無國界醫生：請聯合國常任理事國協助停止敘利亞的屠殺

圖、文／無國界醫生

國際醫療人道救援組織無國界醫生（Doctors Without Borders/Médecins Sans Frontières）指出，昨天（10月31日）敘利亞大馬士革附近的杜馬（Douma）鎮上一個市集遭到空襲，造成至少70人死、550人受傷。由於市集最近的臨時醫院於之前一天已被轟炸，醫護人員都艱難地應付大批傷者。無國界醫生擔心，敘利亞中部和北部於整個10月裡愈趨密集的轟炸情況，一旦蔓延至大馬士革一帶，將不堪設想，因那裡有近100萬人被圍困，無法逃離，當地亦只有少數幾間醫療設施，也沒有辦法能把重傷者撤離至其他地區醫治。

▲敘利亞北部衝突惡化。（圖／MSF）

市集遭空襲後，當拯救隊伍救出傷者時遭進一步炮擊，造成更大傷害。250名傷者接受了手術，另有300人治理了傷口，無需手術。醫護人員指，傷者多處受傷的情況，是他們所見過最差的。

位處市集附近、由無國界醫生支援的一間醫院，協助接收了第一批的傷者，該醫院總監說︰「這是極端暴力的轟炸。傷者的傷勢都是我們所見過最差的，並有大批死者。我們做了佷多宗截肢手術，而且有很多傷者大量失血，是以我們需要大量靜脈注射液和血液。我們已盡了最大努力，但重傷人數實在遠多於我們在有限資源下所能應付的。」

由於很多醫院已在敘利亞衝突中被破壞，很多設施唯有移至地下運作，或把服務分拆至不同地點，以便保持運作。杜馬臨時醫院的入口大閘已於周四遭轟炸，導致15人死、100人受傷。由於醫院服務最近已分散至不同大樓內，故醫院尚能應付部分傷者。不過，由於昨天市集空襲的重傷者人數太多，單憑一間醫院根本無法應付，是以另外6間臨時醫院亦展開大型傷亡事故應變，協助治理傷者。

於2015年，在大馬士革一帶的被圍困地區，民用基礎設施如醫院和市集被轟炸的情況已明顯地愈趨密集。單是今年，在東古塔（East Ghouta）地區，由無國界醫生支援的醫療設施曾接收的死者和治理的戰爭傷者中，有近40% 是婦女和15歲以下兒童。造成這極高的平民死傷數字，原因之一是該區人口密集，而且當地遭圍困，人們成為逃不掉的人肉目標，無法逃離轟炸。

負責無國界醫生敘利亞救援行動的行動總監迪里雲尼（Brice de le Vingne）說︰「這次對繁忙市集的猛烈轟炸，以及多次對少數仍能運作的醫療設施作出破壞，是違反了所有的戰爭規範。」他續說︰「在東古塔其中兩個被圍困的地區，有臨時醫院尤其遭頻密轟炸，今年內我們已第4次要提供財政和後勤支援，以便這些設施能重新運作。由於有狙擊手伏擊，令人們無法逃離被圍困地區，一旦這種透過圍困人們來達致「慢性死亡」的手段轉為快速的空襲大屠殺，後果將不堪設想，多麼可怕。」

杜馬醫院已用了1,000公升的靜脈注射液和300包血液，無國界醫生已緊急派送物資，以填補他們所必需的，並提供後勤支援，例如燃料，以便一旦再有空襲，救護車能立即運作。無國界醫生亦可能會進一步提供緊急醫療物資捐贈和技術支援。

無國界醫生促請聯合國安全理事會的常任理事國，按著它們之前（聯合國安全理事會2165決議）同意、有關保護人民的授權，盡快停止敘利亞不斷升級的空襲屠殺。

註︰

無國界醫生在敘利亞北部正運作6間醫院，和直接支援超過150間位處全國各地的醫療站和前線醫院，並以被圍困地區為重點。這150多間設施，大部分都是臨時設施，沒有無國界醫生的員工在內工作，但無國界醫生提供物資和遙距培訓支援，以協助敘利亞醫護人員應付當地龐大的醫療需要。這支援網絡已設立了超過4年。

