**5. Israeli humanitarian assistance and medical aid to Syrians**

At the end of February 2013 on a Saturday night much like any other, a routine Israeli Defense Forces (IDF) military patrol along the border with Syria came across a group of seven badly wounded Syrian combatants located close to the border fence. They were mostly unconscious and clearly in need of urgent medical care. A local operational decision was made, based on their medical condition alone, to take in these individuals and transfer them by military ambulance to the nearest hospital capable of caring for severe trauma, the Ziv Medical Centre (ZMC) in Safed, Northern Israel. No high-level command or political considerations were involved. Upon the arrival at the emergency room, which came as a surprise to the staff, the wounded were transferred to the trauma department, and all seven began complicated and prolonged investigations, surgeries and other treatments. All seven survived and were eventually returned to Syria by the military authorities. At the beginning this episode was considered to be an isolated exception, but in the subsequent weeks, repeated transfers of wounded Syrians were made, and it became apparent quickly that this trickle of wounded Syrians was becoming a flood. A public debate opened in the media and political echelons. The questions were difficult. Who were these combatants? Why should Israel get involved, and what would be the risks and costs? Should civilians also be offered medical aid? What was the legal framework? Would all the patients return to Syria, and could they return for follow-up? How would continued care be guaranteed in Syria? The Israeli government decided on a two-pronged policy:


These have remained the publically defined limitations of the medical assistance programme since then.

Israel has had a long record of offering high-quality humanitarian aid to victims of disasters all over the world. In the last decade alone, Israel has sent fully equipped medical missions to Africa, Turkey, Haiti, Nepal and other countries, often being the first and quickest among international efforts. The IDF has a full rescue system ready to deploy at short notice and on stand-by at all times. Although this arrangement had never been utilised within Israel's own borders, the equipment and procedures were prepared and were able to be put in place within a short time. It was decided to open a fully equipped field hospital near the border in the Northern Golan, close to the Druze village of Majdal Shams, as a first step. This facility had X-ray, laboratory, intensive care capabilities as well as a fully functional operating room and admission ward. Patients were initially treated there after undergoing triage and following stabilisation either returned to Syria or were transferred onwards

**271**

*Treating the Enemy: Victims of the Syrian Civil War in Israel*

and the field hospital became inactive most of the time.

not was sporadic and often limited or sub-standard.

**6. The nature of the Israeli medical assistance programme for Syrians**

For readers interested in reading further about the medical details of the injuries, diseases and suffering of the Syrian patients and the treatment that was given, they can do so in the book *Complicated War Trauma and Care of the Wounded: The* 

to one of the civilian hospitals in Northern Israel. During the years 2013–2018, the two hospitals mainly involved were ZMC as already mentioned and the hospital at Nahariya, although the hospital at Poriah and the Rambam hospital in Haifa also treated some individuals. The medical staff were mainly drawn from the reserve forces of the IDF and were in practice physicians and surgeons working in routine civilian practice all over the country. Thus the burden of this project fell indirectly on all the Israeli health system. The field hospital operated for various periods of time, depending on the flow of patients and the available resources. At one point the Assad regime forces began shelling the hospital (in line with their policy of targeting medical facilities as explained above), and this required determined countermeasures by the IDF to silence this. After a period however, it was decided that the optimal procedure was the direct transfer of patients to civilian hospitals,

The transfer of patients in both directions across the border was at all times the sole responsibility of the IDF, with each transfer taking on the character of a fully fledged military operation. This was especially true after terrorist organisations launched sporadic attacks along the lines in an attempt to harm IDF forces in the course of their activities. Initial triage was carried out at the crossing points by regular IDF paramedical staff. Thereafter the patients remained under the responsibility of the military until they returned home, even when they were being treated in civilian facilities. The contacts and arrangements made by the IDF with groups on the Syrian side, for the purposes of coordination and logistics, are beyond the scope of this chapter. Nevertheless, it is clear that some form of communication existed and enabled fairly smooth operations to take place throughout this period. Many thousands of Syrians were transferred to Israel for medical treatment in the years 2013–2018. At the beginning all patients were treated as in-patients; however as time went on, it became apparent that the health needs of the entire population of the Daraa region required a significant expansion of the scope and nature of the programme. In late 2017 the head of the IDF announced that a major shift of policy had been decided upon. Henceforth not only severely injured or sick patients would be treated as in-patients but that a complete ambulatory system would be set up for the day care of patients suffering from all manner of routine medical problems. This initiative was coined the "Good Neighbours Initiative", echoing an earlier and similar policy vis-à-vis Lebanon in the 1980s, called "The Good Fence". A further feature of this remarkable initiative was to provide medical supplies and drugs to patients in Syria for up to 3 months after treatment in Israel. It was also widely rumoured that international medical aid agencies were also provided with security guarantees for their personnel working inside Syria. Following its promulgation, regular groups of Syrian civilians including women and children were brought by chartered buses to out-patients' clinics at ZMC and Nahariya for clinic and day hospital treatment. Many additional thousands of patients thus benefited from the medical assistance programme, and all of this should be stressed at the highest professional level at no cost to the patients. This stands out in stark contrast to the situation in neighbouring Arab and Moslem countries where Syrian patients often had to pay dearly for medical care even when available, which more often than

