By Franklin Lamb. Al-Mouwasat Hospital, Damascus, Syria September 6, 2016

Manual and Mohammad-Kamal in happier days
(image byFranklin Lamb)

These beautiful children above, shown in happier days, are the younger siblings of Ghina and Nagham who were shot by a sniper in the surrounded and cutoff town of Madaya, Syria (“Syria: A Children’s Story”). Ghina, Nagham and their mother Sahar Wadi were rescued by the Syrian Arab Red Crescent Society (SARCS) from Madaya two weeks ago and taken to Al-Mouwasat Hospital, Damascus for urgent medical treatment of the children’s explode-on-impact bullet wounds.

Their daring medical evacuation occurred as part of an Iran-UN agreement based on the “4 Towns Agreement” (itself unlawful under international law and which has both saved and cost some lives in this maelstrom civil war). The agreement signed in September 2015 stipulates parallel evacuations and aid deliveries for four encircled towns; two in Outer Damascus and two in Idlib province. Sunni Madaya and Zabadani are encircled by the regime fighters and Shia Fuaa and Kafariya are encircled by rebels based in northern Syria.

Ghina is still recovering from the militia sniper wounds. Both girls were shot while returning from Madaya’s clinic, near their home, with medicine for their severely anemic mother Sahar. Ten year old Ghani’s severely shattered and infected left leg and thigh were tentatively scheduled for amputation in Madaya two weeks ago. Fortunately the medical evacuation and the specialized medical care in Damascus saved Ghina’s leg. And this week (9/5/2016), eight year old Nagham finally had her arm and hand stitches removed, personally by the medical director of the hospital, Nagham’s mother told this observer proudly. Nagham wounds are now largely healed from the effects of last month’s sniper attack. The psychological and emotional wounds of the children will take much longer.

Mother Sahra and recovering daughters Ghani and Nagham (author seated)
(image by Franklin Lamb)

But Ghina and Nagham’s younger sister and brother, Manal and Mohammad-Kamal are still under siege in Madaya. On 9/5/2016, Sahar, the four children’s mother provided this observer a detailed account of her youngest children’s current deteriorating health conditions as she begged for help from the Beirut-Paris-Washington DC based NGO, Meals for Syrian Refugee Children Lebanon (MSRCL) to rescue her babies. There are growing urgent fears, given just received alarming reports of an escalating outbreak of Meningitis in besieged Madaya.

Both children still trapped in Madaya are ill and have fevers. There are no medications available to them in the town. Both children are increasingly malnourished, with their only food boiled bulgur, lentils and a thin soup made from grass and wildflowers, the children’s mother explained to this observer on 9/6/2016. They have no milk nor any fruits or vegetables, eggs, bread or meat of any kind. Psychologically, the 3 and four years old Manal and Mohamad are terrified, and desperate to be with their mother Sahar and sisters Ghina and Nagham.

The Syrian Arab Red Crescent Society (SARCS), who heroically saved Ghina and Nagham last month, has been updated on this family’s dire situation and are trying to put Manal and Mohammad-Kamal on a future evacuation list. But whether they can do it anytime soon, if ever, is unsure. These intensely politicized days are not easy when illegally besieging and starving civilians has become a widely employed form of tactical warfare.

In this observer’s opinion and based on observing SARCS work for the past few years, and tours this summer of many SARCS facilities, while spending hours in the company of SARCS staff and heroic volunteers, there is not a more humanitarian organization working in Syria today than SARCS. Granted, local and international politics sometimes makes their humanitarian work complicated to say the least. This observer has heard on the same afternoon from disparate sources that SARCS helps only the government areas with its work and other critics who claim that it only helps the rebels with its work.

My observations convince me that SARCS, like Medicines Sans Frontiers (MSF) and the Syrian American Medical Society (SAMS) helps everyone everywhere that it can. In fact SARCS, true to its motto “Helping Everyone, Everywhere: employs more than 1,592 staff and more than 6,000 volunteers working in 14 branches and 62 sub-branches. They are doing amazing humanitarian work for which we are all indebted. Just last year SARCS delivered various services to 4.7 million people, including million people with medicines and medical treatment. In addition, 4.6 million Syrians received food and nearly one half million were given household essentials, over 316 thousand people received protection services through teams and community centers, plus 1.32 million people gained access to clean drinking water and sanitation.

