Resume of Amnesty’s report: “Squeezing the life out of Yarmouk War crimes against besieged civilians”

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Syria Freedom Forever publishes a section of the report of Amnesty on the siege of Yarmouk. You can read the full report here: http://www.amnesty.org/en/library/asset/MDE24/008/2014/en/c18cfe4d-1254-42f2-90df-e0fce7c762fc/mde240082014en.pdf

Before this, I would just like to say that Yarmouk is one example out of hundreds of areas throughout Syria that suffered similar actions from the Assad regime. Yarmouk like other neighborhoods suffered inhumane bombings and inhumane siege.

The siege on Yarmouk also demonstrates one more example that the Assad regime is an enemy of the Palestinian people and of the Palestinian cause, and this is not new, it started in 1976 with the complicit role of the Assad regime in the massacre of Tell Zaatar and the repression of Palestinian and Lebanese progressive forces in Lebanon. This is in addition to the refusal of Hafez Al Assad in 1970, at the time he was minister of Defense, to come and help the Palestinian and Jordanian progressive forces in their struggle against the Jordanian Monrachy, which resulted in the massacres and terrible events of Black September…

We should not also forget that in the beginning of the Syrian revolutionary process it was Bouthaina Shaaban, adviser to Syrian Dictator Bashar Assad, who accused Palestinians from the refugee camp of Ramel, near Latakia, of causing trouble by shooting at the security forces and of provoking sectarian tensions in the area. Hundreds of Palestinians were assassinated by the Assad regime since March 2011 because of their support to the Syrian revolution.

This is to repeat that the struggle of the Palestinian people is linked to the Syrian people and vice versa as well, and that the liberation and emancipation of the Syrian people is linked to the liberation and emancipation of the Palestinian people and the opposite being true as well. The People in struggle are one! Viva a Free Syria and Viva a Free Palestine”

1) Introduction

This report focuses on the situation in Yarmouk, where the siege has been particularly prolonged, has had the harshest impact, and has caused the largest number of deaths from starvation. A highly built-up area of 2km2, Yarmouk is situated on the south side of Damascus. Its residents include Palestinians and Syrians; the former are refugees, Palestinians and their descendants who fled or were expelled from their homes during the 1948 conflict that saw the creation of the State of Israel or the subsequent war of 1967 when Israel invaded and occupied the West Bank and Gaza Strip. When the current crisis began in Syria, Yarmouk was home to the country’s largest Palestinian refugee community. It was a densely populated area that resembled a residential district rather than a refugee camp. Its residents comprised some 180,000 Palestinian refugees and several hundred thousand Syrian nationals. Once the conflict took hold, thousands of people displaced by fighting in other parts of Syria arrived to seek shelter in Yarmouk, while thousands of its existing residents left to seek shelter elsewhere, some as refugees and others who remain internally displaced within Syria.

Government forces besieged Yarmouk in December 2012. In July 2013 they began to prevent all access to Yarmouk. Since then, with the exception of some intermittent distribution since 18 January 2014, the Syrian army has prevented the entry of all people, and all food and goods, including medical supplies, into Yarmouk. The civilians who remain, reportedly numbering some 17,000 to 20,000 people, include many who are elderly and sick and families with young children.

Scores of civilians are reported to have died in Yarmouk as a direct result of the siege or have been killed in attacks by Syrian government forces. Amnesty International has obtained information about 194 individuals, all said to be civilians, who have lost their lives since government forces tightened the siege in July 2013. Starvation, lack of adequate medical care and shooting by snipers are the three main causes of death reported to Amnesty International. Many other Yarmouk civilians have been wounded or maimed, or have fallen victim to illnesses caused by the severe conditions to which they have been exposed for so long. Yarmouk’s civilians have been brought to the brink of starvation, forced to forage for any food that they can find. They have few and diminishing medical facilities available to treat their sick and wounded. Every day they face uncertainty about their future and what the Syrian government forces may do to them if and when the siege ends. Elsewhere, other communities in Syria remain under siege by government troops and face similar privations and fears.