At least 550 wounded in horrific market-bombing in Damascus besieged area

MSF urges 5 permanent members of the UN Security Council to stop the massacres in Syria

At least 70 people have been killed and 550 injured in an airstrike on a marketplace in the Douma neighbourhood near Damascus, Syria, the international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) said yesterday (30 Oct.). As the nearest makeshift hospital had been bombed the previous day, medical workers struggled to cope with the influx of injured people. MSF fears the intensification of bombing that has been seen in northern and central Syria over the course of October could become even more horrific if it spreads to besieged areas around Damascus, where almost a million people are trapped with no way to escape, few medical facilities, and no options for medical evacuations of seriously wounded.

The devastation caused by the initial airstrike on the market was exacerbated by further shelling on the rescue teams who were attending to the wounded. 250 patients required surgery, and a further 300 patients have been treated for non-surgical wounds. The multi-trauma wounds are described by medics as being worse than anything they have seen before.

This was an extremely violent bombing," says the director of a nearby MSF-supported hospital who assisted in the first wave of mass-casualty response. "The wounds were worse than anything we've seen before, and there were large numbers of dead. We had to do many amputations. And a lot of the wounded had massive blood-loss, which means we needed large amounts of IV-fluid and blood bags. We did out best to cope, but the number of critically wounded was far beyond what we could handle with our limited means."

Because so many hospitals have been destroyed in Syria's conflict, many facilities have moved services underground or split up services across different locations in a bid to remain operational. The entrance gate of the Douma makeshift hospital had been struck by bombing on Thursday, causing 15 dead and 100 wounded. Because the services had recently been split across several buildings, the hospital was able to respond to part of the mass casualty influx. However, the overwhelming numbers of critically wounded meant that no one single hospital could have coped, and six other makeshift hospitals also launched mass casualty response plans to help treat the wounded from the marketplace bombing.

In the besieged areas around Damascus there has been a marked intensification of bombing on civilian infrastructure, such as hospitals and markets, during 2015. To date this year nearly 40 percent of people killed and war wounded patients treated in MSF-supported medical facilities in the East Ghouta area have been women and children under 15 years old. This extraordinarily high percentage of civilian deaths and casualties can be explained by repeated targeting of densely populated areas, and also because in besieged zones people are captive human targets, with nowhere to run to escape the bombing.

"This massive bombing on a crowded market and the repeated destruction of the few available medical facilities breaches everything that the rules of war stand for," says Brice de le Vingne, Director of Syria Operations for MSF. "In two of the besieged neighbourhoods in East Ghouta there are makeshift hospitals that have been particularly frequently bombed - we are now, for the fourth time this year, financing and providing logistical support to reinstate both facilities. With sniper-fire preventing people escaping from the besieged areas, we can only imagine with dread what would happen if the slow-death approach of putting people under siege turns into a fast-aerial-massacre approach."

Douma hospital has used up 1,000 litres of IV fluids and 300 blood-bags, and MSF has sent an urgent emergency resupply of some of the essentials they need, as well as providing logistical support such as fuel to the ambulance teams responding to the airstrike. MSF may also assist with further emergency medical supply donations and technical advice.

MSF is urging the permanent member states of the United Nations Security Council to comply with the mandate of protection they have been given（UN Security Council Resolution 2165 ）and to stop as fast as possible the escalating aerial massacres in Syria.

Note:

MSF operates six medical facilities in the north of Syria and directly supports more than 150 health posts and field hospitals throughout the country, with a particular focus on the besieged areas. These are mostly makeshift facilities with no MSF staff present, where MSF provides both material support and distance training support to help the Syrian medics cope with the extreme medical needs. This support network has been built up over the past four years.

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