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Syria ER: Where They Conduct Operations on Kitchen Tables

Dr. Greg Elder is deputy director of operations at Médecins Sans Frontières/Doctors Without Borders France. The organization currently operates five field hospitals in Syria. An emergency room doctor by training, Elder has made two trips into Syria, the last one six months ago in the vicinity of Aleppo. Based in Paris, he helps oversee operations for MSF’s Syria team, designing and evaluating programs and supporting teams in the field. .

Written by Karen Leigh Published on Read time Approx. 3 minutes

0Syria is a dangerous place to work, and I’ve been there a couple of times to assume the responsibility of where we’re putting people in the field to practice. If we’re not prepared to go there ourselves, it’s irresponsible to send doctors into the field to work. We also need to make sure they have the equipment and resources they need.

Part of my role is also to represent our headquarters in the negotiations we have to engage in to get access to where we want to work. We tried very hard to negotiate with government officials in Damascus to work in the field, but we weren’t able to do that. So we’re working in nongovernment-controlled areas. There’s the Free Syrian Army and a whole other range of people who claim to have control over the territory. It’s quite fragmented.

We had to adapt houses and existing infrastructure to be able to put in place the sorts of standards that we think are important, even for doing basic trauma surgery. We were supporting a network of local doctors, giving them training, and we heard some pretty dramatic stories about surgeries people were doing on kitchen tables, without anesthesia, without supplies. Doctors were targeted. People were doing the best they could with the resources they had, but things just weren’t clean and hygienic.

We’ve put more effort into resources and investment, into taking houses in a small village and making them hospitals, into building an operating theater with sufficient equipment to be able to do emergency trauma surgery and to help manage the injuries we were seeing. [When we first went in] the conflict was raging, so we were getting pretty ugly war trauma. Wounds, fractures, burns. We sort of assumed responsibility for trying to do first-stage trauma surgery, like saving limbs, if we could.

We had a dilemma because the quality and level of infrastructure we had to put in place wasn’t sufficient for stage two and stage three reconstructions. For people with complicated trauma or plastics injuries, do we keep those patients and do the best we can, or do we try to transfer them into a more stable site? We run a regional hospital in Jordan, so we were able to get some there, and to Turkey.

I did hear and see a homemade telephone video of a patient being operated on without anesthesia, and it’s just barbaric. Other things that struck us from a moral and philosophical view is that from the beginning, there was a very deliberate targeting of medical staff. It drew our attention and made us say that even if we can’t work on both sides, we can’t stand by if people can’t go to a safe place when they’re injured.

In health care, one of the things that gets less attention is that the health system’s totally collapsed. Less than 20 percent of the public health structure is still functioning. Even with a lot of support being given [by international organizations], it’s nowhere near enough to support what’s collapsed. So now, what we’re starting to see in our clinics are much more routine things, like emergency surgery from non-trauma causes, and referrals to do caesarean sections because there’s no good obstetric care or functioning obstetric hospitals.

There’s a lack of routine medical care that’s becoming apparent – people don’t have functioning dialysis units anymore. There are kids not being vaccinated. Last week we did a vaccination campaign because there has been an outbreak of measles. Being able to understand what that means in terms of mortality, in terms of absolute numbers, is just as important [as the death rate from conflict injuries]. Where are people going to go now to get care? Syria had a pretty decent level of health care before; middle-aged people with hypertension and diabetes were in care just like you or I would be, kids were getting vaccinated. And then suddenly it just stopped. At the beginning [of a conflict], all the attention goes to trauma cases, but you start to get people who have fallen out of the regular care they were getting.

At the moment we’re running five hospitals inside Syria. There are 40 international staff and 400 people [total, including Syrians] working in those hospitals. We’re also in Lebanon, Iraq and Turkey working with refugees, and there are easily 40 or 50 people involved in these refugee projects. It’s a massive deployment for us. We’re close to exhausting our capacity on this as a single operation. And every week there’s a discussion to see if we can extend and open something new. There’s just so much to do.

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