The Fight to Save Lives in Syria – Field Hospitals Treat « Horrific and Brutal » Injuries – by Shaza Zafer Al Jundi

Article  •  Publié sur Souria Houria le 15 novembre 2012


Hundreds of civilians across Syria are facing a dire situation.  It doesn’t matter whether they have suffered a heart attack or a sniper shot, there is nowhere to access safe medical care.

The result is a new phenomenon of small secret field hospitals cropping up around Syria. These are set up in basements, schools or even in tents, equipped with only the most basic equipment and minimal medical staff.

The field hospitals, known only through a secretive local network, treat anything from gunshot wounds to Caesarean sections. Even though they are severely under-resourced they provide a vital lifeline to the local community.

During the worst of the shelling people are too afraid to leave their homes to obtain medicines. Now they will venture out during moments of fragile peace to get free prescriptions from a small field hospital.  Doctors working in this field hospital report that on busy days, up to three hundred people can attend the clinic for medical attention and to obtain their medicines.

These hospitals, which have been declared illegal by the Syrian regime, have so far carried out hundreds of operations on wounded Syrian fighters and civilians, including women and children.

The field hospitals in Syria are performing hundreds of life-saving operations on those caught up in the conflict.  The main field hospitals have a team of medics, including surgeons and anaesthetists, together with nurses working there to provide emergency medical care to casualties of the war. Some hospitals are equipped with an emergency room, operating theater, and resuscitation area, while other hospitals do not have the basic equipment needed to save lives.

A field hospital offers the first phase of treatment to the injured. Most of the field hospitals have no electricity, and rely on electric generators. In most of them there is no x-ray machine, just a few shelves with medical supplies and an oxygen tank. The hospital has about a dozen beds, a sterilization room, an operating room, an emergency resuscitation room and a recovery room.  Medical supplies are lacking. And although more field hospitals are opening throughout the country, most Syrian physicians who operate the makeshift facilities are inexperienced in treating battle wounds.

Most of the volunteers working in field hospitals were medical students with neither the qualifications nor the experience to deal with serious injuries. The doctors worked under harsh conditions. As well as the constant risk of arrest, they struggled to provide care given the shortage of medical resources and money. Convalescent treatment after surgery was hard to provide.

One of the doctor said about the most painful memory from his time at a field hospital was when (he and his colleagues were unable to offer the necessary treatment to an adolescent who had been shot in the back, and who ended up paralysed).

The locations of the field hospitals are being kept secret because they are being targeted. Many hospitals have been destroyed, and patients and injured persons were killed.

There are dozens of field hospitals hidden in the conflict areas, especially in the hardest-hit areas, where army shelling has reduced much of the neighborhood to rubble.

The locations are all secret after the army bombarded some hospitals, including all private hospitals that was shelled and finally destroyed. Most doctors asked not to be identified for fear of retribution from the authorities.

What happened to the public hospitals?
Doctors don’t refer civilians or fighters to public hospitals and civilians don’t dare go there themselves. If you show up with a shrapnel or bullet wound, it means you are coming from nearby neighborhoods, and that means you are with the revolution.

Going to a state hospital is no longer an option for many people. The army controls the main hospitals, which activists believe are filled with Syrian security personnel.

The disruption of Syria’s health care system means surgeries are being postponed and many patients with chronic health problems are not being treated.  Expectant mothers are not getting sufficient pre-natal care, and children are often skipping life-saving vaccinations.

One doctor said: « I saw wounded fighters arrive at one of these public hospitals and get beaten and arrested before being treated,”.  The regime’s control of the healthcare system led to the formation of Doctors’ Coordination Committees and Health Revolutionary Committees. Medics set up makeshift centers in areas close to the fighting. They had been able to operate in greater safety once the Free Syrian Army was in control of large areas.

Normal health centers are almost non-existent in areas that have witnessed heavy fighting between government troops and the Free Syrian Army.

