Manal: I saw detainees tied to their beds with metal chains. Their skin was pale. They were so thin. Their hands, legs and bodies used to be blue. Clear signs of heavy beatings.
Fritz Streiff: In June 2020, in the German state of Hesse, the authorities arrested a man called Alaa M. Alaa M was a Syrian doctor in his thirties, who had lived in the small West German town of Bad Wildungen, with his wife and two children since 2015. Unlike many others, Alaa M hadn't left Syria to flee the war or the violent oppression of the regime - he'd left to advance his medical practice. And he'd been able to do this. At the time of his arrest, Alaa M had been practising medicine at a hospital near the city of Kassel for the past five years.
So why was he arrested? He was arrested because of a strong suspicion of complicity in crimes against humanity, committed by the Syrian regime since 2011. To be more precise, Alaa M is accused of participating in the sexual violence, torture and killing of Syrian civilians at Military Hospital Number 608 in Homs, in the prison of Intelligence Branch 261, also in Homs, and in the Military Hospital Mezzeh Number 601 in Damascus.
He's accused of abusing detainees by whipping them with medical instruments, by stepping on open wounds and operating without anaesthesia. He's accused of intentionally killing a detainee by lethal injecting them, and he's accused of pouring alcohol over a teenage boy’s genitals and setting them on fire.
“He bragged that he had invented a new method of torture,” the prosecutor read out on the first day of the Alaa M trial, which began in January 2022 in Frankfurt.
German privacy law means defendants are not referred to by their full names before they have been convicted. And so, I'll be referring to him as Alaa M throughout the episode.
The Alaa M case has shown that the systematic violence of the Syrian regime, the “terror machine”, as one of the plaintiff lawyers put it, is multifaceted. It does not only oppress and kill its civilian population in detention facilities, and it is not only intelligence officers who inflict this violence. It also uses the people you'd expect to heal you and the places where you'd expect to be cared for. The terror machine uses doctors and hospitals.
This is The Syria Trials, Episode 2 - No Longer a Place to Heal.
Manal: My name is Manal. I used to work as a nurse at the Red Crescent Hospital in the Syrian capital, Damascus. The hospital was close to Al-Khateeb State Security Branch, also known as Branch 251. I worked at this hospital from 1992 until the end of 2012.
Fritz: This is not Manal’s real voice, and Manal is not her real name. Someone else is voicing Manal’s words to protect her identity. The Red Crescent Hospital where Manal worked was not only geographically close to State Security Branch 251. The two places were also linked in other ways.
Manal: In 2008, several guarded detainees were brought from Al-Khateeb Branch to the hospital. They would be placed in separate rooms. Nurses and doctors were only let in with the guards’ permission. I saw the detainees tied to their beds with metal chains. I knew that they were detainees because their skin was pale. They looked like they had not seen the sun in a very long time and had lost a lot of weight. They didn't smell good and they were so filthy that we had to use gloves to touch them.
Fritz: Colonel Anwar Raslan was Head of the Investigations Division at Branch 251. He was found guilty at the Koblenz trial of overseeing the murder of at least 27 and torture of at least 4000 prisoners at Branch 251 in Damascus. These branches were known by Syrians, and it's now also been proven in court, to be places of torture and death. But where do hospitals fit into the picture?
Annsar Shahhoud: In 2011, and for private reasons, I moved between different hospitals in Damascus and Homs, I witnessed the nurses and doctors violating some patients in the public hospitals in Damascus.
Fritz: Annsar Shahhoud is a genocide studies scholar, focussing on state violence in Syria. She is Syrian herself and fled the country in 2013. She now lives in The Netherlands.
Annsar: So when I came to the Netherlands, the question was how far doctors were implicated in the violence of the Syrian regime.
Fritz: The Syrian healthcare system is governed by three ministries - the Ministry of Defence, the Ministry of Health and the Ministry of Higher Education.
Manal: The Ministry of Higher Education governs, amongst others, the Children's Hospital and Assad’s University Hospital. Other civil hospitals and healthcare facilities are governed by the Ministry of Health. The Ministry of Defence governs several healthcare facilities in Damascus.
Fritz: The final ministry, the Ministry of Defence, is in charge of medical facilities like the Military Hospital 601 and the Air Force Intelligence Clinic, that mainly serve military staff and their families - although civilians are also permitted to use them.
Manal: The Red Crescent Hospital where I worked was a civil hospital, not a military one. I never saw any doctors or nurses torturing people or openly mistreating them. But of course, the quality of care was very poor and minimal. Any regular patient deserves much more care than what they would give to those patients. I do not know about the situation in military hospitals. I worked only at the civil hospital during the protests. Some of my colleagues worked in military hospitals, but they're afraid to share their experiences. They prefer to stay silent.
