The reality of encirclement: First Madaya patient dies of malnutrition-related kidney failure

Madaya’s first patient to die of kidney failure passed away on Saturday. His name was Deebo Ibrahim al-Kuwayfi, and he was 54 years old.

Al-Kuwayfi didn't have to die. His condition was a result of malnutrition caused by years of encirclement around this former mountain resort town 40km northwest of Damascus that signed onto a truce with the regime in September 2015.

Today, at least 25 of Madaya’s remaining 40,000 residents are in varying stages of kidney failure directly tied to severe malnutrition, Syria Direct reported last month.

The medieval-style siege of Madaya means nothing and no one enters or exits without the regime’s permission. International aid organizations can only sit and watch, and wait, to be granted rare access.

None of the kidney failure patients has left the town. Seven remain in “extremely critical condition,” Dr. Mohammed Darwish, one of Madaya’s three remaining medical professionals, tells Syria Direct's Bahira al-Zarier and Razan Yasin.

“We’ve reached out to humanitarian organizations,” Darwish said. “The only response that we have gotten is that patients must be evacuated in accordance with the Four Towns agreement,” the dentist said, referring to the truce between the regime and opposition that governs evacuations from the town.

A spokeswoman with the Syrian Arab Red Crescent (SARC), a regime-affiliated aid organization, told Syria Direct on Tuesday that SARC “is ready to evacuate patients when an agreement between the parties is reached.”

The thing is, it’s really one party that is in control. And the notion that his fate lies in the hands of the people who created the conditions for his illness is of little comfort to Ali Ghassun, age 31. Last month, Syria Direct interviewed Ghassun’s sister as part of a report on malnutrition leading to kidney failure. Due to the encirclement of Madaya, no medical supplies other than mild painkillers are available for Ghassun.

“Here in Madaya, we can only give our loved ones false hopes and promises so their desire to live won’t die,” says Rula Ghussun.

Dr. Mohammad Darwish, a dentist in Madaya and the town’s leading medical professional.

Q: What was the cause of Deebo Ibrahim al-Kuwayfi’s death?

Deebo, who was 54, had been suffering from kidney failure for a month. Unfortunately, he had acute kidney failure and his creatinine levels were high. He didn’t respond to the inflammation medication and diuretics we gave him as an alternative form of treatment.

[Ed.: A diuretic is a drug that increases the production of urine.  According to the Centers for Disease Control, creatinine is a waste product formed when creatine, which helps convert food into energy, breaks down. When kidneys malfunction, creatinine levels in the blood increase.]

Inflammation medication and diuretics are by no means a cure to kidney failure, but they ease its symptoms.

Sadly, Deebo didn’t even respond to this treatment because of his age and weak immune system. His situation worsened every day.  He passed away on Saturday, even though some patients are in more critical condition than he was.

A Child in Madaya. Sign reads, “Save the kidney failure patients.” Photo courtesy of Madaya.

Q: How are the other 24 patients doing?

Seven patients are in extremely critical condition, including Ali Ghussun, whom you interviewed last month. We expect him to die any day. Of course, God will decide his fate, but his situation is grim. He has progressed from acute to complete kidney failure. His kidneys have completely stopped working.

Other patients include Fawaz Ghussun, who has high levels of creatinine in his blood, Abdelfitah Jaber, Samar Asaaf and women and children of all ages.

Q: Have you contacted organizations for help? How have they responded?

Yes, we’ve reached out to humanitarian organizations such as the Red Cross, Red Crescent, World Health Organization and UNICEF.

The only response that we have gotten is that patients must be evacuated in accordance with the Four Towns Agreement. But there are no patients in Fuaa and Kafariya who need to be evacuated right now.

[Ed.: Right now, the evacuation of patients from Madaya is tied to a ceasefire known as the Four Towns agreement, signed in September 2015. It stipulates parallel evacuations and aid deliveries for four encircled towns: two in Outer Damascus and two in Idlib province. Madaya and Zabadani are encircled by the regime and Fuaa and Kafariya are encircled by rebels in northern Syria.]

Q: How are Madaya residents responding to news of Deebo al-Kuwayfi’’s death? Are they afraid of becoming sick and suffering the same fate?

People in Madaya are no longer afraid of death. They’re only afraid of getting sick, suffering from disease or getting shot by a sniper.

In the end, we’ll die because the sick in Madaya suffer, and suffering leads to one place—death.

On October 13, Syria Direct interviewed Rula Ghussun, 31, a Madaya woman whose 30-year-old brother, Ali, is suffering from kidney failure due to malnutrition. Here, Rula updates readers on Ali’s current condition.

Q: How is Ali’s health?

Very bad. After his right kidney failed, his bile ducts began to swell. His symptoms increased; he’s throwing up and suffers from severe headaches.

Q: How did Ali and you receive the news of Deebo’s death?

The news stunned me. I’m terrified that my brother will be next.

Deebo’s death made me realize that we humans, who used our genius to reach outer space, are completely incapable of reaching into the depths of our own conscience, an act that would ease the suffering of many.

I hope that no one will ever have to feel and experience what I’m going through. It’s devastating and much harder than losing a loved one.

Here in Madaya, we can only give our loved ones false hopes and promises, so their desire to live won’t die.

We didn’t tell Ali.

Q: Why didn’t you tell Ali that Deebo al-Kuwayfi had died?

The news could make Ali lose all hope that he’ll be evacuated or treated. If he finds out, his symptoms could be exacerbated.

We even hide medical reports from Ali. We don’t want him to lose hope.

Q: What did the doctors tell you about Ali’s situation?

Doctors inside and outside of Madaya consider Ali to be a unique case. Test results show that Ali’s body is putting up an amazing fight. They are surprised by this. If Ali isn’t evacuated or treated soon, however, he’ll reach the end of his fight. He could die at any moment. 

Bahira al-Zarier

Bahira is from Damascus. She studied business and marketing before moving to Jordan in 2013. She did volunteer work in support of many refugee organizations before joining Syria Direct.

Jessica Page, Reporter/Translator

Jessica was a 2013-2014 Georgetown University Qatar Scholarship Program fellow in Doha, Qatar. She received her BA in both Arabic and International & Area Studies from Washington University in St. Louis. She has worked and studied in Jordan, Oman, and Qatar.

Kristen Demilio

Kristen Gillespie Demilio has more than 10 years of experience reporting from the Middle East while based in Amman. She regularly contributed to news outlets including CBS News Radio, NPR, The Jerusalem Report and PBS and is a graduate of Columbia University's Graduate School of Journalism as well as the Institut Français des Etudes Arabes in Damascus.

Razan Yasin

Razan is from Douma in East Ghouta. She holds a degree in pharmacy from the Islamic Society College. She wants to write about Syrians’ daily life during wartime.