Hospitals in many of the country’s worst hit cities have been taken over by the army and turned into military bases. Those that are still open are not safe for injured civilians to seek treatment – reports of torture and medical negligence are widespread.

Even in cases where the wounds of injured civilians have been medically treated, once the patients are well enough to be moved they are transferred to military intelligence centers to be detained, interrogated and eventually killed.

To compound the problem, medical staff that previously ran primary care services has had to close their clinics and flee to safer areas. Many doctors report having their surgeries ransacked and destroyed. The same is being reported by pharmacies.

In addition to this, it is now a criminal offense for medical staff to treat an injured demonstrator; many doctors have been arrested for doing this and subsequently detained, tortured or killed. Others have had their families attacked or their wives raped to stop them providing further care.

Doctors in state-run hospitals in Syria are facing a grievous trade-off: to offer treatment and risk torture to patients and possibly themselves, or withhold treatment to those under their care. A report by Amnesty International, published on Oct 25, 2011, alleges that patients with firearms injuries admitted to state-run hospitals are being targeted and tortured by the authorities to quell dissent that has spread throughout the country since March, 2011.

Doctors and students were killed or tortured for treating injured persons. Three Aleppo University students, who had been helping treat demonstrators shot by Syrian security forces, were arrested at a checkpoint in mid-June. Their mutilated and charred bodies were found in a burned out car a week later.  If the regime intention was to shock, it worked – other doctors, nurses and volunteer student medics were horrified by the gruesome fate of their friends. But if the intention was to intimidate them, it backfired, they told the Media. The brutal punishment instead redoubled their commitment to serve.

What kind of injuries that doctors dealt with?
Doctors declared that, they have seen more injuries from tank shelling, aerial bombardment, and heavy artillery every day.

Doctors were shocked by the number of civilians hit in the crossfire. They saw many children wounded in the stomach, head and chest by shrapnel or hurt when their homes collapsed on top of them after army shelling.

Many of them informed us “we’ve largely been seeing people wounded by bullets, mortar fire, or shells. The most common injuries have been to people’s limbs, stomach area, or between the neck and abdomen”. Though most of the patients are men, women and children have also been arriving, and often too late.

One of the doctors said « I am a surgeon and my profession is to deal with blood daily. But in this place, I wept from what I saw, » he says.

A Syrian surgeon said conditions were growing increasingly dire in Syria, and nearly all her patients were victims of the fighting – about 60 percent suffering from explosions and 40 percent from gunshot wounds.

Most of the injuries that doctors dealt with resulted from sniper shots to the head or spine. The victims often suffered permanent disability, if they survived at all.

“Young men in their prime suffered quadriplegia,” the doctor recalled, and random shots fired at protesters typically resulted in limb injuries, often requiring amputation.  One injury resulted in a hindquarter amputation [an operation in which the entire leg and part or the entire pelvis is removed]. One day we received about seven children all at once, following a bombing in the bazaar in a nearby town. One was a nine-year-old girl who had an eviscerated bowel and injuries to both legs. We did the bowel surgery and had to amputate one of her legs, he said.

It’s very common for several wounded people to come from the same family. This is when the situation becomes most critical. Each one of them would be moaning in pain while asking about his brother or his father, at which point the doctors start lying.  ‘Your brother is well so we sent him home’ – they will not tell that that the house was destroyed.

Many doctors describes what happening as (« Horrific and Brutal » Injuries)      Imagine, every day there’s almost 1,000 wounded — added on top of the 1,000 wounded the day before.  “If you have 100,000 disabled, that means a half-a-million dependents will have lost the persons supporting them.  For the future for Syria this going to be the major issue, these disabilities, and the psychological effect is going to be unbelievable, and the need will be beyond our capacity to handles.

International and Regional and National Support
Many of the deaths and permanent disabilities in Syria have been the result of poor access to medical care, with patients often having to make a grueling journey across the Syrian border into neighboring countries for treatment. Syria’s neighbor has received over 400,000 people fleeing the conflict in their homeland and nearly 30% of these persons are injured and need urgent medical care. Turkey, Jordan, and Lebanon have provided mobile medical units at the Syrian borders – to see and treat the injured.

