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They come from all over the world but are citizens of no nation. The children of foreign ISIS fighters and radicalized mothers, they have been brought to Al-Hikma Hospital from the Al-Hol refugee camp in eastern Syria. All show signs of moderate to acute malnutrition. The hospital says it has received more than 1,000 tiny patients from that camp since February, when the U.S.-led coalition pinned down Islamic State fighters in the last remnants of the caliphate. Every day since then has witnessed at least one fatality, if not more, says Saad Ali, the hospital director.
For the international community the children represent a real challenge. Unlike their parents, it is impossible to classify them as a security threat. “We get inquiries all the time from governments exploring the possibility to bring them back,” says a humanitarian worker. “The governments have made it very clear: ‘We want to sneak them in.’”
“Our responsibility is to receive and treat them like any patient,” says Mr. Ali. “But we are a country at war, where we are lacking everything. On top of everything else we have to carry this burden for other countries.”
Tucked away within the heart of a bustling souk in northeastern Syria lies a hospital treating dozens of babies, gravely ill survivors of the final siege against the Islamic State’s so-called caliphate.
The majority are the children of foreign fighters and mothers who subscribed to a radically hard-line interpretation of Islam.
All show signs of moderate to acute malnutrition: loose skin on emaciated bodies even for those whose rosy complexion hints at recovery. For others, whose cheeks are especially hollow and jaw lines sharp, warm pink blankets and fortified formula seem unlikely to do the trick.
They come from all over the world but are citizens of no nation.
“Often we don’t know who the father is in the first place,” explains Saad Ali, the director of Al-Hikma Hospital in Hassakeh city. “Some have no mothers. There are so many nationalities. But here we don’t care if they come from Uzbekistan or the United States; we proceed as a hospital.”
The children have been brought to Al-Hikma, which was founded in 1986 as a private medical establishment, from the Al-Hol refugee camp in eastern Syria. Their black-clad mothers, who wear the most conservative of Islamist garments, are considered a security risk and are immediately returned to the camp after dropping off their children, if allowed to come at all.
The hospital administration says it has received more than 1,000 tiny patients from that camp since February, when the U.S.-led coalition pinned down Islamic State fighters in tight but tough terrain on the banks of the Euphrates River.
Every day since then has witnessed at least one fatality, if not more, says Mr. Ali. “The vast majority of our cases are malnutrition,” he says. “About 10 percent of the cases are shrapnel.”
The hospital was already struggling to cope in a country at war, where most of the health system has been destroyed and medical personnel routinely and deliberately killed.
It sits on a street divided between forces loyal to the government in Damascus and forces loyal to the Autonomous Administration, the governing structure overseeing parts of northeast Syria that Kurds refer to as Rojava. A Syriac Christian militia mans the checkpoint between the two, closest to the hospital entrance.
A hospital official reminds visiting journalists that they are in the “Syrian Arabic Republic.” While the flags of the U.S.-backed Syrian Democratic Forces and its dominant Kurdish militias fly over much of the city, in this area the shutters of shops have been painted over with the Syrian flag.
The patients at Al-Hikma mirror the diversity of Syrian society, with men sporting traditional Arabic, Kurdish, or Western garb and women donning anything from shapeless niqabs to office outfits, heads veiled or uncovered.
The hospital became so pressured and overcrowded as a result of the young new arrivals that another floor had to be hastily built. Nearly 80 children have been divided between two rooms at the top of fresh concrete stairs.
In one room, smaller babies lie in neat rows of white rocking cradles. None of these cradles rock except for the one closest to a caregiver, who is busy bottle-feeding.
Against the back wall, toddlers stick their feet and arms through the bars of magenta cradles. Some sulk in silence; others cry loudly to be held.
Among the babies, Osama puckers and watches the world wide awake. Mohammed sleeps soundly next to him. Both boys are thin but on the mend. Next to them, Razan fights an infection. Her scalp bandaged, her eyes flutter furiously as her frail body tries to throw off a wool blanket. Nasreen sleeps on her back, toes resting on a pack of therapeutic food. Next to her, an emaciated Sarah lies completely still, her gaze lost in space.
“She was even worse when she arrived,” notes a nurse, whose charges range from two months to three years old. She strives to transmit a sense of warmth and safety. The caretaker to child ratio is a respectable 1 to 6. “What can we do other than treat, feed, and bathe them? What fault do they have in all this?”
‘We want to sneak them in’
For the international community – jubilant after the U.S.-backed Syrian Democratic Forces declared “total” victory Saturday in the fight to crush the last crumb of the caliphate – these children of ISIS represent a real challenge. Unlike their parents, it is impossible to classify them as a security threat. Still, they fall predictably low on the priority list.
“There a lot of unaccompanied minors, as a lot of people were lost in the chaos [in the final battle against ISIS at Al-Baghouz],” an international humanitarian worker says, speaking on condition of anonymity due to the sensitivity of the issue.
“Governments have made it clear that it is easier to bring the babies back without their mothers,” she adds. “The really complicated cases are mixed nationalities. We get inquiries all the time from governments exploring the possibility to bring them back. The governments have made it very clear: ‘We want to sneak them in.’ ‘We don’t want a song and dance.’”
The International Rescue Committee warned this month that the Al-Hol camp was at a breaking point. Since December, 120 deaths have been reported either en route to the camp, shortly after arrival, or following referral to a hospital. Some 80 percent of them are children under the age of 5, according to the latest figures of the United Nations Office for the Coordination of Humanitarian Affairs.
Al-Hol now houses about 74,000 people, two-thirds of them women and children who stayed or were forced to stay with ISIS until the bitter end.
“The Islamic State isn’t truly over,” commented a Syrian humanitarian worker wryly. “It has just been squeezed into this camp. The caliphate has been simply relocated.”
‘Now we serve the whole world’
More than 240 unaccompanied children are at the camp where conditions are dire by all accounts. Women end up caring for children who are not their own.
“All of these people are human beings who are entitled to humane treatment,” International Committee of the Red Cross President Peter Maurer said Friday after returning from northeast Syria. “Let’s not allow fiery rhetoric around the foreign fighters blind us to the suffering arising out of the humanitarian emergency.… Showing moral courage in the face of public anxiety and political pressure is hard. But we are better than this.”
The nationalities of the children at the camp and hospital reflect the diversity of those who were drawn by the promise of an Islamist utopia that devolved into a reign of terror: the Maldives, France, Germany, and Tajikistan are but a small sample of the range of the nationalities on the radar of those catering to these children.
“We used to serve all Syria; now we serve the whole world,” jokes Yusra el-Issa, a nurse at the hospital with a ready smile and quick sense of humor.
“We don’t deal with the politics,” stresses Mr. Ali. “Our responsibility is to receive and treat them like any patient. But we are a country at war, where we are lacking everything. On top of everything else we have to carry this burden for other countries.”