Inside Assad’s Hospitals of Horror

Know your evil
The Assad Family Embezzled $62 Billion From Syria
From Fiery Steel to Sultry Silk

TFS Note: Is this Vanity Fair article in response to Vogue’s calling Asma al-Assad a desert rose at a time when her husband was massacring children and women in his jails? Well worth reading this long exposé.

Source: Vanity Fair – by Adam Ciralsky (Documenting Evil: Inside Assad’s Hospitals of Horror)

When a photographer-archivist working for Syria’s military police defected with grisly evidence of the regime’s brutality, he became a war-crimes whistle-blower. Adam Ciralsky uncovers “Caesar’s” story.

a stifling day in August 2013, a police photographer with chiseled features and a military bearing moved hurriedly about his office in Damascus. For two years, as Syria’s civil war became ever more deadly, he lived a double life: regime bureaucrat by day, opposition spy by night. Now he had to flee. Having downloaded thousands of high-resolution photographs[see second set of images below] onto flash drives, he snuck into the empty office of his boss and took cell-phone pictures of the papers on the man’s desk. Among them were execution orders and directives to falsify death certificates and dispose of bodies. Armed with as much evidence as he could safely carry, the photographer—code-named Caesar—fled the country.Since then, the images that Caesar secreted out of Syria have received wide circulation, having been touted by Western officials and others as clear evidence of war crimes. The pictures, most of them taken in Syrian military hospitals, show corpses photographed at close range—one at a time as well as in small groupings. Virtually all of the bodies—thousands of them—betray signs of torture: gouged eyes; mangled genitals; bruises and dried blood from beatings; acid and electric burns; emaciation; and marks from strangulation. Caesar took a number of these pictures, working with roughly a dozen other photographers assigned to the same military-police unit.But Caesar himself, like the intelligence operation of which he became a part, has remained in the shadows. He appeared only once in public, last summer, before the House Foreign Affairs Committee, where he wore a hood and spoke through a translator. He spoke briefly, and in a restricted setting, though I have been able to obtain a copy of his complete testimony. He sought and was granted asylum in a Western European country whose name Vanity Fair has agreed not to disclose, for his personal safety.Since going into exile, Caesar has turned inward, according to several of his closest associates. He has stopped talking with some of his key supporters and will not speak with journalists. He has postponed several meetings with prosecutors in the U.K. and Spain, who would like to use his information to bring war-crimes charges against Syrian officials. But Vanity Fair, in an exhaustive investigation, has managed to piece together Caesar’s story with the help of his lawyer and confidantes, including members of Syrian opposition groups, war-crimes investigators, intelligence operatives, and Obama-administration insiders. All of these people have their own agendas, but their accounts reinforce one another. These individuals have also helped to furnish documents and provide entrée to medical-staff members who worked in the hospitals where Ceasar photographed—on the very wards that are at the center of the Assad regime’s brutally repressive machinery.Here, then, is Caesar’s tale, revealed in detail for the first time: equal parts Kafka, Ian Fleming, and The Killing Fields.

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From its perch atop Mount Mezzeh, Syria’s presidential palace offers sweeping vistas of Damascus. Bashar al-Assad, the 49-year-old ophthalmologist who has ruled Syria since 2000, has an unobstructed view of Mezzeh military hospital, an unprepossessing structure located at the foot of the hill. Mezzeh, in turn, lies several miles from a sprawling complex called Tishreen, which happens to be where Assad did his residency. Both Mezzeh and Tishreen are run by Syria’s Military Medical Services and are supposed to provide in-patient and emergency treatment for soldiers and civilians. In truth, however, the hospitals are way stations in a sadistic assembly line. They are black sites where enemies of the state—protesters, opposition figures, and ordinary citizens who, often for capricious reasons, have fallen out of favor with the regime—are tortured, executed, or simply deposited after being killed off-site. “These are not hospitals,” one survivor, now a refugee in Turkey, told me during a recent trip I made to the region. “They are slaughterhouses.”U.S. and European officials allege that Assad’s regime has committed war crimes on an industrial scale. They contend that rarely in the annals of international justice has the evidence of such actions been as voluminous. For reasons perhaps known only to Assad and his inner circle, hospital functionaries, working closely with Syrian intelligence agents, have been carefully documenting the regime’s handiwork, using a distinctive numbering scheme to track victims and keep records of the killings that contain fictitious death certificates.Digital photos have played a vital role as well. For several years, Caesar served as a crime-scene photographer for Syria’s military police. (Vanity Fair has examined and vetted his official credentials. Caesar himself, through intermediaries, has requested that I not use his real name, which is known to the magazine, fearing retribution against his family.) Operating from a drab office inside the Defense Ministry’s Criminal Forensics Division, Caesar chronicled everything from traffic accidents to suicides. After each assignment, he would return to headquarters, upload his pictures onto a government computer, and fasten hard-copy prints onto official reports. It was a good job, though a monotonous one. Caesar was no dissident.

