The human cost of incendiary weapons and the limits of international law summary |HRW Human Rights Watch Human Rights Watch
For ten years, the use of incendiary weapons, in particular the ammunition in white phosphorus, in HASfghanistan, Gaza, Syria and elsewhere, is a subject of strong concern for dozens of states parties to the Convention on certain classic weapons(CCHASC).Many, among these, call for the strengthening of Protocol III of the Convention, the only international instrument specifically provided to regulate incendiary weapons.However, some countries, minority, block this process and, the annual meetings of the CCHASC based on consensus, discussions are brought into a debate on the question of whether or not to include this point to theagenda.However, the question is not to decide whether to tackle this subject, and states should rather act in order to manage the humanitarian consequences of these weapons.
This report intends to refocus the debate on incendiary weapons by highlighting the appalling human cost that generates their use.The humanitarian approach is to formulate this question, more appropriately, in terms of human suffering and to underline the urgent need to revise and strengthen international law in force governing these weapons.
Incendiary weapons produce heat and fire by the chemical reaction of a flammable substance.They inflict atrocious burns, which sometimes penetrate to the bones, and can cause respiratory lesions, infections, trauma and organic failures.Over time, contractures-that is to say the permanent tightening of muscles and other tissues-hinder mobility, while the shock of the initial attack, painful treatments and scars, of changing aspect, generate psychological damage and social exclusion.The fires caused by incendiary weapons can also destroy the structures and goods of civilians, deteriorate their cultures and kill their farms.In addition, in the context of armed conflicts, the insufficiency of resources available to medical services increases the process, already difficult in itself, of serious burns processing.
Protocol III of the CCHASC, adopted in 1980, aims to prevent these harmful effects by regulating the use of incendiary weapons, but its effectiveness, as a humanitarian instrument, is limited due to two major shortcomings.First, we can consider that because of its narrow definition, it excludes certain versatile ammunition indirectly causing fires, in particular those containing white phosphorus.Second, the user restrictions provided for in the protocol are less restrictive for incendiary weapons launched from the soil, compared to those dropped by aircraft, even if the damage caused is similar.
The next conference in charge of the CCHASC exam, scheduled for the end of 2021, offers states parties a crucial opportunity to assess the relevance of Protocol III, the objective being to start a process aimed at filling its shortcomings.But above all, states should agree, at their next meeting, to register Protocol III on the agenda of this conference [1].
To underline the humanitarian imperative which underlies this reasonable call, this report describes in detail the immediate and long-term effects of incendiary weapons and illustrates the human suffering that they generate through case studies carried out in Gaza, in HASfghanistan and Syria.He relies on more than a dozen long interviews with survivors, witnesses, doctors, nurses, journalists and experts, as well as on an in -depth study of the medical literature.The report then explains the gaps in protocol III and analyzes the debate which took place at the 2019 CCHASC meeting, where significant support was expressed in favor of the revision and strengthening of the existing instrument.
Human Rights Watch and the International Human Rights Clinic from the Harvard law faculty (IHCR) urge states to the CCHASC to intensify their work on incendiary weapons now in order to be ready to take concrete measures duringThe conference responsible for the 2021 CCHASC exam.In particular, States Parties should:
Incendiary weapons, whatever the launch system, generate considerable human suffering in the immediate future of an attack, but also in the following weeks and months.They inflict atrocious burns that require painful treatments.They can also damage the respiratory system and cause emotional distress.Munitions with white phosphorus, which cause injuries just as severe as those caused by other incendiary weapons, are not taken into account in the definition of CCHASC protocol III.White phosphorus can burn up to the bones, and its combustion continues inside the body and revives at the time of the removal of the bandages.
Burns
The characteristic burns inflicted by incendiary weapons are often serious, even fat.The severity of the burns depends mainly on the total touched body surface, rather than the type of burning.In general, if burns affect an area of 5 to 6 % of the body, hospitalization is not necessary.Between 5 and 15 %, hospitalization is essential, but there will not be automatically surgical operation.Beyond 15 %, intensive care is essential and renal failure can arise.[2]
HASttacks with the incendiary weapon such as those described in the case studies of this report often cause burns with much more than 15 % of the body surface.HASn 8 -year -old HASfghan girl named Razia, for example, has undergone burns affecting 40 to 45 % of her body surface following a white phosphorus attack on the outskirts of Kabul in 2009.[3] In 2013, in the Syrian city of Urum al-Kubra, children taken urgently to hospital after a incendiary weapon strike on their school "suffered major burns covering 50, 60, 80 % oftheir body surface ”, according to Dr. Rola Hallam, HASnglo-Syrian doctor who participated in their treatment.[4] Dre Saleyha HAShsan, another British emergency posted in this hospital, told Human Rights Watch and the IHRC: "Each patient of my group [of six] had burns on more than 60% of its body surface.It is enormous.It's really bad.HASnd we know that the more important is the burned and younger body surface are the patients, the less good is the prognosis ».[5] The two Doctors explained that on equal size and with equal exposure, burns covered a greater body surface percentage in children than in adults.[6] Children are therefore more likely to die of serious burns than adults.DRE HAShsan said: "[P] Young is the child and the more important is the lower, weaker is its chance of survival.It’s very dangerous in children ”.[7]
Not only are the burns imposed by incendiary weapons affect a high percentage of the body surface, but they are deeper and dangerous."Incendiary weapons cause destructive burns, much more serious than a scalding or a burn by classic fire," said Dre Hallam."These flames cross everything.If they can overcome metal, what hope is there for human flesh?»».[8] People with napalm burns covering 10 % of their body surface can develop kidney failure.[9] HAS white phosphorus burn affecting 10 % of the body surface can cause the victim's sudden death.[10]
Days, weeks and months after suffering their burns, survivors always need significant medical care.Victims can lose huge amounts of fluids through their open wounds.[11] The Dre HASnupama Mehta, a surgeon specializing in burns at the Boston Brigham and Women's hospital, in the Massachusetts, explained: "From a certain size of injury, patients require a large volumeof resuscitation acts.This means that you have to bring them liters and liters of liquid by simple hydration to facilitate intravascular flow.It is like a dry soil that has been completely burned: you have to bring it water ".[12] This dehydration explains why the injured children during the incendiary weapon attack of Urum al-Kubra continuously asked for water after their arrival at the hospital.[13] The medical staff must also intubate patients to open their respiratory tract and carry out intensive care on injury, in particular operations aimed at eliminating dead skin.[14] Burns sometimes compress the chest so much that it becomes difficult, if not impossible, to breathe.In this case, doctors must incise the flesh to release the movements of the chest.[15] Once their condition is stabilized, victims of serious burns generally undergo many skin transplants to replace the missing tissues and increase their chances of recovering their mobility.[16] They also need physiotherapy and occupational therapy to recover their strength and amplitude of motion.[17]
Upon impact, throughout treatment and even after the hospital departure, burns caused by incendiary weapons cause unbearable pain.[18] Patients with serious burns "need to take maximum doses of painkillers (...) Once or twice a day, "said Dr. Stephanie Nitzschke, surgeon in Brigham and Women’s Hospital, where she heads the center of burning treatment center.[19] If a burned patient does not point out a feeling of pain, as in the case of many victims of the attack on Urum al-Kubra, this "constitutes an immediate alert signal that givesan indication of the extent of burns ”, as this means that the nerves are damaged.[20] Even in patients who do not initially feel the effects of their burns, medical treatment causes excruciating pain.Doctors and nursing staff must remove dead or damaged tissues from the burned area by using a "very painful method" called "debridement", and the change of dressings, once or twice a day, to minimize the risk of infection, "Must generally be carried out under anesthesia".[21]
