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Project Update: The Long Reach of Conflict
November 9, 2012
This article is part of the Fall 2012 issue of the MSF Alert newsletter.
Soon after the fighting began in Syria, MSF started trying to establish programs to work inside the country. Attempts to make arrangements through official channels were repeatedly rebuffed, however, so MSF began sending in medical supplies to besieged areas. While MSF has been working with some of the 290,000 Syrian refugees estimated by the UN to be seeking sanctuary in surrounding countries—a number almost certain to rise in the coming months—the desire was always to provide direct patient care inside the country as well.
This past summer, after extensive planning was completed, MSF sent in a team of medical professionals—MSF veterans who knew the risks they were taking—across the border and into the country to set up medical facilities. Once inside Syria, in a location not far from severe fighting, the team transformed a private house into a field hospital. Through mid-August, they had admitted more than 300 patients and carried out 150 surgeries in what was and is one of the very few projects established by any humanitarian agency in Syria during the war. The pace of the work was very intense. Injuries were largely conflict related, most caused by tank shelling and bombing or gunshots. Surgical specialist Anna Novak, a veteran of more than 20 MSF missions, discussed setting up the project and the work that followed:
“With the support of a group of Syrian doctors, we were able to identify a location to perform operations. After an initial brief visit, we decided on an empty villa. The two-story, eight-room house was still under construction, but we didn’t have any other choice. For six days, we worked like crazy to transform the place into a surgical hospital with a dozen hospital beds, a sterilization room, an operating theater, a resuscitation room for emergencies, and a recovery room. In addition to the difficulties involved in recruiting medical staff locally, we also had to solve supply problems, knowing that it’s risky right now to import or to buy medical supplies in Syria.
“The first patients arrived on June 22, the day after the hospital opened. At first, we admitted mostly injured people who already had undergone surgery. Unfortunately, we had to do this under poor hygienic conditions, which generally means a higher risk of infection. As new conflicts broke out, the hospital quickly reached its limits. After a few days, we were getting up to six injured people at a time, a relatively modest number but still high considering our resources and treatment capacity. Then, injured people started coming from everywhere. We had to come up with other ways of accommodating people, even if it meant putting beds on the terrace. Sometimes the wounded didn’t arrive during the day because of fighting, because the roads were blocked, or because traveling to the hospital was risky. Sometimes they came at night or at dawn. It was tiring, even though we could count on the help of the patients’ caretakers. The openness and willingness of these people to help out was really touching.
“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. At the moment, there is fighting and bombing about ten kilometers [six miles] from our facility. But our patients sometimes came from far away, risking their injuries becoming worse or even death. This makes you wonder about what hurdles stand in the way of getting quality care in Syria today, including for people whose wounds are not conflict-related.
“To limit the risks, hospital staff in Syria are working in a discreet and cautious manner, and many of the field hospitals disappear as quickly as they appear. In this context, the existence of a facility like ours is very important for injured people who need assistance, but it is also a very delicate situation. Security constraints limit our resources and capacity. A typical war wound requires an average of five days of hospitalization. With the exception of the most serious cases, we sometimes have difficulties keeping patients in the hospital longer than this. Patients who live close to the hospital or who are staying with family and friends nearby can come back for checkups or to get a dressing. But even though there’s lots of solidarity among the people here and lots of patients are able to stay in the area temporarily, some leave the hospital and we never hear from them again.”
(Aside from the surgical project, MSF is distributing drugs and other medical supplies in Syria, including to the Syrian Red Crescent, and is also assisting people displaced by the fighting in some parts of the country.)