“Caesar fits a sort of central casting role . . . trim, square-jawed, and hardworking,” noted Stephen Rapp, the U.S. ambassador-at-large for war crimes issues, sitting in his State Department office in Washington. Rapp, over the past year, helped work behind the scenes with his foreign counterparts to ensure that Caesar’s story would reach the outside world. “He was like many people I know who get up every day and earn a living by doing a job that serves the broader interest of society.”But in March 2011, Syria’s social fabric started to fray as the Arab Spring reached Damascus, and citizens began demanding reform and even revolution. The volume of calls to Caesar’s office—requesting photographic documentation—increased rapidly. Though he and his team were accustomed to driving out to crime scenes of all kinds, they soon found themselves repeatedly returning to Mezzeh and Tishreen. Like other such sites, these military hospitals became a dumping ground for those held by Syria’s ruthless spy agencies, including Branch 215 (a Damascus sector of military intelligence) and Jawiyya (the Air Force Intelligence branch).Caesar and his squad, using Fuji and Nikon digital cameras, would painstakingly photograph the remains of people from all walks of life: men, women, young, old, Sunnis, Christians. The security forces responsible for the killings even went after Alawites, the close-knit Islamic sect to which Assad and the rest of the ruling elite belong. (Some of the bodies, as is evident in Caesar’s photographs, arrived with what turned out to be an ironic marking—a tattoo of Bashar al-Assad’s face.) While a number of the victims, according to Syrian opposition figures, might be considered anti-regime activists, the rest simply found themselves for whatever reason on the wrong side of the regime. In many cases, sources say, individuals had merely been detained at checkpoints by guards who found their loyalties suspect based on their religion, where they lived, or even their demeanor.These unfortunates may have lived and died in different ways, but they were bound in death by coded numerals scribbled on their skin with markers, or on scraps of paper affixed to their bodies. The first set of numbers (for example, 2935 in the photographs at bottom) would denote a prisoner’s I.D. The second (for example, 215) would refer to the intelligence branch responsible for his or her death. Underneath these figures, in many cases, would appear the hospital case-file number (for example, 2487/B). Such documentation is reminiscent of schemes used by the Nazis during World War II and is eerily reminiscent of an image bank collected by the Khmer Rouge during their Cambodian reign of terror in the 1970s.According to David Crane, a war-crimes prosecutor who helped put Liberian strongman Charles Taylor away for half a century, the system of organizing and recording the dead served three ends: to satisfy Syrian authorities that executions were carried out; to ensure that no one was improperly discharged; and to allow military judges to represent to families—by producing official-seeming death certificates—that their loved ones had died of natural causes. In many ways, these facilities were ideal for hiding “unwanted” individuals, alive or dead. As part of the Ministry of Defense, the hospitals were already fortified, which made it easy to shield their inner workings and keep away families who might come looking for missing relatives. “These hospitals provide cover for the crimes of the regime,” said Nawaf Fares, a top Syrian diplomat and tribal leader who defected in 2012. “People are brought into the hospitals, and killed, and their deaths are papered over with documentation.” When I asked him, during a recent interview in Dubai, Why involve the hospitals at all?, he leaned forward and said, “Because mass graves have a bad reputation.”

The rationale is coldly sinister: no body, no evidence; no evidence, no crime.

