The Syrian government has prosecuted the war by intentionally targeting civilian populations in restive areas and any perceived opposition supporters. It has imposed sieges on opposition-held areas, shelled and bombarded densely populated urban centers, and conducted a campaign of arrest, torture, and enforced disappearance of suspected insurgents and their supporters that has laid waste to much of the country and sparked an exodus of millions of Syrians seeking refuge in neighboring countries and beyond.
The Syrian government and its allies have also systematically targeted health facilities and health workers as part of a wider strategy of war aimed at breaking civilian populations and forcing them into submission. Since the beginning of the conflict, Physicians for Human Rights (PHR) has documented 583 attacks on health facilities; the Syrian government and its allies have been responsible for carrying out more than 90 percent of these attacks. Through their purposeful assault on health, the Syrian government and its allies have systematically denied access to medical care in areas outside of their immediate control and actively persecuted health workers who, in adherence to their professional ethics, courageously provide such care to the sick and wounded, including opposition supporters. The Syrian government has blatantly disregarded special protections afforded to medical units and personnel under international humanitarian law and has branded health workers – who provide nondiscriminatory health care in line with their legal and ethical obligations – as enemies of the state.
The formerly detained health workers interviewed by PHR were arrested by Syrian government forces specifically because of their status as care providers, and their real or perceived involvement in the provision of health services to opposition members and sympathizers. This report details the price they paid for doing so, while recognizing that they are among those fortunate enough to have survived Syrian government detention facilities.
Dr. Youssef was in his fourth year of surgical residency when the conflict in Syria erupted. He joined several friends to create an anonymous network of volunteers who established medical points to treat individuals who were injured while peacefully protesting.
On August 21, 2011, seven plainclothes security officers arrested Dr. Youssef as he was treating a patient in a hospital in the Qalamoun region north of Rural Damascus governorate. They took him to the al-Nabek State Security Branch. There, the authorities took his personal effects, strip-searched him, and confined him in a 1-by-1.5 meter cell for the next 69 days. He was not charged or given any reason for his arrest and was not allowed to contact his family or seek counsel. State security authorities interrogated and tortured Dr. Youssef daily for periods of between one and three hours. The interrogators had detailed knowledge of his activities, including awareness of jokes he had told to certain individuals on specific days. Dr. Youssef’s interrogators repeatedly asked him about the medical point network he had helped to establish and the network’s members. Interrogators told him they detained him for supporting “terrorists” and working against the regime. The severity of the torture increased in each session. The initial torture sessions consisted of his interrogators beating his stomach and legs with heavy electric cables. They later applied electricity to his genitalia and administered electrical shocks to his body while he was submerged in water. They threatened to hang him on three separate occasions. Despite the constant torture, Dr. Youssef continued to deny all charges, both fabricated and real, in order to protect himself, his colleagues, and his friends.
A month into his detention, an interrogator told Dr. Youssef that authorities had already detained his colleagues, mentioning them by name. The guards nevertheless continued to torture him, apparently solely to punish him. They beat the soles of his feet with thick plastic pipes filled with concrete. He eventually confessed to various activities he was accused of having been involved in, including providing support to protesters, on the express condition that his captors improve the conditions of his detention. The authorities required that he write his confession three separate times.
On the 69th day of his detention, the authorities moved Dr. Youssef to a larger cell within al-Nabek State Security Branch for two weeks before transferring him to the General Intelligence Branch in Kafarsouseh, Damascus. At the end of these two weeks, and after almost three months of detention in intelligence facilities without charges, he was transferred to Adra Civilian Prison north of Damascus. In Adra, Dr. Youssef had more regular access to food, and could communicate with his family for the first time since his arrest. The authorities finally filed formal legal charges against him in the Civil Court of Damascus and subsequently released him on bail in December 2011 without rendering a verdict.
In September 2013, Dr. Youssef learned from members of the opposition that they had information from an agent working with an intelligence branch in al-Nabek that the authorities intended to re-arrest him. He immediately left for opposition-controlled Idlib, where he began working in a field hospital. In August 2014, Dr. Youssef left for Turkey. While he is not able to practice medicine in Turkey, he has continued to provide administrative and programmatic support to the medical sector inside Syria.
Before the conflict, Tareq worked in marketing in Aleppo. He had no previous medical training. Soon after the government crackdown began in 2011, he trained in first aid and started working as a paramedic, transferring patients between medical facilities. He eventually joined a group of doctors as a member of a non-profit organization that offered medical services in eastern Aleppo and became the administrative director of one of the main trauma hospitals in opposition-controlled East Aleppo.
Toward the end of May 2013, Military Security arrested Tareq at home and placed him in solitary confinement at the Military Security Branch of Aleppo until the end of the summer. In addition to a raft of accusations related to “undermining” the Syrian state, Tareq’s interrogators charged him with “membership in a terrorist organization,” in reference to the Aleppo City Medical Council. About four months into his detention, Military Security transferred Tareq to Damascus, where he was imprisoned underground in al-Mazzeh Military Airport for one week before being transferred to the Palestine Branch of Military Intelligence in Damascus. They placed him in solitary confinement in cell number 56. He was interrogated and tortured three months later and then again two months after that.
