The revolution through the eyes of the rebel physicians

By Razan Zaitouneh

It seems that Syrians can no longer benefit from treatment in regular hospitals, be they private or public. All Syrians have left are the few, ill-equipped field hospitals, which could be raided at any moment, their equipment confiscated and their staff arrested.

A field hospital is a miniature version of the inferno that lies outside its walls. Inside are people striving to chase away the spectre of death as they move from hospital to hospital and city to city, witnessing the enormous suffering that Syrians go through every day. They use their scarce medical supplies to rescue children, soldiers who have defected and even prisoners of war, captured fighting on the regime’s side. These medical activists discriminate in favour of only those who have a better chance of survival.

When measured against the total number of physicians in Syria, the number of those among them who have joined the revolution seems small. Most of them are still young and haven’t finished their medical residencies, yet they often find themselves forced to perform all sorts of medical duties irrespective of their area of expertise.

Fida, a field physician, is in his final year of general surgery but decided to postpone his education and join the revolution when it first broke out. The following is Fida’s own account of the two days he spent in Rastan, near Homs, one of the many cities he and his colleagues have visited in order to save the victims of shelling and sniping from imminent death.

On the road to Rastan

“I set about my journey out of Damascus with two other physicians, accompanied by a man from Rastan, a former lawyer who became an armed militant after several members of his family were killed. Judging from our experience of travelling into and out of security hotspots, we have come to learn that being asked to stay away from the windows is a sign that we are up for a bumpy ride. As the team leader, I took it upon myself to ease the tension by talking and joking with my colleagues along the way, while the only picture in my head was of me being killed and my mother mourning my death.

“A little before arriving at our destination, there was heavy shooting near us. I found out later that the fighters were trying to distract the [regime forces], which were heavily guarded with tanks and armoured vehicles, so that we could safely go through.

Inside the field hospital

“We finally arrived at the field hospital. Like all other makeshift hospitals, it was located in a house: the guestroom was reserved for casualties, while a blanket hanging in the middle screened the medical staff’s lounge from what was supposed to be the emergency room.

“That miserable place could be taken for anything but a hospital. There was a suction unit, but it wasn’t designed for surgery, and not all instruments were sterilised. In a real hospital, if around 10 people arrive who were injured in a car accident, the alarm bell would start ringing and the whole hospital would be in a state of emergency as spare operating rooms are being opened. In a field hospital, however, something like the aftermath of a horrible car accident happens every half-an-hour: a collision between either a rocket or a mortar shell and a building, while the pseudo-hospital has around two physicians or sometimes none.

“My greatest escape in situations like these is drinking tea out of an akrak ajam glass – a tiny cylindrical goblet that narrows down at the centre – even it was dirty, along with an Al Hamra cigarette, which I have to smoke whenever I run out of imported tobacco. This time, though, we were offered tea in plastic cups as a sign of hospitality!

“At the hospital we found three doctors, including a surgeon, who hadn’t slept for three days. They disappeared from the emergency room 10 minutes after we arrived in order to get some sleep. From that moment on, we started hearing intermittent explosions of mortar shells, and a few minutes later, around five or six injured people arrived.

The business of saving lives

“The first casualty we received was a 30-year old man who was hit by a shell fragment in the abdomen and was suffering from a hemorrhage and shock. When we discovered that there was no anesthesiologist or anesthesia technician, I decided to operate on him after the internal medicine practitioner and I anesthetised him.

“As I was making an incision in the patient’s abdomen, I went through one of the most anxious moments in my life. His brother was standing next to me, begging me to save his life because ‘he has children’ – a scene usually uncommon in operation rooms.

“While working, I try to limit my thoughts to the field of vision in front me, which contains nothing other than blood. The mere act of thinking can make a surgeon collapse. I asked for the patient’s brother to leave the room before proceeding with my first spleen-removal surgery ever, while the patient was only locally anesthetised.

“When we asked for cotton, the nurse handed us a non-sanitised roll which I refused to use. He then told me that I would ask for it again and would have to use it! He was right; we were even reducing the amount of serum we were giving to each patient because we had to save a little for someone else.

