*The Syrian American Medical Society (SAMS) has been sending top doctors into some of the hardest-hit areas of Syria since the start of the armed conflict. *
Dr. Abdalmajid Katranji is a surgeon from Michigan who has made several trips into the country, the latest in January. Here, he discusses performing specialty tissue surgeries in understocked hospitals, and the rapidly deteriorating psychological state of Syrian medical staff still working around the clock on the ground.
I last went in in January. I’d rather not say where, because I still have family there. Last year I was in Aleppo. I do surgeries, I’m a specialist, so when I went to Aleppo it was to assess the medical needs there. Most of my surgeries are done at the border hospitals. There you see the direct horror [coming from] Aleppo, or you deal with the remnants of it in Atmeh or Bab al-Hawa, Azaz or Afrin.
I’ve operated on shoulders, reconstructing nerves, attempting to reconstruct hands, fingers, elbows. I’ve done a couple of surgeries on lower extremities – reconstructing nerves, arteries and joints so that patients can function again. We have also had to use general surgery skills to help remove shrapnel or stop bleeding.
We use certain field hospitals with a greater amount of resources given the relative stability – but the war doesn’t leave any place untouched. We try to make the most of the resources there and have established a trauma system within Syria. We can now identify level one and level two patients and deliver them accordingly to the field hospitals. We’ve become quite creative in how we rebuild tissues. One time we ran out of instruments, and we didn’t have what we needed. So we went down to the local mechanic shop and found tools, sterilized them and used them. They’re not as delicate as ours, but pliers are pliers, and a wrench is a wrench, and we used them to remove shrapnel or screws or plates from other surgeries.
You’ve got two categories of medical workers. You’ve got the Syrian volunteers, and the psychological state they’re in is one of resilience, but at the same time, untreated or rapid coping, in the sense that they haven’t had the chance to process what they’ve seen every single day. They throw themselves into it harder and harder, because if they do pause or let up, they won’t be able to start again. There’s a great sense of hopelessness.
With the other group, foreign aid workers, it’s shock – they go in to do what they do [at home] and they come out having seen things with their eyes that human eyes were not meant to see. They’re dealing with severe psychological trauma and coping with a medical system that doesn’t appropriately address the refugee situation.
It’s rapid. You’re dealing with a situation that’s deteriorating. The PTSD rates, the psychological trauma, have to be more than 90 percent. Those there are rapidly burning out, they are under constant stress. It’s not just because they’re helping Syrians and seeing what they see – it’s also because they know their families in Syria are under threat of retaliation. It’s not that they give up, it’s that they’re burning out.
Sometimes you meet a surgeon who’s been working for nine months with no days off, and he’ll say that because it’s all a blur, he can ignore the stress. One surgeon took a weekend off and it all caught up with him, and he didn’t have the resources available to cope. He ended up having to emigrate to Europe. It was just too much. It’s not just who’s able to deal with it now, but how are these doctors going to deal with it years from now? How are they going to deal with their kids? How will they behave and react in the future? Without improving the resources for these people, I’m scared.