Syrian Conflict: Madaya, The Town That Has Become A Prison …
(image by Public Domain)

Yesterday (9/6/2016), this observer learned from Dr. Darwish the dentist working to provide medical aid, along with a veterinarian and a former medical student inside Madaya that the besieged town is experiencing an unfolding meningitis epidemic. Fourteen cases have been reported over the past two weeks and more reportedly appearing nearly daily. The “medical team” explains that they cannot confirm 100% the diagnosis because “we don’t have the tools to diagnose and treat patients.”

Signs of viral meningitis, which Manal and Mohammad-Kamal both now exhibit, according to their mother Sahar who speaks regularly when she can get a call through, with the children’s grandmother (Sahar’s mother) still trapped in Madaya and who is trying to care for her malnourished and ill grandchildren. She reports symptoms comparable to the flu, and that the children today have headaches, a fever with cold hands and feet. They have no appetite. Manal and Mohammad-Kamal’s case is one of countless cases in Madaya that cry out for humanitarian intervention to allow innocent civilians to live.

A British pediatrician at London’s Great Ormond Street Hospital, the UK’s largest pediatric center, contacted on 9/5/2016 on behalf of MSRCL, about Manal and Mohammad-Kamal’s symptoms, advised that the UK National Health Service (NHS) urges children or adults exhibiting these symptoms not to wait for a rash to develop, but to seek medical help immediately. Later in the day The UK Doctor explained to MSRCL that babies and young children under five-years of age (Manal is 4 and Mohammad-Kamal is 3) are those most serious at risk for developing life-threatening bacterial meningitis because their body’s defenses are not yet developed.

The gentleman urged immediate evacuation of Manal and Mohammad-Kamal. “These cases are especially urgent” he added “because Dr. Darwish reports that in Madaya’s only clinic the medical staff do not have the medicines or the knowledge to treat meningitis or even the equipment to diagnose it.” Dr. Darwish and his medical team attribute the appearance of meningitis to malnutrition of residents, weakened immune systems and high summer temperatures.

Along with Madaya’s 40,000 residents, Sahar, the children’s mother, fears that an epidemic is rapidly spreading. According to Dr. Darwish yesterday (9/6/2016), “We’re afraid that some people may have a mental breakdown out of fear, paranoia is developing among residents, who are rushing to the field hospital with any of the signs of meningitis. Darwish confirmed from Madaya that his medical team suspects a virulent outbreak of meningitis, with the above noted 14 reported cases over the past two weeks. But they cannot confirm the diagnosis because “we don’t have the tools to diagnose and treat patients.”

Dr. Darwish’s stated yesterday (9/6/2016) that his two-kilometer walk to work at the field hospital now takes him more than an hour and a half, because “hysterical” residents stop him en route for medical advice. “They ask, ‘what are the symptoms of meningitis? I have those symptoms–do I have it?”

Can SARCS or the UN rescue Manal and Mohammad-Kamal?

In addition to the medical and humanitarian case for saving Manal and Mohammad-Kamal and evacuating them as soon as possible from besieged Madaya, there is a compelling legal case that warrants mention.

One imagines that not a great number of serious observers would likely dispute solid customary international law as well as treaty law on the subject of war crimes and crimes against humanity including the siege and starvation of civilians during armed conflicts. Specifically that they include but are not limited to, certain unconventional and improvised weapons and weapon systems such as barrel bombs, cluster munitions, incendiary weapons, poison, and poisoned weapons, chemical weapons, such as gas, encirclement, “surrender or starve” warfare targeting civilians, starvation of children, and blocking humanitarian access to civilians including the treatment of life-threatening injuries.

With respects to 4 year old Manal and her three year old brother Mohammad, still trapped and starving inside slowly dying Madaya, this observer, now honored to be a family friend, would offer the following arguments, among others, during an en blanc session, if granted 15 minutes maximum with the UN Security Council. To plead the little ones case for emergency humanitarian evacuation to join their mother, sisters and new “American Uncle” here in Damascus.

The more recent evolution of principles, standards and rules of modernly established and evolving International Law where armed conflicts are now often fought in urban areas rather than in battlegrounds far from the civilian population, makes it very difficult to conduct a siege that is both successful and lawful. Siege warfare is only legal under contemporary law in the narrowest of circumstances and none of those are present in besieged Madaya.

[Franklin Lamb volunteers with the Lebanon, France, and USA based Meals for Syrian Refugee Children Lebanon (MSRCL) which seeks to provide hot nutritional meals to Syrian and other refugee children in Lebanon. . He is reachable c/o].

At $2.25 per meal x 500 children per day ($ 1,225), the budget for a month (30 days) requires approximately $36,000.
(image by Franklin Lamb)

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