Asa’ad and his daughter were able to cross the border for free healthcare months ago, under authorization from the Turkish government. According to figures issued by authorities from the Syrian crossing, more than 500 patients entered Turkey to receive treatment last February.

That was until the spread of the Coronavirus (COVID-19) accelerated, prompting the Turkish government to cut off their lifeline in mid March, just three days after Ankara confirmed its first case and two weeks before Damascus declared the appearance of its first confirmed cases.

Doctors in the Idlib governorate have stated that since mid-March only a handful of high-risk emergency cases were allowed entry into Turkey, amidst an increasing number of cases in both countries. Patients suffering from cancer and other chronic illnesses are not among them.

For the time being, Marah, along with hundreds of other patients, remains stranded and unable to receive life-saving treatment.

As Asa’ad carries his ailing child on his forearm, she rests her head on his shoulder to whisper unintelligible words. His eyes fill with tears as he says, “She has jaw cancer and as the tumor grows, her pain grows with it. These days she cannot even sleep from the agonizing pain, despite taking all types of painkillers. My daughter needs treatment. Please, Lord, don’t forsake us.”

Due to lack of treatment in north Syria, doctors have unanimously agreed on the necessity for Marah to head to Turkey for medical care, says the family, but she remains until this day stranded at the border.

With the continued spread of the Coronavirus and the accompanying restrictions against Syrians along the Syrian-Turkish border, this investigation explores the plight of those suffering from cancer and other chronic diseases as they await their turn to enter Turkey.

400 Cancer Patients Await Reprieve

The Idlib Health Directorate describes the scale of the suffering cancer patients are facing in northern Syria, amidst increasingly poor medical care in the region. Issues hindering access to treatment include acute shortages of medicine, equipment, and working medical facilities, not to mention the rising costs of the few available treatment drugs left in the area. Such difficulties prompted patients to enter Turkey through the Bab Al Hawa Border Crossing, after obtaining a medical referral from the health directorate.

On the 13th of March, the Bab Al Hawa Border Crossing announced its closure towards ‘cold case’ patients – the Arabic term that encompasses chronic illness such as cancer and heart disease – and travellers. The crossing remained closed to cancer patients until the first of June, after which authorities allowed the entry of only 5 patients a day for treatment in Turkey, following coordination between the crossing administration and Turkish authorities.

Barely a week had passed before the border pass was once again closed off, an act prompted by a number of reported Coronavirus cases in north Syria. The crossing was reopened later on, under strict requirements for patients to adhere to safety measures against the virus.

According to Doctor Mohammad al-Salam working at Bab Al Hawa Hospital, the repeated closure led to a rise in critical cases among ‘cold case’ patients.

Mazen Alloush, the director of the Office of Public Relations and Information at the crossing, has revealed that over 400 cancer patients have been waiting their turn to enter Turkey for weeks, aside from the dozens that haven’t applied in the first place. Alloush also stressed that the majority of patients need entry as soon as possible due to mounting critical cases.

As a result of recent restrictions, the medical state of Maram al-Sayyed, 45, is in rapid deterioration. This is the third consecutive time she has not been allowed to cross into Turkey for treatment, even though her 8-month-old Leukemia condition has reached well into its advanced stages.

She takes several minutes to gather her strength to speak, “I am exhausted; the disease has been eating away at my body for some time, and I am getting worse. I cannot go to government-held hospitals where people are getting arrested, while Turkey here closes the crossing. What do I do as this cancer ravages my body?”

Maram is receiving pain medication as well as up to two blood transfusions per day at the Idlib Central Hospital, to no avail.

It is up to hospitals and health centers in the liberated north to work with aid agencies to secure medication for the time being, until the rest of the cases are transferred to Turkey for the appropriate treatment.

With spread of COVID-19, the Turkish government cut off the lifeline to Syrian cancer patients seeking treatment by mid March; Three days after Ankara confirmed its first case and two weeks before Damascus declared the appearance of its first cases

“The man’s attempts to enter his cancer-afflicted daughter into Turkish territory to receive the necessary treatment have yielded no results despite putting in several applications to gain entry… For the time being, Marah, along with hundreds of other patients, remains stranded and unable to receive life-saving treatment.”