Fritz: The nature of medical violence is intimate, which may be why Manal never witnessed torture at her hospital. But with the spread of pro-democracy protests across Syria from early 2011 onwards, the Syrian regime made a decision.
Annsar: What happened after 2011 is the massive, systematic and organised use of hospitals as torture places. The Syrian regime used these hospitals as prisons to kill and eliminate its opposition.
Manal: There were many changes at the hospital between 2011 and 2012. The officers working at Al-Khateeb Branch brought more and more detainees to the hospital. They would often have lice or scabies. Guards and intelligence officers were now always present.
Annsar: With the escalation of violence in Syria, the Syrian regime was doing massive arrests. With the increase of the number of detainees, they started transferring detainees, sick detainees, to hospitals. And not only opposition here. Many people were detained by Syrian regime, they didn't have political awareness and they were not part of the opposition. There were civilians who were taken just because of suspicion.
Manal: Doctors and nurses were told to handle these patients with minimal care and as quickly as possible. We were not allowed to talk to them. We were not even allowed to comfort them or show any compassion. Once I was told off by an intelligence officer who said, “come on, hurry up, just finish”. I was too scared to express any of my true thoughts and feelings, so I stayed silent. So did many of the doctors. Doctors could be detained or even killed if they were suspected of cooperating with protesters or the opposition. Nurses used to talk about the detainees in a disparaging manner, calling them names. They also refused to look after some of them.
Fritz: Some doctors and nurses acted on their own accord, showing their loyalty to the regime by refusing to treat injured demonstrators. But it was clear that the increasing use of the medical sector as a tool of torture and oppression was a top-down approach. The violence was not just coming from doctors and nurses on the ground. Orders were coming from the highest levels. As Annsar Shahhoud writes in her master's thesis “Medical Genocide: Mass Violence and the Health Sector in the Syrian Conflict”.
Voiceover reads from Annsar’s thesis: The scale of violence and the massive mobilisation of sources and human resources suggest that incidents of medical violence in Syria were not isolated, but were rather a deliberate policy. It was a top-down process instigated by higher political, military and medical authorities in the country. Leaked documents from the regime Intelligence Apparatus and Crisis Unit suggest the involvement of the Syrian President, top army leadership, the National Security Bureau and other security apparatus in carrying out a genocidal campaign and clinicide.
Fritz: But why did the Syrian regime decide to use hospitals, as well as doctors and their medical knowledge, to inflict great harm on its own population?
Annsar: Dependence on doctors was because they are efficient in the way they kill, the way they torture. If we look to the way the Syrian regime was designing the torture, specifically in prisons, we could see a scale of negligence, a medical negligence. Some doctors who were in prisons, they spoke about their inmates dying in very quick way because of illness. The doctors’ tools, if we can say, knowledge and skills help them to kill in the cheap way. Put them in suffocating cells. Little food, no medical care, and the people’s health will deteriorate very fast and they will die within weeks.
Fritz: Working within the medical system, it was impossible for Manal not to get caught up in the new way hospitals and their staff were being used.
Manal: On a night in April 2012, I was working the night shift. It was a warm night and I was wearing light blue pyjamas. Two people came from Al-Khateeb Branch and asked the doctor to see the emergency room nurse. I answered that I was the nurse on duty. The officer said, “we need you urgently at the branch”. I remember my body was shaking. I got dressed and left with them.
When we arrived, we took the stairs and descended down three floors underground. I was taken to the office of a military officer. He said, “there's a bitch inside. Search her and see if she has got anything on her”.
I entered the room the woman was in, it was a bathroom. It was unbelievably dirty. The bathtub was filthy. And in here there was a very scared woman. Her hair was wet and wavy. I'll never forget how she looked. She was horrified, shaking. I said to her, “don't be scared. I have nothing to do with them. They brought me here to search you. But I will not touch you. Just tell me if you have something on you”.
The woman told me her name and that she was detained along with her husband. She told me that she was a journalist who had been working and helping families that had been displaced from the city of Homs. We were whispering.
I was asked to leave the room. I went back to the hospital, but I wasn't allowed to tell anyone what had happened. I held back tears and bit my lips for hours to resist crying in front of my colleagues. I felt like my heart was literally bleeding.
Fritz: Another key part of mobilising the medical system was the use of military hospitals - so the hospitals that were under the control of the Ministry of Defence. Many of the stories and evidence that have come out of Syria since 2011 indicate that the very worst atrocities happened in these places. One that has become notorious is Mezzeh Military Hospital 601 in Damascus. The hospital sits at the foot of Mount Mezzeh, within walking distance from the Presidential Palace that sits on top of the Mount.