Within the context of the siege, Syrian security forces have also arrested scores of Yarmouk residents, many of whom they have subjected to enforced disappearance. Some have died in custody in suspicious circumstances. Those arrested include at least 12 medical workers; six of whom were subjected to enforced disappearance and remain unaccounted for and another who died in the custody of Syrian security forces. All appear to have been targeted by the Syrian security forces on account of their activities as medical workers. Other medical and health workers have been killed and injured in apparently targeted or indiscriminate attacks by the Syrian government forces besieging Yarmouk. The plight of the Palestinian refugees of Syria is a catastrophe within the wider catastrophe of Syria. Almost two thirds of Syria’s 530,000 Palestinian refugees have once again been displaced. Approximately 270,000 Palestinians are internally displaced in Syria. More than 50,000 are reported to have fled to Lebanon, 11,000 to Jordan, 6,000 to Egypt, 1,000 to Libya, 1,000 to Gaza and others to Turkey, Malaysia, Thailand and Indonesia and other countries. As early as July 2013, the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), which provides protection and assistance to some 5 million Palestinian refugees across Syria, Lebanon, Jordan, the West Bank and Gaza Strip, described the community as “unravelling and in acute distress”.

2. THE SIEGE, THE OVERVIEW

When widespread popular protests spread across Syria in 2011 and were met with government repression, the residents of Yarmouk sought to remain on the sidelines, reflecting long-standing efforts by the Palestinian refugee community to avoid entanglement in primarily Syrian political affairs and disputes, and its recognition that the Ba’athist governments of Syria’s current president and his father, Hafez al-Assad, had accorded Palestinian refugees greater rights than other host countries in the region. However, the government’s brutal crackdown on mostly peaceful protests led to the growth of armed opposition groups and armed conflict evolved. Yarmouk was inexorably drawn in.

On 6 June 2011, some 21 people were reported killed when armed members of the Popular Front for the Liberation of Palestine – General Command (PFLP-GC)4 and Syrian security forces fired on a procession of angry people in Yarmouk. The PFLP-GC had provoked anger by not participating in a demonstration lamenting the killing of people, including individuals from Yarmouk, by the Israeli military at the border with Israel the previous day.5 Resentment against both the government and the PFLP-GC increased further when Yarmouk came under heavy shelling, apparently by government forces, in August and September 2012, reportedly killing at least 20 people. Soon after this, fighters belonging to armed opposition groups linked to the opposition umbrella group known as the Free Syrian Army (FSA) established a presence in Yarmouk. They recruited a number of local residents into their ranks and engaged in armed clashes with Syrian government forces and the PFLP-GC.

On 16 December 2012, a Syrian government MiG warplane carried out raids on Yarmouk, bombing a number of civilian targets, including four schools – two of which were shelters for internally displaced people (IDPs), a mosque that was also an IDP shelter and the al-Basel Hospital. Reports by local human rights organizations and other sources indicate that the targets were purely civilian, that no members of armed groups were killed or injured and that at least 25 civilians were killed. UN Secretary-General Ban Ki-moon called the air strikes “a matter of grave concern”. The next day, government forces shelled Yarmouk again and, assisted by the PFLP-GC, began the siege that has remained in force ever since. In subsequent days and weeks government forces are reported to have also subjected Yarmouk’s inhabitants to attacks by artillery, mortars and Grad missiles, causing many deaths and injuries, particularly among civilians.

In the weeks surrounding the beginning of the siege at least 140,000 Palestinian refugees as well as tens of thousands of Syrians reportedly fled Yarmouk. Others, however, remained: according to Amnesty International’s sources they included many of the poorest residents and those who had least possibilities to seek alternative shelter, including many Palestinian refugees, for whom it is more difficult to find shelter in other parts of Syria and who face greater obstacles than Syrians in obtaining refuge in neighbouring countries.

Initially, Syrian forces allowed the residents to receive a trickle of food supplies, such as small bags of vegetables, though too little to meet their needs. But as resistance continued they progressively tightened their noose around Yarmouk, allowing in only meagre supplies of food and water. In or around April 2013, government forces cut the main electricity power supply; since then, residents have had to depend on generators, which are costly to run and lack the capacity to meet more than a fraction of their needs. The lack of a power supply has directly affected the functioning of the area’s hospitals and treatment centres, already hard pressed with an unceasing flow of casualties from government snipers and bombardments, and people suffering illnesses resulting from the deprivation. In July 2013 the Syrian army began to prevent the entry of all people and all food and goods, including medical supplies, into Yarmouk.

The actions of armed opposition groups that established a presence in Yarmouk – allegedly against the wishes of most Yarmouk residents, who hoped to preserve their “neutrality” amid the Syrian unrest and conflict – added to the problems faced by the besieged civilians. In particular, fighters from some armed groups are reported to have raided medical stores and removed medicines and medical supplies from Yarmouk’s hospitals and clinics, so prioritizing the needs of their own casualties over those of the area’s civilian population. The FSA fighters, who were the first opposition fighters to set up in Yarmouk, had mostly departed by May 2013 in order to join in fighting in other parts of Syria, including in Eastern Ghouta,

Qalamoun and Quseyr. Some members of Suqour al-Jolan, an FSA-linked armed group, are said to have remained, however.

