Madaya and its 40,000 people are among an estimated one million people currently living under total blockades in Syria.

In December 2015, the airtight encirclement of Madaya—reinforced by thousands of landmines laid around the town by Hezbollah—led to mass starvation, with residents of the mountain town, less than an hour’s drive from Damascus, surviving on grass and leaves.

Despite international outrage and several food aid deliveries, at least 86 encirclement-related deaths occurred in the town as of May 2016, Physicians for Human Rights (PHR) and the Syrian American Medical Society (SAMS) stated in a joint report last month.

Medical aid last entered this past April. In terms of professionals to administer it, the majority of Madaya’s doctors have either fled or died, leaving the remaining medical team—two dentists and a veterinarian—under-equipped and under-prepared.

“If a situation requires major surgery, there’s nothing that we can do,” Mohammed Darwish, a former dental student and one of the Madaya field hospital’s three medical professionals, tells Syria Direct’s Bahira al-Zarier. “One time, there were three children who were injured by a landmine. They were rushed to the hospital, but we just stood there staring. The children died before our very eyes that day.”

Q: What does medical care look like in an encircled city of 40,000 people with only a vet and two dentists? Are we talking triage or something entirely different?

There are three medical professionals in the Madaya field hospital. I was a dental student, the second is a dentist and the third is a veterinarian. We aren’t specialists, and we don’t have the proper training. But because of the city’s encirclement and our medical education, we’ve had to make do.

Beyond this medical brain drain, the lack of medicine and equipment further exacerbates the already difficult situation. For instance, last Friday a baby girl died after her delivery because we don’t have neonatal incubators. That wasn’t the first time, and it certainly won’t be the last as long as we continue to lack the proper medical equipment. Too many children have died for this reason.

We don’t have the training, and we don’t have the expertise. We’re out of our depth right now.

 Madaya’s medical team. Photo courtesy of the Madaya Medical Commission.

Q: As a veterinarian and two-dentist team, what medical cases are you equipped to handle?

We can perform C-sections, natural births and amputation operations, but that’s it. We try to treat sick people that come our way, but with our limited training, it’s just not possible sometimes.

In many situations, we contact doctors who are abroad via WhatsApp for medical advice. They’ve been able to help and advise us on certain cases given the limited expertise and resources that we have available.

Q: What happens when there is a medical case that you are unable or unequipped to handle?

If a situation requires major surgery, there’s nothing that we can do. One time, there were three children who were injured by a landmine. They were rushed to the hospital, but we just stood there staring. When it comes to these situations, we’re normal people; we aren’t trained doctors. The children died before our very eyes that day, and there was not a single thing that we could do except pray.

Q: Have the most serious cases been able to get medical care outside of Madaya?

We’ve appealed to any number of international organizations: the United Nations, UNICEF, the Red Cross, the Syrian Arab Red Crescent, Doctors without Borders, you name it. And every single time we get the same answer, that they are all bound by the regime’s terms and that for every person that is let out of the regime-encircled cities of Madaya and Zabadani, so too will someone be let out of the rebel-encircled cities of Fuaa and Kafriya.

This past Friday, the regime complied in allowing 18 emergency patients to seek treatment outside the city. [Ed.: Opposition forces concurrently allowed 18 emergency patients from the rebel-encircled cities of Fuaa and Kafriya to seek medical care, ICRC’s Damascus media relations delegate, Ingy Sedky, told Syria Direct.]

With no medical aid getting into the city—and our hands effectively tied—we need all the help that we can get.

Q: What are the most common medical cases in Madaya?

There are 500 people who suffer from calcium deficiency and other malnutrition-related diseases in addition to a number of individuals with diabetes, rheumatism, high blood pressure and other chronic diseases.  

In terms of the most serious cases, there are 20 people who need to seek immediate, emergency medical care outside of Madaya. These are people who suffer from kidney failure, appendicitis and gallbladder inflammation.

Q: Which medicine is in short supply?

We’ve essentially run out of all painkillers, needles, anti-pyretics (drugs used to prevent or reduce fever) and medicine to treat chronic diseases. When these are out, they’re out. There are no alternatives. This is not to mention that we also don’t have laboratory diagnostic equipment.