from his employer, the Syrian Ministry of Health. He hasn’t told them he is leaving the country, only that he is opening a private clinic. That way, if he does come back, he won’t be penalized.

Sahloul thinks it’s unlikely that someone like Ahmed will ever return. That’s why, he says, it is so important to persuade the doctors still in Syria to stay. But he admits it’s a losing battle. “Doctors there not only have to deal with patients and disease, but politics and fighting groups and security. I can see why they are fleeing, but for the sake of Syria’s future, I wish they would stay.”

—With reporting by Hania Mourtada / Beirut

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