As FSA-linked fighters moved out, fighters belonging to other armed groups moved in and used Yarmouk as a base from which to attack the Syrian army. They included fighters belonging to Jabhat al-Nusra and the Islamic State in Iraq and al-Sham (ISIS).10 Members of these armed groups engaged in fierce fighting with Syrian government forces in July 2013, capturing a number of positions from the Syrian army and forcing it to relinquish ground, but prompting a further tightening of the siege of Yarmouk by government forces, the PFLP-GC and members of a Shi’a pro-government armed group, the Abu Fadl al-Abbas Brigade, many of whom are said to be Iraqi, Lebanese and Iranian.

All current and former Yarmouk residents with whom Amnesty International is in contact say that local people did not support either the entry or the presence of armed groups such as Jabhat al-Nusra and ISIS. Nevertheless, while some members of armed opposition groups are reported to have looted premises and in some cases stolen medical supplies, Amnesty International has not received any reports of armed groups preventing Yarmouk residents from seeking to leave the siege area.

As the ultimately unsuccessful internationally backed negotiations between representatives of the Syrian government and the opposition were about to convene in Geneva in early 2014, local negotiations involving representatives of both sides in the struggle for Yarmouk and the Ramallah-based Palestinian Authority resulted in an agreement that brought some relief to Yarmouk’s desperate residents. Under this agreement, since 18 January 2014 the Syrian government has allowed hundreds of sick and wounded civilians, together with some members of their families, to leave Yarmouk and some food parcels to be taken in to those still under siege. These positive developments, however, have had only limited impact in alleviating conditions for the thousands of civilians who remain under siege in Yarmouk. Those civilians who remain are estimated to number between 17,000 and 20,000 people, and include many who are elderly and sick and families with young children.

Another glimmer of hope emerged when the UN Security Council passed resolution 2139 on 22 February 2014. Three years into the worsening human rights and humanitarian crisis, this was the first Security Council resolution to address the humanitarian situation in Syria. It calls on the parties to the conflict to immediately lift sieges of populated areas, including Yarmouk; end violations of human rights and international humanitarian law; and allow rapid, unhindered and safe access – including across borders and conflict lines – for humanitarian agencies to reach people in need.

As a consequence of recent and ongoing negotiations, several relief convoys have managed to bring vital but limited humanitarian supplies into Yarmouk. From 18 January until 26 February some 7,493 food parcels were delivered by UNRWA, the agency stated, to families at the edge of the Yarmouk. Each parcel contains dry foodstuffs to feed a family for up to 10 days. However, the quantities are inadequate for the desperate needs of the people in Yarmouk. In addition, during the same period, hundreds of the most vulnerable individuals have been allowed to leave and be escorted to hospitals.

According to local and international sources, some 2,000 to 3,000 members of armed opposition groups were present in Yarmouk until early February 2014, when most were reported to have found means to leave the area despite the ongoing siege. As of late February 2014, all individuals inside or from Yarmouk interviewed by Amnesty International said that most if not all members of armed opposition groups had managed to leave Yarmouk via secret routes and there were hopes that the camp would return to its earlier status of neutrality once the siege comes to an end. On 2 March 2014, however, government forces shelled Yarmouk repeatedly following the return of members of Jabhat al-Nusra to Yarmouk. A statement issued by Jabhat al-Nusra and seen by Amnesty International accuses the Syrian government and PFLP-GC of reneging on their commitment towards ending the siege.

2.2 DEATHS UNDER SIEGE

Amnesty International has received information on the deaths of 194 people, all said to be civilians, who are reported to have died between the tightening of the siege in July 2013 and 22 February 2014. Information on these cases is presented in a table in the Appendix to this report. It is likely that some fighters may also have died in Yarmouk during this period, although Amnesty International has only seen information concerning one such death.

The main sources for the deaths are the Palestine Red Crescent Society – Syria (PRCS-S) and several human rights NGOs with a presence or contacts inside Yarmouk, notably the Action Group on Palestinian Syrians (AGPS),12 the Palestinian League for Human Rights (PLHR),13 Group 194,14 and the Palestinian Camp News Network Union (PCNNU). For 46 of the reported fatalities, reports are supported by still or video images of the deceased.

In almost all cases, the full names of the deceased have been given, but in several only partial names can be provided and in three cases the individuals’ identities are unknown.

