Hospital Bombings in Aleppo: Innovating Healthcare for Unpredictable Environments

The image of 5-year-old Omran Daqneesh sitting in an ambulance covered in blood and ash has been shared so many times on social media that he is now being referred to as just “the Aleppo boy.” The picture sparked outrage and protest on social media from people across the world and finally brought attention to this war-torn city. However, the responses focused mainly on what could be done to stop the bombing and who was to blame. When asked in the second U.S. presidential debate in early October, “If you were president, what would you do about Syria and the humanitarian crisis in Aleppo?” nominee Hillary Clinton blamed Russia and Syrian President Bashar al-Assad for the crisis and her opponent Donald Trump blamed Clinton (1). In the U.S., little has been discussed about what can be done to help the victims of the Aleppo bombings, except for whether or not the United States should accept Syrian refugees.
    
The bombs that have been dropped on Aleppo in recent months are not being dropped indiscriminately. They are specifically targeting hospitals and schools. Currently, there are 3 major state-run hospitals – Al-Razi, Aleppo University Hospital, and Ibn-Rushd Hospital – left to provide for over 1.5 million residents living in the government-controlled half of Aleppo (2). Several humanitarian groups, namely the American Red Cross and Doctors Without Borders, are doing their best to provide emergency care for bombing victims like Omran. But what about the chronically ill people of Aleppo, who are depending on these few remaining hospitals for services like dialysis treatment, chemotherapy, insulin shots, and prescription medicine? 
    
According to the Syrian government, “Aleppo’s healthcare facilities provided residents of government-controlled areas with 280,000 discrete medical services – everything from major war-related surgeries to diabetes insulin treatments” (3). With hospitals under attack and physicians fleeing Aleppo for their own safety, there is little to be done for chronically ill patients. Dialysis machines need great amounts of electricity and insulin shots need to be refrigerated (neither of which can be done with the recurring power outages), and everything needs to be administered by a physician. Dr. David Nott, a British surgeon who volunteers in Syria with Doctors Without Borders, says little can be done for people with chronic illness during a war: “People with cancer, diabetes, hypertension are in trouble,” Nott said, “they just die at home” (4). A Syrian doctor, Dr. Hamza, says that sometimes the best he can do for cancer patients is give them pain killers, “They suffer horribly,” he says (5).
 
Al-Kindi Hospital in Syria used to be one of the top facilities for cancer treatment in the Middle East, but it has since been reduced to rubble. Nott says that “makeshift doctors without degrees are setting up shop” to make extra money. He even came across a mechanic-turned-doctor, saying “He reckons he can fix cars so he can fix people” (6). With 60% of Syrian hospitals destroyed and half the physicians fleeing, medicine in Syria is taking several steps backward when it could be moving forward.
    
Several new medical innovations could provide some aid to the chronically ill in Aleppo and other war-torn cities like it. For example, telemedicine could help the few remaining physicians to provide care to more patients. Using just a smartphone, the physician or the patient can relay symptoms, injury pictures, or vital signs to a network of available and qualified doctors around the world, who can provide a diagnosis and advice. While this wouldn’t necessarily help patients needing dialysis or chemotherapy, it could help alleviate some symptoms and make “doctors without degrees” quite useful. This technology is often used in rural parts of the United States, where there are not physicians on call 24/7. Vinaya Sermadevi, a critical-care specialist, says “It’s almost like being at the bedside—I can’t shock a patient [restart his heart with electrical paddles], but I can give an order to the nurses there” (7). It’s possible that by using telemedicine, qualified doctors can talk regular citizens through providing simple healthcare like administering vaccinations or checking blood pressure.
    
Furthermore, some medical machine manufacturers are changing their products to be usable in “predictably unpredictable environments” such as war zones. Often times, hospitals and manufacturers will donate used machines to developing countries, but these machines frequently end up in storage closets because the rural hospitals don’t have the tools for machine maintenance or cannot get replacement parts when the machine breaks. Guardian Healthcare makes a Universal Anesthesia Machine that can convert room air into usable oxygen and has a rechargeable battery that can last up to 10 hours. It can be repaired using only a hex wrench, a screwdriver, and minimal training (8). Embrace BabyWrap is a low cost newborn incubator that can work during intermittent power outages. Another company, Daktari, makes a portable CD4 counter that counts white blood cell levels for HIV, AIDS, and cancer patients. There are several new portable technologies, including ultrasounds and blood pressure monitors, that can be used anywhere by linking to a smartphone.
    
Solar power is also playing a large role in medical devices for unpredictable environments. For example, TrueEnergy has created a solar-powered vaccine refrigerator that could be very useful in Syria for refrigerating immunizations and insulin shots when there are power outages for several days. There are also solar-powered blood pressure monitors that can do up to 300 readings without being recharged do not require a physician, which means patients with chronic hypertension can monitor their blood pressures from home. Finally, and most importantly, the Solarclave is a solar-powered medical instrument sterilizer. One of the leading causes of death in war zones is infection from using non-sterilized equipment during emergencies. Often times, nurses have to resort to using boiling water or swabbing instruments with alcohol, neither of which truly sterilizes equipment.
    
No single technology can help chronically ill patients, who also happen to be living in the middle of a warzone, survive the terrible things that are happening in Aleppo. However, many of these technologies could decrease the number of “excess deaths”, or deaths that are caused by byproducts of war rather than the war itself. Humanitarian efforts from the Syrian government, private companies, non-profits, and even the American government should focus more on providing long-term health solutions to the people of Aleppo, rather than just emergency care. They should focus their efforts on getting some of these new devices to the few remaining hospitals in Aleppo. Regardless of whose fault this humanitarian crisis is, the bottom line is that it is happening and it will not end soon. Though the bombings in Aleppo may have only come into the public spotlight recently because of the picture of Omran Daqneesh, Aleppo has been a divided warzone for over four years. The goal should be to give the people remaining in Aleppo the best chance of survival by not letting them die of preventable diseases.

​(1) “Presidential Candidates Debates: Presidential Debate at Washington University in St. Louis, Missouri.” The American Presidency Project, 9 Oct. 2016, http://www.presidency.ucsb.edu/ws/index.php?pid=119038.
 
(2) Aboud, Rami. “Devastating Fighting Has Left Aleppo’s Hospitals In Critical Condition.” The Huffington Post, 9 Aug. 2016, http://www.huffingtonpost.com/entry/aleppo-healthcare-system_us_57a9f9ffe4b0ba7ed23d87e6.
 
(3) Ibid.
 
(4) Giovanni, Janine di. “Frontiers Without Medicine.” Newsweek, 15 Feb. 2016, http://www.newsweek.com/2014/03/28/war-torn-syria-health-crisis-emerges-248001.html.
 
(5) Ibid.
 
(6) Ibid.
 
(7) Beck, Melinda. “How Telemedicine Is Transforming Health Care.” The Wall Street Journal, 26 June 2016, http://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402?mg=id-wsj.
 
(8) Miesen, Mike. “Designing Medical Devices for Predictably Unpredictable Environments | The Lancet Global Health Blog.” The Lancet Global Health Blog, 4 Mar. 2014, http://globalhealth.thelancet.com/2014/03/04/designing-medical-devices-predictably-unpredictable-environments.

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Image: © Dinosmichail | Dreamstime.com - Refugee camp in Greece