AMMAN – Nine-year-old Mohammad Naji was riding his bicycle near his home when an explosion sent him spinning into the air. It was July 2012 and Iraq was plunging deeper into sectarian violence following the withdrawal of U.S. troops. Mohammad lived in a Sunni stronghold in the heart of Baghdad. He believes the bomb was planted by sympathizers of Shia militants, but can’t know for sure.
“If they are bad people, Sunni and Shia are two pairs of the same shoe,” says Mohammad, now 13. Wise beyond his years, this is his take on the sectarian conflict that is tearing apart his country and the reason he was paralyzed.
Every patient at the Mowasah Reconstructive Hospital in Amman carries scars from the violence that plagues the Middle East – sectarian clashes, shelling, airstrikes, terrorist attacks – and has prompted people to flee to safer countries such as Jordan. Jordan currently hosts more than 1 million refugees and asylum seekers, an overwhelming majority of them Syrian, followed by Iraqis and a few thousand Somalis and Sudanese.
Mowasah, like many Arabic words, has a highly contextual meaning. The approximate translation is “comfort.” But no word in the English language comes close to describing what this surgical ward run by Doctors Without Borders (Médecins Sans Frontiers – MSF), the only one to offer reconstructive surgeries for free in the Middle East, has done for thousands of lives. Medical staff at Mowasah strive to repair both the physical and psychological damage of their patients.
Like Mohammad, many of their lives took a terrifying turn in an instant. Doctors work around the clock tending to the complex physical injuries of the patients, which require specialized care. But healing the psychological scars has proven much tougher.
The mission of this one-of-a-kind hospital, funded and run by MSF, is to rebuild the identities of patients, most of whom are forced to confront their trauma every time they see their reflection.
The five-storey building is home to 148 patients, 60 percent of them Syrian refugees. The process by which the patients are transferred to this hospital is no easy feat. A local network of medical liaison officers selects each patient based on needs and urgency before transferring them to Amman. MSF incurs all costs of their surgery and rehabilitation.
For children with terrible facial injuries, the levels of psychological trauma are particularly high. “Most of them start thinking of themselves as monsters,” Talha al-Ali, a paediatric counsellor, told Refugees Deeply. “Usually they either totally withdraw, or they start hurting themselves and other children.”
Studies show that patients with facial injuries are more likely to report symptoms of depression, anxiety, suicidal tendencies and poor compliance with treatment.
Especially in cases of amputation, children develop a sense of inferiority and loss. “It is common for them to steal objects, as they want to be attached to something that they can physically keep with them, and that won’t go away,” said Ali. She said this is especially the case with objects that are red, a colour subconsciously connected to emotions.
The recovery ward also helps the children with activities such as drawing, painting and group activities that provide cathartic ways of releasing emotions. Children draw themselves as super heroes and engage in daily activities that create routine. They relearn how to interact in social settings. “The goal is to convince them that they are still the same person,” Ali said.
Parents, who are also obviously anxious and worried, sometimes unintentionally heighten their own children’s anxiety. They arrive at the hospital with the aim of saving their children’s futures, but with their own share of trauma. “They say children are the mirrors of their parents, but some cannot handle looking at that image anymore,” Ali said.
Due to the large numbers of refugees in the region, wounded adults, particularly men, receive little psycho-social support after fleeing. Wael Samir al-Shouafi, in his early 20s, is among the fortunate exceptions. If it weren’t for Mowasah, he could have been in the ranks of the millions of single refugee men who are often the last ones to be aided.
Shouafi has been at Mowasah Reconstructive Hospital for more than two years, undergoing treatment to heal burns that cover most of his body. His face appears weathered due to extensive stretch marks and scars. Yet, the freshness in his smile reveals a sweet, youthful personality.
He has not seen his family since a fateful night in 2011 when his body was scorched in his hometown of Taiz, Yemen. According to Shouafi, government troops threw scalding oil on crowds gathered to protest against the former Yemeni president Ali Abdullah Saleh. The shelling that followed set fire to the makeshift camp in which the protesters had gathered.
“I was one of the few to survive,” said Shouafi, “many of my friends were killed.” To recover from his debilitating injuries, he has undergone more than 20 operations in the past five years.
Gwenola Ghanes, who provides psycho-social support through MSF, explained that while plastic surgery helps patients recover from their physical wounds, their deepest scars are not visible. “The face is the social part of the body, through which people express their emotions and interact with each other,” said Ghanes. “By providing psychological support we help them regain confidence and cope with the way other people look at them.”
But a successful surgery does not always produce an immediate positive change. Some who feel disappointed with the results of surgery relapse into recurring spirals of shock, denial, anger and depression before getting back on the road to recovery.
Those working at Mowasah try their best to prepare their patients for the real world. This is the most intangible part of the their job description because they cannot possibly predict how the patients’ communities will react to them or how the patients themselves will adapt once they leave. “Here they are patients among patients,” said Ghanes, “but in the outer world they are disfigured people who might be unrecognizable to their families and neighbors.”
Since 2006, when MSF first started running a reconstructive surgery program, they have successfully operated on 8,238 people – mainly from Iraq, Gaza, Yemen and Syria. But their work never stops. They realize this is a drop in the ocean compared to the number of people awaiting help.
Top image: MSF doctors perform orthopaedic surgery on a patient from Syria. Tissue is removed (grafted) from the upper part of the leg to substitute the damaged skin on the foot. (Federica Marsi)