Fifty-four of those reported to have died are female, and 139 individuals are male. In one case the deceased’s sex could not be determined. For 16 of the reported fatalities, the sources provided information indicating that the deceased individuals were aged between 60 and 85 years old; a further 25 deceased individuals were reported as being “elderly”, without additional clarification. Twelve infants under 12 months old are among the deceased, in addition to six children.

Regarding the causes of death, 128 individuals, two thirds of the fatalities listed, are reported to have died as a result of starvation. Lack of proper medical care is also a factor in these deaths, as starving individuals could in other circumstances be treated through administering fluids for intravenous therapy, but such fluids are in very short supply as medical facilities and services have been decimated during the siege. Fifty-one individuals, according to the information received, died from illnesses and injuries that required a degree of medical care no longer available in Yarmouk. Even when individuals have died after suffering multiple injuries from shelling, or potentially life-threatening conditions such as heart attacks, medical workers in Yarmouk told Amnesty International that in most cases their lives could have been saved had proper medical care been available. Ten individuals are reported to have died from wounds they received when they were shot by government snipers; of these, at least two were shot while foraging for food to eat in the small fields adjacent to Yarmouk. Two others were said to have been shot by snipers during protests, one of which followed an incident on 16 January 2014 in which a government helicopter reportedly dropped barrel bombs on Yarmouk.

2.3 STARVATION

From December 2012 to February 2013, the Syrian armed forces at Yarmouk’s checkpoints permitted fewer and fewer individuals to bring in even the smallest amounts of food, such as vegetables, that had occasionally been allowed. Those who tried to bring in food and medicine also put their lives at risk. On 12 January 2013, Ghassan Shihabi sought to drive into Yarmouk with his children and with bread to give to other families. However, when he arrived at a Syrian army checkpoint outside Yarmouk, Air Force Intelligence officers at first prevented him from proceeding before he was cleared to do so by members of the PFLP-GC.

His widow told Amnesty International that when he then drove forward, he was shot dead by a government sniper.

From July 2013, Syrian government forces prevented all food, medicines and other supplies from entering Yarmouk, exposing the area’s remaining inhabitants to untold hardship and serious risk. Since the area was sealed, the inhabitants have faced an increasingly difficult struggle to survive. Rampant malnutrition has led to scores of reported deaths from starvation as well as widespread illness, with the sick, the elderly, young children and pregnant women at highest risk.

With the Syrian army and its armed allies blocking the entry of all food supplies, Yarmouk’s markets and shops have run out of stocks. All that could be obtained in the market, one resident told Amnesty International in February 2014, were “spices and a kind of green starch that can be fried and eaten”.

As the impact of the siege took hold, local people had to resort to increasingly desperate measures. First, when there was no more flour to make bread, families baked substitutes using lentils and then crushed bulgur wheat. Then, these supplies too were exhausted or became too expensive – by late 2013, a kilogram of rice cost between 10,000 and 15,000 Syrian pounds (US$70 to $100). One woman told Amnesty International that her brother had sold packs of cigarettes for the equivalent of US$40-50 each, then used the money “to buy dry foods that last, such as rice and lentils”.

For months residents survived scouring the area for anything that might be edible, including cactus leaves, dandelion leaves and other plants. Hunger has driven many to expose themselves to government snipers while searching for food. For example, a hospital nurse described the case of a boy aged 16 or 17 whose body was brought in after he had been shot dead while collecting leaves to eat. Addressing the lifeless boy, his grieving father said: “You died for the sake of bringing hibiscus leaves for your brothers and sisters.”

A Syrian national who remains in Yarmouk told Amnesty International in February 2014: “I eat anything that I can get my hands on. I eat on average one meal every 30 hours. Either we have to go to the small field areas overlooked by snipers, looking for herbs, or group together to buy a kilo of rice or lentils at 10,000 Syrian pounds and cook it, but we cannot afford to do this each day due to the cost. For a year and two months we have been without electricity.

There are some generators but the diesel for it is scarce and expensive. After some recent food deliveries got into the camp, the prices have gone down by about 30%, but they do not reach the markets and are instead sold on the informal market like drugs.”

Other residents told Amnesty International that they have had no fruit or vegetables to eat for many months. Speaking in January 2014, one said: “The last time I ate vegetables was more than eight months ago.”