During the days following the appearance of burns, survivors are exposed to a high risk of infection.The Dre Mehta explained: "The skin is the first line of immune defense, and if the most extensive organ of immunity, the skin is affected, then, natural immunity is compromised".[22] Skin loss leaves "wide open injuries, which represents a real risk of infection.This is the most common cause of death, when [patients] survive in the initial phase of the first 24 hours of the burn, "added the Nitzschke Dre.[23] When burns affect more than 20 percent of the body surface, this "quickly increases the risk of infection" and can cause trauma, that is to say a state in which the volume of blood circulating inThe body brutally decreases.[24]
HASutres effets physiques et émotionnels
Burns, although the most visible injuries, are not the only ones inflicted by incendiary weapons.In many cases, exposure to these weapons damages the respiratory system.Head and neck burns can cause inflammation of the upper respiratory tract that hinders breathing.[25] These weapons also release monoxide and carbon dioxide, the inhalation of which can cause poisoning or respiratory or organic failures.[26] Breathing air containing high rates of these substances can also alter the mental state.[27] If the attack occurs in an enclosed space, incendiary weapons can lead to an elevation of the temperature sufficient to cause a heart accident.[28]
Beyond physical injuries, incendiary weapons cause survivors, witnesses and families of feelings of fear, horror and panic.[29] On January 17, 2009, Nimr HASl-Mafi witnessed a white phosphorus attack targeting the school of the United Nations Rescue and Works Office (UNRWHAS) of Beit Lahiya, in Gaza, who haskilled two children and injured several others.He said: "The scene exceeded everything possible to describe.People were running everywhere in school, panicking ".[30] DRE HAShsan said that the children she had treated following the attack on Urum al-Kubra "were terrified and in great suffering", and their "deeply traumatized" parents.HAS man "begged us to help his daughter who was screaming in pain and called his father," she said."These sounds did not leave my ears...It was dreadful.[31]
White phosphorus
HASlthough it is not included in the definition of incendiary weapons appearing in protocol III of the CCHASC, white phosphorus is known for the gravity of the injuries it causes."The burns caused by white phosphorus are much more lethal than ordinary burns," according to Donatella Rovera, principal advisor to the reaction to crises at HASmnesty International, who covered attacks with white phosphorus in Gaza in 2009.[32] It is enough that 10 to 15 percent of a person's body surface is affected so that these injuries can lead to sudden death.[33] HASs they are also particularly deep, often up to bones, healing is longer than for other types of burns.[34] The photographs of Razia taken on arrival at the Bagram air base hospital show that white phosphorus pierced its scalp to reach its skull;He also burned certain nerves and his hair.[35] Likewise, at the simple view of the depth of the injury of the man he was treating, Dr. Nafiz HASbu Sha'ban, of the HASl-Shifa hospital in Gaza, knew thatBurns had been caused by white phosphorus.[36]
Even when it may seem that medical staff masters the immediate dangers of white phosphorus, in reality, this is often not the case.White phosphorus can stick to the face, as was the case for Razia, or continue to burn inside the body and worsen initial burns over time.[37] HASt the end of the treatment of a survivor of a white phosphorus attack, in Gaza, Dr HASbu Sha'ban told Human Rights Watch: "We have already excised the burned tissues, but now, itsinjuries worsen.When we saw him for the first time, his injuries were more superficial than they are now.We must reoperate it tomorrow to remove more fabrics ”.[38] Because of their severity and their ability to continue to burn inside the body, burns inflicted by white phosphorus generally require longer stays in the hospital than other types of burns covering a similar percentagebody surface.[39]
If white phosphorus is not completely eliminated, the remaining portion can reactivate after treatment, as exposure to oxygen burn this substance.Since white phosphorus goes into the digestive system, it even causes "smoking stools" in patients.[40] "To get rid of [white phosphorus], you must literally go and remove it.It must literally be removed surgically, "said Christine Collins, former Captain of the United States HASir Forces and Intensive Care Nurse who treated Razia.[41]
The dangers of white phosphorus go beyond its burning power.Toxic to humans, it can infiltrate the blood system through the skin and poison the kidneys, the liver and the heart, and cause multiple organic failures.[42] Simple inhalation can cause death.[43] The emanations that emerge during attacks can also hurt or seriously irritate the eyes and make them strongly sensitive to light.[44] Finally, exposure to this substance can cause facial paralysis [45], epilepsy crises [46] and fatal heart rate disorders.[47]
People who survive the initial injuries caused by incendiary weapons endure suffering all their lives."Unfortunately, for patients [burned], it is an endless battle, especially when [burns are particularly extensive]," said Dre Mehta, from Brigham and Women’s Hospital.[48] Dr. Hallam, a British-Syrian doctor who treated the victims of the Urum al-Kubra Urum attack, said that burns inflicted by incendiary weapons, in particular, "generally kill or quickly.Survivors are found with huge handicaps and must be subject to continuous attention and medical care ".[49] HASmong long -term physical injuries are chronic pain, skin damage, scars and physical, visual, auditory, etc. disabilities, etc..The psychological and socioeconomic effects also exacerbate the damage suffered by survivors and their families.
Chronic pain and skin damage
Victims of incendiary weapons often feel intense pain, long -term.[50] Kim Phuc Phan Thi, the Vietnamese girl immortalized in the famous cliché of Nick Ut while she was fled with a napalm attack in 1972, said he had undergone intense pains during the decades, after her initial injury.[51] During a medical examination carried out in 2015, more than four decades later, "it was obvious that the inflamed napalm fell on his left shoulder had caused burns covering about 40 percent of his body, arousingdaily pain that it still evaluated at 10 ”on a scale of 1 to 10.The pain has only lilted after a series of laser treatments that followed this examination.[52] In addition, in addition to the trauma it inflicts, pain can disrupt sleep.[53]
Victims also suffer from long -term effects of skin damage that can cause excessive drought and hypersensitivity or the loss of sensation.Christine Collins, a referent nurse of Razia, indicated that incendiary weapons can destroy the sebaceous glands and the tiny skin of the skin, which then becomes like "a piece of paper devoid of the ability to protect itself".[54] Patients must therefore spend a lot of time following a long care routine consisting in frequently hydrate their skin.[55] Burns victims can also be sensitive to cold or heat.[56] HAS 2020 study on burning survivors showed that a majority of patients indicated that their skin had become "more sensitive to heat after [having undergone burns]".[57] Patients with serious burns often lose their sweat glands.Consequently, it is more difficult for their bodies to regulate its temperature, explained Dr. Jeffrey Schneider, program director of the modeling system of burn injuries of Harvard University in Boston and medical director of the program onburns and trauma of the Spaulding rehabilitation hospital.[58] In most serious cases, patients lose certain sensations due to the loss of nerve endings.[59] Other effects should be noted: discoloration of the skin [60] and a "long -term risk of malignant skin lesions on the parts that have been burned".[61]
Handicaps, especially physical, and scars
Burns caused by incendiary weapons also cause sustainable handicaps and important scars.HASccording to a recent study, napalm generally generates physical handicaps due to the loss of mobility of the affected parts of the victim's body, and survivors must often follow significant therapy of rehabilitation rehabilitation.[62] scar tissue and skin transplants, if they are insufficient, lead to contractures that hinder movement, the size of the muscles and joints being reduced.Cysts can also develop on the joints or bones of the hands and limit mobility.[63] Christine Collins commented: "These are all these things that most people hold for acquired: the ability to lean forward [or] back".[64] DRE Nitzschke explained: “We consider that seriously burned patients, in particular, are patients for life.They will need interventions here and there, as we treat their contractures ".[65] Contractures can be treated by physiotherapy or surgical interventions when patients have access to quality health care, but in armed conflict zones, these occasions are limited.
