by Günther Deuschl
The year 2016 is beginning in many places with wonderful progress for neurology. But we should not forget that many of our colleges are working under the hardest imaginable conditions. The war in the middle east taking currently place in Syria, Iraq and neighboring regions is the most brutal and unhuman war which this region has ever suffered. I am writing about Syria but the situation is similar in the neighboring countries. The United Nations estimated at the beginning of 2015 that 220,000 people had been killed in Syria, but other monitoring groups put the death toll much higher. The people living in this region are constantly exposed to violence from all sides, the educational system suffers vita minima and regular jobs are a fiction for most people. Besides all direct military actions people suffer from unexpected explosions or killings for no reasons when walking on the road. Children and women are subject to violence through many and mostly unthinkable ways. Particularly young men fear of getting arrested at military barriers for recruitment and getting killed after a few days in front lines. There is a strong movement to Turkey or Lebanon and meanwhile to Europe. While Syria had 22 Million inhabitants in 2011 before the war currently almost 10 Mio of them are refugees abroad or have moved from the rural areas to the safer cities. The economic situation is also catastrophic as the inflation is grossly affecting all parts of the Society. While 1 US $ equaled 60 Syrian pounds (SP) in the past it equals now 250SP. Black market economy is increasing the suffering in particular of the poorer population. Physicians working in government services earned 400-600$ in the past but are now just between 50-75$ due to inflation and therefore also their families suffer.
This dramatic situation does affect the whole health system and in particular neurological services. EAN has connections with several neurologists still working in Syria who are witnessing the catastrophe and more importantly who still try to maintain neurology services for the population. They need to stay anonymous because otherwise they are endangered and I mix up their reports to guarantee anonymity but I guarantee that all the quotes and data are original. Almost no more health services exist on the country side but limited services seem to exist for military and also for civil persons in the so-called safe areas with a strong military presence including governmental health services. Very few physicians working in private practice can still maintain almost normal neurologic practice for a very small number of patients. “The situation is truly dramatic and patients are almost left alone with their acute and chronic neurologic diseases” told me a colleague from the region. Services at hospitals in ‘safer’ cities may sometimes even include CT or MRI-scans in urgent cases. Such services are supplemented with the most needed neurologic medications for epilepsies, Parkinson’s disease, encephalitis, meningitis, diabetes or elevated blood pressure. But regular services for stroke do not exist. Neither rTPA is available nor a health system which can treat stroke patients adequately. “….the truth is that even such dramatically limited service is available only in a few places” neurologists from the region say. “The majority of our population is without neurological service.”
Education has reached its all-times low. Student education in medicine does practically no longer exist. Residents are taken at the few existing hospitals which are not yet bombed out. In the region of ISIS residency programmes have been completely stopped as education at all levels of schools has been terminated. The future of the young generation and thereby the whole country is dramatically jeopardized. The last meeting of the Syrian Society for Neurology was held in 2011 when still more than 200 neurologists attended the meeting. The last meeting of neurologists was held a few months ago on the request of the medical syndicate to reelect Society councils. It was attended by 50 neurologists. Our colleagues tell me: ‘Eventually we are Syrian doctors, and we have the main responsibility to stay with and take care of our population in our crises.’
The ‘Medicines without Frontiers’ had to close projects and stop support activities in areas controlled by the ‘Islamic State group’ and have also been unable to date to receive permission from the government of Syria to work in areas it controls. There is not much that we as European neurologists can do to help our brave colleagues in these regions but it is important to make them aware that they have the solidarity of European neurologists everywhere. One way to help them is to provide health care services to the many refugees – their former patients – seeking for cure for their neurological diseases in our neurological hospitals in Europe. They do not only suffer from all kinds of neurologic diseases and particular from diseases of the Middle East but they are frequently traumatized and come with all kinds of somatizations after these terrible experiences of civil war. Also we should educate those colleagues who come to Europe and want to get neurologists by including them into our residency programmes.
Let’s keep solidarity with them also in the upcoming year 2016. Our colleagues tell us: ‘We really thank you for your kind concern about our disaster and appreciate your stand with us in our misfortune.’