Another said he had “not eaten fruit for seven months, nor vegetables for six months”, but had eaten a plant known as bird’s foot trefoil that is usually eaten by cows and other livestock. Other residents have also eaten this plant but some have suffered an allergic

reaction, including bloating, as a result. Cases of food poisoning and other illnesses became common as many people have been forced to exist on a diet of leaves and weeds. In desperation, some have killed and eaten cats and dogs, a practice reportedly permitted through a fatwa issued by local sheikhs, in some cases suffering food poisoning as a result.

According to one resident, some people have resorted to drinking dog milk.19 Another resident told Amnesty International that many eat from rubbish bins, and this is also purportedly shown on YouTube video clips. A common “meal” is said to be water mixed with spices.

Many Yarmouk residents have been killed or injured by government snipers while foraging for food, especially in the south where there are some fields. A local human rights activist told Amnesty International in late January 2014 that people had been able to search for food there without being shot at times but that the situation had now changed: “The area is sniped upon by members of the Syrian army. Currently, no one is able to enter the area without being shot at.”

A voluntary medical worker at Palestine Hospital said that people were generally shot and injured daily there, and sometimes killed.20 Despite hopes and expectations around 12 February 2014 that a large food delivery was to arrive at Yarmouk, on that day it was reported that Talal Awad was shot dead by a sniper while foraging for food at the edge of Yarmouk camp.

2.4 MEDICAL WORKERS, MEDICAL SERVICES AND THE HEALTH OF THE BESIEGED

The long and violent siege has had a devastating effect on the people who remain in Yarmouk, according to health workers inside the area, local human rights activists and residents with whom Amnesty International has been in contact, and representatives of international organizations that have sought to monitor conditions. Medical facilities in particular have been badly hit and medical personnel have suffered both through being targeted as well as through indiscriminate attacks and the collective punishment of the siege.

Among at least scores of individuals arrested during the siege, at least 12 are medical workers. Of these, six are reported to have been subjected to enforced disappearances and one died in custody in suspicious circumstances. Government security forces arrested Dr Hail Hamid, a hospital consultant and professor in the faculty of medicine at Damascus University, at his clinic in Yarmouk on 11 August 2012. His fate is unknown. Dr Aladdin Youssef, a neurological surgeon, disappeared after being arrested at a Syrian military checkpoint on or around 18 December 2012. A volunteer with the PRCS-S told Amnesty International that Dr Youssef was detained after he entered into an argument with security officials at the checkpoint who refused to allow him to exit in order to fetch medicines. The fate of urinary surgeon Dr Nizar Jawdet Kassab, who was detained by government forces at a Yarmouk checkpoint on or around 19 December 2012, is also unknown. The fate of paramedic Hussam Mou’ad, who was arrested on 30 December 2012, is unknown. Salma Abdulrazaq, an engineering student aged 21 who volunteered with the medical scouts (al-Kashafa al-Tibbiya) of the Palestine Liberation Organization (PLO), was also arrested on 30 December 2012 when she was searched at a checkpoint and found to be carrying a small quantity of medicines into Yarmouk. She was taken to the Palestine Branch of Military Intelligence for interrogation, after which her fate is unknown.22 Abd al-Rahman Salameh, an assistant anaesthetist nurse, was arrested on 1 September 2013. His fate is unknown.

Government forces arrested Mohammed Abu Rughba, a paramedic, in October 2012; he was released in or around late December 2013. Medical workers in Yarmouk told Amnesty International that many of their colleagues left Yarmouk during this period, fearing arrest. Lack of medical personnel inevitably impacted the services available and put lives of injured and sick patients at greater risk. As the widow of Ghassan Shihabi told Amnesty International: “As soon as I arrived there [at Palestine Hospital], a health worker told me that my husband hadn’t made it. There were no doctors at the hospital because a few days earlier, Dr Aladdin Youssef was arrested and so others were scared to come to the hospital.”

Other medical professionals who were among those detained include Mohammed Najma, the owner of a medical supplies company who assisted the group of volunteer medical scouts (al- Kashafa al-Tibbiya) of the PLO. They acted as a first response team when rockets fell and people were injured, helping the wounded into ambulances and access emergency medical care. A senior medical worker told Amnesty International that government security officials from the Palestine Branch of Military Intelligence detained Mohammed Najma on 1 September 2013 at his company office, after first beating him with his laptop computer, and then took him away. He was released in or around late November 2013.

At least one medical worker has been named among the scores of detainees from Yarmouk and thousands from elsewhere in Syria who are reported to have died as an apparent result of torture and other ill-treatment in the custody of Syrian government forces during the past three years. Security forces arrested Dr Firas Abd al-Razzaq al-Jild, a dentist, on 21 December 2012 as he sought to enter Yarmouk; his desecrated body was found two days later on a Yarmouk street.