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“There are lots of Caesars,” said Dr. Abu Odeh, who worked at both Tishreen and a smaller facility called Harasta, on the outskirts of Damascus. I visited him this spring in a Turkish border town. (Abu Odeh is a pseudonym; the doctor, who aids Syrian refugees, still has family inside Syria.) “Caesar took pictures in the military hospitals.We lived there, 24/7.” Abu Odeh said that some patients were dead on arrival—brought to the facilities in official vehicles or even passenger cars—while others were tortured and killed following admission. “Each mark you see [on the bodies], cigarette marks and the like, was done in front of me. The Mukhabarat [intelligence officers] would be smoking when I’d walk into the room [for a consultation], and they’d put out their cigarettes on the patients and yell, ‘Get up, the doctor is here!’ ”
Caesar and his cohorts were responsible for providing a photographic record of death, but it fell to doctors such as Abu Odeh to pronounce a cause—which generally meant making one up. “Almost every day the Mukhabarat would drive up and bring dead bodies with them,” he explained. “I’d go out to the car, find a corpse lying in the back seat, can you imagine? Even if the dead guy was missing his head, the Mukhabarat demanded that I write that he died of ‘sudden death.’ That was their preferred choice, even though the injuries I saw ranged from, well, decapitation to electric shocks to stab wounds to ligature marks around the neck. This much was clear: these people had not died of natural causes. They were tortured to death by the intelligence services.” Abu Odeh said he would generate about seven to eight death reports a day.
With introductions furnished by the Syrian opposition and humanitarian-aid workers, I interviewed six other medical professionals who had firsthand knowledge of what Syria’s military hospitals have become. “Every day I saw 30 to 40 dead bodies,” a nurse named Ayman al-Abdallah told me. He claimed to have worked for 12 years at Tishreen before leaving Syria; as proof, he provided pictures and his military I.D. “I also witnessed cases where people were tortured. I will never forget people who had acid on their hips. I could see straight through to the bone.”Al-Abdallah, a Sunni, is unique in that he had access to a high-security underground area at Tishreen, an alternative emergency room, that was otherwise off-limits to non-Alawites. “The alternate E.R. had four rows of beds with two people in each bed,” al-Abdallah recalled. “They were chained to each other and to the bed, and they were blindfolded. Every night the soldiers would get up on the beds and start walking on the patients. It was a ritual.” Another ritual, he said, was wrapping men’s genitals so tightly with a rubber glove that the pressure would cut off circulation. According to Abu Odeh, intelligence agents would walk up to patients recovering from surgery to repair bone fractures and would literally rip external fixations—used to hold bones in place—from their broken limbs. “So many times we had to do operations twice,” he said. “They weren’t doing this torture to get patients to talk—it was just torture. Sometimes the Mukhabarat guys would pee on the wounds. Other times they would dip a prisoner’s bandages in toilet water and put them back on.”Some of those brought into the hospital with bone fractures, it turned out, had been medical aides wounded in Syrian air strikes and shellings. According to ward staffers, the security forces doing the torture seemed to be singling out their victims because their presence on the battlefield—as evidenced by their wounds—suggested that they had been pitching in to help treat the enemy: injured anti-government troops. Indeed, the Assad administration, according to recent reports by both the U.N. and Physicians for Human Rights, has appeared to deliberately target medical transport, clinics, and their staff.The facilities had another purpose as well. To hear Abu Odeh and al-Abdallah tell it, Tishreen—while a torture chamber for perceived regime opponents—remained a functioning hospital for loyalists and served as something of a showcase for visiting dignitaries and foreign soldiers, who would walk through the wards and speak with injured government troops. “I saw Iranians and Hezbollah fighters come through,” al-Abdallah told me. “The Russians and North Koreans would also show up.” Abu Odeh spoke about the time his bosses requested that he put in an appearance the day Bashar al-Assad himself was scheduled to do a walk-through, in 2011. “In the days leading up to his visit, they took the healthiest people and put them in place. The Army gave people talking points, telling doctors, patients, and their families what to say and not to say.”

By his own account, Abu Odeh, like a number of Sunnis within the military-hospital system, was pulling double duty: treating regime members in the daytime and then moonlighting at field clinics, where he would patch up opposition combatants and their civilian supporters. He worked at Tishreen on the morning of the Assad visit, but persuaded his superiors to cancel his televised cameo, arguing that appearing alongside the president might increase the risk that rebels would recognize him, accuse him of being a government lackey, and kill him at a checkpoint. (Three weeks after I met with him, he informed me that one of his close family members had been arrested in Damascus, taken to an interrogation center, and sent to Harasta military hospital, where, two weeks later, that person died.)