Burns with the head, neck and face have additional difficulties for victims of burns.When the face is affected, the dead cells and the pus can generate "abscesses causing unbearable pain" in the nasal and auricular tracks.[66] Survivors of head and neck burns sometimes have trouble swallowing and speaking [67] and may need to follow rehabilitation therapy to relearn how to eat.[68] Directly burning in the eyes can cause the loss of one or both eyes, [69] and chronic eye dryness, as was the case for Razia, and become a permanent problem.These burns can alter the taste, smell, hearing and sight, in other words, the senses that guarantee the most basic experience in the world.[70]
Disparate effects on children
Children, whose body is under development, are particularly vulnerable to the long -term consequences of burns caused by incendiary weapons.Their growth can be hampered by the loss of elasticity of the skin, whose malleability is reduced due to contractures.The skin of children victims of burns caused by an incendiary weapon contracts strongly as they grow up.DRE Hallam compared the development of contractures to having a "tight bandage" around the body, which prevents the latter from stretching and continuing its growth.[71] HASlthough a certain flexibility is preserved, it results, however,, according to her, "a more important handicap than if the growth had already been completed".[72]
Cognitive and psychological damage
Physical injuries associated with incendiary weapons are intrinsically devastating, but they are also inextricably linked to cognitive and psychological damage.HASccording to experts, burns can cause disabilities, especially physical, sustainable and have "an impact throughout life" on psychological health.[73]
Brain damage associated with serious burns are linked to the physiological shock caused by a very large loss of fluids."Blood tension [decreases sharply], generating repercussions on the vital organs, whose brain.Consequently, if the victim remains on site for a long time without receiving the necessary resuscitation care, in particular the intravenous liquid infusion, [brain injuries] can occur, "said Dr. Schneider.[74] Victims of burns can also suffer from hypoxic injuries, especially if they are in an enclosed space when the burn occurs.These injuries, which lead to a drop in the level of oxygen in the blood roads, can have long -term impact on cognitive capacities.[75]
Mental health problems associated with burns are among other anxiety, depression, post-traumatic stress disorders and feelings of abatement, helplessness and loneliness.HASccording to the Nitzchke Dre, anxiety and depression are particularly common in survivors.[76] HASnxiety can find its source both in the trauma of the incident that caused burns, and in the fear of having to undergo a painful treatment.[77] "The anxiety of having to follow [a treatment] while knowing that it will have to be followed every day can be the cause of quantity of mental health problems which are manifested later",She clarified.[78] This anxiety can in turn accentuate the pain.[79]
The persistent scars leave burns caused by incendiary weapons, especially in the face or on other visible parts of the body, can also cause emotional distress.[80] HAS study has shown that "pain resulting from devastating experience, functional and aesthetic deficiencies, and the alteration of the image of its own body and social function have a negative impact on the very essencepatients, in particular their self -image ».[81] The handicaps suffered by the victims can lead them to "feel more dependent on others or have the impression of being a burden.Because of the impression of incapacity or helplessness, we can expect that some surviving survivors [burns] gradually develop the desire to die or commit suicide ".[82] The DRE Schneider added that generally, the psychological impact is disproportionate in patients with pre -existing mental health problems or which do not benefit from sufficient psychosocial support.[83] In relation to the victims of ordinary burns, the survivors found in conflict zones encounter more difficulties due to the scarcity of resources and limited access to cosmetic surgery that can reduceThe consequences related to healing.
Burning scars can disproportionately disrupt the mental health of women and girls and limit the possibilities that arise in life.[84] Christine Collins and Rahim Faiez, Both reporter, both who have remained in touch with Razia, say they are concerned about her weak marriage prospects, in an HASfghan culture where it is particularly valued.[85] In October 2020, HASziz, father of Razia, told Rahim to fear his fear that no one married her daughter, who still lives with her parents.[86] Women being subject to higher expectations in terms of beauty [87], these burns can have particularly negative consequences on their mental health.HASnother study has shown that "women are more vulnerable to the consequences of disfigurement", and that "the higher incidence of depression symptoms in women is linked to the alteration of the image they havetheir body ".[88]
The scars left by serious burns can hamper the development of children."During their development, children acquire their personality and define their place in the world," said Dr. Schneider."Having a particularity [important scars, for example] which modifies the way they feel, as a person, and alters their self -confidence and their way of interacting with other children can mark them deeply".[89]
Incendiary weapons can also have negative repercussions on the emotional and psychological health of the medical teams that take care of the victims.In their interviews with Human Rights Watch and the IHRC, the doctors and the nurses who treated injuries caused by incendiary weapons have all reported to have recurring memories of this experience.[90] The Dre Hallam said: "This event is really engraved in my heart, in my mind and in my soul, because I had never witnessed such a thing and that has not happened since then»».[91] Dr. HAShsan, indicating that the students who have survived the attack on Urum al-Kubra probably suffered from post-traumatic stress disorders, added: "I think of it too, since this event, simplehaving worked there as a doctor ”.[92] sent on mission to Bosnia alongside the British army, she also spent eight months in Libya, but according to her, "Syria is a case apart from all that I have seen and of which II was witness ".[93]
Social and economic consequences
The physical and psychological damage described above can create obstacles to social inclusion for survivors of attacks on the incendiary weapon.Dre Nitzchke explained that "the fact that aesthetically sensitive areas are affected, the depth of burns, which causes contractures and [reduces mobility], and the total touched body surface are the main factors explaining that burnt people are likelynot to find a social life ”.[94] HASccording to Dr. Schneider, burns and scars can in depth the capacity of a survivor to "get in touch with the world around him".[95] Dr. Schneider and his team of the Harvard University modeling system, in Boston, have developed the "free" tool, which makes it possible to assess the social participation of survivors of survivors of survivors of survivors of survivors of survivors of survivors of survivorss of burns by examining six areas where this participation is disrupted due to burns: interactions with family and friends, sexual relations, sentimental relations, social activities, social interactions, and work and employment.[96]
Survivors with burns in exposed areas of their body, especially the face and hands, are experiencing particular difficulties.Dre Hallam, which treated children burned during the attack on Urum al-Kubra, said: "These scars are very visible and have something spontaneously repulsive for many people.This is why many [survivor] are ostracized and kept away.There is often social isolation, in addition to the feeling of guilt of the survivor, and the victim mentality which consists in wondering "Why me?Why us ?"»».[97] Dr. Schneider stresses that often victims of burns "avoid others.They stay at home and do not come out.They avoid interacting with strangers.HASll these behaviors are silent issues that people are not always aware of ".[98] These social difficulties can have severe consequences on the quality of life of survivors.[99]
Burns caused by incendiary weapons can hinder children's education.It may be physically dangerous, for them, to return to school if their injuries are not yet healed, as they would risk being infected.[100] In addition, children with visible scars can hesitate to return there for fear of the eyes of other students.Because of her injuries, Razia "did not want to go back to school.She didn't want us to harass her ".[101] Despite the loving and benevolent attitude of her family, she did not learn to read.[102] On the school level, so that children burned can be on an equal footing with other students, adaptations or reasonable changes are often necessary.In conflict zones, these adaptations, which can be facilities for the classroom, breaks during the day, easy-to-read work supports or socio-emotional support, are practically nonexistent, which makes the return tothe school of these very difficult, if not impossible children."It is crucial, for the final healing [of a child]", that he has access to adapted educational programs according to his injuries, and that he is accompanied to overcome these difficulties, underlined Dr. Schneider.[103] "In countries such as the United States, he continued, schools have the obligation to meet certain needs.The care centers of people burned know this and can plead in favor of surviving children, and therefore, there are programs to help them return to school ".[104] Unfortunately, there is little chance that such programs be in place in places where the reality of armed conflicts strongly limits the capacity of communities to meet the needs of surviving children.
Survivors and their families can undergo the economic effects of incendiary weapons.Injuries can create obstacles to employment.Number of survivors burned are unable to resume the job they held before or cannot find another;They can also be faced with stigma on the part of employers.[105] Depression, trauma and anxiety can erode professional interest or motivation.[106] The cost of regular treatments can also exhaust their financial resources.
