"The reported symptoms of the patients, in addition to the epidemiological pattern of the events... strongly indicate mass exposure to a neurotoxic agent. This would constitute a violation of international humanitarian law, which absolutely prohibits the use of chemical and biological weapons."
Three hospitals in Syria's Damascus governorate that are supported by the international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF) have reported to MSF that they received approximately 3,600 patients displaying neurotoxic symptoms in less than three hours on the morning of Wednesday, 21st August, 2013. Of those patients, 355 reportedly died.
Since 2012, MSF has built a strong and reliable collaboration with medical networks, hospitals and medical points in the Damascus governorate, and has been providing them with drugs, medical equipment and technical support.
Due to significant security risks, MSF staff members have not been able to access the facilities.
“Medical staff working in these facilities provided detailed information to MSF doctors regarding large numbers of patients arriving with symptoms including convulsions, excess saliva, pinpoint pupils, blurred vision and respiratory distress,” said Dr Bart Janssens, MSF director of operations.
Strong indication of exposure
Patients were treated using MSF-supplied atropine, a drug used to treat neurotoxic symptoms. MSF is now trying to replenish the facilities’ empty stocks and provide additional medical supplies and guidance.
“MSF can neither scientifically confirm the cause of these symptoms nor establish who is responsible for the attack,” said Dr Janssens.
“However, the reported symptoms of the patients, in addition to the epidemiological pattern of the events—characterised by the massive influx of patients in a short period of time, the origin of the patients, and the contamination of medical and first aid workers—strongly indicate mass exposure to a neurotoxic agent.
"This would constitute a violation of international humanitarian law, which absolutely prohibits the use of chemical and biological weapons.”
In addition to 1,600 vials of atropine supplied over recent months, MSF has now dispatched 7,000 additional vials to facilities in the area. Treatment of neurotoxic patients is now being fully integrated into MSF’s medical strategies in all its programmes in Syria.
“MSF hopes that independent investigators will be given immediate access to shed light on what happened,” said Christopher Stokes, MSF general director.
“This latest attack and subsequent massive medical need come on top of an already catastrophic humanitarian situation, characterised by extreme violence, displacement, and deliberate destruction of medical facilities.
"In the case of such extreme violations of humanitarian law, humanitarian assistance cannot respond effectively and becomes meaningless itself.”
MSF in Syria
MSF provides medical assistance in Syria through two different approaches. MSF international and national staff operate six hospitals and four health centres in structures fully under the organisation’s direct control in the north of Syria.
In areas where MSF cannot send its own teams because of insecurity or lack of access, the organisation has expanded a programme begun two years ago of supporting Syrian medical networks, hospitals and medical posts, by providing drugs, medical equipment, and technical advice and support. Through the latter programme, MSF has been supporting 27 hospitals and 56 medical posts throughout Syria.
From June 2012 through the end of June 2013, MSF teams carried out more than 55,000 medical consultations, 2,800 surgical procedures, and assisted in 1,000 births inside Syria. MSF teams have also provided more than 140,000 consultations for Syrian refugees in neighbouring countries.
Find out more about MSF's work in Syria