 Thank you very much for inviting me and I'm really honored and humbled to be among you. I attended some of the sessions in the morning and I'm really impressed by the quality of the speakers and the sessions and This very young and energetic attendance. This speaks really very well for MSF before this Speech one of my friends who is an MSF member. He texted me a couple of weeks ago And he said I heard they're gonna be the speaker and MSF science day. I said yes Is that important? He said of course, it's important and then he he sent me this email I said he said MSF is great. I love both MSF and Sam's I'm from organization called Syrian American Medical Society Sam's But when it comes to Syria MSF Wishes it were Sam's that's his code Keep that in mind. He said five years into the crisis MSF is still looking to Sam's For guidance in spite of having 45 years of more experience and 30 times the budget I Congratulate you for having 45 years of experience and very large budget and actually we are learning from you You know really I believe that Sam's is here because of you you paved the way in the last 45 years for us To be able to challenge a failing system and save more lives And let me go into that presentation and It's always good to see good friends like my friend here from ICRC London Marcus geezer who I is always good to see you and He used to be in the United States and now he's stationed here in London London is a beautiful city. I used to stop in London with my family Every time are coming from Syria to watch Harry Potter movie You're you're setting it a lot of good trends for the rest of the world Including the election of a good mayor So I'll start with this Slide from an event that we've done in the fall of last year and this was done in coordination with physicians for human rights and also with MSF USA You're the president of Sam of MSF USA Dr. Deanne Marshmine was there and spoke and this is called a die-in at that time We wanted to demonstrate in front of the United Nations that 670 healthcare professionals in Syria were killed because they are trying to save lives That event happened after the bombing of MSF Hospital by my government in condos in Afghanistan and it happened also After 670 physicians in Syria were killed and there were many physicians there You see only part of the picture, but there are about 300 physicians Most of them are not Syrian Americans who demonstrated in front of the UN Unfortunately, now we are talking about Syria after another bombing of MSF facility in Aleppo al-Quds hospital and the killing of the last pediatrician in Aleppo Dr. Wasim Maaz So this is something is ongoing at that time They were 670 people or healthcare professionals who were killed in Syria and now we have 730 healthcare professionals who are killed in Syria This is an article that I Corot in American thoracic society I'm a critical care specialist and it talks about the impact of war on the healthcare system and Syria and some of these images are very famous including the images of I'm sorry for the graphic nature of this image of children Who died of suffocated suffocated to death in East Al Ghouta? in August 23rd 2013 after the Syrian gas massacre one of my friends who is an Ecologist in one of the small hospitals in Ayn-Turma in East Al Ghouta Told me that his hospital capacity is only 20 beds and at that time he had an influx within two hours of 700 patients Struggling to breathe and he had to decide which patients who need to be put on the ventilator And which patient that would not need to be put on the ventilator by the end of the night He had 144 of these 700 patients dead Including 44 children So that will give you a scale of the challenges that doctors in Syria are dealing with We're not only dealing with conventional weapons, but also they are dealing with unconventional weapons This is pictures from the Syria before the crisis a picture of Damascus with lights This is a picture of the Umayyad mosque and this is a place where John the Baptist and Imam Hussein and Salah al-Din Ayyubi are buried in the same mosque So Syrians consider themselves the descendant of John the Baptist of Salah al-Din Ayyubi of Imam Hussein a very beautiful site in Damascus all Damascus This is a picture of a church in my city hummus and it's a picture of a city of Hama All of these cities are important in that you during the crisis my city hummus at one point called the heart of the crisis or the heart of the revolution And this is a picture that is very depicting to what's happened in the last five years Syria Descended into darkness literally. This is a study that was done by Chinese physicians Or researchers who took pictures of Syria from the satellite at night in 2011 compared them to pictures of Syria in the satellite at night in December 2014 And as you see many of the lights went out 83% of the light went out in five years in Syria a lippo, which is large city in Syria There is no lights in 2014 December 2013 You have more lights actually in Turkey because you have large displacement of Syrians to Turkey and also to Jordan But the reason that you have more lights is because of multiple things first of all the destruction of Infrastructures that people leave leaving Syria and we're talking about the refugee crisis We have 4.8 million refugees who left Syria and because of siege areas under siege in Syria has no electricity And all it all started with with the demonstrations in the part of the Arab Spring that people young people in Syria wanted to have political reform and You know, I was reading a few days ago one of the of the presidents of MSF when he Received the Nobel Prize for peace and he said that humanitarianism is not a tool To end war or create peace. It is a citizen's response to political failure What we are seeing in Syria is really political failure from all parties including this the the Syrian government