In Turkey I also interviewed Eyad Ibrahim, a heavy-set man who worked as a nurse at Tishreen before the civil war and at the military hospital in Deir Ezzour after it began. “The killing is systematic,” insisted Ibrahim. He described a singularly abhorrent incident. In the aftermath of a raid that the Syrian Army conducted on Mou Hassan–Ibrahim’s home village—a lieutenant in the Makhabarat, he recalled, began asking if any members of the medical team had grown up in that town. Confident that the officer already knew the staff members’ backgrounds, Ibrahim stepped forward. A short time later, he said, he was escorted to an area near the E.R. where he came face-to-face with a villager wounded in the raid. It was his cousin. “They ordered me to torture my cousin,” he conceded. “I did everything they asked. I beat him with my hands, kicked him with my legs, beating him and saying, ‘I’m sorry.’ ” After a pause, he added, “I wished the earth would have opened up and swallowed me whole. . . . No matter how we describe or explain the torturing and killing that took place in the military hospitals, we can’t do it justice.”

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The task of documenting the dead—up to 50 a day, by Caesar’s own estimate—was taking its toll, and he feared he had become a witting accomplice. He admitted as much in his appearance before the House Foreign Affairs Committee, acknowledging that he had photographed some of the dead, but mostly helped organize the most incriminating images into a vast picture archive for a period of almost two years. That invites the question: How could someone witness and document large-scale atrocities over such a long period of time and not, somehow, be a party to them?According to those close to Caesar, other people in his unit, from time to time, were sent to take pictures of individuals who were still alive. On some occasions, these sources say, regime officials on the scene ordered the photographers to “finish [them] off so we can keep going.” Several photo sequences, in fact, show victims who, in one frame, appear to be living; in the next, they appear to be dead. We may never determine who among Caesar’s team, if any, took part in such killings.With his office computer, along with access to the image archive, Caesar had a wider aperture than his peers. Most of the photos were collected according to the specific intelligence unit responsible for each “detainee.” Caesar was thus able to view pictures of those tortured and killed, and could easily ascertain where their bodies wound up, primarily at Mezzeh or Tishreen military hospitals. As he scrolled through hundreds and, in time, thousands of images, he began to see the long arm of the security services striking very close to home. As he told members of Congress, “Sometimes I would actually run across pictures of some of my own neighbors and some of my friends that I actually recognized. I would be heartbroken for them, but I would not dare tell their own families, and could not even communicate what had happened to their children, because death would have been my fate if the regime found out I was leaking . . . secret information.”Over time, said one source who helped coordinate Caesar’s exit, he began to plot how he might flee the country, taking photographic evidence with him. As a senior member of his unit, Caesar’s responsibilities included not only uploading and archiving his own pictures, but also cataloging pictures taken by others. According to the account given by Caesar during his testimony on Capitol Hill: “I have never in my life seen pictures of bodies that were subjected to such criminality, except when I saw the pictures of the Nazi regime. . . . My work ethic, my morals, my religion did not allow me to be quiet about the horrendous crimes that I see. And I felt as if I was a partner to the [Syrian] regime in these horrendous crimes that I was taking photos of.”Caesar kept his emotions in check while on the job in Damascus. He did not, however, stay silent. Rather, he shared his anguish with a family member who, in turn, reached out to the Syrian National Movement (S.N.M.), an opposition group led by a professor named Dr. Emad Eddin al-Rasheed. Al-Rasheed turned for support to Mouaz Moustafa, the 30-year-old executive director of the Syrian Emergency Task Force, which represents the interests of some of the anti-regime forces in Syria. (Moustafa is a well-connected former Senate staffer. In 2013, he arranged for Senator John McCain, for instance, to sneak into Syria to meet with opposition figures, and since that time has worked with U.S. officials to help arm the Syrian resistance.)

I met with al-Rasheed in Washington and also interviewed him by phone in Europe, where he now lives. “Caesar might not otherwise be a risk-taker,” al-Rasheed stated. “The horrendous things he saw forced him to be.”

Caesar began working with a handler—a Syrian academic and human-rights figure named Hassan al-Chalabi. In two lengthy conversations, al-Chalabi—who is not related to the Iraqi opposition politician Ahmad Chalabi—described running a shadowy intelligence network inside Syria, though his claims cannot be independently verified. The initial batch of images arrived via courier in July 2011 while al-Chalabi was attending a conference in Istanbul; these were the first photos in what would come to be known as the Caesar File. “I was rattled to the core,” said al-Chalabi, recalling his reaction to the pictures. Unfortunately, the images could not immediately be publicized since it would have been fairly easy for the Syrians to narrow down their source—a military police photographer—and mete out retribution. “We were between a rock and a hard place,” al-Chalabi explained, “between taking him out of the country (because of his and his family’s safety) and foregoing an opportunity to get more evidence out.” He opted to do what seasoned operatives often do when handling an agent-in-place: he kept Caesar there.