At least three medical volunteers were arrested in the vicinity of the checkpoint at the main northern entrance to Yarmouk on or around 2 February 2014. Ahmed al-Solh, Ahmed al- Qudemi and Ahmed Taha all had permission to leave the camp: Ahmed al-Qudemi had been granted permission to accompany his injured brother to a hospital while both Ahmed al-Solh and Ahmed Taha had been given permission to leave to register for university. Ahmed al- Qudemi, a law student, also worked as a member of the group of volunteer medical scouts (al-Kashafa al-Tibbiya) of the PLO.

Other medical workers have been killed and injured in attacks by government forces on Yarmouk during the siege. Some government attacks, including aerial bombing and tank or artillery shelling, have been indiscriminate, carried out with gross disregard for the civilian population, while others appear to have deliberately targeted civilian objects, such as hospitals and medical centres. Dr Ahmed Nawaf al-Hassan, a surgeon at the Palestine Hospital, died on 17 June 2013 when a rocket apparently fired by government forces struck the hospital. A PRCS-S volunteer who witnessed his killing told Amnesty International: “He died instantly when a rocket fell at the front door of the hospital (about 12m away) and he was sprayed with shrapnel, one piece of which pierced his heart.” Another Palestine Hospital doctor, Mohammed Hemedi, was reportedly killed in a rocket attack outside Yarmouk.

The PRCR-S volunteer said that government forces appeared to be pursuing tactics designed to cause casualties among medical staff and volunteers: “When a rocket hits a building, the government forces know that the medical staff will run out to save the injured. They wait a few minutes then fire a second and third time knowing the medical staff are likely to be there.”

Medical professionals and volunteers who have sustained injuries include: Khaled Salama, who was wounded in the foot by a rocket explosion; Adnan Qassem, who was injured while driving an ambulance; Ahmed Hassoun, wounded in the foot; Asmaa al-Khayat, who sustained injuries to her back, hand and chest; Majd al-Masri, who was struck in the face by shrapnel; and Wissam Moussa, who received wounds to his shoulder and ribs when he was shot by a government sniper in November 2013.

The Palestine Hospital, run by the Palestinian Red Crescent Society (PRCS), is the main hospital in Yarmouk that continues to function, although it has been damaged by bombing, has lost many of its staff and its capacity has been reduced as a result of the siege. One health worker at the hospital told Amnesty International that it has been bombed a number of times by Syrian government forces: “On one occasion, a rocket hit the fourth floor and destroyed the generator. Another time a bomb fell at the front entrance.” He said that rockets had also struck the area surrounding the hospital several times, including one that hit a nearby building, causing damage to the door of the hospital and wounding one of the hospital’s staff. By February 2014, the Palestine Hospital’s capacity and services had been severely diminished by the months of siege; it had only two doctors, depended for its electricity on generators that were kept going using diesel fuel provided by residents from their own diminishing stocks, and was running low on medicines and other medical supplies, including fluids for intravenous therapy, locally referred to as “serum”. Yet the hospital continued to receive casualties – victims of shooting by government snipers and people suffering from a wide range of siege-related injuries and illnesses as well as others whose existing ailments have been exacerbated by the shortages of food, water, electricity and medicines arising from the siege.

Before the siege, the Palestine Hospital carried out around 600 surgical operations each month, including plastic surgery, ear, nose, throat and eye operations. Today, however, after months of siege, no surgeons remain and the hospital lacks proper medication for surgery patients; even so, according to a PRCS medical worker in Yarmouk who spoke to Amnesty International, “any necessary surgery is carried out by nurses who are learning by experience and study.” Unsurprisingly, another medical worker said “many have already died here due to a lack of serum and other medication.”

A PRCS-S volunteer told Amnesty International: “People are dying from injuries sustained from being shot by snipers, or in explosions, particularly if they were hit in the head or chest, since there is no one able to treat them. Other civilians are dying specifically due to the lack of medical equipment and supplies such as defibrillators, incubators, blood bags and serum.

We also lack gauze and simple sterilizers.” A PRCS worker added that “babies are dying because there is no milk, neither powder nor from their mothers” and that hospital staff were trying to remedy this by arranging for other mothers who were successfully lactating to breastfeed several children in addition to their own.

According to one PRCS health worker, three women and five newborn babies died due to complications during pregnancy and childbirth in December 2013 and January 2014 because the hospital was unable to give them the medical treatment they required.