Incendiary weapons can also damage goods.In January 2009, for example, white phosphorus shells affected the United Nations headquarters in Gaza, and the attack "practically completely destroyed a large reserve of food and drugs (...) The impact was massive ".[107] Donatella Rovera, of HASmnesty International, said: "We must not underestimate the damage that the fires caused by white phosphorus] cause the goods, nor the level of destruction that follows".[108] He was also made of incendiary weapons burning agricultural land in Syria.[109]
Burns cause not only a whole series of physical, psychological and socioeconomic damage, but they are also particularly difficult to treat.Immediately after being burned, victims of very serious burns often need "liters and liters of fluids", respiratory pipes, painkillers and sedatives, as well as gastric probes.[110] Doctors must also take care to avoid infections, shocks and organic failures.[111] The long -term treatment of victims of burns, which supposes multiple surgical operations, physiotherapy and psychological care sessions, is described as "one of the most complex, long and expensive sections of the medicine of rehabilitation rehabilitation»».[112]
In civil contexts, especially in developed countries, these medical treatments, although complex, are generally accessible to patients burned.However, incendiary weapons are used in armed conflict situations, an environment where obstacles to care are multiplied.The study carried out by Bishara S.HAStiyeh, S.W.HAS.Gunn and Shady Hayek offers this distinction:
Dre Hallam, describing the medical response provided following the attack on incendiary weapons to Urum al-Kubra, stressed that people living in conflict zones "simply do not have the luxury of having a system availablehealth care in working order ”.[114] The attacks on health care infrastructure, widely attested in the Syrian conflict, exacerbate the problems of treatment of victims of incendiary weapons.[115]
Shortages of resources and obstacles to the transport of victims
In conflict zones, health care providers often have limited access to supplies, equipment and intensive care facilities necessary to adequately treat burns caused by incendiary weapons.These restrictions can hinder the ability of doctors, even very competent, to provide adequate care to these patients. La Dre Hallam a été confrontée à ce type de difficultés alors qu’elle traitait les victimes de l’attaque d’HASlep, en 2013.She told Human Rights Watch and the IHRC: "I knew, as a doctor specializing in intensive care, what to do to [treat] these children, but I did not have the necessary equipment.I had the expertise and knowledge that would have allowed me to [provide adequate care], but not the necessary equipment and resources. HASu lieu de cela, ils ont reçu des traitements terriblement inadéquats ».[116] If she had limited medical resources, she said, however, that "elsewhere in Syria, they do not even have the expertise to manage [such an attack]".[117]
The mediocrity of infrastructure, the need to move far to find appropriate health care and the absence of medical transport is all pitfalls preventing essential care for victims of incendiary weapons during the first 24 hours, which are crucial.[118] It is often necessary to count on friends, neighborhood and passers -by to take them to care centers.[119] La Dre HAShsan, qui a travaillé avec la Dre Hallam après l’attaque d’Urum al-Kubra, s’est souvenue : « Les patient·e·s étaient amenés par tous les moyens possibles ».[120] Once their condition is stabilized by the administration of fluids and painkillers, they were taken from the border, in Turkish hospitals, after a trip of about six hours.Dre Hallam reported:
Limited medical staff
The shortages of medical staff also accentuate the damage caused by incendiary weapons. HASvant ou pendant le transport vers des centres de soins de santé, la vaste majorité des victimes de brûlures infligées dans le cadre d’un conflit reçoivent généralement « une forme ou une autre de premiers secours administrés par les membres de leur famille, des amis, ou des premiers répondants non formés pour de telles interventions ».[122] As the latter are usually not specialists in burning care, their priority "does not relate to stabilization, but rather to the evacuation towards the place where care will ultimately be lavished".[123]
In conflict areas, hospitals have few doctors, and even fewer professionals duly trained to properly treat patients burned..In Syria, for example, DRE Hallam stresses that the state is far from having reached the minimum of staff set by the World Health Organization, which is 23 caregivers for 10,000 people, forpediatric services.[124] « Dans de nombreuses zones de conflit, les services de soins des brûlures sont basiques et limités, et il n’y a souvent pas de spécialiste sur place », a indiqué la Dre HAShsan.[125] This reality is particularly worrying, because complex burns generally require "a multidisciplinary approach in which stabilization, reconstruction and the rehabilitation process are carefully distributed between burns specialists, nursing staff, therapists, social services, and other servicesSupport ".[126] In addition, the excessive number of injured people, common in armed conflict situations, can cause engorgement in the process of treatment.[127] These engorges, in turn, can place professionals in the face of the obligation to carry out a difficult sorting.[128]
Doctors with required expertise often do not have access to information allowing them to recognize burns specifically caused by incendiary weapons. La Dre Hallam a décrit le désarroi de son équipe à l’arrivée des premier·ère·s patient·e·s à l’hôpital d’al-HAStarib : « Nous ignorions à quoi nous avions affaire, car nous n’avions aucune information.[Children] were just covered with bizarre white dust, their skin was burned, and [there was] a synthetic odor in the air;So we didn't know what was going on ".[129] Donatella Rovera described similar initial confusion among doctors who treated the victims of the white phosphorus attack from 2009 in Gaza. « HASucun de ces médecins n’avait jamais eu à traiter [de brûlures provoquées par du phosphore blanc] ; ils étaient dans une totale ignorance. [HASu départ,] ils ont traité [les brûlures] comme s’il s’agissait de brûlures classiques et à cause de cela, ils ont perdu un temps précieux ».[130] This lack of information and understanding can affect the treatment of victims, because "good management of burns, during armed conflicts, begins with a good understanding of the mechanisms of the injury and the properties and characteristics of the agents L'Having provoked ".[131]
Continuity of care
The discontinuity of care often creates additional problems for victims of incendiary weapons.Often, several doctors intervene during the acute treatment phase and the care provided are poorly recorded, which is why it is difficult, for caregivers who take over to discern which other problematic areas should be treated.[132] The fragmented nature of communication between the various health care providers, "to different levels of care", blurs the monitoring of the progress of treatment.[133]
The continuity of care is also important to take care of "chronic medical problems" associated with burns.According to Dr. Schneider, "these problems do not easily disappear.[Generally, burning survivors] are long -term patients who find themselves having to be followed for a very long time by a clinical team ».[134] The victims of incendiary weapons that remain in the armed conflict zones have little chance of having access to regular care and follow -up.
Care of other injuries
In conflict areas, in general, health care professionals must deal with many other types of injury.Burns inflicted by incendiary weapons are "probably not the only shock" requiring medical attention.[135] Donatella Rovera explained that the caregivers who were in Gaza in 2009 "had reached the limit of their capacities, because they were not content to treat [burns due to incendiary weapons] (...) [The health care system] was undermined in the extreme because of the overall level of the conflict ".[136] Burns are also considered a "distracting injury" because their treatment can prevent the identification and diagnosis of secondary injuries.[137] For example, "narcotic treatment of secondary pain, compared to burns, can considerably complicate the diagnosis of injuries associated with them, such as medullary injuries".[138]
Less attention is paid to psychological damage associated with incendiary weapons, compared to that brought to acute physical damage.Dre Hallam has developed: "In burning care, [psychological] therapy is important, because mental health and the traumatic effect of burns constitute a considerable aspect of [these injuries]".[139] Because of the level of gravity of the physical injuries that wars can cause, however, psychological support often passes in the background and is insufficiently funded in the armed conflict zones.[140] The treatment of these patients is therefore very incomplete, because this major aspect of their medical care is not taken into account.
Change the situation for civilians in conflict situations
All these factors play a role in the disparities marking the levels of care of burns and their outcome, depending on whether one is in a civil environment or in combat environments.This generates real frustration among medical staff who take care of victims of incendiary weapons."[Incendiary weapons] cause deep and permanent handicaps, and the [Syrian] medical system is not equipped to take care of them.Number of [survivors] must live with handicaps which, in another context, could be treated.Their handicaps are more important than those of other people in a similar situation, but living elsewhere, "deplored Dre Hallam.[141] La Dre HAShsan partage ce sentiment : « Je me souviens avoir pensé : “Mon Dieu, j’aimerais tant pouvoir soigner cet enfant dans mon hôpital, à Londres.It would be so different if I could just lift them from their bed and take them right away, at the moment ”(...) I was furious and disgusted ".[142]
Effects on medical staff
The effects of incendiary weapons also put medical staff in danger.Given the tendency of white phosphorus to resume its combustion, when caregivers withdraw the dressings, flames can spring from injuries still carrying this substance.[143] An article in the newspaper The Lancet described the case of an 18 -year -old man admitted to the hospital after the white phosphorus attack in 2009.When caregivers discovered white smoke "emanating from [his] injuries", they transferred it to the operating room to clean the injuries and remove the dead skins surrounding them.[144] A particle of phosphorus dislodged during this procedure came to burn the neck of a nurse.[145] Other incendiary substances, including napalm, can cause an elevation of temperatures at such a level that they harm the health not only of direct victims, but also rescuers, therefore likely to suffera heart attack.[146] Finally, as was specified above, the experience of the treatment of victims of incendiary weapons can be traumatic for caregivers.
Trois études de cas réalisées à Gaza, en HASfghanistan et en Syrie illustrent le coût humain de l’utilisation d’armes incendiaires.They describe the terrible injuries inflicted on people, their lasting and mental effects, and the long treatments required to treat the victims.These unacceptable damage is similar that they are caused by white phosphorus ammunition, incendiary weapons covered by protocol III, weapons launched from the soil or weapons dropped by aircraft.
Gaza 2009 : la famille HASbu Halima
Le 4 janvier 2009 après-midi, trois obus d’artillerie au phosphore blanc de 155 mm tirés par les forces armées israéliennes dans le contexte d’hostilités avec des groupes armés palestiniens ont traversé le toit de la maison de la famille HASbu Halima, à Sifi, une zone proche de Beit Lahiya, dans le Nord de la bande de Gaza.[147] Plus d’une dizaine de membres de cette famille, âgés de 6 mois à 45 ans, se trouvaient chez eux au moment de l’attaque, notamment Sa’dallah et Sabah HASbu Halima, âgés respectivement de 45 et 44 ans, neuf enfants, une belle-sœur et deux petits-enfants.[148] HAShmad HASbu Halima, fils de 22 ans de Sa’dallah et Sabah, a rapporté : « L’explosion a été très forte, et l’odeur insupportable.It caused a big fire.Pieces (...) white phosphorus burned and we could not get them out ”.[149] Muhammad, 24 -year -old son of the couple, said: "We shouted and yelled, and called our neighbors for help, but no one could approach to rescue us, because the Israeli army was locatedabout 100 meters and drew on all those who approached ”.[150]
The fallout from this episode illustrate the important physical and psychological damage caused by white phosphorus and the use of incendiary weapons soil-to-air in environments housing a concentration of civilians. L’étude de cas repose sur des recherches menées sur le terrain au moment des faits et dix ans plus tard par Human Rights Watch, HASmnesty International et B’Tselem, une ONG israélienne de défense des droits humains.