International organizations were able to provide health care and medical support to injure and war victims inside Syria; on the Syrian borders and in Turkey, Jordan and Lebanon, and their work is very much appreciated by the Syrian people.

Doctors Without Borders (MSF) informed the Syrian government of its work shortly after arriving in the country, in secret, but was not authorized to stay. “They’re aware of our presence,” said Olivier Falhun, a Paris official at Doctors without Borders, known in French as Médecins Sans Frontières. But the government has indicated that the group’s work will be conducted “at our risks and perils,”. The location of the field hospitals has been kept secret.

MSF expanded its response in Lebanon to provide urgent assistance to the influx of thousands of Syrian refugees. The organization has opened new medical projects in the north of Lebanon in the Wadi Khaled area, in Tripoli, and also in various locations in the Bekaa Valley. In order to develop a comprehensive understanding of the refugees’ health conditions and living situations, and to adapt its programs accordingly, MSF carried out a study at the end of May 2012. In these three locations, representatives of 889 families were interviewed.

Aside from the surgical project, MSF is distributing drugs and other medical supplies in Syria. Despite the difficulties accessing the country, MSF remains ready to assist all victims of the conflict and continue to expand their activities in Syria and neighboring countries.  At present, MSF is admitting about 50 injured Syrians a month to the reconstructive surgery project in Amman, Jordan, and they are also offering psychological support and primary care to Syrian refugees in Lebanon.

The ICRC helped the Lebanese Red Cross evacuate 1573 Syrian casualties to Lebanese hospitals; provided post-operative and rehabilitation care for Syrian casualties, together with medicines, consumables and artificial limbs; paid for over 100 severely injured refugees from Syria to receive treatment at five hospitals in Bekaa; and trained health personnel who were treating Syrian casualties.  In addition to provided financial support for the Lebanese Red Cross blood bank and distributed emergency aid to around 23,250 refugees from Syria

Syrian American Medical Society (SAMS)
Syrian- American Doctors have traveled to the region and made multiple clandestine trips across the Syrian border from Turkey to reach field hospitals and treat the many wounded. The journeys are perilous and have found these volunteer doctors sneaking through holes in barbed wire fences and dodging border guards. Once there, these doctors treat hundreds of casualties under the constant threat of attacks by Syrian military artillery and airstrikes.

The SAMS conducted several training Courses for Syrian Doctors working in Field Hospitals inside Syria.  Three US trained specialists including a radiologist, an intensivist and a surgeon formed the expert team. The group taught total 24 filed hospitalists working inside Syria for a three days course, covering the use of ultrasonography in trauma i.e. FAST exam, shock management, and lifesaving trauma principles and techniques. The participants were from different medical specialties background with the majority being surgeons. At the end of the course, 10 hand held ultrasound machines felt most needed for the work in the field hospitals and 15 arterial sonograms were distributed to the trainees after demonstrating adequate competence. A system was designed to get the feedback of the trainees as the circumstances on the ground allow.

The French military sent its own team of doctors to the Syria-Jordan border to set up a mobile hospital.

Canadian Relief for Syria (CRS). The group is made up of physicians who travel to the Turkish border with Syria every month to set up field hospitals and work to get much-needed medical supplies to the area. Canada announced that would provide financial support to purchase medical supplies and set up more clinics for Syrian war victims.

Qatar Red Crescent (QRC) is expanding its programme to help Syrian refugees in Turkey, Lebanon and Jordan which focus on providing the affected people emergency needs including medical care, food, shelter and psychological support. As part of the initiative of the State of Qatar to provide humanitarian assistance to Syrian refugees and displaced people, Qatar Red Crescent is involved in “We Are All Syria” which was launched in Qatar in July with the support of Qatari charitable organizations to help provide medical treatment to Syrian refugees on the Syrian-Turkish borders at Bab Al-Salam refugee camp.  QRC has established several hospitals for Syrian refugees on the borders, including a programme for providing prosthetic devices to amputees.