the regional powers and the international power including the United Nations Security Council if The responsible powers acted early in Syria We will not have what we have right now in Syria in term of the crisis. This is a picture of a second grade student in the city of Aleppo who were asked who was asked to To draw something and usually children when they ask to draw they draw happy children playing rivers trees Sun and But he chose to draw Children crying you have helicopter Dropping barrel bombs you have house and fire and you have children with amputated heads and and arms Every time I look at this picture, you know, it influenced me because you have children who are crying They are still alive, but the dead ones are smiling Before the conflict Syria was a middle-income country with good healthcare benchmarks We had actually some of the best benchmarks for healthcare compared to the regional Countries in Syria in spite of the low spending on healthcare by the government about $100 per citizen at that time Most of the healthcare were provided by government trying hospital and primary care facilities And we had only advanced medical care in major cities like Damascus Aleppo, Hormuz and Latakia The rural health or rural areas had in some insufficient facilities We had also a transformation of Healthcare that is catering to infectious diseases and malnutrition In the 70s to health care that is focused on non communicable diseases We had an epidemic of smoking. Syria had the highest smoking rate in the Middle East About 70 percent of men smoke in Syria. We had an epidemic of obesity We have epidemic of hypertension, diabetes, dyslipidemia and cardiac diseases That was the main killer of the population before the crisis in spite of that The vaccination rate was very high more than 95 percent and the benchmark in term of mortality for a pregnant woman And children was actually some of the best in the region Now five years into the crisis All of that was erased And I always use this quote for Valerie Amos the past UN chief for humanitarian affairs Who said every time we use a new figure in relation to the Syrian crisis We say it is unprecedented and these are some of the figures from the Syrian crisis And some of you are familiar with it 470,000 people were killed 1.9 million injured 13 million in urgent need for humanitarian assistance The total population of Syria is 22 million 4.4 million registered refugee and I had to update that yesterday the UNHCR report And they said right now that your registered refugees is 4.8 million A 7.8 million IDPs UNHCR expects 8.7 million this year to be internally displaced in Syria 800,000 in besieged areas 5.5 million children afflicted by the crisis 4 out of 5 Syrians have no jobs We have a last generation we have this this integration of the public health care system We have a regional crisis because of the refugee we have refugee crisis Not only in the region but also in Europe because of Syria We have terrorism that feeds on the chaos and the void of leadership And the average life expectancy in Syria went down from 76 years To 56 years in 40 years We dropped 20 years in life expectancy This is one study in the British Medical Journal About the number of civilians who were killed in four years or the first four years in the crisis Most of the death happened in non-government controlled areas more than 90% of the death And as these are the causes of death of civilians You have of course small guns shooting you have shelling and you have air bombardment Which is increasing in percentage of killing the civilians in the last few months Most of the civilian death was were related to air bombardment either by barrel bombs or by fighter jets Whether it's syrian fighter jets or whether it's russian fighter fighter jets About 25 percent of syrian civilians who were killed were women and children So who is killing civilians in syria? The media focus on this And of course the elephant in the room is this And I would like you to focus on this because this is where the solution is found Of course, we have to focus on isis. They are extreme extremist group. They're very brutal and they had to be There is no place for them in syria But this is what's causing most of the deaths in syria the syrian government and their supporters Um the impact of the syrian war um is huge, you know, we have influx of trauma cases 1.9 Million syrians have disabilities or have trauma related to the violence to the bombing to the shelling Amputations losing eyes spinal cord injuries infections chronic infections. We have this ability related to that We have psychological trauma, which is really uncounted for 65 percent of syrian refugees in libanon have some type of psychiatric trauma post-traumatic Stress disorder depression anxiety bedwetting for children and so forth. We have attacks on health care and medical neutrality We have destruction of infrastructure Shortage of medical supplies and human resources siege We have about 800 000 people under siege epidemics of infectious diseases and including polio at one point We have severe malnutrition that we've never metless in syria before We have increased morbidity and mortality because of non communicable diseases Which is still probably the main killer of people in syria, not the violence. We have unconventional weapon attacks Chemical weapon attacks displacement of refugee and refugee crisis We have torture and human rights violation An exploitation of women and children all of this is because of the crisis in and in the war so if you condense world crises And in five years the end product will be what we are seeing right now in syria That's why syria is important. It's the worst humanitarian crisis in our lifetime This is a report that we published in 2013 called risking lives to save lives the ordeal of medical personnel in syria It talks about the ordeal of