Beyond war wounds: Caring for kidney transplant recipients in Syria

"Ten years ago, I underwent a kidney transplant. In that moment, I switched roles. I was not the doctor anymore, I became the patient. This operation turned out to be a decisive moment in my life."
© Lucille Favre
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Bombing and shelling have escalated in northwestern Syria’s Idlib province in recent months, where hundreds of thousands of people have sought shelter from fighting elsewhere. In addition to those directly affected by the war, some people face additional health issues that make their lives even more challenging. For the past five years, Syrian endocrinologist Mohammad Al Youssef has been working with Doctors Without Borders/Médecins Sans Frontières (MSF) to provide lifesaving treatment to people who have received a kidney transplant. Here, he describes his experience.

Ten years ago, I underwent a kidney transplant. In that moment, I switched roles. I was not the doctor anymore—I became the patient.

This operation turned out to be a decisive moment in my life, but also in my career. An endocrinologist by training, I had, until then, focused mostly on the treatment of diabetes. My transplant, as well as the war that started two years later in my country, encouraged me to change my specialty. Today, I am one of the only doctors in northern Syria providing treatment for patients who underwent a kidney transplant.

Difficulty in getting medicine in Syria depicted in an illustration
Checkpoints prevent patients from getting the medicine and treatment they need.
© Lucille Favre

“Everything changed”

Before the war broke out in Syria, these patients’ treatment was quite straightforward. They would get taken care of in governmental hospitals or health centers. Everything was available, and dialysis or medications were free of charge for kidney transplant patients.

But in 2011, everything changed. Checkpoints started to appear everywhere on the roads, and people could not go in and out of their village or town to receive their treatment as they used to. Depending on where you were from, you could get arrested or even killed. It did not matter if you were sick. Coming from the wrong place could considerably complicate your movements and, by extension, your medical treatment.

All of the people I knew who had received kidney transplants resorted to buying their own medicines or asking their relatives abroad to ship them to Syria. These drugs were their only way of survival. After a kidney transplant, patients have to take immunosuppressants for the rest of their lives, in order for their body not to reject the new kidney. If they stop the medicine, patients go into kidney failure. If there’s kidney failure, they have to start dialysis.

Dialysis is a much less convenient and also much more expensive form of treatment than taking immunosuppressants. For instance, when you sum up all expenses, the cost for dialysis, per patient, is about $450 to $500 per month. In comparison, taking immunosuppressants usually doesn’t cost more than $150 to $200 per month. But even this is a huge amount of money for people in Syria. It is more than an average person’s monthly salary. Most of the patients can simply not afford it.

“The situation of these patients has been completely overlooked”

That’s why, in 2014, I decided to reach out to MSF, with the help of local health authorities. I told MSF that I knew 22 kidney transplant patients in this situation, unable to afford their medications, and provided the organization with their medical files. MSF agreed to support these patients and to provide, free of charge, the treatment that would keep them alive.

MSF provides life-saving medicine and treatment for kidney transplant patients in Syria
MSF supports kidney transplant patients and provides free treatment.
© Lucille Favre

This made me incredibly happy. As a kidney transplant recipient, I wanted to support the patients, to be there morally, but also to help, as much as possible, practically. Since the beginning of the war and until then, the situation of these patients had been completely overlooked by most humanitarian organizations.

The cohort I started to follow grew over the next few months and years. Through word-of-mouth mostly, more and more kidney transplant patients started to reach out to me, to benefit from the donation of medications. This shows how much such support was needed. From 22 patients, I started to treat 45, then 73 and then almost a hundred!

In 2015, another humanitarian organization replicated the same activity in Aleppo governorate and asked me to help there, too. I started sharing my time between MSF and this second organization, overseeing the treatment of over a hundred patients in the north of Syria. Some of my patients, displaced by the conflict, also come from other parts of the country.

Kidney transplant patients are finally overlooked no more in Syria
Dr. Al Youssef's cohort grows as more kidney transplant patients reach out for help.
© Lucille Favre

“My patients did not give up on me”

Taking care of these patients for the past five years has changed me. When people talk about Syria, we often hear about wounds and trauma injuries. There is little to no focus on what the situation can be like for patients who underwent a transplant and now need lifesaving treatment.

Since 2014, the work that I have accomplished has brought me relief and satisfaction, but if I am completely honest, I am also very tired of working and living in such a challenging situation. I even wanted to give up at some point, but my patients did not give up on me. They told me that I had to continue—they didn’t have anyone else to rely on.

A doctor cares for a kidney transplant patient in Syria
"I will not give up on my work, as long as my patients need treatment."
© Lucille Favre

Today, in Idlib, the context is particularly bad, and the war is far from over. We cannot know what the future holds because everything changes every day. The only thing that I am now sure of is that I will not give up on my work, as long as my patients need treatment.

I cannot abandon them, and I’ll continue to do this job until I am sure they are safe. These people don’t care about war; they just want to live a normal life. Providing this treatment is the only way to make this possible and to ensure their survival.