Annsar: It was known before the war as a slaughterhouse. They used it briefly in 1980s as a prison. After 2012, part of the hospital became a prison, and they refer patients from Branch 215 and Air Force Intelligence to this section of the hospital, guarded by nurses and soldiers. And patients were killed systematically, and those who were killed in Branches and intelligence dungeons were sent to hospital with the order of Ali Mamlouk.
Fritz: Ali Mamlouk has been in the Assad's inner circle since Bashar's father, Hafez al-Assad, ruled Syria. Mamlouk was the Head of the National Security Bureau, so he was in charge of coordinating the work of the Syrian intelligence agencies and also advised the President of the Syrian Republic
In 2018, France issued an international arrest warrant against Mamlouk, which accused him of complicity in crimes against humanity and war crimes, including torture and enforced disappearances. He is also accused of being one of the Syrian officials behind the attack which killed the war correspondents Marie Colvin and Remi Ochlik in Homs in February 2012. Since 2019, Mamlouk has been the Vice President for Security Affairs - so he is still very much at the top of the regime.
Back at 601, the bodies were piling up. According to former detainees and personnel who worked at the hospital. Corpses were piled in bathrooms, in garages, anywhere they would fit. It seems a similar thing was happening at the Red Crescent Hospital, where Manal worked.
Manal: The janitor of the hospital was responsible for the key to the morgue. He would let people in and out of the morgue according to a specific schedule. At the beginning of 2012, we learned that the key was taken from him and we were no longer able to enter the morgue and do our job as we had previously done. The janitor told us that the key had been given to the “branch people”. When I was on night shifts, I started to notice that sometimes an ambulance would leave the morgue gate at 5 a.m. before sunrise. I think that they used to collect the dead bodies and transport them all at once.
Fritz: In a way documenting their own crimes, it appears that the regime made sure that every victim's body was registered and the cause of death noted by doctors at these hospitals.
Evidence of this exists in an archive of over 50,000 photos smuggled out of Syria by the military defector codenamed Caesar. Caesar was a Syrian military photographer who took photos of bodies amassed in morgues, as well as the courtyards and car parks of hospitals. He took a huge number of these images in the courtyard of Military Hospital 601.
Annsar: Hospitals shouldn't be a prison. Hospitals should be a place where people heal, are not killed. While in dungeons, people expected to die of torture or expected to receive torture - when they are transferred to a hospital, they were (at the beginning) shocked that going to the hospital was more deadly than staying in the dungeon. They begged not to be transferred to the hospital. The doctors and nurses were more harsh than those who tortured them in prisons, and the percentage of the killing or like losing your life was much higher in the hospital, because somehow it was quick… So in the mind of detainees, being sent to 601 meant that you are going to die.
Fritz: The idea that one of these doctors, like the accused Alaa M, could work in a hospital outside of Syria, within a medical system whose hospitals and doctors do adhere to the codes of medical ethics, is highly alarming.
It was Dr Mohammed Whabi, a colleague of Alaa M’s from Homs Military Hospital, who first reported him after seeing a post on Facebook, in which Alaa M mentioned that he lived in Germany. Annsar interviewed Dr Whabi for her thesis.
Voiceover reads from Annsar’s thesis: Dr Mohammed Whabi, a urology resident, worked at Homs Military Hospital during 2011 to 2012. He witnessed brutal and cruel treatment, torment and killings committed by his colleagues. Dr Mohammed, regardless of whether he was a passive bystander or perpetrator, witnessed two colleagues operating on a healthy patient and killing him on the surgical table. He also heard his colleague, Dr Alaa M, speaking of torturing sick detainees on different occasions. Dr Alaa, a surgery resident, proudly spoke to his colleagues about how he operated on a patient without anaesthesia and added, “we could learn something”.
Annsar: They use more medical techniques. They use medical thinking in the way they killed people. Like what we see in the trial of Alaa Moussa. He wanted to do experiments to learn more about how to do surgery. And this is really striking. And I don't know how we can say it… it's a very brutal way to use human bodies as subjects for experiments.
Fritz: It is immensely disturbing to think that doctors who trained and worked to save people, could suddenly switch and decide to kill them. Annsar spoke to many doctors who were perpetrators of violence for her thesis. One of them stood out for her.
Annsar: This guy spoke about believing in the state and that their orientation is to defend the state, and their communities, their beloved ones. So, fear was very important in mobilising doctors. At the end, doctors, they belong to the society. They are member of the society, of communities. They are not someone who is neutral as, or as impartial as they want them to be in medical ethics.
Fritz: Annsar also found that there was a psychological switch that happened for some doctors.