syrian physicians and nurses and how come that they have to struggle Every day to save people with very limited resources without support from the international community and risking their lives every day You have physicians or nurses who can be injured or killed because of what they are doing because they are trying to save life And this should not happen. This should not happen in the 21st century 150 years after geneva convention This is al-kindi hospital one of the largest medical center in alippo Before the crisis and this is the picture of the same place after the crisis I took the picture myself in the city of alippo And as you say the whole building is destroyed This is a medical center that cost the syrian Taxpayers 350 million dollars. It's the largest medical center in northern syria before the crisis Many of my colleagues were trained in this center and now it is like this This is the same picture with ambulances one time. I attended workshop by msf about Working under fire or healthcare under fire And at that time they were telling us that you have to put the emblem Of the red cross or red crescent on the ambulances to protect them in syria We actually advocate not to because that means they are they will be target, especially from the from the skies 75 percent of ambulances in syria were destroyed because of the dark Target destruction This is one of the report of the physicians for human rights the last report seven hundred and thirty healthcare professionals were killed 359 hospitals were attacked 91 percent of the killing done by the syrian government Russian attacks replaced the syrian government in term of targeting healthcare Attacks increased in intensity and frequency by time 70 percent of doctors in syria have forced to leave syria because of the crisis 70 percent in a developing country east alippo, which has Population of two two million before the crisis right now have a population of 250 250,000. It has only 60 physicians We have only two vascular surgeons among them in east al-ghota, which is under siege 90 percent of medical staff have left And that's why you have medical students You have nurses who sometimes do operations on patients to save lives. This is dr. Abdel azeez I took this picture with him after his hospital in alippo and zarzure hospital was was bombed and his main concern He's the head of surgeon in that hospital was to salvage some medical supplies in the hospital To use it to save lives for the next patient Who is doing killing? Focus the media focuses on this of medical workers, but of course, this is the largest culprit Of course because of the crisis in syria, we have a refugee crisis Europe is suffering from their refugee crisis And that's why you have more attention to what's happening in syria Not because the the population and civilians are suffering and the health care Civilian is health care workers in syria are suffering but because the refugees right now Reach europe unfortunately I'm heading to greece after this Visit we have Medical missions to greece, but as you know more than 500 000 syrians arrived to europe last year only 500 000 syrians arrived to greece took the dangerous trip from Turkey to greece and then to germany and other countries in europe And we really appreciate the hospitality and the welcoming by the by the european people Especially in german and sweden and france and other countries that opened their arms and houses and hearts of the syrian refugees In 2014 we had 100 000 Refugees in syria if this pace continued and it will continue because the crisis in syria is still happening You expect to have more than 500 000 refugees coming to europe this year I talked with some of those refugees in greece and they told me that they are leaving by the way from syria Not from turkey these are refugees who leave syria through turkey They they go to greece because they want to have safety and they have they want to have future For their children and many of them were telling me that many of their friends also Gave up on what's happening in syria and they are planning to take the same trip This is a picture of the largest refugee camp in the middle east It's the second largest refugee camp in the world after the dub Refugee camp and this is the fifth largest city in jordan al zaatari camp This is a picture of a refugee camp on the greek macedonian border in a cali area called idomini And you see many of the refugees here most of them are from syria But you also have refugees from iraq from Kurdistan from iran and other countries and many of them have fled syria because of the bombing I've seen syrian refugees from dar'a from nawa from other places. They fled fled from the bombing The healthcare system right now is fragmented. So you have healthcare system in Government controlled area that is acting probably near normal and you have healthcare system that is being under attack by The different arm group controlled areas and you have healthcare system that is under the control of isis Which is a black hole? We don't know what's happening there But there is a huge shortage and we have also also healthcare system that is controlled by Different Kurdish group. So we have at least four different systems of healthcare in syria because of the crisis This is one of the report that we produced last year and I testified in front of the united nations about The ordeal and life and death in syrian communities under siege. We have more than 50 communities in syria Under siege about 800,000 people and at that time ambassador ambassador, Samantha power Our un ambassador in united states, you know told the media that everyone who listened to the presentation was in tears And we're talking about united nation security council ambassador We don't really need tears from ambassadors in the united nations. We need action. We need to prevent this happening These are some of the