*DOI: http://dx.doi.org/10.5772/intechopen.87936*

#### *Treating the Enemy: Victims of the Syrian Civil War in Israel DOI: http://dx.doi.org/10.5772/intechopen.87936*

*Education, Human Rights and Peace in Sustainable Development*

Israeli government decided on a two-pronged policy:

2.No Israeli soldiers or civilians would enter Syria.

side the urgent need for humanitarian assistance for the local and refugee population including the provision of medical assistance for civilians and combatants alike. Thus a remarkable and in some ways unique programme of medical assistance was born, provided at no charge by Israel, for the citizens of its enemy neighbour Syria. There has never been a precedent for a campaign similar in scope and duration between two hostile neighbours, and therefore the nature of this event and its

At the end of February 2013 on a Saturday night much like any other, a routine Israeli Defense Forces (IDF) military patrol along the border with Syria came across a group of seven badly wounded Syrian combatants located close to the border fence. They were mostly unconscious and clearly in need of urgent medical care. A local operational decision was made, based on their medical condition alone, to take in these individuals and transfer them by military ambulance to the nearest hospital capable of caring for severe trauma, the Ziv Medical Centre (ZMC) in Safed, Northern Israel. No high-level command or political considerations were involved. Upon the arrival at the emergency room, which came as a surprise to the staff, the wounded were transferred to the trauma department, and all seven began complicated and prolonged investigations, surgeries and other treatments. All seven survived and were eventually returned to Syria by the military authorities. At the beginning this episode was considered to be an isolated exception, but in the subsequent weeks, repeated transfers of wounded Syrians were made, and it became apparent quickly that this trickle of wounded Syrians was becoming a flood. A public debate opened in the media and political echelons. The questions were difficult. Who were these combatants? Why should Israel get involved, and what would be the risks and costs? Should civilians also be offered medical aid? What was the legal framework? Would all the patients return to Syria, and could they return for follow-up? How would continued care be guaranteed in Syria? The

1.Syrians who required medical assistance and who reached the border between the two states would be offered whatever aid they required on a humanitarian

These have remained the publically defined limitations of the medical assistance

Israel has had a long record of offering high-quality humanitarian aid to victims of disasters all over the world. In the last decade alone, Israel has sent fully equipped medical missions to Africa, Turkey, Haiti, Nepal and other countries, often being the first and quickest among international efforts. The IDF has a full rescue system ready to deploy at short notice and on stand-by at all times. Although this arrangement had never been utilised within Israel's own borders, the equipment and procedures were prepared and were able to be put in place within a short time. It was decided to open a fully equipped field hospital near the border in the Northern Golan, close to the Druze village of Majdal Shams, as a first step. This facility had X-ray, laboratory, intensive care capabilities as well as a fully functional operating room and admission ward. Patients were initially treated there after undergoing triage and following stabilisation either returned to Syria or were transferred onwards

effects on Israelis and Syrians are of considerable interest and importance.

**5. Israeli humanitarian assistance and medical aid to Syrians**

**270**

basis.

programme since then.

to one of the civilian hospitals in Northern Israel. During the years 2013–2018, the two hospitals mainly involved were ZMC as already mentioned and the hospital at Nahariya, although the hospital at Poriah and the Rambam hospital in Haifa also treated some individuals. The medical staff were mainly drawn from the reserve forces of the IDF and were in practice physicians and surgeons working in routine civilian practice all over the country. Thus the burden of this project fell indirectly on all the Israeli health system. The field hospital operated for various periods of time, depending on the flow of patients and the available resources. At one point the Assad regime forces began shelling the hospital (in line with their policy of targeting medical facilities as explained above), and this required determined countermeasures by the IDF to silence this. After a period however, it was decided that the optimal procedure was the direct transfer of patients to civilian hospitals, and the field hospital became inactive most of the time.