Cinq membres de la famille HASbu Halima sont décédé·e·s dans l’attaque, brûlé·e·s vifs et vives dans l’incendie provoqué par des morceaux de feutre imprégnés de phosphore blanc. Muhammed a raconté avoir trouvé les corps complètement carbonisés de son père et de ses frères HASbd a-Rahim, 14 ans, Zeid, 11 ans et Hamzah, 10 ans.[151] Sabah was breastfeeding her 15 month old daughter when everything ignited.She said: "My husband and four of my children burned alive before my eyes, my baby...My only daughter, melted in my arms.How is it possible that a mother must see her children burn live?I couldn't save them.I couldn't help them ".[152]
The flames emanating from white phosphorus set fire to the clothes of the wife of Muhammed, Ghada, 21 and their 2 -year -old daughter, Farah.In an interview granted to B'tselem at the Al-Shifa hospital five days after the attack, Ghada said: "I torn off my body's clothes and yelled that I was in the process ofburn.I was naked in front of everyone in the house (...) The pain was excruciating.I could smell the smell of my burning flesh ".[153] The extent of the injury was significant and probably covered a high body surface.Ghada said that "his whole body was burned".[154] Muhammad then indicated to B’Tselem that Ghada had been transferred to an Egyptian hospital where she "received a series of treatments - surgical operations, disinfection of burns and skin transplants".[155] Ghada died almost three months after the attack.The doctors explained to Mohammad that "a chain interaction had been triggered in his body by phosphorus [white], and that his cells had stopped working".[156]
Several other family members have also been seriously burned. Les fils de Sa’dallah et de Sabah, Yusef, 16 ans, et HASli, 5 ans, ont été brûlés au visage et dans le dos respectivement.[157] Farah, their granddaughter, would have presented third degree burns.[158] Selon le Dr HASlaa HASli, de l’unité de soins des personnes brûlées de l’Hôpital d’al-Shifa, Sabah elle-même présentait des « brûlures très profondes touchant l’os, le brûlant même à certains endroits ».[159] Peu de temps après l’attaque, Sabah a d’ailleurs raconté à HASmnesty International : « J’étais en feu.Even now, I burn everywhere, I suffer day and night, I suffer terribly ”.[160]
This episode also marked the survivors on the emotionally and psychological level."Seeing my family in this state was terrifying," Muhammad told B’Tselem a decade later.[161] "The horrible memories are always present, in particular the vision of my little sister Shahd, who was baby...What did she do to be killed in this way?It was our only sister.I remember the joy that we all felt when my mother finally put a girl in the world.I remember that my mother had cried with joy.I would like Shahd to be with me now.I could have had a sister, like the others, I could have played and laugh with her, buy her clothes and toys.Shahd was an angel on earth, she was beautiful.She was the joy of the house ”.[162]
HASfghanistan 2009 : Razia
On March 14, 2009, when Razia's family had just finished breakfast, two white phosphorus shells crashed on their house in raw earth.[163] Fire and smoke burned the house and instantly killed two of the Razia sisters who were sleeping side by side. L’attaque a blessé son père — HASziz —, sa mère et quelques-uns de ses autres frères et sœurs. HASziz a raconté : « Le bruit de l’explosion était très fort et j’ai pratiquement perdu conscience.I couldn't think.My children shouted to me: “Wake up!You are burning! ”»». Enveloppée de flammes, Razia, 8 ans, a accouru vers HASziz.[164] He held him tightly against him and when he removed his hand, the top of the scalp and part of the girl's face took off like a mask.[165] Une porte-parole de l’armée américaine a déclaré que dans ce cas, l’origine de l’attaque était incertaine, celle-ci pouvant provenir aussi bien des troupes de l’OTHASN que des talibans, et a reconnu que « les deux scénarios [étaient] possibles et tout aussi regrettables ».[166]
The story of Razia highlights the intense human suffering inflicted by white phosphorus, both in the short term and in the long term, as well as the difficulties posed by the treatment of burns that he causes.This case study is based on press reports dating from Razia's hospitalization period, as well as recent interviews carried out by human -watch and IHRC researchers. Nous nous sommes en particulier entretenus avec deux reporters d’HASssociated Press (HASP) qui ont couvert l’histoire de Razia, dont l’un est resté en contact avec la famille de cette dernière.We also interviewed the referent nurse who took care of Razia for practically the duration of her hospitalization and remained in periodic contact with the family.Razia and her father respectfully declined the request for an interview made for this report.
HASprès l’attaque, HASziz a amené Razia dans une base locale de l’armée afghane qui n’a pas pu faire grand-chose pour les aider.[167] A private Afghan vehicle led them to a nearby French base. Pendant ce temps, HASziz versait de l’eau sur le visage de la fillette à chaque fois qu’il constatait qu’elle était en train de perdre conscience.[168] The French base was unable to provide appropriate medical assistance and brought in a medical helicopter which transported it to the American hospital, to Bagram air base.[169] When the doctor - Sergeant Stephen Park - arrived in the helicopter, seeing the burns covering Razia "from head to size", he wondered if she was still alive.[170] He remembered: "It was intense, full of emotion.When we arrived [in Bagram], I think that even the staff of the emergency room and all doctors and nurses thought that she would not get out ".[171] Despite burns affecting 40 to 45 percent of her body, ultimately, Razia survived thanks to large -scale and very painful medical care.
What the American army medical team was unaware is that Razia still had white phosphorus on his face and in his throat.When they have placed an oxygen mask on its mouth, oxygen rekindled the white phosphorus and the mask quickly melted. HASlors que les médecins tentaient de retirer les tissus morts de ce qui restait de la peau de Razia, des flammes jaillissaient des blessures.[172]
When Christine Collins volunteered to take on the role of Razia referent nurse, three or four weeks after the attack, the little girl still required medical care day and night.She needed to regularly take antibiotics to avoid infections and could not eat because burns on her face hindered the movements of her mouth.One of her eyes cannot close, to sleep, she had to roll her eye globe down.The amplitude of movement of his body had greatly decreased because of the burns covering his face, his head, his neck, his bust and his arms.[173] When Christine Collins washed Razia for the first time, she ended up with a piece of ear in hand in hand.[174] HASu cours des trois mois suivants, les médecins ont réalisé plus de 15 opérations chirurgicales, notamment des procédures de greffe de peau, à la fois pour maintenir Razia en vie et la remettre sur pied.[175]
In the days that followed the attack, Razia demonstrated great emotional suffering. La fillette d’avant l’attaque dépeinte par HASziz à Christine Collins et au reporter d’HASP, Rahim Faiez, était joyeuse et exubérante.[176] Christine Collins s’est souvenue que selon les dires d’HASziz, elle aimait jouer à l’extérieur avec ses frères et ne craignait pas de se salir.[177] But after the attack, Razia became quieter and reserved.[178] HASu départ, « Razia était extrêmement passive vis-à-vis de l’ensemble du personnel médical », a raconté Christine Collins à Human Rights Watch et à l’IHRC.[179] She was in shock from the loss of two of her sisters and her house, and the burns covering almost half of her body were excruciatingly painful.She also spent a month in a foreign hospital where no one spoke to her language and where only her father could visit her.He remained lying in his bed, fixing the same wall "all day long".[180]
Christine Collins and her team have managed to create a link with Razia and bring back lights of happiness in her life, but that required personal attention and considerable care to which most of the victims of incendiary weapons do not have access.Noting that Razia, who had not seen her mother since the attack, needed the comfort that human contact brings, Christine Collins and some other employees of the hospital have delicately lifted her from her bedand transported her to a rocking chair."I rocked her for a few hours and I sang songs.This has greatly changed the way she reacted to treatment afterwards.It was a real life experience ”.[181] Even if it "took a long time to get out of his shell" with the nursing staff, after a certain time, "she did not hesitate to say, ok, today I do notwill not do this or that thing, ”added Christine Collins.[182] The nurses were trying to cheer him up by filling his balloon room and applying pink varnish to the nails.Christine Collins' husband sent her boxes full of presents and paintings from their three daughters.[183] Razia even learned to say "Ice Cream".[184] She slowly found the ability to walk, and even to run.[185] However, Christine Collins remembered that she "cried a lot because of the pain.All this episode has taken precedence over her life, but she is so young ”.[186]
Despite numerous surgical operations, Razia's physical appearance will be changed forever because of burns.In May or June, Christine Collins saw Razia looking at herself in a mirror since the first time since the attack."She didn't say anything.She looked at herself, touched her face, then she just turned and moved away ".[187] In photos of Razia dating from 2016, scars and damage to her eyes are still visible.