Annsar: The performance of the killing. So, when they go to the hospital, they are the killers. And when they go to their families, they are the normal, kind doctors and fathers and mothers who have very smart, intelligent persona. Very beloved by the family. And then they go and perform the evil, if we can say, in the hospitals.
Fritz: This concept is known as doubling. Doubling as the dissociation into two selves - the normal self and the perpetrator self - which allows these perpetrators to suppress their consciences towards their crimes and their victims. This separation of identities also helps explain how doctors like the defendant Alaa M, if the accusations prove true, were able to continue working with little sign of their previous actions affecting their current work and personality.
Annsar: Person like Alaa Moussa, doctor who is in Germany and practising medicine, I think it's enough shock for everyone to see the level of how those criminals could penetrate in the system, without us noticing them. How they can change their lives very easily without any remorse and continue their lives. And this is a message for every one of us who are living in Europe - that dictatorship and their impact and what they have done in Syria and Iraq and Yemen, and the others. is not far from us. It could impact us one day. And I think the example of Alaa Moussa trial goes for that.
Fritz: The Alaa M trial has raised awareness of how the Syrian regime weaponised its medical sector. It's yet another example of just how brutal the regime can be. The trial has been progressing slowly. As of early October 2020, a number of witnesses and victims who joined the proceedings as joint plaintiffs have testified. And generally, witness testimonies have been very emotional, and debates in the courtroom have at times been quite heated, with the defence lawyers rigorously questioning evidence and testimonies, as is their job.
Alaa M continues to deny the charges, calling the accusations against him a conspiracy, while at the same time telling the judges that he was in no position to disobey orders from officers in the military intelligence - because otherwise he'd be detained himself.
But like with Anwar Raslan, who was convicted at Koblenz, Alaa M is another fairly small cog in the wider Syrian terror machine. Bashar al-Assad has command responsibility for Military Hospitals - he is not on trial. Dr Ammar Suliman is the Head of the Military Medical Directorate - he is also not on trial.
The same doctors are still in charge in Syria. They're still able to perform medical violence - but they are perhaps one doctor down.
While many Syrian doctors are guilty of crimes against humanity, there are also many doctors who didn't participate in these violent crimes.
Annsar: So in order to organise mass scale of medical violence, you need to exclude those who might resist. So that's what happened. The Syrian regime oppressed doctors who resisted order of the violence or resisted the security apparatus. Doctors who resisted or attempted to resist were subject to imprisonment and torture, severe torture, and most of them were killed.
Manal: One day in November 2012, a man was brought to the emergency room. He was wrapped in a thick and very filthy rag. He was guarded by four heavily armed people in military uniforms. They were the same people used to bring in other detainees from the Branch. I saw the man lying on the examination table. His body was all blue. It was clear that he had been tortured.
They drew the curtains across, but allowed one doctor to stay to examine him. I stood in the room, separated only by the curtains from the patient. When the doctor finished the examination. He came from behind the curtains. His face was grim. Minutes later, he went back to check the heartbeat of the patient and he announced that he was dead. The doctor who examined the detainee asked me if I had recognised the man. I had not. He reminded me that he was our old colleague, a cardiologist who we used to work with at a different hospital back in 2010.
A short while after I left Syria, I saw that the family of the dead doctor was looking for him. I wrote to them and I told them that he was dead. At first, they did not believe me. They asked how I knew and how I had this information, if I was no longer in Syria. I explained to them what had happened, the date of his death, and described what I had seen with my own eyes.
I didn't want to continue to be silent. The feeling of repression was killing me. But sharing my true thoughts and being honest would have also killed me. It was too dangerous. So I decided to leave Syria and I left at the beginning of 2013, without handing in my official resignation to the hospital.
I am ready to testify in international courts. I want to get in touch with lawyers and judges, anyone in the legal space and tell them what I saw. I have not yet figured out how, but I'm ready.
Fritz: The fate of doctors who resisted the command to violence was shocking. Individual doctors were the regime's first targets. What happened next, no one saw coming.
With the escalation of persecution, and of the war more generally in Syria, many of the doctors who resisted moved to areas controlled by the opposition and set up field hospitals and medical facilities in these areas. These healthcare facilities, in what could be seen as collective punishment of doctors and anyone who dared oppose the regime, became targets themselves.
From very early on, in an atrocious violation of the laws of war, the Syrian regime and later its Russian allies attacked and bombed opposition medical facilities.
Next time, in Episode 3 of The Syria Trials, we look at the fate of the doctors who resisted and at the legal efforts to hold the perpetrators of these attacks accountable. I'm Fritz Streiff. Thank you for listening.