There has been an increase in miscarriages due to food shortages and poor nutrition for pregnant women, and due to the collapse of antenatal facilities and care under the siege. A medical worker told Amnesty International that the hospital possesses an aged ultrasound machine but has no doctor to operate it; consequently, it cannot be used to identify potential foetal problems prior to birth. The lack of gynaecologists and surgeons means that the hospital cannot carry out Caesarean births; at least one pregnant woman is reported to have haemorrhaged to death. The hospital has just two midwives to advise and assist women during pregnancy and birth.

The Palestine Hospital’s two remaining doctors continue to treat patients with internal illnesses or injuries, to provide anaesthetics and first aid, but they have virtually no medical supplies. One of the hospital’s two stores of medical supplies has been exhausted while the other was seized, apparently for their own use, by armed men believed to be members of Suqour al-Jolan, an FSA-linked armed opposition group.

One medical worker told Amnesty International that he witnessed the armed men removing the store of medical supplies provided by the PRCS: “I saw their van full of our medical supplies stamped with ‘Ramallah’ on them.” The same armed opposition group is also reported to have been responsible for seizing the Palestine Hospital’s entire fleet of five 15 ambulances.

The Palestine Hospital pharmacy is still operating but it is now the only pharmacy in Yarmouk, one medical worker told Amnesty International. Before the siege there were around 100-120 pharmacies.

The Faiz Halawa hospital, where patients requiring surgery were often treated, and which had facilities for conducting X-rays and a paediatrics department, is no longer functioning, having been repeatedly shelled by the encircling government forces. Residents told Amnesty International that the hospital was struck more than 30 times. Such equipment and supplies that remained are reported to have been looted in early 2013 by unidentified armed men, suspected members of one or more of the armed groups that had taken up positions in Yarmouk.

The Deir Yassin medical centre, run by the PRCS, formerly offered a wide range of medical services, including paediatrics, gynaecology, dermatology, physiotherapy, dentistry and primary health care. Today its staff, mainly made up of volunteer paramedics, are able to provide only the last three services.

The small al-Basel Hospital, which now reportedly has only one doctor, provides mostly dental and general medical services, and has had to reduce its hours to mornings only.

These three medical institutions are the only ones still functioning, albeit at a reduced level, and are continuing to provide some assistance to the burgeoning number of wounded, sick and infirm victims of the siege. UNRWA has been forced to close its three clinics in Yarmouk due to damage and the lack of UNRWA medical staff remaining in Yarmouk.

The Rahma Hospital has also closed due to the damage it has sustained and its dangerous location, close to the front line between government troops encircling Yarmouk and the opposition fighters engaged in combat against them.

At the Palestine Hospital, health workers report that they have to contend with new illnesses resulting from the harsh conditions to which besieged residents have been exposed, including a rising incidence of malnutrition-related health problems, including food poisoning. People have become ill after they have been driven by hunger to “eating the stalks of plants that are not always edible”, one PRCS worker told Amnesty International in February 2014, adding that “even those stalks sell for a very high price”. At least three men are reported to have been admitted to Palestine Hospital when they became ill after consuming a waxy mixture of sugar and water that women use to remove body hair, and recently a young girl was brought in suffering from stomach problems after her family had killed and eaten a dog. By mid- February 2014, according to one medical worker at the Palestine Hospital, around 60% of Yarmouk residents were suffering from malnutrition. “For the first time I am seeing smallbabies with bloated stomachs, skin on bones,” he told Amnesty International. “The old people and babies are suffering the most.”

The same medical worker said that jaundice has been “spreading like wildfire” among Yarmouk residents. Jaundice, which affects the liver, is often a result of food contamination caused by a failure of hygiene. A PRCS-S volunteer told Amnesty International: “Jaundice is 16 very widespread amongst both children and adults…. At the Palestine Hospital we see at least six or seven cases every day. The other clinics may see more. They can do a simple urine test to detect it, but the medicine is the problem. Some of the private clinics donate whatever samples of medicines or vitamins they have, but it is not enough.” According to a medical expert consulted by Amnesty International, the probable cause is of jaundice in such circumstances is hepatitis A or hepatitis E. Both of these forms of hepatitis are transmitted from food or utensils contaminated with human sewage and are therefore closely related to a lack of hygiene. In addition, there has been a rising incidence of skin ailments, such as scabies and eczema, also apparently caused by endemic malnutrition and lack of hygiene, as well as keratomalacia, an eye disorder that affects the cornea and is caused by severe vitamin A deficiency. The hospital has also received several cases of rickets, which is caused by deficiencies of vitamin D and calcium.