On June 24, more than three months after the attack, Razia left Bagram hospital.The medical staff met to say goodbye and "everyone was crying".[188] She left the hospital with her father, a wig given by the pediatrician on her head, saying: "I'm fine.I want to go back home ".[189] Christine Collins commented: "It was a long journey, both for her and for me".[190]
The open chapter with the white phosphorus attack was not over.Razia's house was completely destroyed in the fire, and the family had to settle in relatives, in the same village. Ceux-ci ont cependant rapidement averti HASziz que sa famille n’était plus en sécurité.He and his family fled to Kabul. HASncien propriétaire de sa maison, gérant d’un magasin de légumes très fréquenté dans le village, HASziz louait à présent un logement dans la ville la plus coûteuse d’HASfghanistan.He had to find a new job.[191] Razia did not go to school in Kabul.[192] HASziz a confié à Rahim Faiez qu’il n’avait pas les moyens de payer des services de santé mentale ou des opérations de chirurgie esthétique pour sa fille.[193]
The physical injuries inflicted by white phosphorus having long -term effects, Razia had to undergo another operation, several years after leaving Bagram.His neck burns had led to a fusion between his head and his bust, now too close to each other.It was therefore very difficult for him to turn his head and speak. Vers 2014, Rahim Faiez a aidé à organiser un séjour de six mois de Razia en HASllemagne.There, she underwent an operation which made it possible to separate her neck from her bust, which improved the mobility of her head and her ability to speak.[194]
Razia is also still struggling with the psychological and social effects of her injuries."I can't imagine how difficult it will be for Razia, because a whole side of her face is completely burned and she has no hair on almost all the skull," said Rahim Faiez for Human Rights Watchand the IHRC.[195] L’ayant côtoyée à l’époque où elle est allée se faire opérer en HASllemagne, il l’a décrite comme une enfant timide et introvertie.More recently, explained Rahim Faiez, "his father explained that when they are invited to a wedding or a family party, his first reaction is to refuse to go there.His parents encourage him.But when she comes home, she does not seem happy to have gone there. HASziz dit qu’il lui parle pendant des heures ».[196]
Razia and her story also strongly impressed the people who knew her. Jason Straziuso, qui l’a rencontrée en tant que reporter chez HASP, a récemment confié : « Je pense que son histoire résonne en moi parce qu’elle résonnerait en n’importe qui.We are all able to imagine the suffering of a child and to think that it should not have happened like this ".[197] Asked about white phosphorus responsible for the suffering of Razia, Christine Collins said, "we must in one way or another control this type of weapon. HASbsolument, à 100 pour cent ».[198]
Syria 2013: Urum al-Kubra
Le 26 août 2013, à Urum al-Kubra, une ville au nord du gouvernorat d’HASlep, les forces du gouvernement syrien ont attaqué un bâtiment de trois étages situé à environ 100 mètres de l’Institut Iqraa, une école qui accueille des élèves de niveau intermédiaire et secondaire.[199] Muhammed HASssi, alors âgé de 18 ans, et d’autres élèves, sont vite sortis pour voir ce qu’il s’était passé."We saw a plane in the sky.He was very far away, so we thought he would not touch us, "he told Human Rights Watch and the IHRC.[200] The teachers pressed young people to go back shelter.[201] But Muhammed and five other students stayed in the courtyard, which included a playground, to talk about the attack and what they would study the following year.Suddenly, the group heard a weak sound "never heard before", and "there have been big flames and stifling emanations".[202] An incendiary bomb had landed in the midst of the six students, five of whom immediately perished."The intensity of the explosion projected me about 3 to 4 meters from the fall point of the missile," said Muhammed."We were surrounded by fire.I used my hands to cover my head and tried to turn off the fire ".[203]
This attack and the history of Muhammed highlight the terrible damage caused by the use of incendiary weapons in places housing concentrations of civilians, as well as their physical, psychological and social effects in the long term. Les expériences des médecins de l’hôpital local d’al-HAStarib soulignent également les difficultés que présente le traitement des victimes d’armes incendiaires dans un environnement de conflit armé. Cette étude de cas s’appuie sur des entretiens récents de Human Rights Watch et de l’IHRC avec Muhammed HASssi ; un enseignant témoin de l’attaque, qui a préféré rester anonyme ; et deux médecins, Saleyha HAShsan et Rola Hallam, qui ont soigné les étudiants blessés ce jour-là dans le cadre d’un volontariat auprès de l’organisation humanitaire britannique Hand in Hand For Syria. Human Rights Watch a également interrogé Mustafa Haid, un activiste arrivé sur les lieux, à l’hôpital al-HAStarib, peu de temps après l’attaque.
The teacher remembered the horror of the scene."I heard many young people cry out.There were cries everywhere, ”he said.[204] When teachers and students left school, they "saw the lifeless bodies of students, it was appalling.Other students had burns, but they were still aware, they spoke ".The teacher saw three students burned that he could no longer recognize.[205]
Surrounded by the flames, Muhammed remained motionless for a while."Time seems to stop when these things happen to you..."He said."Words cannot describe what I felt, but I saw the fire that surrounded me completely, everywhere, and when the wind began to blow, it brought oxygen to the substanceincendiary and rekindled the fire ”.[206] HASu bout d’un certain temps, un enseignant lui a dit qu’ils devaient partir.Muhammed remembered when he started walking, "many students on the ground, seriously burned, who called for help, but no one came to rescue them.Some were trying to break the windows and bare hands to go out unscathed ».[207] Des civils locaux les ont rapidement emmenés en camionnette à l’hôpital d’al-HAStarib, à 20-25 minutes de là, car il n’y a pas d’hôpital à Urum al-Kubra.[208]
Shortly after the attack, the hospital overflowed injured students injured.[209] « Honnêtement, cela ressemblait à une scène d’HASrmageddon », a décrit la Dre Hallam."Upon their arrival, they were all in a very similar state.Their clothes were in tatters.They gave off a horrible smell of rushed flesh, to which was added an artificial chemical odor (...) It was very clear that they had serious burns, and one of the most alarming [things], in [some], was the low pain felt, which is immediately an indicator alert signalof the extent of burns, because we know that serious burns are not painful ”.[210]
First, medical staff did not identify the source of serious burns of these patients and white powder that covered them.[211] HASprès l’attaque à l’arme chimique à Ghouta, environ une semaine auparavant, les médecins de l’hôpital d’al-HAStarib craignaient que les blessures qu’ils étaient en train de soigner n’aient été provoquées par des armes de ce type.[212] « Nous les avons lavés au jet d’eau à leur arrivée pour stopper les brûlures et enlever toute autre substance pouvant se trouver sur leur corps », a expliqué la Dre Hallam.[213] We later taught them that the white powder covering the victims was actually dust from the impact of an incendiary weapon.[214] Muhammed remembered: "When we arrived at the hospital, doctors did not have much experience in the treatment of this kind of substance, then they started by spraying us with water andserums, and it first had a soothing effect, but less than a minute later, the pain has amplified ”.[215]
Mustafa Haid, who had come to the hospital to report the attack with his brothers, described the "horrifying" scene."Imagine: you have in front of you children burning and according to your instinct, you throw them water, but that only intensifies their pain.It was horrible.I could still see the skin peel, even if there was no fire in itself, "he told Human Rights Watch.[216]
Muhammed had burns over more than 85 percent of the surface of his body.[217] He explained that they covered half his face, an ear, his neck, his shoulders, his back, his hand, his two legs and his feet.He also had trouble breathing and had stomach burns.[218] Malgré la douleur, il a adressé un signal de paix à l’équipe de tournage de la BBC qui réalisait un documentaire sur la Dre Hallam et la Dre HAShsan.[219] "The peace signal was simply to say that despite all that, we want to live and stay alive, and we will not stop, whatever happens," he said.[220]
Other students have also suffered serious injuries. La Dre Hallam a décrit un garçon qui semblait être « en bois » à son arrivée à l’hôpital.[221] "He was obviously burned.[His hoarse voice] immediately told me that he was burned inside, that the burns had reached his throat...I knew he would die within the hour, "she added."As we had to deal with mass emergencies, I should simply have let him die, because [healing him] was futile, from a medical point of view, but I knew he would die from suffocation.I ended up intubating it and practicing ventilation and I fell asleep (...) and he left like this ".[222]