facts about siege. We have different areas under siege in syria There is no electricity water and phone lines No sewage treatment and garbage collection in these areas under siege east al-ghouta, which is a large Area in syria that has about 400,000 people has no electricity for 3.5 years for three and a half years Imagine yourself without electricity for one hour This is the siege impact and this is lamar al-awmar seven month She has severe malnutrition and some of the pictures probably you've seen on social media It's one of the effective ways to let people know what's happening in syria because Reporters are not allowed into malaya and other areas under siege And the united nations and other agencies are stations in syria. Their performance is really terrible They are reaching only 3.6 of the population 0.5 of them with with food Vaccination rates about 25 80 of pregnancies are ending with c-section because women do not have access to hospitals in the middle of the night So they have to plan their end of pregnancies We have medical supplies and food Including baby milk and meat that are removed from the convoys when they are allowed into areas under siege Including daraya just two days ago when the un convoy was allowed finally the Checking points they removed the baby milk and medications from the convoy and then prevented the convoy from going in Because of that you have this extreme situation where medical students are doing surgeries and on flashlight I'm going to skip this chemical open up. By the way, it's still happening Uh, let me just spend the last two minutes about what happened in terms of uh adaptation to what's happening in syria And how are we dealing with the situation? This is a picture of emergency room in aleppo where you see the usual things you see in the emergency room But but also you see sandbags to protect the physicians and nurses from uh from bombs and barrel bombs There is no electricity. There is no diesel fuel in east alwota They are producing energy by methane methane gas. So they they're changing They are transforming animal waste into methane gas to generate to open or to To um to be used for the generators to produce electricity Many of our facilities in syria right now is under uh, uh, underground We have 22 facilities underground to provide protection for patients and for hospitals Six out of the syrian govern govern rates. Uh, we have facilities that are underground This is dr. Hasan al-araj. He's ahead of our direct medical Directorship in hama and uh, if you look at this picture, it's a normal picture of a hospital, right? You have monitor. You have ventilator. You have a patient here who's behind the dr. Hasan al-araj who has svt Dr. Hasan al-araj. I visited him in this facility. Uh, just two months ago This is the facility from the outside This is a mountain This is the facility from the inside Do you know what's the name of this facility? For those who understand arabic meshfa al-maghara al-marqazi the central cave hospital of syria It's funny, but it's painful You know what happened to dr. Hasan al-araj Just three weeks ago. He was inspecting his facility and after he left his car was targeted by air to surface muscle He's seeking missiles and he was killed. He was the only cardiologist in that area in syria We use telemedicine To reach areas in in syria. So we have a camera I can look at my iphone and I connect to icu's in syria where they can Show me the patients. I can talk with the physicians They can seek our advice and about what to do with critically ill patients So are using telemedicine or electronic icu to reach difficult to To reach areas in syria. We are using technology. We train syrian physicians on how to use portable ultrasound And they we had a study that showed 80 of them were capable to use portable ultrasound and use it To manage their patients who have a trauma and this is a patient I took this also myself in the city of alipbo who had the shrapnels and they were looking doing surgery in him and they're looking at His heart with a portable ultrasound They are we are doing teaching tele teaching also. This is dr. Basil atasi who's in chicago He's providing instruction to medical students in east al-ghouta Through the internet and you can ask me how come that they have internet and there's no electricity They are using car batteries to operate the internet So there's always solutions. Uh, so in uh, 2014 we were able to serve 1.3 million in 2015 We were able to to serve 2.3 million and we have many facilities including hospitals mobile clinics icu's emergency room birth centers, uh, and so forth In spite of the challenges in 2015 we had 72 attacks on our and uh on 25 facilities that we had We lost so far 27 healthcare professionals and 50 were injured But we believe that we can do a lot especially in coordination with our other partners So we have coalitions We call it american relief coalition for syria that is addressing the prices the crisis in syria in multiple aspects And we always hopeful for the future. We believe that syrian children and the young people of syria and the diaspora will build their country Um Let me let me end with this, uh, you know statement I had the pleasure uh to meet with president obama in august of 2013 And that that was an event in the white house and I told him at that time I delivered a letter on behalf of sams I told him I think your legacy would be determined by by what what you do in syria And and he laughed and he said but my legacy would be determined by other things also I told him but your legacy would be determined by what you do in syria Uh, I think our legacy would be determined by what we do in syria In the first session dr. Louise Lorese the deputy the deputy executive director of un aid said that if the un follow your lead Uh, the world would have been much better. I believe in that statement. Thank you very much