A Children’s Story: Panic from Outbreak of Meningitis in “Death camp” Of Madaya

Al-Mouwasat Hospital, Damascus

Starving and sick infants have a strong international humanitarian legal case for immediate evacuation from Syria’s “death camp” of Madaya.

“Let me be clear: The use of starvation as a weapon of war is a war crime.” So declared UN Secretary General Ban Ki-Moon recently, connecting with the starvation cases of the two infants discussed below, Manal and Mohammad-Kamal, and with all civilians in Madaya, a besieged Syrian town near the Lebanese border.  Less than an hour NW of Damascus, Madaya has been encircled by armed forces for more than a year and is described by some locals as “the open air prison’ and “the death camp.”

Here is Damascus the evidence is found in hospitals such as Al-Mouwasat and others, of the consequences of the fact that children are suffering not as a result of an accident of war, but rather as the foreseeable consequence of an intentional tactic – surrender or starve. And that tactic is directly contrary to the law of war and subject to individual criminal responsibility for the perpetrators.

The UN’s Children’s Fund (UNICIF) issued a statement on 9/6/2016 stating that it is “extremely” concerned for the safety of children caught up in violence in Madaya and elsewhere in Syria. Saad Houry, of the fund, said children make up a third of the population trapped in besieged areas, and called for unhindered humanitarian access and for children to be protected and evacuated for emergency medical treatment.

Madaya remains surrounded by approximately 65 checkpoints as well as military personnel, snipers, and heavy weaponry. In between the town’s residents and these checkpoints lie approximately 12,000 landmines, trenches, and dirt mounds, all designed to ensure that none of the 40,000 residents can get into or out of Madaya’s 12-square-kilometer area without risking their life.

Among the UNICEF estimated quarter millions of cases across Syria today involving besieged children, most malnourished and seeking sanctuary, are 4 year old Manal and her brother 3 year old Mohammad-Kamal shown below. These beauties are the younger siblings of Ghina and Nagham whose sniper victim’s case has been circulated via the Internet and who were allowed to leave Madaya two weeks ago for urgent medical treatment.

Their evacuation occurred as part of an Iran-UN agreement based on the “Four Towns Agreement” (itself unlawful under international law and which has both saved and cost some lives in this maelstrom civil war). The agreement signed in September 2015 stipulates parallel evacuations and aid deliveries for four encircled towns; two in Outer Damascus and two in Idlib province. Sunni Madaya and Zabadani are encircled by the regime and Shia Foah and Kafarya are encircled by rebels based in northern Syria. The “Four Towns” agreement has been somewhat successful at reducing violence in Madaya, Zabadani, Foah, and Kafraya but it has not done much to lift the illegal sieges imposed on each town. Consequently, deaths from traumatic injuries and lack of food and health care – all a direct result of the conflict, continue.

The sisters Ghina and Nagham, whose near-death experience in Madaya, was reported earlier, are now recovering from militia sniper wounds. Dear reader may recall that the sisters were shot while returning from Madaya’s clinic, near their home, with medicine for their severely anemic mother, Sahar.   Ten year old, Ghina, whose left leg and thigh which had tentatively been scheduled for amputation in Madaya two weeks ago, will not lose them thanks to specialized medical care in Damascus.  And this week (9/5/2016), eight year old Nagham finally had her arm and hand stitches removed (by the medical director of the hospital, her mother told this observer proudly). Nagham is now largely healed from the effects of last month’s sniper attack. Some good news is that on 9/7/2016, Ghina got out of bed for the first time and with Nagham offering sisterly encouragement from behind, she is practicing walking with her new crutches. But unfortunately, the 8 large medical spikes deeply embedded into Ghina’s thigh and leg, and which protrude nine inches out from her legs and thigh must remain for several more weeks.


(10 year old Ghina will not lose her leg after all and on 9/8/2016 the angelic sniper victim started practicing walking again. Photo: F. Lamb 9/7/2016)

But Ghina and Nagham’s younger sister and brother, Manal and Mohammad-Kamal are still under siege in Madaya.  On 9/5/2016, Sahar, the four children’s mother provided this observer a detailed account of her youngest children’s current deteriorating health conditions as she sought assistance from the Beirut-Paris-Washington DC based NGO, Meals for Syrian Refugee Children Lebanon (MSRCL) to  rescue her babies from Madaya and bring them to Damascus.