Idlib opposition Health Director Dr. Monzer Khalil describes the damages done to health facilities in northwest Syria by stating, “The regime has targeted more than 75 medical centers from April 2019 until today. Government forces advancing on and taking areas from the northern rural Hamah to the Southern rural Idlib, have caused the facilities’ closure.” He went on to point out, “Acute shortages of specialized medical staff also cannot match patient numbers. There is also a shortage in medical equipment such as MRIs, CT scans, and many others.”

Delay Leads to Death

Weeks ago, Yousef Barbour, 22, passed away due to delays in entering Turkey to receive treatment, despite the repeated appeals of his mother. The young man had needed a bone marrow transplant.

Such amounts of increased suffering prompted Syrian humanitarian actors to call on Turkish authorities to find some way to admit critical cases for medical care in their hospitals. However, the crossing remains closed.

A 3-year lung cancer patient, Salem al-Ahmad, 50, had been lucky enough to enter Turkish hospitals for treatment earlier. He says, “Things were much simpler then; Turkish doctors at the border crossing would not reject cancer patients, who were considered priority cases. What used to be over 100 cases admitted per day became just five cases, and this led to the deprivation of many patients’ early treatment.”

Mazen al-Saud, a professor at the Faculty of Medicine at the Free Aleppo University and former director of Doctors Without Borders hospital in Ma’arat al-Nu’man, comments, “The lack of radiotherapy in the Idlib Governorate is a major obstacle for cancer patients there, since chemotherapy is often ineffective, with the tumor reappearing more aggressively in other areas in the body.”

He adds that the number of cancer patients in the Idlib region has multiplied by 10 percent than in previous years, specifically breast cancer for women and lung, colon, and stomach cancer for men.

The WHO stated in an earlier report that cancer in Syria is 3rd among the 10 main fatal illnesses, with cases expected to further rise amidst damaged hospitals left unavailable for use.

According to the report, around 25,000 cancer patients require treatment every year, including a staggering 2,500 below the age of 15 years suffering from leukemia and lymphoma.

Within the camps of Tal Alkarama in the Harem District north of Syria, Monaf Mohammad al-Saleh, 11, suffers from speech impairment, an amputation in his left leg, and deformed fingers, along with a hazardous lack of sensation.

Monaf was hit by rocket shrapnel from Russian air raids as he played outside his home in Sarha in eastern Hama. Doctors say his leg suffered from a bacterial infection that reached the bone and left dead tissue in its wake.

His father says, “We couldn’t find him treatment. In addition to the financial situation and lack of good hospitals, he hasn’t been able to receive the proper treatment yet. He needs to enter Turkey as soon as possible. Sadly, the closed border due to the Coronavirus is endangering his life, keeping in mind that the chances of him recovering and benefiting from his treatment lessens as time passes.”

After Syrian government forces entered the village of Sarha, Monaf’s family fled to camps in northern rural Idlib. Doctors were forced to amputate the infected leg after the boy’s condition deteriorated due to lack of proper health requirements. He later got an infection on his tongue from unknown causes.

The father recounts, “It became hard for him to speak and talk. He also lost sensation in his body and couldn’t feel heat or cold or fire.”

Weapons Residues

Among the reasons for the recent spike in cancer cases in Syria, Dr. Hind, a research oncologist at the Idlib province, lists three: there has been a spread of kidney infections and liver diseases that – when left untreated – can become precursors to cancer; poor food quality and the consumption of expired goods; as well as the drastic “loss of hospitals, medical equipment and personnel that impedes routine checkups and, thus, lowers chances for early detection and diagnosis.”

The rise in cancer rates was a foreseen consequence in liberated areas, however, where toxic chemicals, heavy weaponry, rampant destruction, and environmental pollution are widespread remnants of the war.

To that extent, Dr. Ayham al-Ahmad posits the higher cancers rates in liberated areas as a result of the heavy presence of toxic and oxidized weapons, as well as the overall lack of environmental hygiene and cleanliness in these areas – all of which encourage viral and bacterial infections that act as catalysts for the development of cancerous tumors.