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I met a man in Istanbul whom I’ll call Youssef. He recounted to me his grueling experiences as a patient lost in the Syrian hospital system. He is a burly figure who still bears the scars of his odyssey through three interrogation sites and the wards at Mezzeh. In May 2013, while a prisoner (of Air Force Intelligence), Youssef became very ill and was taken to Hospital 601 (Mezzeh).“I saw dead bodies in the rooms that were set aside for the different intelligence divisions,” Youssef began. He said space was at a premium and hygiene was not a priority. “Six people on each hospital bed, chained together at the foot. If a prisoner died in one of the beds, they would take the chain off the leg, put the corpse in the bathroom or in the hallway, and we’d have to step over it. . . . They’d stay there for a day or day and a half. Some prisoners were forced to take the bodies to an auto garage at Mezzeh.”

That garage—located not far from Assad’s palace—is a recurring backdrop in many of the pictures that Caesar spirited out. After Mezzeh ran out of space to store the deceased, Caesar would contend, the Syrians transformed an adjoining parking area into a makeshift morgue with a concrete roof and open sides. The photos depict rows of bodies—some naked, some wrapped in plastic—overseen by hospital attendants wearing masks, presumably to cope with the stench.The situation often veered toward the surreal. According to a Syrian government intelligence report I obtained, a strange disagreement broke out at one point when a doctor at Harasta military hospital lodged a formal complaint. in which she argued that the Mukhabarat—not medical staffers—ought to be the ones placing detainees’ bodies in bags before burial. She also claimed that, at times, intelligence personnel would take the keys to the morgue freezer home with them at night. The Mukhabarat, in response, accused the doctor, on one occasion, of refusing to allow its officers entry when they tried to drop off corpses.Meanwhile, Youssef told me that at Mezzeh “death was routine” and often came at the hands of the staff. Patients referred to one employee as “Abu Shakoush,” Arabic for “father of the hammer,” based on his facility with blunt instruments. “Another [worker] was Azrael, the archangel of death”—evoking the nickname associated with Dr. Josef Mengele, the SS physician who conducted sadistic experiments on inmates at Auschwitz. Youssef described how, one night, he and his fellow prisoners smelled what they thought was burning plastic. The next day, when they asked a staff member about the odor, Youssef said, “We were told Azrael melted a plastic bucket over someone’s head until [he] burned to death.”Ahmad al-Rez, a Syrian émigré now living in Western Europe, spoke to me about Tishreen hospital. In February 2012, he claimed, he was at the Damascus International Airport when he was pulled aside by members of Branch 215. “They said, ‘Come with us for two minutes.’ Two minutes turned into two years.” After falling ill at Syria’s infamous Sednaya prison, he was taken to Tishreen. On his initial stay, in October 2013, al-Rez said, he was regularly denied food and water, and the guards would routinely beat him with what patients mockingly referred to as the “Lakhdar Brahimi,” a green stick named after the former U.N. and Arab League’s joint special representative to Syria (who, in 2012, had been dispatched to persuade Assad to step down or accept a transitional process toward that end). Two months later, al-Rez said he was re-admitted to Tishreen and over the course of two days was ordered to use plastic to wrap 20 or more corpses, whose prisoner numbers had already been inscribed on their foreheads. “Tishreen,” he concluded, “is a killing center.”