Both children still trapped in Madays are ill and have fevers. There are no medications available to them in the town. Both children are increasingly malnourished, with their only food, as their mother explained to this observer on 9/6/2016 being boiled bulgur and lentils.  They have no milk nor any fruits or vegetables, eggs, bread or meat of any kind.  Psychologically, the three and four years old Manal and Mohamad are terrified, and desperate to be with their mother Sahar and sisters Ghina and Nagham.

The Syrian Arab Red Crescent Society (SARCS), who heroically saved Ghina and Nagham last month, has been updated on this family’s dire situation and are trying to put Manal and Mohammad-Kamal on a future evacuation list. But whether they can do it anytime soon, if ever, is unknown.

In this observer’s  opinion and based on observing SARCS work for the past few years, and  tours this summer of many SARCS facilities, while spending hours in the company of SARCS staff and lovely volunteers, there is not a more humanitarian organization working  in Syria today, than SARCS. Granted, local and international politics sometimes makes their humanitarian work complicated to say the least. This observer has heard on the same afternoon from disparate sources that SARCS helps only the government areas with its work and other critics who claim that it also helps the rebels with its work.

My observations convince me that SARCS, like Medicines Sans Frontiers (MSF) and the Syrian American Medical Society (SAMS) helps everyone everywhere that it can. In fact SARCS, true to its motto “Helping Everyone, Everywhere: employs more 1,592 staff and more than 6000 volunteers working in 14 branches and 62 sub-branches. They are doing amazing humanitarian work for which we are all indebted. Just last year SARCS delivered various services to 4.7 million including medicines and medical treatment to more than 2.5 million. In addition, 4.6 million Syrians received food and nearly one half million were given household essentials, 316.2 thousand people received protection services through teams and community centers plus 1.32 million people gained access to clean drinking water and sanitation.

But against this somewhat encouraging backdrop, there are growing urgent fears for the lives of 4 year old Manal and her 3 year old brother Mohammad-Kamal, given just received alarming reports of an escalating outbreak of Meningitis in besieged Madaya.

Yesterday (9/6/2016), this observer learned  from  Dr Mohammad Darwish working inside Madaya, that the besieged towns thre-member heroic local medical team that tries to treat its 40,000  residents and which includes, Dr. Darwish, the dentist,  plus a veterinarian and a former medical student are witnessing an unfolding meningitis epidemic. Fourteen cases have been reported over the past two weeks and more suspected cases appearing nearly daily. The “medical team” explains that they cannot confirm 100% the diagnosis because “we don’t have the tools to diagnose and treat patients.”

Signs of viral meningitis, which Manal and Mohammad-Kamal both now exhibit, according to their mother Sahar who speaks regularly when she can get a call through, with the children’s grandmother (Sahar’s mother)  still trapped in Madaya  and trying to care for her malnourished and ill grandchildren.  She reports symptoms comparable to the flu, and that the children today have headaches, a fever with cold hands and feet. They have no appetite.  Manal and Mohammad-Kamal’s case is one of countless others in Madaya that cry out for humanitarian intervention to allow innocent civilians to live.

A British Pediatrician at London’s Great Ormond Street Hospital, the UK’s largest pediatric center, contacted on 9/5/2016 on behalf of MSRCL, about Manal and Mohammad-Kamal’s symptoms, advised that the UK National Health Service (NHS) urges children or adults exhibiting these symptoms not to wait for a rash to develop, but to seek medical help immediately. Later in the day the London Doctor explained to MSRCL that babies and young children under five-years of age (Manal is 4 and Mohammad-Kamal is 3) are those most serious  at risk for developing life-threatening bacterial meningitis because their body’s defenses are not yet developed.

The gentleman urged immediate evacuation of the Manal and Mohammad-Kamal. “These cases are especially urgent” he added “because Dr. Darwish, reports that in Madaya’s only clinic, the only three medical staff, do not have the medicines or the knowledge to treat meningitis or even the equipment to diagnose it.” Dr. Darwish and his medical team attribute the appearance of meningitis to malnutrition of residents, weakened immune systems and high summer temperatures.