 His eyes fill with tears as he says, “She has jaw cancer and as the tumor grows, her pain grows with it”

Moreover, the entirety of northwest Syria suffers a shortage of cancer treatment medications, compelling patients to make the journey south towards regime-controlled areas, where treatment is more available. With its gruesome roads, many checkpoints, and costly travel expenses, however, the lengthy trips are exhaustive to both the patients’ health and their pockets.

Faisal, 43, lives with his wife and nine children in a tent at one of the many makeshift camps sprung along the Syrian-Turkish border. Six months ago, he was diagnosed with a cancerous brain tumor and has since not been able to get treated owing to the dilapidation of medical facilities in the Idlib province and the unfeasibility of obtaining medicine from Turkey after the shutdown of its borders.

Faisal outright refuses to go to Damascus, where he is adamant that regime forces detained two of his brothers for aiding the Syrian revolution. According to him, one of his brothers was murdered and the other disappeared not long after.

“The Turkish medical team refused to let her pass despite all our appeals, saying she is a non-emergency ‘cold case’… The delay in her treatment can lead to the growth and spread of the tumor, deteriorating her already worsening state.”

As his health deteriorated with the growth of the brain tumor, the imperative to find medication grew more urgent, and Faisal turned to charity-based pharmacies for help. Alas, to no avail.

The Turkish medical team refused to let her pass despite all our appeals, saying she is a non-emergency ‘cold case’… The delay in her treatment can lead to the growth and spread of the tumor, deteriorating her already worsening state

A doctor working at the Syrian American Medical Society (SAMS) office in the Turkish city of Gaziantep notes, “The SAMS center in Idlib is the only place offering treatment for breast cancer, lymphatic cancer and colon cancer in the entire province. The treatments are free and available to all, but due to the center’s lack of funding and the restrictions set on the import of certain drugs, about a third of our patients are forced to buy their medication from local drug stores run by the clinic.

Not everyone is able to procure their treatment, and the center isn’t able to treat everyone. We used to move more critical patients, like those suffering from leukemia or brain cancer, to Turkey for treatment, but that all halted with the coronavirus pandemic.”

Deteriorating Health Conditions

In the city of Ma’arrat Misrin north of Idlib, Ru’aa al-Ali, an 8-year-old brain tumor patient, hasn’t been able to enter Turkish territories for treatment despite best efforts, as Turkey continues to cut-off access to its border passes with Syria due to the ongoing pandemic.

Her mother says Ru’aa was diagnosed a year ago and underwent a 3-month-long treatment in Turkey. She returned to rural Idlib after her condition stabilized, however, “her state has worsened recently and she needs radiotherapy, which is unavailable here.”

The distraught mother goes on to say, “The Turkish medical team refused to let her pass despite all our appeals, saying she is a non-emergency ‘cold case’… The delay in her treatment can lead to the growth and spread of the tumor, deteriorating her already worsening state.”

Turkish authorities in the border crossing could not be reached for comment, while the head of a Turkish-run medical center in rural Aleppo declined to comment on the halt of medical transfers regarding both cancer and chronic disease patients.

With the continued closure of the border pass amidst the ongoing pandemic and the number of those suffering from chronic illnesses continuing to grow, the fate of more than 400 cancer patients denied access to treatment, remains pending.

This investigation was carried out under the supervision of the ‘Syrian Investigative Reporting for Accountability Journalism‎ (SIRAJ)’ and the support of the ‘International Center for Journalists (ICFJ)’, as well as the Facebook Journalism Project, published on Raseef22

The post With Bab Al Hawa Border Closed, Syrians Are Deprived of Cancer Treatment appeared first on SIRAJ.

Using the trick successfully, Aiysha convinced her son (5) to keep the preventative rules. Nonetheless, the trick failed to mitigate the negative impact the measures addressing the virus, the ensuing lockdown and curfew, had on his life. Hussain’s personality was a lot different. He was psychologically shaken, turned irritable, and demanding. With a restless sleep, Hussain was less active at home and withdraw into his world on the second month of the lockdown.

Aiysha’s trick proved a successes at her home, but it failed to help Abu Rida, who lives with his sex children at a three square meter tent, surrounded by jammed tents at every side. The forty-something man heard that COVID-19 has arrived in Northern Syria; however, he could do nothing to protect his family.

