A Normal Working Day in a Syrian Field Hospital: Deciding Who Receives Oxygen and Who Dies

Abdul Karim Jaafar

(Raqqa, Syria) – Marwan is a 30-year-old volunteer doctor in a field hospital in the city of Raqqa in northeast Syria. He asked his real name not be used due to the danger the disclosure could pose to him and his family.

On most days he wakes up to the sound of explosions then quickly heads to the hospital, knowing that he’s needed because he is one of just a handful of volunteers. Sometimes he needs to go in the early dawn, so he walks for half an hour in the dark, trying to avoid the stray dogs on the road.

When Marwan reaches the hospital, he faces challenges that most doctors in the rest of the world do not have to deal with.

The hospital is based in the cellar of a government building that was abandoned when the opposition took control of Raqqa city in March. The main room is packed with beds, leaving little space for movement. Relatives of the injured sit on the floor of the corridor leading into the makeshift operation room, where they can hear through the concrete walls their loved ones’ pain as the effect of the anaesthetics wear off.

Raqqa has been bombed by the government’s air force almost every day since the opposition took control. Sporadic clashes also erupt between opposition fighters and government forces around two military headquarters outside the city and at the military airport in the nearby city of Tabaqa, which are still under the control of troops loyal to Syrian President Bashar al-Assad. Violent skirmishes also break out occasionally between gunmen from the Islamic State in Iraq and Sham, which is affiliated with Al-Qaeda, and members of the Free Syrian Army.

All of these incidents cause a high number of casualties among civilians and opposition fighters and put great pressure on the seven field hospitals and the government hospital. They all suffer from a lack of emergency equipment and medicines, according to doctors who work there.

Marwan says that the hospital in which he works receives around 10 casualties on a normal day, including “very difficult cases,” as he put it. The number of injuries treated by the hospital could rise to 40 or more when airstrikes target residential areas, and many of those injured often die.

But the most difficult case that Marwan recalls treating was two wounded people with cerebral haemorrhage, both in dire need of a respirator, which was not available in the hospital at the time. He ran to an ambulance parked outside and took a small respirator from it, but he realised that the amount of oxygen in the device was not enough for two people.

“I could not take responsibility for what was happening, so I gave the device to the other volunteers to decide which of the two needed oxygen the most, which meant that the other person must die.”

In the end, both people died that day because their injuries were very severe.

In addition to Marwan, 17 other doctors offer their services to this hospital. Three of them also work in the governmental hospital and continue to take their salaries from the Ministry of Health, while the rest are paid only with small amounts of money donated by charity foundations.

Most doctors have fled Raqqa fearing the wrath of the government forces, the leaders of which have vowed revenge after the opposition took control of the city.

“This has led to an acute shortage of medical staff; this is why I was prompted to volunteer,” said Marwan, adding that in cases of heavy bombardment the number of volunteers and blood donors increase, which gives hospital workers moral support.

In addition to civilians, this hospital treats wounded opposition fighters, some of whom carry their weapons inside. Others also walk in with their weapons to escort their wounded fellows, which raises fears among volunteers that the hospital might be targeted by government forces.

Altercations that could result in shootings also take place inside the hospital.

“I was hit by a splinter from the wall when a bullet hit it and a colleague of mine was shot during a fight between a gunman and a thief he had arrested,” said Marwan.

On another occasion Marwan had to step in to stop a militiaman from beating up a wounded government security agent.

Marwan recalls cynically saying to the opposition fighter: “At the hospital we save people’s lives; if you want to beat him up let me finish my work and then do what you want outside.”

Another challenge Marwan has to deal with is having his family worry about him.

“My mom is the first victim of my work at the field hospital,” he said. “Sometimes she hears the sound of shelling but cannot reach me to make sure that I’m well because I’m busy, so when I return I find her on the verge of a nervous breakdown.”

On most days Marwan works around 15 hours at the hospital, so he rarely spends time with his family and friends.

“It’s been months since I’ve seen my friends and I’ve almost forgotten our beautiful evenings together,” he said. “Now my friends are the hospital volunteers; I see them more than I see my family.”

After Marwan graduated from the faculty of medicine in 2009 as a general practitioner he did not continue his studies, nor was he able to open a clinic because he evaded compulsory military service.

He earned his living by working at his father’s car repair shop, and was then able to  start an internship at the government hospital in Raqqa, before the outbreak of the events in Syria in 2011, because the internship position did not require proof of completing military service. But he left work after six months, due to the fact that he participated in peaceful demonstrations and feared that security agents at the hospital would arrest him. The hospital was controlled by a “terrifying gang of security members,” as he described it.

Marwan used to exchange banter with fellow doctors at the field hospital, saying they have treated cases that require all kinds of medical specialties, except for delivering a baby. But to their surprise, they actually received a pregnant woman about to give birth and suffering complications.

“It was a very difficult birth,” he said – but they were able to complete it successfully, despite the modesty of the medical equipment available.

Marwan’s harsh daily reality has not stopped him from dreaming. He says that he aspires to opening a small clinic, just like “any physician outside Syria,” but then adds he cannot do it now because of “my duty towards the people of my city.”

“I hope for the return of security to my country and that we all enjoy peace,” Marwan said.