Along with Madaya’s 40,000 residents, Sahar, the children’s mother, fears that an epidemic is rapidly spreading. According to Dr. Darwish yesterday (9/6/2016), “We’re afraid that some people may have a mental breakdown out of fear, paranoia is developing among residents, who are rushing to the field hospital with any of the signs of meningitis. In reality, we’re facing an epidemic that is sweeping the city.” Dr Darwish confirmed from Madaya that his medical team suspects a virulent outbreak of meningitis, with the above noted 14 reported cases over the past two weeks. But they cannot confirm the diagnosis because “we don’t have the tools to diagnose and treat patients.”

Dr. Darwish’s stated yesterday (9/6/2016) that his two-kilometer walk to work at the field hospital now takes him more than an hour and a half, because “hysterical” residents stop him en route for medical advice. “They ask, ‘what are the symptoms of meningitis? I have those symptoms—do I have it?”

In addition to the medical and humanitarian brief noted above for immediately saving Manal and Mohammad-Kamal and evacuating them from Madaya to Damascus, hopefully today but if not, then  as soon as possible, there is a compelling legal case that warrants mention.

One imagines that not a great number of serious observers would likely dispute solid customary international law as well as treaty law on the subject of war crimes and crimes against humanity including the siege and starvation of civilians during armed conflicts. Specifically that they include but are  not limited to, certain unconventional and improvised weapons and weapon systems such as barrel bombs, cluster munitions, incendiary weapons, poison, and poisoned weapons, chemical weapons, such as gas,  encirclement ‘surrender or starve’ warfare targeting civilians, starvation of children, and blocking humanitarian access to civilians including life-threatening injuries.

Blocking  Humanitarian aid to Manal and Mohammad-Kamal

 The deliberate starvation of civilians such as Manal and Mohammad-Kamal is not a new tactic of war and one is reminded of Leningrad, Biafra, and Sri Lanka. International Humanitarian Law erases any doubt that the deliberate starvation of civilians as a tactic of war is prohibited and constitutes a prosecutable war crime. This prohibition finds clear expression in Article 54 of the Geneva Convention Additional Protocol 1, which states that besieging forces may not starve civilians “as a method of warfare.” Similarly, it is prohibited to “attack, destroy, remove or render useless” any items necessary for civilians’ survival. This includes food, land used to cultivate food, water, and irrigation works, regardless of whether the objective is to starve the civilian population, to cause them to flee, or is premised on some other motive.

The preventable deaths and suffering which continue in Madaya as a result of the siege exemplify, as the NGO Physicians for Human Rights (PHR) noted in a recent Report,  exactly why siege warfare against civilian populations is illegal and amounts to a war crime. Imposed sieges that deprives a civilian population of goods essential to survival is prohibited under international humanitarian law. The Geneva Conventions prohibit starvation of civilians as a method of warfare by demanding “protection of objects indispensable to the survival of the civilian population. Customary international humanitarian law prohibits starvation of a civilian population as a method of warfare and prohibits parties from attacking objects indispensable to the survival of the civilian population, denying or deliberately impeding access of humanitarian aid intended for civilians in need, and restricting freedom of movement of humanitarian relief personnel. Willfully impeding aid in an attempt to starve civilians as a method of warfare is a war crime.

The ICC Statute goes farther than the International Humanitarian Law treaties. It allows for the prosecution of the intentional starvation of civilians as a method of warfare as such, but also “by depriving them of objects indispensable to their survival, including willfully impeding relief supplies.


(Photo: Rahaf Orabi, 9/5/2016 Manal and Mohammad-Kamal’s mother, sisters and their “American uncle” urge all sides fighting the war in Syria to immediately allow the family’s reunion.)

This observer and MSRCL trust SARCS and the ICRC and has placed their confidence in their humanity to rescue 4 years old Manal and  3 year old Mohammad-Kamal from Madaya.

Hopefully too, the five Permanent Members of the UN Security Council will take a short break from their self-serving political posturing in the now multi-proxy Syrian war, and focus on ending this carnage that is increasingly targeting more than a quarter million innocent children.

Franklin Lamb volunteers with the Lebanon, France, and USA based Meals for Syrian Refugee Children Lebanon (MSRCL) which seeks to provide hot nutritional meals to Syrian and other refugee children in Lebanon. http://mealsforsyrianrefugeechildrenlebanon.com. He is reachable c/o fplamb@gmail.com.