1/3 of Syria’s children were deprived of education due to war; a larger proportion has been even denied necessary healthcare services.

UNICEF

In Syria, COVID-19 cases started to surge, while real case numbers were kept a secret amidst poor protective and preventative measures, as well as treatment efforts. Thus ominous, the situation threatens Syrians with a scenario that might bear a striking resemblance to the one suffered by Italy.

With its symptoms, the many people it rendered dead, the following closure of schools, curfews and bans on leaving home, COVID-19 had affected children in ways of dire consequences, which psychologists believe might be of a long-term.

Medically speaking, international studies concluded that infected children might show COVID-19 symptoms, including fever and high temperature. Even though children are less vulnerable to testing positive, Syria is currently witnessing large outbreaks. To date, there are no clear estimates of the pandemic’s spread, nor reports of child infections throughout the country, which might be attributed to the fragility of the healthcare system and shortage for diagnostic tests and laboratory equipment, which absence plays a key role in the underdiagnosis of cases.

Furthermore, interviews conducted with families throughout Syria point out the wide lifestyle gap between children from various geographical backgrounds. Children in the capital Damascus, for instance, have a different life from their peers in Northern Syria’s camps, where they are subjected to unmatching economic and social conditions, as well as different housing and living modes, let alone the environment-related discrepancies.

Given the current situation, psychologists are actually urging parents to maintain their calm and low stress levels, for children do mimic their actions.

2.6 million children have been forcibly displaced. About two million children are out of school. 3 out of 10 schools in Syria are destroyed or unusable.

– Human Rights Watch, 13 March 2020

 

“We know the poorest, most marginalised children who were already the furthest behind have suffered the greatest loss, with no access to distance learning – or any kind of education – for half an academic year,” Save The Children chief executive Inger Ashing said.

On the whole, this applies to all children around the world, but it, particularly, does not pertain to Syrian children, whose living conditions are largely different from children in other countries, as they have been doomed to lose a lot during the conflict.

According to a UNICEF report, one-third of Syria’s children were deprived of education due to war; a larger proportion has been even denied necessary healthcare services.

The Syrian Network for Human Rights, on its turn, documented the death of 29,296 children at the hands of main actors in Syria between March 2011 and last June.

Moreover, in a report entitled “They have erased the dreams of my children,” the Commission of Inquiry for Syria outlined multiple blatant right violations children have been subjected to, including death, miming, injury, orphaning, deprivation of education, and enduring the myriad violations by warring parties, as well as the displacement of over five million children, internally and abroad, over the course of the war.

The report, including interviews with more than five thousand children, witnesses, relatives of survivors and medical staffers conducted between 2011 and October 2019, states that “pro-Government forces have also deployed cluster munitions, thermobaric bombs and chemical weapons, claiming dozens of children casualties.”

Rape and sexual violence have been also used against men, women, boys and girls as a tool to punish, humiliate and instil fear among affected communities. On top of this bitter reality, which Syrian children are coerced to endure, here comes COVID-19 to rub salt in their wounds.

It is necessary to block rumours and inform children only of facts available on the Internet and social networking sites, to help them resist stress, particularly with the criticism aimed at governments that announce the daily number of cases, a thing that boosts anxiety and tension.

 “On top of displacement,” here comes COVID-19

Ibrahim (13) was displaced a few months ago from the city of Saraqib, rural Idlib. Fleeing the shelling and the battles, he sought refuge in a small village east of Idlib. As if it was not enough that he lost his home, school and friends, cases of COVID-19 started emerging, destining him for heavier losses. Once again, Ibrahim was deprived of school and playing football, among many other things.

“As the coronavirus hit Idlib, my son’s life changed drastically. He was not allowed leaving home, going to school or the park, and playing with his friends,” Hussain’s father Jihad al-Ibrahim said, adding that it was displacement first, and then came the virus. Both have changed the child’s lifestyle.

Before COVID-19, his son went to school, had fun with friends and moved around freely. All of a sudden, everything stopped.

