by Dr. Tammam Aloudat (Deputy Medical Director, Medecins Sans Frontieres, Switzerland)
The past weeks have seen Madaya, a town in Syria, reach the news headlines for a few brief days, and then fall into oblivion again. This is because the town has been subjected to a brutal siege that has prevented any food or humanitarian assistance from reaching it, leaving its people devastated and its children severely malnourished.
My own memories of Madaya are those of a different time, when as a child I passed through the town with my parents many times on our way to Zabadani, a hilly town in the outskirts of Damascus where families go on spring and summer days in search of cooler temperatures and good food. I remember the excitement of the road trip and the games I played with my cousins in what seems now like a lifetime ago. Madaya was, until recently, a name that evoked in me good images of my extended family gathered around a weekend lunch. Not anymore!
The civil war in my country Syria, and my work for Médecins Sans Frontières/Doctors without Borders (MSF) are inevitably intertwined. I have spent the past five years, the lifespan of this war, trying to untangle the two and prevent one from encroaching on the other in a way that might reduce my impartiality as a humanitarian worker or my consciousness as a Syrian citizen. The brutal siege of Madaya has taken me to the edge of that balance where still finding my proper place in the two facets of my life, and preventing myself from falling into a nihilistic oblivion, has become a daily exercise.
Out of sight, out of mind
As with many places with which we at MSF deal, Madaya faded out of the spotlight not because the atrocities its population was suffering had ceased, but just because the next international headline had popped up needed space.
News reports from Madaya indicate that ten days after the sole aid package was delivered, revealing to humanitarian workers horror of the military siege and starvation, the town is once again on its own facing the bitter cold and the shortage of food and medicine. MSF’s call to evacuate the sick and provide continuous access to life-saving medical supplies and food has not been answered beyond that one orphaned, and probably overly celebrated, convoy.
International Humanitarian Law may prohibit using starvation as a method of warfare, even the United Nation’s Secretary General might call it a war crime, but neither mean it will not continue or happen again.
Sifting through social media, one gets the impression that Madaya has touched a nerve with Western audiences who are shocked at images of starving and dying children. Who wouldn’t be? The images are too brutal and a sense of sympathy is almost inevitable, that is of course if you are not supporting those imposing the siege and who choose to taunt the starving population with Twitter photos of food.
Madaya is an abomination, but one that has managed to reach the news, even though its problems were not solved beyond a sole food delivery. Many other towns and populations that pay their dues to the gods of war are not as “lucky”.
Wars and identities
Over the past few years, we have been witnessing what feels like an intensification of conflicts. These conflicts have been harsh for people in many places around the world, and while we are hardly able to imagine the brutality of war until we have actually experienced it, it is impossible not to be aware of its consequences in the West. This is clearly visible both from the political discourse and the flow of refugees seeking survival and dignity.
MSF has intense familiarity with both the victims and survivors of these conflicts; witnessing their plight and carrying their voices is an imperative in which we strongly believe. From carrying out surgery on the frontlines of Syria, Yemen, and South Sudan all the way to sea search and rescue in the Mediterranean, our MSF colleagues have been by the side of people who have been fleeing the brutal wars of the past few years.
What this tells us is that as brutal and extreme as the Madaya siege has been, it is one of the numerous examples where war has stopped being the mere “continuation of politics by other means”, as van Clausewitz puts it, to become essentially a brutal act of eliminating any opposing form of identity, belief, or group. I can hardly imagine a better, or more ominous, identification of the problem that that of Amin Maalouf talking about identities we regress to when our higher selves are challenged and collapsed, we go back to our ethnic, religious, or family ties that risk separating rather than uniting us.
Last August, I was in an MSF car that drove us from Sanaa in Yemen to Ibb, a neighbouring province where MSF wanted to install a project. I had memories from previously working in Yemen in 2011 where bloodshed was a danger but not yet a daily reality.
Since that time in 2011, the last war in Yemen has turned into a series of sieges, bombings, and battles that have devastated the underdeveloped nation and amplified its pre-existing poverty and malnutrition. I sat beside a mother in the maternity hospital in Ibb and heard of the difficulties she had had even in reaching the hospital while I examined her severely sick child. She was lucky, she could reach the hospital. That is not the case for thousands of other Yemenis.
In the months following my visit to Ibb, my MSF colleagues in Taiz, one of the most politically and militarily contested parts of Yemen, have seen the town besieged and medical supplies interrupted. It took five months of intense negotiations for medical supplies to reach hospitals there. Crossing the combat lines with medical supplies is a reason to celebrate but by no means a guarantee that such an act can be repeated.
More examples come to mind. Early in 2014, MSF cared for two camps in the town of Bossangoa in the Central African Republic. We looked on desperately as it became increasingly difficult to provide basic aid to 30,000 Christian civilians who were threatened by the Seleka militia and had to be crammed into the grounds around the town church. The same aid was as difficult to deliver to the 8,000 displaced Muslim civilians who were only stopping long enough in Bossangoa to find ways to flee further in fear of the Anti Balaka militias. I recall with pain the discussions we had about the difficulty in providing the very basics, even toilets and malaria prevention, when thousands of people are shoved into a very small space.
Loss of empathy
While Madaya continues to starve today, Taiz is hardly on the news even as the war in Yemen still rages . Bossangoa feels like a distant memory. Many other besieged or warring towns do not even have the meagre luxury of being heard of.
Arthur Schopenhauer once wrote: “What distinguishes a moral virtue from a moral vice is whether the basic feeling towards others behind it is one of envy or one of pity  Envy reinforces the wall between Thou and I: pity makes it thin and transparent; indeed, it sometimes tears the wall down altogether, whereupon the distinction between I and Not-I disappears.”
When looking at Madaya, Taiz, Bossangoa, and many other places where the gods of war rule, one cannot but wonder what has led to our collective sense of indifference and inaction, the limbo between moral virtue and moral vice.