PERPIGNAN (Thomson Reuters Foundation) – Last October, photojournalist Sebastiano Tomada Piccolomini was taking pictures in a hospital in the northern Syrian city of Aleppo when yet another air strike began. Everyone ran outside and he found himself alone with an infant who was bleeding from an earlier shrapnel wound to the head. Tomada took the picture that was to win him a World Press Photo prize, fetched some water and sat next to the child until his father and the medical staff returned.
Tomada, aged 27, received a separate award this month from the International Committee of the Red Cross (ICRC) for his work in conflict-riven Aleppo, where he has documented the struggle to provide medical care to both civilian victims and combatants amid devastating attacks on healthcare facilities.
The ICRC's Humanitarian Visa d'Or, now in its third year, recognises reporting that highlights the obligation to respect the medical mission in war and other violent situations.
“Sebastiano Tomada’s report illustrates the atrocities that are being carried out in Syria and suggests that part of this war is being waged in healthcare centres, by bombing hospitals and ambulances,” said Dr Rony Brauman, former president of Médecins sans Frontières and chair of the prize jury.
Tomada, who was born in New York and spent much of his childhood in Italy, told a conference at the Visa pour l'Image international photojournalism festival in Perpignan, France, that it was "beyond insane that the (Syrian) government especially is doing what they can to hit and destroy medical facilities."
After an air strike last November razed Dar al-Shifa – a key emergency hospital on the opposition side of the frontline – medical staff responded by setting up smaller ad-hoc clinics in different parts of the city to carry on offering treatment, Tomada said.
But they have been struggling with a lack of equipment and medicine, and poor sanitation.
"Once you walk into these hospitals, you are literally walking on blood, constantly," Tomada said. "People are being treated on the ground because there are no stretchers ... It's a mess, they need everything."
On Friday, United Nations war crimes investigators said Syrian government forces had deliberately targeted and attacked hospitals with fighter jets, and prevented the sick and wounded from receiving treatment, using "the denial of medical care as a weapon of war". Their report also included details of a smaller number of incidents in which rebel forces attacked hospitals.
In an interview with Thomson Reuters Foundation, Tomada said people living in rebel-held areas of Aleppo – a city he has visited five times over the past 18 months – have to cope with limited access to water, electricity and basic essentials like milk, as well as the threat of violence.
Despite the desperate conditions, some have chosen to stay to take care of their families and keep their businesses going. While around 2 million people have left Syria, becoming refugees in neighbouring countries, the situation in camps and host communities is also tough as foreign governments and aid groups struggle to cope, Tomada said.
"Most people just don't want to leave (Aleppo) because they do not want to be considered as refugees," Tomada said. "People would rather just hold on to what they have and participate – whether directly or indirectly – in the revolution, and remain in the city."
Tomada has not gone back into Syria for several months, noting that it is getting harder to access Aleppo and Western journalists are in growing danger of being targeted by kidnappers.
One reason for this is an influx of Islamist fighters from places like Iraq, Libya and Chechnya, who have joined the ranks of the opposition Free Syrian Army (FSA), which needs their expertise, equipment and cash, he said. Their presence in the country raises the prospect of a future clash between the FSA and the Islamists, which could plunge Syria into fresh chaos, Tomada said.
"Let's say the government does fall, Assad falls, the opposition takes over the country, we will have another reality that will be extremely complicated ... There will be another internal battle. We're not talking only about control, we're talking about religion and we're talking about politics."
"These foreign fighters are not coming in just to play around. For them, it is an investment. Syria could possibly become a training ground for al Qaeda-affiliated groups," he warned.
(Filming and additional reporting by Claudine Boeglin)