Since 18 January 2014, conditions have been alleviated somewhat by the government’s agreement that many seriously ill residents could leave the besieged area. On 14 February, a PRCS health worker told Amnesty International that “most of those suffering from serious illnesses have left, approximately 450 individuals.” Many were accompanied by family members and were expected to receive treatment at Damascus hospitals. However, not all survived the exodus. “One young woman died yesterday at the checkpoint after having been referred to hospital outside the camp,” according to the PRCS worker. A PRCS-S volunteer also told Amnesty International the same day that the medical assessments for those being evacuated from the camp are made at the Palestine Hospital, but must then be approved by the PFLP-GC and the Syrian government security forces managing the crossing point. On 13 February, they finally agreed to the exit of a pregnant woman whose passage they had denied for four days. In another case concerning a young girl who had been shot in the forehead with a bullet, the health worker said “it took 10 days to get approval for her to leave,” although it was obvious that she was critically wounded.

2.5 ARRESTS, DETENTIONS AND DEATHS IN CUSTODY

Syrian military forces, in some cases assisted by members of the PFLP-GC and other progovernment groups, are reported to have arrested scores of people during their siege of Yarmouk, including the 12 medical workers cited above. The Violations Documentation Center, a prominent Syrian NGO documenting violations committed in Syria since April 2011, has the names of 150 people from Yarmouk arrested since that date and more than 80 names of individuals held as of late February 2014.27 The actual number is likely to be higher, possibly much higher; documenting arrests by forces that act with impunity and frequently detain and hold people in secrecy for indefinite periods invariably presents serious challenges, and is especially difficult in the context of a protracted siege within a country engulfed by armed conflict and undergoing an humanitarian crisis. Local activists and members of human rights NGOs have told Amnesty International that they believe Syrian forces may have arrested hundreds or even thousands of people from Yarmouk during the past two years, although they cannot verify this. Some of those seized may have been opposition fighters but all of Amnesty International’s sources insist that the majority were civilians not directly participating in hostilities. They include people who went to collect food parcels that the Syrian authorities had allowed into the besieged area, students who had received official permission to exit Yarmouk in order to resume their studies in other places, and humanitarian aid and health workers. Uncertainty surrounds the fate of these individuals; many appear to be victims of enforced disappearance. The Syrian authorities have neither disclosed their number nor their identities, nor where they are held, and there is no independent access to them. It is feared that many will have been taken to the Palestine Branch of Military Intelligence in Damascus, where torture and other abuse of detainees, in some cases resulting in deaths, has long been rife.

Fuelling these fears, the Action Group for Palestinians of Syria, a local human rights group, reported the enforced disappearances or deaths in custody of 29 individuals from Yarmouk between 22 May 2011 and 17 September 2013. In all but one case, the perpetrators were believed to be Syrian government forces or their allies.28 Khaled Bakraawi, a prominent humanitarian worker, was reported to have been arrested on 19 January 2013 by government forces while trying to assist individuals displaced from other locations into Yarmouk. He reportedly died as a result of torture or other ill-treatment on 11 September 2013.29 Further arrests and at least one suspicious death in custody of individuals from Yarmouk are reported to have occurred subsequently. On 2 February 2014, Maher Mohammed al-Sayad was reported by local activists to have died in custody after being seized at a government checkpoint some nine months earlier.

Most recently, Syrian government forces detained dozens of people from Yarmouk in early February 2014. They included 27 people who were arrested on 2 February during an officially authorized food and aid distribution at the Syrian army checkpoint on the northern side of Yarmouk. Some of the 27, whose names were subsequently published by local human rights activists, were among those who went to collect food parcels for Yarmouk’s residents, while others had received official permission to leave for study reasons. All were said to have been taken to the Palestine Branch of Military Intelligence in Damascus; their fate remained unknown as of late February 2014.30 Also arrested on or around the same day was Fuad Amr,who acted as a mediator in the then ongoing negotiations and was reportedly seized by members of the PFLP-GC. He is reported to have been taken to the Palestine Branch of Military Intelligence in Damascus, prompting concerns for his safety.31 On 3 February, members of Fateh al-Intifada, a Palestinian organization that supports the Syrian government, were reported to have seized Mahmoud Mou’ad, a humanitarian aid worker, and taken him also to the Palestine Branch of Military Intelligence. According to the information received, the Syrian authorities have provided no information about him since he was detained; there are fears for his safety.

Video

‘Shocking’ scenes in besieged Syria refugee camp

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