Of the most critical psychological effects that Ibrahim suffered were excessive irritation, spending long hours on the Internet and video games, according to his father, who added that: “He was awake till five in the morning, playing video games and surfing the Internet and slept for most of the daytime. He also asked me to by him an up to date cellophane so he could play PUBG.”

Ibrahim said that he used to meet his friends after school every day. They would gather somewhere and then play football. Nonetheless, he cannot do this today, while also robbed of the chance to spend summer at the town of Darkoush, western rural Idlib, expressing his great desire to enjoy all these activities when COVID-19 risk disappears.

In a report published on 13 March 2020, Human Rights Watch stated that 2.6 million children have been forcibly displaced. About two million children are out of school. Three out of 10 schools in Syria are destroyed or unusable.

Furthermore, the report noted that four out of five people in Syria live below the poverty line, leading to recruitment into fighting, child labor, and child marriage.

Horrified Children

When the Coronavirus pandemic first took over the world, Jana (11), from Suwaida province, was not scared. Nevertheless, she was grabbed by fear when the first case was reported in Damascus, especially because her grandparents are old and her father works at a shoe store, forced to get into contact with countless people, which makes them vulnerable to greatest risk from COVID-19.

All that Jana knows about the disease is that its symptoms resemble the flue, causing people to lose their sense of smell. Once the lockdown was enforced, Jana started doing sports, eating healthy food that boost the immune system, and washing her hands constantly to protect herself from the disease. This information, she got from TV, for she always joined her father as he watched the news.

“When the first case was reported, I was so scared for my father. When he stayed with us at home, since all the stores were closed, I was not as afraid as before. Upon reopening, fear struck me again, because my father gets into contact with many people,” Jana said.

The virus deprived Jana of leaving home and seeing her beloved friends. Her heart ached when schools were closed, she said, because she misses her friends, who were all forced to stay home.

“Fear, anxiety, and tension initially controlled my daughter, and the virus became all she talked about,” Jana’s mother said, referring to the negative impact the lockdown had on her daughter’s psychological health. The mother, however, cooperated with the child to smooth things down, helping her to do sports at home and other similar activities.

Summarizing the most critical behavioural and psychological disorders suffered by the girl, the mother pointed out to fear, heightened tension, and anxiety, as well as obsessed mentioning of COVID-19 and an intense interest in the quality of food.

The mother also noticed that Jana’s headaches went worse because she had excessive brain electrical charges, while she stayed up at night, turned more irritable and regularly bored.

“I believe that being afraid and the quarantine were the principal reasons that her headache seizures worsened,” the mother added, concluding that anxiety and tension badly affect Jana’s illness.

29,296 children died at the hands of main actors in Syria between March 2011 and last June.

– Syrian Network for Human Rights

Assessing the situation, psychiatrist Muhammad Abu Hilal said that the quarantine increased “socially unacceptable behaviours” among children to varying degrees, such as bullying those who cough, aggression, shouting, hyperactivity, sabotaging furniture, no to mention relentless complaining.

“The reason is that there are not enough child-friendly spaces in Syria. Then, there was the outbreak which complicated the situation for the children. Consequently, they became less active and further isolated from their peers at home,” he said.

The pandemic also gave rise to tension and fear of the disease, the signs of which were shown buy children, as they turned “obsessive” and confused about the appropriate manner of behaving, while many became less trusting of others.

“In general, the children’s language changed from one concerned with playing and studying, to one dominated by virus-related terms, mask and quarantine, which resulted in a new behavioural pattern among them,” the psychiatrist added.

The new pattern, the psychiatrist said, is represented by isolation and lack of social contact, the child’s loss of opportunities to learn from peers and play with them, hyperactivity, violence towards others at times, unjustified crying, mood swings, refusal to obey parents and negative feelings towards them, in addition to irregular sleep that corresponds to changing daily habits and spending long hours on cellophanes and video games.

Upward trajectory

This fear syncs to the mounting coronavirus cases that are recording an unprecedented upward trajectory across the country.

On 10 March 2020, the Syrian Ministry of Health announced the first COVID-19 positive case, confirmed as coming from abroad. The infection then started spreading, and cases ascended on the upward trajectory of the disease, both in regime-held areas and others out of its control.

