October 14, 2016

With intensive care units full and medical supplies running out, eastern Aleppo’s seven remaining hospitals cannot cope for much longer, says surgeon Dr. Abu Huthaifa.

"We’ve got used to the daily scenes following a mass bombing, when the hospitals are so crowded with the wounded that we have to step over them to reach other patients in need," says Dr. Abu Huthaifa, one of the few remaining surgeons in eastern Aleppo. "At these times, we ask for help in the emergency room from everyone who is available—caretakers and cleaners as well as health workers—to put pressure on patients’ bleeding wounds, apply basic dressings, triage patients according to the severity of their injuries, and move those who can be saved into the operating theater."

The three-month-long siege of eastern Aleppo and the relentless bombing of the city over the past three weeks are taking a deadly toll on the estimated 250,000 people trapped in the area. Access to medical care has suffered as well, with just 35 doctors remaining and only seven hospitals still functioning. Three weeks ago there were eight, but one hospital has since closed after it was hit several times during the aerial bombing campaign.

Dwindling Staff and Supplies

"There’s a shortage of medical staff," says Dr. Huthaifa. "Many were visiting their families and relatives outside Aleppo when the siege started, so they got stuck outside Aleppo. There is also a lack of fuel, which we need to keep the hospitals’ generators running 24/7, as there is no electricity supply in east Aleppo. There’s a shortage of medical supplies, as well as of drugs and intensive care beds."

Before the siege, says Dr. Huthaifa, many patients in need of long-term intensive care were referred to other cities in Syria, or to Turkey. "Now, under the siege, we cannot," he says. "Sometimes we are forced to turn off life support for a hopeless patient in order to admit another one with a better chance of survival."

For the past three weeks, the situation in the city’s hospitals has been desperate, with services overwhelmed by the number of injured. "We received a patient wounded in an airstrike and he needed a laparotomy," [an incision into the abdomen for examination and diagnosis] says Dr. Huthaifa, "but all the operating theaters across Aleppo were full. We had to put him on hold until one became available. He died, because there was no space in any operating theater for us to perform the surgery."

Working Around the Clock

In these circumstances, just finding time to eat or sleep can be a struggle, says Dr. Huthaifa. "When one patient leaves the operating theater, and as another is brought in, we do things like praying or eating. We’ve been working almost 24/7 and we’ve been receiving wounded people around the clock. Sometimes we try to steal a nap between two surgeries—we try to sleep for half an hour to gain the strength to perform another surgery."  

Although hospitals had prepared for the eventuality of a siege by stockpiling medical supplies, these are now running very low, according to Dr. Huthaifa.

He describes what is likely to happen if no aid is allowed into the besieged area. "We could fail to save many of our patients, because of the lack of fuel to run the generators, or because we have no space in the intensive care unit. Some patients need intensive care beds for a month or two, according to their injuries; patients with brain injuries need intensive care for a long period of time. With patients who have lost a lot of blood, we may not find the matching blood type, because most people in eastern Aleppo have already donated blood, many of them tens of times over. And we may not have medical supplies or sutures for performing surgery." He is also concerned about children going unvaccinated, and the unavailability of formula milk for babies, fresh vegetables, and food in general.  

A Crippled Ambulance Service

The ambulance service has also been heavily impacted by the siege and the indiscriminate bombing of the city, with terrible consequences. "We received one patient at 4:00 a.m.," says Dr. Huthaifa. "A bomb had exploded next to his house while he was sleeping and he was hit by shrapnel in the chest. His family tried to get him to [the] hospital as quickly as possible. But because of the shortage of ambulances, due to the lack of any kind of fuel to run them, the man arrived dead an hour and a half after being injured. And all because there was no vehicle to bring him to hospital."

As protection from shelling, the hospitals are using basements or the lower floors of buildings only. "The general scene is wounded bodies all over the place," says Dr. Huthaifa. "I’m not sure if this is normal or not, but we have got used to this scene because it’s a frequent one. We have to deal with these victims and treat them as soon as possible with what we have, and with what our hospital can provide, no matter how modest."

Read More: The War on Children in Eastern Aleppo

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