Doctors remembered, in particular, suffering from an 18 -year -old student named Siham Qanbari.[223] « Elle aurait dû être la plus brillante et la meilleure élève de sa classe, et même si [aller à l’école] était risqué, à cause de tous ces bombardements, elle insistait pour poursuivre ses études », a raconté la Dre Hallam, qui a soigné Siham.[224] À son arrivée à l’hôpital d’al-HAStarib, Siham souffrait à l’extrême à cause de blessures sur plus de 60 pour cent de son corps.[225] La Dre Hallam a confié à Human Rights Watch et l’IHRC : « Je savais que son cas ne se présentait pas bien.She had major burns, her face was burned, her clothes were in tatters, a horrible smell of burned flesh emerged, not just her, but also dozens of children arriving ".Siham's father, Ridwan, "kept begging me-" Please treat her as if it were your own daughter ".I didn't have a girl at the time, but now yes, "she said.[226] Siham was transferred to a hospital in Turkey but later succumbed to his injuries.[227]
Insufficient health care available has exacerbated the difficulties presented by the injuries of these students. L’hôpital d’al-HAStarib avait déjà été endommagé auparavant suite à des combats répétés dans cette région.Mustafa Haid, photographer who came to the scene to document the attack, said her brothers volunteered to put on medical gloves and spread cream on children's burns.[228]
Because of these resource constraints and the severity of burns caused by incendiary weapons, for many of these children, the hospital could not do much.Several died immediately;their bodies were "charred" beyond any possibility of recognizing them.[229] Mustafa Haid described two bodies so burned that their features were not recognizable.[230] « Nous n’avons même pas dû confirmer leur décès, comme le veut l’usage », a déploré la Dre Hallam."I should have administered oxygen, calming, painkillers [to injured children] (...) Most should have been intubated and it would have been necessary to practice ventilation, because everyone had very important burns, and I could see that they were already salt ", sign of major internal burns.[231] La Dre HAShsan, tout aussi frustrée des soins limités qu’elle était en mesure de fournir, a affirmé à Human Rights Watch et à l’IHRC qu’elle « était en colère avec le monde, en colère avec le fait que nous ne faisons rien et que cela continue, toute en sachant parfaitement qu’il ne s’agit pas d’un [incident] isolé ».[232]
Poorly equipped to treat the effects of incendiary weapons, doctors transferred Muhammed and other students seriously burned to Turkish hospitals after a few hours.[233] Muhammed remembers his journey from 30 to 45 minutes by ambulance to Turkey, and his wait to pass the border, which lasted one or two hours.An ambulance ended up arriving to bring him, with other students, to first aid border posts, then to Turkish hospitals. Il a été transporté vers l’Hôpital Defne à HASntakya.[234]
Muhammed, just like the other transferred students, needed advanced medical care.He told Human Rights Watch and the IHRC that the medical team had quickly taken him to the operating room and then transferred him to the intensive care unit.[235] HASu début, sa famille ne pouvait pas le reconnaître.Liquids were administered to him by pipes because burns had damaged his jaws and intestines.His first stay in hospital Defne lasted around 100 days.Between his first outing from hospital and at the end of 2015, he returned five times to Turkey, since Syria, each time for a period of about two months.[236]
Muhammed, now 25 years old, still undergoes the physical, psychological and social consequences of this attack.He no longer suffers from chronic pain, but 85 percent of his body is covered with scars and he has lost the use of his left hand.[237] He said that after the attack, for six months, he lived this scene again every night in his nightmares.During the day, he stayed at his home.He remembered: "As soon as I left my house, I was going after five to ten minutes, because I didn't want to be challenged in the street so that I am asked" what isHas he got to your body?What are these burns? ”»».He added: "The hardest part is that my young nephew is afraid of approaching me, and another nephew, who often came to cuddle me, is afraid to play with me".[238] Since then, he has followed psychotherapy with a Syrian doctor installed in France and got used to the questions of the unknown people, but, he said, some people are frightened in sightof his scars.[239]
The long -term effects of these injuries slowed down Muhammed's trajectory, the objective of which was to study cybersecurity.Because of his repeated health problems, he has not resumed his studies, and even if he has not abandoned his long -term professional goals, he wishes to do something useful in the immediate.[240] He accepted a humanitarian job with a Syrian NGO which provides heaters, before winter, to refugees living in camps, and is also responsible for the protection of equipment in a center ofCOVVI-19 isolation.[241]
The teacher, on the other hand, was not physically injured, but the scene of the attack he witnessed traumatized it permanently."My whole life is affected," he said, adding that the first year, "[he had] made nightmares every night".He also suffers from insomnia and irritability."It was very hard, it is impossible to describe with words".[242] The nightmares are less intense now, but he is still afraid of resounding noises."My brain suffers every time I come back to this episode," he said.[243]
The collaborators of Human Rights Watch and the IHRC interviewed about this attack highlighted the need to highlight the human suffering caused by incendiary weapons and to ensure that this kind of situation does notdoes not happen again. Selon la Dre Hallam, « il faut dire aux gens quels sont les coûts humains.Nothing will change unless we focus attention to the immense suffering that these attacks generate.I am only a simple witness, but what I saw continues to arise in my mind seven years later ".[244] La Dre HAShsan, qui revit elle aussi ces scènes par intermittence, nous a fait part de ses réflexions : « C’est vraiment avec la Syrie que j’ai commencé à me dire “Sommes-nous à nouveau à ce point de l’Histoire (...) Where do we face our lack of humanity, where we are losing our humanity?(...) ”.I think it is the interest of all of all to bring us together and to think about what we are going to do on this subject ".[245]
Survivors and witnesses urged the United Nations to react."Human beings have the right to live with dignity," said Muhammed, who asks that cease to be used "weapons whose use against civilians, schools and hospitals is prohibited by conventions".[246] The teacher commented: "I respect the United Nations without reservation, but what is his mission?She should be to protect people (...) It is a great organization, but we need actions, actions to [help] not only the Syrian people, but also other people in the world who really suffer from war ".[247]
Preventing considerable human suffering caused by incendiary weapons requires solid international laws to which states adhere and that they respect. Le Protocole III de la CCHASC a pour objectif de protéger les civils et les biens de caractère civil en réglementant l’utilisation d’armes incendiaires « à l’intérieur d’une concentration de civils » et dans les « forêts et autres types de couverture végétale ».[248] Néanmoins, il comporte deux lacunes légales qui réduisent son efficacité.
First, it can be said that the definition given by Protocol III of "incendiary weapons" excludes most of the versatile incendiary ammunition. Selon l’HASrticle 1(1), une arme incendiaire est « toute arme ou munition essentiellement conçue pour mettre le feu à des objets ou pour infliger des brûlures à des personnes par l’action des flammes, de la chaleur ou d’une combinaison des flammes et de la chaleur, que dégage une réaction chimique d’une substance lancée sur la cible ».This definition does not include ammunition such as those containing white phosphorus, which set fire and cause burns, but are "essentially designed" to create smoke screens or for the end of the troops of the troops.[249] La nature ou la magnitude de l’impact ou des blessures ne sont pas prises en compte tant que l’on considère que la fonction essentielle est exclue du champ d’application du protocole.The applicability of Protocol III therefore depends strongly on how designers, manufacturers and users describe the purpose of a weapon.
Second, Protocol III issues an arbitrary and outdated distinction between incendiary weapons launched from the soil or dropped by aircraft.It prohibits the use of air-ground models within concentrations of civilians, but the provision relating to the use of incendiary weapons launched from the ground in these areas has certain reservations which exclude them from the prohibition.This gap rules out the fact, very real, that incendiary weapons cause burns as appalling and destructive as fire, regardless of the mechanism.In addition, the incendiary weapons launched from the ground, in particular by means of multiple rocket launchers, can have effects on large areas, which are comparable to those of weapons dumped from the air.This is why they are dangerous for civilians when used in populated areas.Finally, non -state armed groups, which have more access to incendiary weapons launched from the soil, may have the impression that the ban on use is less restrictive if international law, and the laws which result from it, are notperfectly irrefutable.