The transfer of patients in both directions across the border was at all times the sole responsibility of the IDF, with each transfer taking on the character of a fully fledged military operation. This was especially true after terrorist organisations launched sporadic attacks along the lines in an attempt to harm IDF forces in the course of their activities. Initial triage was carried out at the crossing points by regular IDF paramedical staff. Thereafter the patients remained under the responsibility of the military until they returned home, even when they were being treated in civilian facilities. The contacts and arrangements made by the IDF with groups on the Syrian side, for the purposes of coordination and logistics, are beyond the scope of this chapter. Nevertheless, it is clear that some form of communication existed and enabled fairly smooth operations to take place throughout this period.

Many thousands of Syrians were transferred to Israel for medical treatment in the years 2013–2018. At the beginning all patients were treated as in-patients; however as time went on, it became apparent that the health needs of the entire population of the Daraa region required a significant expansion of the scope and nature of the programme. In late 2017 the head of the IDF announced that a major shift of policy had been decided upon. Henceforth not only severely injured or sick patients would be treated as in-patients but that a complete ambulatory system would be set up for the day care of patients suffering from all manner of routine medical problems. This initiative was coined the "Good Neighbours Initiative", echoing an earlier and similar policy vis-à-vis Lebanon in the 1980s, called "The Good Fence". A further feature of this remarkable initiative was to provide medical supplies and drugs to patients in Syria for up to 3 months after treatment in Israel. It was also widely rumoured that international medical aid agencies were also provided with security guarantees for their personnel working inside Syria. Following its promulgation, regular groups of Syrian civilians including women and children were brought by chartered buses to out-patients' clinics at ZMC and Nahariya for clinic and day hospital treatment. Many additional thousands of patients thus benefited from the medical assistance programme, and all of this should be stressed at the highest professional level at no cost to the patients. This stands out in stark contrast to the situation in neighbouring Arab and Moslem countries where Syrian patients often had to pay dearly for medical care even when available, which more often than not was sporadic and often limited or sub-standard.

## **6. The nature of the Israeli medical assistance programme for Syrians**

For readers interested in reading further about the medical details of the injuries, diseases and suffering of the Syrian patients and the treatment that was given, they can do so in the book *Complicated War Trauma and Care of the Wounded: The* 

*Israeli Experience in Medical Care and Humanitarian Support of Syrian Refugees* [8], written and edited by the staff of ZMC. A general summary will be given here. Approximately 80% of the in-patients treated were male, and about 20% were under the age of 18. Patients were treated in almost every department of the hospital but especially in intensive care, surgery, orthopaedics, paediatrics and obstetrics. Of note, 24 babies were born to Syrian mothers in ZMC during the duration of the programme. Many of the patients suffered from injuries during combat either directly or collaterally. Among these were severe limb injuries, head and neck, abdominal and chest injuries, and those requiring and plastic surgery. Often these patients required very prolonged treatment including repeated surgery, treatment for severe infections, pain relief and nutritional resuscitation. Almost all patients came with no medical records or documentation, making assessment doubly difficult. Patients who had received medical care in often from severe complications such as botched procedures, multiple resistant bacterial infections, and severe pathogens (such as polio which broke out in various places in Syria). In addition, increasingly patients arrived in Israel with medical problems such as congenital malformations, genetic disease, cancer as well as "routine" disorders such as cardiovascular disease, diabetes and neurodegenerative disease.

Mortality was surprisingly low among in-patients, <5%. Considering the severe condition in which many arrived, the complications and lack of medical documentation, this was an impressive achievement. The work of the orthopaedics department in limb salvage and rehabilitation was especially noteworthy with its chief being invited to lecture worldwide and the author of many books and articles. However, the medical and nursing staffs of all departments worked with commendable skill and efficiency for their patients. Nor were the psychological and social aspects neglected. Psychologists and medical clowns ("dream doctors") working in Arabic provided invaluable support for these unfortunate people, who found themselves in a strange country, a country which all their lives they had been taught to hate, fear and despise, suffering severe pain and disability and above all being completely dependent on the goodwill and skill of caretakers with whom they had almost nothing in common. Social workers also worked hard to provide relief both as facilitators and educators, contact providers between the medical and military authorities and also provide the basics which the patients completely lacked such as clothes, toiletries, reading material and for the children toys and even tablet computers. Arabic-speaking teachers also provided educational materials and teaching programmes.