The Emirati-Jordanian Field Hospital in Mafraq has cared for up to 600 patients a day since it opened on August 28. One of the doctors said “Some victims have had bullets in their bodies for weeks, even three months. « It depends on how long it took them to leave Syria and get to the hospital. That is why the bullets stayed in their bodies for so long. » One of the doctors said, and this could cause permanent disability”.

Syrian immigrants supported financially establishing the field hospitals, a very important project was established in the north of Syria by Orient Humanitarian Fund, the Syrian national project for prosthetic devices (lower limps), and the center provides lower limps to the amputees from all over Syria.

How can you help?
International, regional and national support is needed. The number of war victims and injured persons is estimated around 80,000 persons.

–    The need for financial support to set up more Field Flying, Portable and Mobile hospitals that could be set up rapidly at the site where they are needed most. There are certain unique challenges associated with providing medical care in the field environment that need to be taken into consideration, including safety procedures form medical teams.

–    Medicines and medical equipment are needed urgently for already hospitals under operation.  We need more stocks of medicines.  We need equipment that is lightweight and portable, yet rugged and reliable.  The field hospitals desperately need your help to continue functioning effectively.

–    Support in setting up/establishing of field hospitals (planning and management), either by providing, international experts or by conducting capacity building programmes to national teams to be able to set-up hospitals.  Setting up a field hospital can be a tricky business. It must have a staff that is highly trained in emergency medical techniques.

–    The need for improved (operation of these hospitals) we need to have a team capable of maintaining a clean medical environment in changing environmental conditions. The main benefit is the ability to provide life-saving capabilities anywhere, anytime, in austere environments. The success of a hospital emergency response however only stands and falls with a good team. The biggest challenge in designing mobile field hospitals is meeting the client’s expectations when they may not have a lot of field experience.

–    The success of operations lies with building a national team of trainers that is capable of continuous training, between the supplier and the medical team on the ground.  Therefore, we need to invest a lot in training and preparing people who are working in the field hospitals we need to train them on how to function and how to work in disasters. We need these people to be absolutely flexible and problem-solving.

We need the international community to support our war victims.  We need to prevent permanent disabilities.  There is still a lot to be done as better training and better prepared personnel are needed for our hospitals we need to protect them from the security forces and military attack.  Field hospitals are under attack, (hospitals are being destroyed) hundreds of reports have documented government troops are deliberately targeting field hospitals. United Nations Secretary-General Ban Ki- Moon has expressed concern that medical facilities and teams are being targeted.

The Rights to protect wounded during wartime

All human rights conventions including the Geneva Conventions request protection of persons against the violation of human rights for injured and war victims. These conventions designed to protect wounded and sick soldiers during wartime.  Under these Conventions, civilians are afforded the protections from inhumane treatment and attack afforded in the first Convention to sick and wounded soldiers. Furthermore, additional regulations regarding the treatment of civilians were introduced. Specifically, it prohibits attacks on civilian hospitals, medical transports, etc.

The « vast majority » of human rights violations in Syria, including international crimes, documented have been committed by the Syrian armed and security forces and their allied militia.  Some violations are as serious, deliberate and systematic as to constitute crimes against humanity and war crimes.

According to the UN, Syrian armed and security forces have been responsible for: unlawful killing, of medical personnel and hospital patients; torture, including of children (mostly boys, sometimes to death) and hospital patients, and including sexual and psychological torture.  Amnesty International reported that medical personnel had also been tortured, while the UN said that medical personnel in state hospitals were sometimes complicit in the killing and torture of patients.

The United Nations High Commissioner for Human Rights and others have called for Syria to be referred to the International Criminal Court, for violation of human rights, and crimes against humanity, especially for creating permanent disabilities for large number of persons and for violating the rights of war injured,

We call the international community to implement the human rights Conventions related to the protection of war victims and the medical personnel and to protect the Syrian war victims and support their medical treatment and rehabilitation.