“My job is to ensure quality of care, to supervise and to coordinate the two clandestine hospitals we had inside Syria. One was near Aleppo and the other near Idlib,” he says.
He spoke with us about an increasing number of patients, training local staffers and calming anxious relatives forced to wait in hallways.
In one hospital you have 10 expat field staff from everywhere in the world, and 50 medical nationals, Syrian staff. So I had to make sure that the surgeons had all the tools they needed, weren’t overwhelmed by the patients, and taught them things like triage.
In these hospitals, people are arriving and they are used to entering the operating room with their Kalashnikovs. So we had to explain, “We are a neutral space, please leave your guns outside.” It’s not only the patients but the volunteers who bring them. When they bring bleeding people, the Syrians often want to give blood, because giving blood shows solidarity. So sometimes we had to explain that with donations here, there are blood-risk issues and safety issues, and that we have designated blood banks [elsewhere] and we had to explain to the volunteers and even the patients why we didn’t need their blood, or why we couldn’t take the blood from his brother.
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In a war zone, we act not only as doctors, but we also have to be aware of the context of the situation. We have to explain day by day what we are doing, and that the patients must respect the rules. When someone comes in with a child or a wounded relative, of course you are a little stressed. We have to cool them down.
Our teams are working 12 to 14 hours daily. A big issue for them is to explain to families why we cannot save someone. There’s a lot of normal medical work being performed in an abnormal situation.
We have classic war wounds by bullets or snipers. People in cities like Aleppo are living in apartments, then they flee to rural areas and they are camping. And they try to cook without electricity or gas because it’s too expensive or out of stock, and because they’re all the way out in the country. They use oil, and then we have full families who arrive together, burned, because something exploded.
We have big burns because people have no wood, gas or electricity and they need to cook. Civilians can be severely burned when this artisanal oil explodes. Big burns like that need long-term care, it’s two months of hospital treatment. So when you have only 15 beds, it’s difficult. They need to be in the operating room every two days at the beginning. And you have nine of these patients arriving on the same day.
You need to be very careful in the post-op. You have to feed them special food and be careful with the risk of infection. You have to dress the burns. There are no real hospitals, and with the bombings we are always changing houses. The kitchen is the lab, the sleeping room is the operating room. We are not in the best conditions for these kinds of patients. Some weeks we have fewer, because the winter is over. We are the only people taking care of civilians, so they are coming from over 100 km away.
It’s very hard, because it’s not always a success story. When they arrive super burned, over 80 percent of their skin sloughed, we cannot make miracles. It’s a high mortality rate. We need to bring all that [dressing] material, and burned people need a lot of [anti-pain] gas. They’re not heavy materials, but there’s big volume. And there’s no access to the hospitals for trucks, so you have to bring everything by hand [from outside Syria]. So we have to take care of a shortage issue with local supplies.
Most hospitals don’t vaccinate anymore. There are measles outbreaks, meningitis, things we normally avoided in a country like Syria where health access had been good. Diabetics don’t have any more insulin, and that’s been going on for two years. Hypertension can normally be stabilized, but there’s no more drugs. There are strokes. We have to take care of the surgery cases but also the chronic diseases. There is also leishmaniasis, and kids affected will be permanently damaged.
Diagnoses for that means a biopsy and a lab, and we don’t always have that big lab. We don’t have all the tools we need to cure it. And if we wait for the tools, we will never cure it.
With MSF, we have our own big generators. We have storage for all the drugs we bring, with ventilation, because they don’t always work if they get too hot.
Everybody is affected. Syrian staff, patients, relatives. You can hear the bombings even if they’re far away. One of our drivers had a big brother who was injured and is now handicapped, and he lost the job he had in Aleppo. Everyone in Syria has lost a relative, has been stressed or affected. Or they have no more money.
People are stressed. No one is laughing when horrible things happen. Fear is a weapon used by all parties. The war is really making people afraid. And of course with the neurotoxic event near Damascus, people don’t know if tomorrow there will be more military action or not. The hope for the future is not clear at all, so it’s a day-by-day survival and coping mechanism.