Preparing dinner, I bite my tongue as images of the latest atrocity in Syria flashes on the screen.

“Isn’t he a doctor too?” my daughter asks.

“Yes,” I cringe at the “too” and rededicate myself to the carrots.

But she knows that conversations about medicine are usually far more animated in our household and immediately sniffs out my reticence.

“I don’t get it. Aren’t doctors supposed to help people?”

Since it’s too late to switch channels, I say something benign. But the footage continues, leaving her to conclude, “I guess not all doctors save lives.”

Syria nerve agent attack: why it made sense to Assad | Emma Graham-Harrison Read more

The heart-wrenchingly succinct statement goes to the heart of my own dismay at the appalling crisis in Syria. More than 400,000 dead, most recently in a nerve gas attack. Six million citizens internally displaced. Five million refugees fled to neighbouring countries. An entire country in spasms. And to add to the unspeakable tragedy, at the hands of a president who used to be a doctor. Not just a theoretical doctor, not one of those who enrolled in medical school but never touched a patient. No, Bashar al-Assad was a proper doctor who by all accounts was personable and polite.

A doctor who studied first at the prestigious Damascus University, then committed to post-graduate training and finally went to London to gain further experience in ophthalmology, a niche medical specialty with many aspirants and limited places. A doctor whose boss recalled him as humble and whom nurses thought exemplary in reassuring anxious patients about to undergo anaesthetic.

To his medical class he was unassuming, seemingly unaffected by his status. Perhaps he had secured admission in the way of other entitled offspring, through power and privilege, but he seemed to be at ease with the responsibilities of being a doctor.

Some classmates kept their distance, wary of the dictator-father’s long reach. Some suspected he didn’t have it in him to be a leader, but then, the world needs good followers and it would have been quite normal for Assad to have settled in a leafy corner of London and practised his craft. Not necessarily groundbreaking stuff, but solid, dependable, everyday medicine that relieved the suffering of many. No one thought he would turn out a mass murderer.

Upon becoming president, he returned to London with his glamorous and accomplished wife, herself a cardiologist’s daughter, who presumably possessed insight into a doctor’s obligations. At his old eye hospital, he looked longingly at a slit-lamp and fondly recalled his medical training.

When he was recalled home, Syria was in the grips of a rebellion, Sunni fighting Shia against a backdrop of roiling tensions in the Middle East. Perhaps Assad, the urbane, London-educated ophthalmologist who spoke of Syria’s “own democratic experience”, would be the people’s advocate, the agent of change. But alas, the Damascus spring didn’t last and Assad the kindly doctor transformed into Assad the feared killer.

Revulsion at the horrific abuses perpetrated by the Nazi doctors – Josef Mengele most infamous among them – led to the development of the Nuremberg Code, which govern the ethics of human experimentation. Radovan Karadžić was a psychiatrist and a poet before being convicted of genocide in the former Yugoslavia. British doctor Harold Shipman injected lethal drugs into more than 200 patients.

History has witnessed other doctors turned rogue but Assad’s attack on his own people is staggering by any standard. He has gone from bombing civilians to destroying entire hospitals, and whatever and whoever lies in their wake. Nearly 800 medical personnel have been killed and many others detained and tortured. Four hundred medical facilities lie in ruins, their hapless occupants either dead or badly injured.

Doctors around the world regard Assad’s deeds with dismay and horror

Entire cities have been left without medical aid, turning treatable injuries into fatal wounds. The United Nations has pleaded that “even war has rules” but experts say that no previous war has witnessed such deliberate, systematic targeting of medical facilities and health professionals.

It defies belief, but in a way it makes sense, that a doctor who once felt the pulse of people, knows that the way to still that pulse is by aiming his strongest weapons at the hospitals that keep people alive and give them hope. It would take a doctor to predict the psychological devastation and desperate surrender of a people robbed of gauze for a bleeding wound, antibiotics for a festering sore, surgery for a lodged bullet.

There are interesting views on how someone who once pledged to save lives could so wantonly destroy them. Perhaps he is striving to prove himself to his dead father who had openly favoured his older son who died in a car accident while Assad was becoming an ophthalmologist. The younger Assad was teased for being interested in human blood rather than the blood of politics – this is the revenge of the bullied.

Or more chillingly, all that medical training was just a show and behind the suave specialist lay a murderer who always had the measure of his power. Medical training necessarily inures doctors to pain and suffering: imagine how inefficient a doctor would be if he faltered at a patient’s every tear and cried over every wound. Part of becoming a good doctor is to learn to stand back enough to help, but most doctors experience a continual tightrope in maintaining a professional boundary while being empathetic. Perhaps Assad just dumped the empathy while fortifying the boundary.

Bashar al-Assad: after Idlib is the president's luck running out? Read more

Doctors around the world regard Assad’s deeds with dismay and horror. They know how many of their colleagues leave medicine for far, far smaller reasons than killing a patient. Most doctors can’t bear having a stain on their conscience for missing a diagnosis or misprescribing a drug, never mind that the patient wasn’t even hurt. Doctors take their own lives at the mere thought that they did something wrong. It beggars belief that someone who was once one of them could so systematically and remorselessly kill his own classmates and their patients.

History will diagnose Assad one day but in the meantime, when I see my Syrian patients I can’t help wondering whether to just treat their illness or acknowledge their deeper wounds. Their fragility is obvious as is their concern and shame.

Assad’s crimes against humanity seem distant until they are personalised in the form of a son, a mother, a neighbour. The easiest answer is to feel helpless and stay silent but it just doesn’t feel right. Another is to express solidarity with our fellow human beings even as they live unrecognisable lives in distant lands. This, too, can feel inadequate in the face of punitive government policies. A third is to support the courageous professionals and the organisations that are determined to stay put in Syria against the odds. Most of us won’t go to Syria because we are not skilled or capable of working in dangerous and impoverished settings. But we can be effective through donating to credible charities, such as the Red Cross, The White Helmets and Médecins Sans Frontières, who can channel our aid where it is needed.

Our gestures can seem insignificant in the face of so great a tragedy but I hope it says to the Syrian people that while their own doctor president has given up on them, the rest of the world has not.

