Dr Nabil Antaki

Q. Dr Antaki, please introduce yourself

I am Nabil Antaki, a gastroenterologist and hepatologist. I live in Aleppo which is the second city in Syria and its economic capital.

Q. Can you describe the situation in Aleppo during war time?

The war started in Syria in March 2011 and reached Aleppo in July 2012 when the rebels invaded the East and South neighborhoods of the city. As a consequence, within weeks, half million persons fled from the rebel’s controlled area and take refuge in the government’s controlled area and became displaced people.

Living in Aleppo was very dangerous. For 5 years, daily bombing of our neighborhoods by mortars and gas canister full of nail and explosive sent by the rebels caused multiple casualties every day.

On the medical level, many hospitals were destroyed or burned. Al Kindi Hospital, one of the 2 university hospitals, was blown up and then burned. Saint Louis hospital, the private hospital where I work, received many mortars, fortunately some didn’t explode. 70% of specialist physicians left the city or the country.

Life in Aleppo was not easy. For years, we did not have electrical power replaced by candles, flash lights and batteries then by private generators. For years, the water supply was interrupted. The local authorities drilled 300 wells. Blockades of the city from few days to many weeks each time led to shortage of essential products such as drugs, gas, fuel, vegetables, bread….

Q. What about your medical practice?

Well, I have to tell you that before considering treating patients with liver diseases, I had to deal with three priorities: I had to survive, I had to help the displaced people to survive and I had to create a project to treat the war-wounded civilians.

Q. How did the war impact your practice?

Because of the war, patients were not able to move and come to the centers created by the government in 2009 in the major cities to test and treat the patients with chronic viral hepatitis. But the most serious issue were the sanctions.

Q. The sanctions?

In 2011, few months after the beginning of the war in Syria, the European Union and Switzerland imposed sanctions against Syria which were extended in 2017. The USA had taken more severe sanctions longtime ago. These sanctions on trade and financial transactions led to the closure of the offices of major international pharmaceutical companies. The embargo prevented importation of drugs, medical equipment and spare parts. The sanctions had no positive impact on the events or to bring an end to the war. They penalize the people and the patients in increasing the prices of all products which were introduced illegally to the country and thus became unaffordable to the people and in increasing the corruption.

Because of the sanctions and other difficulties related to the war, I stopped using our Fibroscan because of our inability to calibrate the probe which had to be sent abroad.

We were not able to repair our endoscopes because of the lack of spare parts. We had to wait 16 months to have one Olympus gastroscope repaired.
Only one lab. was still performing PCR and genotype testing. It is a private Lab. And people had to pay for it. Most of patients could not afford the price.
Practicing hepatology in this context was not easy.

Q. Despite all these difficulties, how did you manage your patients with liver diseases?

In spite of all these difficulties, I was able to treat more or less adequately my patients.

I had to limit the lab tests that we usually order in normal time. Liver function tests and a viral load testing by PCR were the only required tests in order to treat chronic viral hepatitis.

The anti-viral drugs for HBV, entecavir and tenofovir, were available before the war, being manufactured in Syria with the raw material imported from China or India, two countries not concerned by the sanctions. Concerning the new HCV anti-viral drugs, some of them, manufactured in Egypt, were available recently on the black market. Sorafenib for HCC was not available.

Q. one last question, do you want to send any message to your colleague and to the hepatology community?

I would like to thank all the colleagues who manifested their friendship and solidarity with the Syrian people during this war.

And I would like to ask all hepatologists in the world as well as the national and international liver associations and societies to put the pressure on the leaders, governments and the members of parliament of the European countries and America and ask them to lift the sanctions against Syria. They have to understand that sanctions have never had a positive impact on any event or war. They penalize the people, the patients and the vulnerable persons.