Tareq’s interrogators subjected him to a broad range of torture methods including a variety of stress positions, beatings, electrocution, burning of the body – including the genitalia – with boiling water, and sexual assault. Tareq described how he often fainted from the pain during interrogation sessions. “Losing consciousness was a blessing because it was a break from all the physical and psychological torture,” he said. At one point during his detention in the Palestine Branch, Tareq was hung naked by the arms in front of a female detainee placed in the same position.
“They brought me in and hung me from the ceiling and, in a second, removed all my clothes. I suddenly realized I was completely naked. I was unable to understand what was happening until I saw a naked woman one meter in front of me. Her nipples were burnt. There were cigarette burns across her chest. Her hair was unkempt. There was dried up blood between her thighs. I felt a deep shame. For three days, the woman was hung in front of me. It was the most difficult period of the past four years. The prison guard used to enter and insult us. He did not touch us with his hands because he was disgusted by us. He used to molest the woman with a plastic tube and tell me: “Why don’t you defend her? Where’s your honor?” In the same way, he used to molest me while interrogating me to get me to have an erection. Ultimately, he would insult her and ask her: “Is it enough? Is its size large enough for you? Are you satisfied?” She would cry.”
In addition, he witnessed several other instances of sexual violence against other detainees.
“They brought in two women and the soldiers on duty raped them right in front of us. One of them fainted from screaming. I thought she was dead. She was a nurse from Qusair in Homs. Confronting those kinds of atrocities and feeling powerless in front of this inhumanity is much harder than physical torture.”
In total, Tareq was detained in the Palestine Branch for 14 months. After numerous cycles of torture, they took his fingerprints, which he interpreted as a sign that he would go to court. Instead, he was transferred to the Military Police prison in Qaboun, Damascus, where he was detained for nearly one month. On October 29, 2014, Tareq was transferred to Adra Prison, which he described as a “five-star hotel compared to the previous detention facilities.” While at Adra Prison, he appeared in Counter-terrorism Court about once every six months. He was charged with “supporting a terrorist organization” (the medical board) and plotting to overthrow the Syrian regime. The court sentenced him to 10 years in prison, revoked his Syrian nationality, confiscated his assets, and fined him 1,800,000 Syrian pounds (the equivalent of $3,500 at the time). With the help of a lawyer provided to him by the International Committee of the Red Cross, he was released after having been detained for four years, five months, and ten days.
Hassan, a nurse from Homs, described the first week of Ramadan in 2012 at the Riot Unit in Homs Central Prison, when prison authorities cut off food, water, and electricity in response to detainees protesting poor conditions. Hassan spoke of how blockaded detainees resorted to drinking stagnant water from an old reservoir and to hunting mice and rats and cooking them over burning blankets to break their fast.
The majority of interviewees described being denied regular access to showers and soap. Omar, the health volunteer from Harasta, explained that in his 63 days of detention in the Kafarsouse Military Security Branch in Damascus, prison authorities allowed him to shower only twice. Describing the process, he said:
“They told us to take our clothes off and rounded us up by groups of 50. They led us from our building to another and then down into a basement. There, we were led into the showers three at a time. The water was boiling hot. They gave us 60 seconds to shower. Anything over that and we would get the whip. They gave us one bar of soap and the three of us would try to lather each other up as quickly as possible. That shower space was also a toilet and the kitchen where the prison’s food was cooked.”
Some interviewees reported not being allowed access to the toilet, forcing them to relieve themselves in their cells. The cells were often described as filthy, with grime, blood, and dirt covering the ground and the walls. Unsanitary conditions led to chronic diarrhea, widespread lice, scabies, and a range of severe skin infections. Describing conditions in Military Intelligence Branch 215, Omar said:
“Lice was itself a form of punishment because they didn’t even try to treat it. Eleven of us would need to share a single blanket, even though some of us would have lice or scabies. It was a tactic they used to transmit these diseases and make us feel even more depressed.”
The gravity of enforced disappearances and their impact on the families of detainees was palpable in Dr. Jamal’s description of the scene outside the Civilian Court in Damascus on the day he was released:
“As soon as I came out of the courthouse – and this is a something I will never forget – about 50 women rushed me. Each one of them had a picture in her hand. ‘This is my son,’ ‘This is my husband,’ ‘This is my brother,’ they would tell me. ‘Have you seen my son?’ I tried to look at the pictures, but I couldn’t recognize any of the faces. There was a man there who told me to leave before more of them showed up. And that’s what I did. I ran away. It was such a difficult moment. They’re just standing there, and they show these pictures to every detainee who gets released out of that courthouse.” '