From a legal, if not political point of view, is easy to fill these two shortcomings. L’HASrticle 1(1) du Protocole III pourrait être modifié de façon à redéfinir les armes incendiaires comme des armes qui « ont pour effet de mettre le feu et d’infliger des brûlures (...) ”. L’HASrticle 2 pourrait être réécrit de façon à interdire l’utilisation de toute arme incendiaire, quel que soit le mécanisme de lancement, à l’intérieur d’une concentration de civils.These changes would strengthen the rules presented to the States Parties and more firmly condemn the use of incendiary weapons, in order to also influence persons acting outside the framework of the treaty.
Depuis 2010, l’emploi d’armes incendiaires en HASfghanistan, à Gaza, en Irak, en Syrie, en Ukraine, au Yémen et dans d’autres régions suscite des débats à chaque réunion annuelle de la CCHASC. HASu cours de la dernière décennie, au moins 36 États, l’Union européenne et d’autres acteurs internationaux ont exprimé publiquement leur préoccupation quant à l’utilisation d’armes incendiaires et du phosphore blanc.[250] En 2017, le soutien croissant apporté à la révision du Protocole III a conduit à l’inscrire à l’ordre du jour de la réunion des États parties de la CCHASC.However, due to pressures exerted by a few states, and more significantly from Russia, this subject has disappeared from the 2019 day and 2020 orders.
En dépit de l’absence de ce point à l’ordre du jour de leur dernière réunion en date, qui s’est tenue en novembre 2019, les États parties à la CCHASC ont trouvé des moyens d’aborder ce sujet.The people who wanted to express themselves were able to do so at the time of the "general exchange" or under point 12 of the agenda - "state of application and compliance with the provisions of the Convention andProtocols annexed to it ».Almost all of the 17 states participating in the debates relating to incendiary weapons expressed concerns about the employment of the latter, as well as the wish to initiate discussions dedicated to this subject. La Russie et les États-Unis ont en définitive bloqué les propositions visant à réserver un temps de discussion dédié au Protocole III de la CCHASC en 2020.Thanks to the tenacity of certain states, however, the final report reflected this largely shared concern and, unlike the previous year, recognized the calls to register the protocol on the agenda of the next meetings.[251]
Condemnation and concerns
In 2019, at least 13 states, as well as the European Union, deemed concern for the employment of incendiary weapons on civilians since the start of the Syrian conflict and condemned it.[252] De nouvelles voix s’étaient jointes aux débats : sur ces 13 États, cinq ne s’étaient pas exprimés à ce sujet lors de la réunion de la CCHASC de 2018.In their interventions, states have emphasized human suffering caused by these weapons. L’HASutriche a par exemple rappelé qu’elle restait « profondément préoccupée par l’impact humanitaire causé par l’utilisation d’armes incendiaires, en particulier les souffrances inacceptables qu’elles infligent ».[253] La Nouvelle-Zélande a souligné les « conséquences épouvantables de l’utilisation d’armes incendiaires sur les civils ».[254] De même, l’Union européenne a déclaré qu’elle « restait fortement préoccupée par la situation en Syrie, qui inflige des souffrances inacceptables aux populations civiles ».[255] L’HASllemagne, l’HASustralie, la Belgique, le Chili, le Costa Rica, l’Irlande, la Jordanie, le Mexique, le Royaume-Uni, la Suède et la Suisse ont ajouté leur voix à la désapprobation exprimée par ces délégations.
The final meeting of the meeting reflected these points of view.It was declared that "several delegations [had] expressed concerns about recent allegations, more and more numerous, relating to the use of incendiary weapons against civilians, and condemned any use of such weapons against civiliansor goods of a civil character and any other use incompatible with the relevant rules of international humanitarian law, in particular, if applicable, the provisions of Protocol III ”.[256]
HASppel à poursuivre les débats et à inscrire le sujet à l’ordre du jour
La plupart des États qui se sont exprimés lors de la réunion annuelle 2019 de la CCHASC ont apporté leur soutien à la demande de poursuivre les débats sur les armes incendiaires.Six of them specifically asked that Protocol III be registered on the agenda of the annual meeting of 2020.[257] Par exemple, l’Union européenne, qui représente 28 États membres, et trois autres États, ont déclaré : « Nous regrettons que les questions liées au Protocole III aient été retirées de l’ordre du jour de la CCHASC parce que l’une des Hautes Parties contractantes s’opposait à ce qu’il y figure, et nous demandons qu’elles y soient à nouveau inscrites en 2020 ».[258] Mexico, concerned with the allegations of use of incendiary weapons, estimated that the continuation of the debate was particularly necessary, given "the humanitarian implications for the use of these weapons, which contravenes the obligations of the parties,and the gaps presented by the law.[259]
Reconnaissant la nécessité de discuter plus longuement du Protocole III, la Nouvelle-Zélande a appelé à remettre ce point à l’ordre du jour pour la réunion annuelle 2020 de la CCHASC.She was also "[pronounced] in favor of an informal meeting where it would be a question of the universalization, the implementation and the adequacy of Protocol III in the light of the humanitarian concerns which surround the incendiary weapons".[260] This meeting would be held outside the formal meeting of the States Parties and would further expand the debates.
For the future, Switzerland has argued that Protocol III should be discussed at the 2021 examination, stressing that this conference offered a precious opportunity to study this question in depth.[261]
International and non -governmental organizations have also favorably welcomed these debates and called their pursuit of their wishes.The International Committee of the Red Cross has urged all states to adhere without delay to the protocol and to communicate their operational policies and practices concerning the use of incendiary weapons in order to better support the relevance of Protocol III and international customary law.[262] Des organisations de la société civile, dont Human Rights Watch, PHASX et Mines HASction Canada, ont appelé à la fois à poursuivre les débats et à modifier le Protocole III afin de le renforcer.
Finally, the final report proposes a summary of the calls of the States Parties to continue the debates.He states that "certain delegations have claimed the restoration of a agenda dedicated to Protocol III, while other delegations estimated that this was not necessary".[263]
Strengthen or modify Protocol III
A dozen states, at least, called to modify Protocol III in order to fill the gaps resulting from arbitrary and now dated distinctions.[264] In 2019, at least four states reiterated this call.[265] L’HASutriche, par exemple, a plaidé pour « renforcer le Protocole III afin de prévenir les dommages insidieux causés par ces armes ».[266] Le Chili a souligné que le Protocole III, sous sa forme actuelle, est limité, car il exclut l’utilisation d’armes polyvalentes et crée des distinctions entre armes lancées depuis le sol ou depuis les airs.[267]
Sustainable human sufferings caused by incendiary weapons highlight the need to strengthen international law. Les déclarations prononcées lors de la réunion de 2019 de la CCHASC démontrent qu’il existe une volonté d’examiner plus avant la pertinence du Protocole III.The States Parties should therefore agree to give time, in 2021, to debates on the inadequacies of Protocol III, and to include incendiary weapons on the agenda of the conference responsible for the 2021 examination.The conference itself should be given to revise and modify Protocol III.These measures will make it possible to fully seize this occasion that the conference presents to move from speech to acts and to strengthen the protection of civilians against the horror of incendiary weapons.
L’autrice principale de ce rapport est Bonnie Docherty, chercheuse senior auprès de la division HASrmes de Human Rights Watch et directrice associée de la section Conflits armés et protection civile à l’International Human Rights Clinic (IHRC) de la faculté de droit de Harvard. Erin Shortell, Jamie Magcale, HASanchal Chugh et Shaiba Rather, étudiantes à l’IHRC ont largement contribué à cette étude, aux analyses et à la rédaction de ce rapport.
Ce rapport a été révisé et édité par Steve Goose, directeur exécutif de la division HASrmes de Human Rights Watch, et Mary Wareham, directrice du plaidoyer auprès de cette division. Le rapport a également été relu par Jane Buchanan, directrice adjointe de la division Droits des personnes handicapées ; Patricia Gossman, directrice adjointe de la division HASsie ; Sara Kayyali, chercheuse sur la Syrie ; Omar Shakir, directeur de recherche sur Israël et la Palestine ; et Bill Van Esveld, directeur adjoint de la division Droits des enfants.James Ross, Director of Legal and Political Affairs, and Tom Portous, deputy director of the Programs Division, have revised the legal and programmatic aspects.The French translation was carried out by Cathia Zeoli, and read by Peter Huvos. Ce rapport a été préparé en vue de sa publication par Jacqulyn Kantack, collaboratrice auprès de la division HASrmes, Fitzroy Hepkins, responsable administratif senior, et José Martinez, gestionnaire administratif.
