Dr. Abdallah Safwan, a Syrian from Aleppo, was an ear, nose and throat specialist working in the province when the conflict began in March 2011. He spent the next three years working in clinics and hospitals in Aleppo’s countryside and city suburbs, one of a handful of doctors who remained as violence worsened.
Safwan is working with Hand in Hand for Syria, a U.K.-based aid agency that takes medical and humanitarian aid into Syria. Having left Syria a month and a half ago, he is currently in the U.K., doing a six-week clinical attachment with the organization.
He told us how treating patients has changed over the last three years. He says the number of injuries increased dramatically after a government barrel-bomb offensive of Aleppo city and its surroundings began in late December.
I worked in the province of Aleppo, the whole province, and at times the suburbs of Homs city and the city of Hama. I was there from the beginning of the crisis; I only came out a month and a half ago. So I was there for around three years. I was educated at the University of Aleppo.
I had been living in Syria, I was an ENT specialist, had a clinic and was working in a hospital. When the crisis began, I stayed. So I was there before. I decided to stay because at the time, it wasn’t as dangerous as it is now, of course. As a doctor, when you see things like that happening, you can’t just leave. When you take an oath as a doctor, when you see injuries, you have to help.
We were working in secrecy to begin with, because doctors are targeted [by the government in retaliation for aiding rebel fighters or activists]. There were only 22 doctors in the whole of Aleppo at the time, so it was dangerous to stay: we were visible targets. I was 42, and I was one of only four or five doctors there who had finished school and declared a specialty. Eight of them had not graduated school yet or finished their medical training, and 14 had finished but hadn’t specialized. There was a tiny number of medical staff who had specialized and who could help in the way that I could help.
From the start there was a threat posed by shelling, but we always knew it was a problem, and fear didn’t stop us from doing anything. When an area I was in was falling, there was chaos where you couldn’t tell who was on your side or working against you, and this is where it started to become very dangerous. Kidnapping was the biggest threat, because you don’t know where or when you’re safe.
At the beginning of the conflict, for example, a mortar shell would fall and injure seven or eight people, and there would be four or five deaths. That was the situation we were dealing with at the start. Then things began to change. In one area there was a chemical attack, then there was a change in the weapons used, and this led to more injuries.
But where we saw real change in the four months before we left was the TNT [barrel] bombs falling, taking down two to three buildings at a time, so you can imagine the number of injuries. There would be 40 to 50 injuries from one barrel that would fall. They would fall on densely populated areas with no discrimination whatsoever. There were horrific scenes. We would walk into the hospital and find people and blood everywhere and not know where to start. In those last four months we saw the most chaotic things, and the injuries coming in were indescribable.
We were always put in very difficult situations, because while we had two operation rooms, out of 40 or 50 people who would come in there were 10 children who needed immediate treatment. So we couldn’t help everyone and we had to prioritize one person’s life over another and sometimes we would send people to other hospitals, if we thought they could hold onto life. Or we transferred them to Turkey, but people would die on the way. Some people were treatable outside of operating rooms because they had simple wounds like broken limbs. But with the other 50, due to a lack of supplies and equipment, there wasn’t much we could do to help. At some points we felt so helpless we wanted to cry.
A lot of the Syrian medical staff, especially the nurses, weren’t nurses before the conflict. They were engineers or something, and they were prepared and trained during the crisis. They came voluntarily, so they had a persistence and hope that someone forced into it wouldn’t have had. It was inspiring to see and it helped them overcome a lot of mental trauma.
But the most difficult thing for all of us was when another hospital would be hit and that crew would be taken to ours for treatment. We were treating people we knew, treating people who had just been treating others. And if they died, we would fall into depression. We wouldn’t be able to eat. Because these were people who were saving lives, and now we couldn’t save them.
Additional reporting by Bushra al-Homsi.