Medical malpractice leads to death, disfigurement and disability in Idlib's struggling health sector

Fatal medical errors have become commonplace in hospitals and clinics across Idlib and northwest Syria. These result from negligence, underqualified staff and a lack of equipment, and are leading to the disfigurement, permanent disability, and even death of patients, largely without accountability or oversight. 

For the most part, the doctors, nurses and pharmacists responsible for these mistakes suffer no consequences while those whose lives have been irreparably damaged are left without compensation or redress.

Poor practice at Idlib's free hospitals

Hanan Shehada (29) lost her unborn baby due to medical negligence at one of Idlib's free hospitals after the doctor failed to carry out a caesarean in time – the delay leading to fatal complications.

"Fatal medical errors have become commonplace in hospitals and clinics across Idlib and northwest Syria"

Hanan's devastation is plain to see as she relates what happened. She was approaching the end of her third trimester with no sign of oncoming labour. Anxious, she went to a gynaecologist who said she needed an immediate C-section. Hanan is one of Idlib's many displaced Syrians and lives in poverty, her husband having failed to find work since they were forced to move to the region.

Therefore, a private hospital was not an option – she went to one of Idlib's free hospitals. However, the doctor in charge refused to do the caesarean immediately, saying they should wait another two days until they saw signs of labour. Moreover, the doctor claimed the baby was in good health, and everything was fine. However, delaying the birth led to complications which resulted in the unborn baby's death in the womb.

"I was so excited, I couldn't wait for him to be born," says Hanan. "Whenever I felt him move I felt so happy, but they killed my happiness with their neglect".

Careless mistakes in routine ops killing patients

Hanan's case is far from unique. Lethal mistakes in hospitals have become increasingly common, claiming many lives across the region. For instance, on 29 May 2021, Ahmad Mahmoud Ali (5) died following a medical error that left him in a coma for 11 days. Hamida Ali (a close relative) says that Ahmad was taken to Issa surgical hospital in the town of Al-Dana in north Idlib to be circumcised. None of the other boys in the family had ever suffered complications from the procedure.

She says the anaesthetist gave Ahmad an overdose which put him into a coma, and none of the medical staff could revive him. He was then transferred to a Turkish hospital but the doctors there were also powerless to help, and he died.

"Ahmad's death was a huge shock not just for his family, but to everyone who heard about it. Everyone believes a crime was committed against the child and his family, due to negligence and a basic indifference for the lives of patients."

"The anaesthetist gave Ahmad an overdose which put him into a coma, and none of the medical staff could revive him. He was then transferred to a Turkish hospital but the doctors there were also powerless to help"

Hamida says the family didn’t file a complaint against the hospital as they didn't believe it would achieve anything – there is no law or no justice system which can compensate for the death of their child. "They consider the matter to be one of fate and God's will," she adds. 

No explanations for bereaved families

In yet another tragic incident, three-year-old Raghd Qudoor (3) died in Al-Majd Hospital in Idlib city due to what her family say was medical malpractice while being treated for hydrocephalus, a condition where there is a build-up of fluid in the brain.

"They used our child as a testing ground," is how her father expresses what happened, accusing the hospital staff of causing Raghd's death due to their reckless mishandling of her case. Raghd went into the hospital on 12 December 2021 for surgery and to have a fluid-draining head device fitted. However, the family were shocked and confused to see burns and swellings on her legs when she came out of the first operation, with no explanation from the staff.

The infant suffered complications immediately after the surgery which increased the swelling in her head and required a further operation. However, her condition deteriorated rapidly following the second surgery and she died. The hospital administration offered no explanation to the family as to what happened during those operations. Additionally, the hospital falsified the medical records for both procedures, using a forged signature from Raghd’s father, according to him. He has filed a lawsuit against the hospital, however, so far the case has not progressed.

Clinical errors in Idlib aren't limited to hospitals, but also affect pharmacists, most of whom are underqualified, with many holding forged certificates.

Unqualified pharmacists pose threat to life

Eight-year-old Salaam Mohammed suffered burns that caused bleeding all over her body and prevented her from sleeping for days as a result of incorrect instructions given by a pharmacist at the Malaysian Village Camp Dispensary in the al-Bardaghli village, north Idlib, where the girl lives with her family. Her mother had sought treatment for Salaam's chickenpox.

"Eight-year-old Salaam Mohammed suffered burns which caused bleeding all over her body and prevented her from sleeping for days as a result of incorrect instructions given by a pharmacist"

Her mother says: "The pharmacist prescribed a solution that he said needed to be diluted by two parts water to one part solution, and then applied to the whole body. However, when the solution was applied, Salaam's body started reddening and she was in more and more pain until her body started bleeding all over and we had to call an ambulance to take her to the hospital. She was treated for serious burns, caused by the solution."

Hospital staff explained that the medication used was a corrosive chemical that needed to be diluted with many times its volume in water, not just twice as much water, as the pharmacist had instructed.

Accusing doctors 'the wrong approach'

Duraid Rahmoun, a primary healthcare official at Idlib's Health Directorate admits to The New Arab that the medical sector is not free from mistakes. However, he thinks that taking an accusatory stance towards these mistakes and failing to put them into context is the wrong approach.

Appalling detention conditions and deliberate medical negligence are killing thousands in #Egyptian jails' writes Ahmed Mefreh https://t.co/m4VXafj08B

— The New Arab (@The_NewArab) May 9, 2020

"Yes mistakes happen but not necessarily due to malpractice – fundamentally doctors have to make assumptions and estimates and any doctor will try to do their duty by predicting what they think most likely and prescribing the most suitable treatment in their view."

He says complaints should be brought to the complaints department at the directorate, which is open to everyone. A specialist medical committee at the directorate investigates all complaints to verify if a mistake was made intentionally or not and to refer the case to the relevant parties if it was intentional and compensate the complainant. If the mistake was unintentional, the complaint will be responded to and the matter explained.

Chronic shortages and overcrowding to blame

Ghanem Khalil, Public Relations Officer at the directorate believes the frequent medical errors are due to serious overcrowding in northwest Syria and a shortage of medical clinics, equipment and specialists. He continued: "That said, we aren't giving excuses for the intentional medical mistakes and malpractice happening because people's lives are entrusted to us and must be protected."

"According to UN statistics, the medical situation in Idlib is dire. There are four million people in the governorate, but no more than 3,065 hospital beds; an average of one for every 1,365 people"

However, he sees no advantage in encouraging press hysteria and outrage on social media and says that the issue can appear exaggerated when viewed from a personal and emotional perspective.

Rahmoun insists the directorate is "concerned with the quality of medical services and that international standards are adopted – we encourage constructive criticism and work to implement it. We are also keen that civilians obtain their rights and seek to prevent unfair treatment towards them, but at the same time we reject medical staff being exposed to arbitrary and falsified accusations."

The health sector in northern Syria has suffered a widespread collapse as a result of successive military operations in the region by the Syrian regime and its ally, Russia, which have caused huge damage to hospitals and health clinics.

According to UN statistics, the medical situation in Idlib is dire. There are four million people in the governorate, but no more than 3,065 hospital beds; an average of one for every 1,365 people. Additionally, there are only 200 intensive care beds and around 100 ventilators. In terms of the workforce, there are estimated to be 1,358 healthcare specialists and medical technicians and just 260 doctors.

Hadia Al Mansour is a freelance journalist from Syria who has written for Asharq Al-Awsat, Al-Monitor, SyriaUntold and Rising for Freedom Magazine.

Article translated from Arabic by Rose Chacko