Abu Firas, a Damascus-based father, has four children, the eldest is 13 and the youngest is only five months old, who turned more demanding amidst the outbreak. The more the pandemic lingered, the more the man and his wife were unable to keep up with the social and psychological condition of their children.

Umm Firas is a retired nurse; she left her job five years ago. Her husband, however, works in the healthcare industry.

The family’s life was organized, but it somehow drifted towards disorder as children stopped going to school, lacked any sense of obligation or definite activities to keep them busy.

“My children used to wake up at eight, go to school, return to do their homework, and then play with their friends. They slept at eight, having their play, computer and TV time all scheduled. Today, because these duties are absent, their life is no longer organized,” Umm Firas said.

“We tried to fill the spare time with at-home activities. Nevertheless, the Coronavirus measures have been going on for months, not a week or two. Therefore, following upon their day to day activities turned somehow tedious,” the husband added.

The eldest son, Firas, was crazy about football, and he waited impatiently for Friday to go with his friends to the stadium, taking the by way of the Sharia School where he studied before the outbreak. He almost had no spare time.

The parents attempt to provide their children with a breather. They visit their grandfather every Friday at his house in Damascus countryside. There, the place is less jammed, and the children get a safe opportunity to come into contact with people and meet relatives.

Sarah (11) is Firas’ younger sister. She was all about paper crafts, spending an hour or two everyday creating things. The girl, however, says that the hobby bored her during the quarantine, and it no longer helped her pass the time.

The family came across a volunteer teacher, who posted video lessons on Telegram, while other family members overcome the long unfilled hours by watching historical drama. “I reached the stage where I stopped keeping a track of their daily schedule. At one point, I even grew irritable. I returned home from work needing to rest and fearing that I could pass them the virus, for I get into contact with dialysis patients, while my children had a lot of energy, being at home,” Abu Firas said.

As a result, the children quarrelled increasingly, jabbed at each other and turned more irritable. The family is also concerned over the worst case scenario — a further spread of the virus with the daily rise in positive cases in Syria. Despite the increase, the family began to allow children to go outside, while maintaining tight preventive measures, for keeping them at home all the time has become impossible.

Age-based response

Psychologist Taher Laila, head of the psychosocial and social support team at the Syrian American Medical Society (SAMS), said that: “Children differ according to their age groups.”

“Those under the age of six can understand the anxiety surrounding them, but it is difficult for them to comprehend quarantine, the virus and its consequences,” he added, stressing that the parents’ duty, in this context, is to advise them and find simple ways to communicate ideas to them, explain the importance of social distancing, and the reason for staying home.

He pointed out that, at this age, children tend to develop feelings of guilt when they are not allowed out to play or are not hugged by their father when he is home from work. Children, thus, blame themselves, which necessitates that they get all these ideas explained.

Furthermore, he stressed the need to block rumours and inform children only of facts available on the Internet and social networking sites, to help them resist stress, particularly with the criticism aimed at governments that announce the daily number of cases, a thing that boosts anxiety and mental strain.

Dealing with children amidst the outbreak, Lila stated, demands that parents maintain low levels of concern, because children imitate their parents’ personalities, becoming stressed, as well. Parents, therefore, must keep their composure and address the pandemic with scientific preventative measures.

Moreover, Lila explained that the story was made rather complicated for children, because they need free and safe spaces to move around. With numerous families living in camps, while others are impoverished, capable of affording the costs of small houses only, due to displacement in Syria, in addition to lacking electricity, Internet and recreational activities, the space dedicated for children was subjected to restrictions with excessive energy that needs to be let out.

The unchanneled excessive energy, the psychologist added, causes children to be sad, depressed and isolated, and renders them anxious, becoming not only demanding, but also vulnerable to other symptoms such as intense anger, and stubbornness at times. This pressure, in fact, affects children’s social skills, through which they manage to integrate into society and communicate with their surroundings. These effects might, in turn, influence their social intelligence, making them shy, lacking in spirit and withdrawn.

In case of primary-school-age children, Lila stated that prolonged confinement to home might affect their linguistic skills.

The post Surrounded by Horror: COVID-19 Increasing Syrian Children’s already Multiple Losses appeared first on SIRAJ.