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In 2011, Caesar began funneling information out to the opposition. And soon after one handoff, in which he’d delivered a few particularly incriminating flash drives to a courier, al-Chalabi said, Caesar was taken aside and questioned at length by authorities. (“If the regime had found [that material] on him,” explained al-Chalabi, “he would have met the same end as those in the pictures.”) Evidently, a couple of bureaucrats had discovered discrepancies in Caesar’s credentials. He was spooked, two confidantes recalled: such intense questioning of a longtime member of a police-intelligence unit seemed threatening to Caesar. Though he was never charged with wrongdoing, Caesar began to feel his world closing in on him. The final straw came in 2013, said these sources, when he began to fear that his job was in jeopardy. He decided to make a break for it. “We knew it wouldn’t end well” for Caesar, al-Chalabi recalled. “They would make him disappear.”Al-Chalabi said he scrambled to arrange an exfiltration. Its scope was audacious: the task involved bringing out Caesar; securing a large archive of photographs; and making sure to establish a clear chain of custody so that the images might someday be used in legal proceedings against Syrian officials. The best option was to approach another opposition group, the Free Syrian Army, and tailor a joint operation with some battle-hardened forces known as the Strangers Battalion.It took a month for the extraction plan to coalesce. In essence, according to two of those involved, Caesar had to die. Or at least it had to look that way to the regime, which would receive word that opposition forces had captured and killed an unnamed Defense Ministry employee. With that as “cover,” Caesar—who had already gathered up his most incriminating evidence—was then moved around Syria to evade detection. After three weeks with the Strangers Battalion, he crossed the Jordanian border, hidden in the bed of a truck. Caesar emerged with his camera, sensitive documents, and, hidden in his shoes, several thumb drives.To help authenticate the photos and establish Caesar’s bona fides, the Syrian National Movement turned to David Crane, along with two fellow war-crimes prosecutors—Sir Desmond de Silva and Sir Geoffrey Nice—as well as Susan Black, a forensic anthropologist; Stephen Cole, a forensic imaging expert; and Dr. Stuart Hamilton, a leading forensic pathologist. (Hamilton recently helped identify the remains of King Richard III.) “We got [Caesar] to retell his story,” Crane said, “and cross-examined him with pointed questions.” Crane contended that he and his team, who presented their findings to the U.N. Security Council, found Caesar to be credible, a cog in the wheel who, at a certain point, decided not to accept the direction the wheel was turning. As Crane explained, “One of the things I asked him was, ‘Why did you do this?’ He said, ‘I love my country. This isn’t what Syria is. This isn’t what the people of Syria are about.’ ” All told, according to Syrian opposition officials, the Caesar team was responsible for bringing out approximately 55,000 pictures. Some 27,000 of these frames, so these sources claim, indicate that between 6,700 and 11,000 Syrian citizens—previously regarded as missing—were, in fact, dead.Stephen Rapp, the State Department’s war-crimes ambassador, told me that he and other U.S. officials agree with Crane on the matter of Caesar’s credibility. “I’ve had a lot of experience with insider witnesses,” he said, “including people who are involved in crimes and come to the prosecutor and say they were aware of—but not involved in—a crime. . . . [Caesar’s] a great witness. And I’ve dealt with witnesses of all sorts, including those who have the blood of thousands of people on their hands.” (Last year, Syrian officials were dismissive of the Caesar Report—compiled by David Crane and his team—saying the effort was funded by Qatar, a Syrian foe, and lacked credibility. Assad himself would reiterate this in an interview with Foreign Affairs in January.)

As for the authenticity of the photographs, the F.B.I. has been analyzing them for almost a year and is said to be close to announcing their assessment of the cache’s authenticity. (According to a senior administration official, the bureau has privately conveyed its findings to insiders: “[There is] no evidence of any alterations—no pixels inserted—except where Caesar used [Microsoft] Paint to clarify a number . . . which he told us about.”)

Last year, Rapp said, Caesar met several American officials, including Samantha Power, the U.S. ambassador to the U.N., and Ben Rhodes, the deputy national security advisor for strategic communications. In a letter last October, Rhodes would write the following to Caesar: “As I said to you in person, I want to commend you for the enormous courage and the great risk to yourself and your family that you have taken to bear witness to the As[s]ad regime’s brutality and to bring the world evidence of its atrocities. This is a service to the Syrian people and all of humanity.” On President Obama’s behalf, Rhodes promised that America would “push to bring the perpetrators of atrocities in Syria to justice.”

This is certainly a tall order. All of this comes at a moment when many world leaders, whether they admit it or not, are finding common cause with Syria’s president in the fight against ISIS. Moreover, certain Syrian opposition groups, including the Free Syrian Army and the al-Nusra Front (al-Qaeda’s local affiliate)—according to outside monitors and press accounts—have committed their own share of abuses. As a result, the prospect of indicting Assad and his leadership for war crimes and for crimes against humanity seems ever more remote.

David Crane, for one, is repelled by the thought that Syria’s dictator may not only survive but be rehabilitated. Over the course of the civil war, Assad, according to overwhelming evidence, has been implicated in the deaths of more than 220,000 Syrians through the use of conventional and unconventional weapons, including sarin shells, chlorine canisters, and jerry-rigged barrel bombs. And the photographic record of these individual deaths—the Caesar File—is hard to refute. But regional conflicts can shift one’s perspective, priorities, and allegiances. “We used to view Assad like cancer—as a terminal disease,” Crane told me recently. Now Assad is deemed to be, in Crane’s words, “a persistent, manageable problem.” Assad’s own hospitals, however, provide the best diagnosis of what he is.

Inside Assad’s Hospitals of Horror

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