"Several severely sick patients may now have their lives saved after medical evacuation from besieged East Ghouta, Syria. This is an important achievement for those patients, a cause for hope in a situation of almost interminable despair, and must be a first step in a process that will certainly require many more to come. But the news that these medical evacuations are conditional on the release of prisoners is extremely disturbing. Medical evacuation is permitted - obliged even - under the international laws related to armed conflict, and the need of the patient should be the only factor in consideration; no other agendas should come into play.

Five of the hospitals and clinics that MSF supported in East Ghouta in 2017 - without the presence of any MSF staff on the ground - have treated huge numbers of war-trauma patients in November and December this year. For instance, in November, those five facilities treated 741 war-trauma patients; which is more than 11 times the number of similar cases in October. And we know that adequate care for some serious non-war-related medical conditions is limited or non-existent in East Ghouta, for instance for some cancer or haematology diseases. There is a shortage of qualified medics in the area; for an estimated 400,000 population there are around 125 doctors – fewer than 60 of them specialists – supplemented by nurses and medical students doing work that is often outside their areas of formal training. These doctors could save more lives, they desperately want to do so, and they can seek specific technical advice when needed from specialists outside the besieged area. Aside from the bombing that all too frequently hits medical facilities, a fundamental impediment preventing them from doing this work is the limited supply chain of essential medical items they need for treating chronic diseases, and for providing a range of surgeries (both trauma and non-trauma).

We fervently hope the patients requiring immediate life-saving medical evacuation can reach the care they need without prisoner-release or other deals complicating their case, and that the process of evacuations can continue. At the same time, we know the medics we support could successfully treat some of the patients proposed for medical evacuation if only they could be supplied more regularly with the medical supplies and equipment they need to do their work, and without key medical items being removed before entry into the besieged area.”