I first went to Damascus in 2012. As a South African I was welcomed, but as a representative of Doctors without Borders (MSF) I was greeted with huge suspicion.
Now, six years later after multiple requests to provide independent medical care and endless unfulfilled promises, MSF is still unable to officially work in Syria.
The South African government invested efforts in supporting our requests but ultimately they have been unable to convince their allies in Damascus that medical care provided by independent doctors poses no threat to the Syrian state.
The denial of access to MSF illustrates the way in which healthcare provision has itself become a battleground in the Syria war.
After numerous visits to Damascus in 2012 and 2013, I developed a proposal to turn a clinic run by the Syrian Arab Red Crescent (SARC) into a facility capable of dealing with obstetric emergencies.
I signed a Memorandum of Understanding between MSF South Africa and SARC in May 2013. We assembled an international medical team with medics from China, Brazil and South Africa among other nationalities to work alongside SARC and the Ministry of Health. They were never issued a single visa.
Nor did we receive permission in 2016 after representatives of MSF met in Damascus with Syrian authorities.
Our efforts to send a cargo plane of medical supplies with an MSF team during the fighting in Aleppo was never accepted. And I received no reply to a letter that I sent to the Syrian Ministry of Foreign Affairs in March 2018 once again requesting MSF be allowed to work in the country.
The Syrian government has been consistent in accusing MSF of supporting terrorism in Syria. Most recently, the Syrian Ambassador to the UN referred to MSF as ‘terrorists without borders’.
This is because when our initial requests to access the country in 2011 were not granted, we opened medical projects - in full transparency - in areas under the control of the armed opposition.
This was not because we supported the opposition, but rather because we wished to work wherever the medical needs of patients were the greatest, and we were willing to negotiate with whoever could grant us access to them.
Part of how we ensure our independence is by not taking money from any governments for our work in such polarised environments as Syria. However, what we can’t always control is how our medical actions are perceived by those with the power to either facilitate or hamper our work.
In the case of Syria, our effort to treat patients wherever we could was interpreted as a direct assault on Syrian sovereignty.
This is in part due to the central role that healthcare has played in the creation of the post-colonial Syrian state. Providing independent medical assistance can be seen as undermining the role of the state.
During the war, health care provision has been controlled, attacked or facilitated in accordance with the need to assert or deny power.
When an organisation like MSF steps beyond the interests of the state, and provides assistance to those deemed a threat, or more recently those the state labels as a ‘terrorist enemy’, we are often subject to the state's outrage. This is not unique to Syria.
While in Syria, I was considered a threat to the Iranian and Russian backed state for my links to MSF, but when I worked in Bahrain I was considered a threat to the Saudi and US backed Bahraini government.
Our impartiality and independence can often be measured against the full political spectrum of those who try to hamper our work.
Over the past years alone, MSF supported health facilities have been bombed by the Syrian government led coalition in Syria, the Saudi led coalition in Yemen and by the US in Afghanistan. The Islamic State group in Syria abducted MSF staff and held them for several months during 2014.
In an era where every state is fighting their own ‘terrorists’, from Nigeria and Yemen to Syria and Iraq, and where healthcare is often deemed a form of support to terrorists, MSF will almost always fall foul of someone’s political and military interests.
Choosing the side of the patients is always a political act. But not in the party-political way that we are often accused of acting.
An organisation like MSF exists because certain people are denied access to health care either through a specific policy of exclusion or through the indirect consequences of poverty that result in some communities being more vulnerable to the consequences of war, natural disasters and epidemics.
It is for this reason that the provision of health care based on medical ethics is something we must defend.
We cannot afford for medicine to be subjected to the political polarisation of war. The doctor of your enemy is not your enemy.
South Africa, and other states that do not fall neatly into the rising cold-war-like political polarisations marking international affairs, can play a role in defending this core principle.
With a new minister in the Department of International Relations and Cooperation and a very likely non-permanent seat on the UN Security Council in 2019, South Africa can play a crucial non-aligned role in defending impartial humanitarianism.
South Africa can support organisations like MSF in the struggle against the use of humanitarian aid as tool for political power plays.
Defending this basic principle of humanity will often mean taking a principled position against the centres of power on the UN Security Council, where member states today are complicit in defending their ability to inflict unhindered harm on civilians in the name of fighting terrorists.
In Syria, MSF should be running its biggest humanitarian projects since our creation in 1971. Instead, we could only reach a limited number of people living in opposition controlled territory.
The South African government can play a progressive role in helping our medics to save lives everywhere in Syria -- independently and impartially. We have lost seven years in denial of access, but we continue to request it because there are still lives to save – on all sides of this war.
* Jonathan Whittall is based between Johannesburg and Beirut as the Director of the Analysis Department at MSF. He can be found on Twitter @offyourrecord.
** The views expressed here are not necessarily those of Independent Media.