“Finally, I asked for the wound not to be sewn up and not to perform an anastomosis, a procedure to connect blood veins, because the patient could not handle it. When we finished the procedure the patient went home very shortly after, even though the operation was very serious.

“More wounded people were arriving one after the other, one of whom had a shell fragment in the head. Three times I have refused to treat a patient who was on the brink of death, because I didn’t want to waste any time. All three cases were in a field hospital. Every time I was ashamed of myself when I heard them take their last breath.

“I hate working in a field hospital. I have never felt that I offered a wounded person everything I could because I’ve never had the time or the means. The most difficult decision is to choose which patient to treat. A doctor should never let the one who is closer to death stand in the way. Time during which death is taking hold with someone mortally wounded should be used to let another victim escape his or her predicament.

A demonstration at the field hospital

“We had a good laugh with one of the patients. He kept making jokes even though he was suffering from severe skin and muscle tissue damage in his thigh, and one of his testicles had come out of the scrotum. He asked us to film his testicle. When we said we were going to send the footage to Al Jazeera he told us not to because he was newly engaged after having been married twice, and he didn’t want to ruin his engagement!

“But of all the people I met, I was touched the most by Abu Muhammad. He was always smiling, at both the living and the dead. He used to take down the names of the wounded and transport them to the field hospital, where he would film them and help us treat them. The second time we saw him he told us that his son was hit. He then started crying and running and I ran after him to find his nine-year-old son Muhammad was hit in the thigh.

‘Why are you crying father. Bashar has to fall, no? Even if we are all killed,’ said Muhammad to his father.

‘I told you not to go out in the street,” Abu Muhammad replied.

‘I wanted to play. Do you think I wouldn’t have been hit if I had stayed home?’ said Muhammad.

“I then knew the reason behind Abu Muhammad’s optimism. Muhammad was constantly asking to be filmed and the footage sent to Al Jazeera, because he was not scared, according to what he said.

“The majority of the casualties were civilians, as it seemed that indiscriminate shelling reached them alone. Nearly an hour before we first arrived, there were three wounded brothers who were all under the age of 12. One of them had an operation and then died on the way to the hospital in Homs, while the other two are still being treated at the field hospital. 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 we start lying. We lie about everything.

‘Your brother is well so we sent him home’ – we wouldn’t tell him that the house was destroyed.

But the amazing part of medicine is anesthetic drugs. Anesthetised patients start acting as if they have had a whole barrel of vodka. This is when the demonstration started inside the field hospital. All those who are under the effect of anesthetics were repeating the songs of Ibrahim Qashush, the singer who was famous for his anti-regime slogans and was found killed. We made sure to film one of the hallucinating singers!

The prisoners of war

“During our two-day stay we treated three prisoners of war who were captured by the Free Syrian Army, FSA. The first was from Manbej, in the province of Aleppo. He had three golden chains and three baby-size undershirts that he seemed to have looted from a house. When we asked him where he was from he lied and said he was from Daraa. He was a thief, a liar and a murderer. When he arrived he was swearing at Bashar Al Assad, but then refused to be filmed because he was scared someone would see the footage. After I treated him he stayed with me until the morning. From the corner where I was supposed to sleep, I could hear him being scorned and subjected to a meaningless investigation, but no one was hitting him.

“The next morning we received another prisoner known to be a sniper. After receiving first aid, he left our hospital and five other people of the same family, who had been injured, arrived. We found out later that someone from that family liquidated the prisoner. Abu Muhammad tried to stop the killing of prisoners and indeed managed to save the one that I treated the day before.

On the way back

“When we told our hosts that we were planning to leave, they started making long lists of the supplies they needed, even though they knew that we were promising far more than we were able to deliver. Ever since I came back from Rastan, I have been looking for a satellite transmitter that the hospital supervisor asked for. When I asked him about the medical use of this device he told me that activists were so eager to go on air and declare Rastan a free city.

“The medical supervisor and Abu Muhammad both bid me farewell, but Abu Muhammad’s words were particularly moving; he told me to hurry back to Rastan lest he is killed before I could see him again.

“At the turning to Homs, we left the car that was scouting the road ahead of us and made a victory sign at the car that was coming from Damascus. The car was carrying a new team that was heading to Rastan to replace us for two days.”