In late 2013, Medicins sans Frontieres (MSF) sent a team of four well-known photographers and videographers – Kate Brooks, Ton Koene, Moises Saman and Yuri Kozyrev – to document its work in Iraq, Lebanon and Jordan and experience the refugee medical crisis through the eyes of MSF staff on the ground.
The goal of the project was to chronicle a day in the life of Syrian refugees across all three countries, collecting narrative images conveying the human scale of the conflict. There are more than 2.5 million refugees currently estimated to be living outside of Syria, with another 6.5 million internally displaced.
“There’s a lack of humanity with respect to Syria because when we talk about Syria, we always talk about figures,” says Dr. Joanne Liu, president of MSF International.
Dr. Amber Alayyan spent nine months as the medical team leader at MSF’s hospital in Ramtha, Jordan, where the MSF team treats those fleeing the conflict. There, she hosted photographers as they documented the treatment and recovery of refugees. Here, she discusses why projects like MSF’s are vital to understanding the crisis.
Syria Deeply: What was the purpose of your trip to Jordan?
Amber Alayyan: In March 2013, we were tasked with an exploratory assessment to see what the health needs are of the Syrian population coming in from southern Syria into Jordan. Several of the MSF operating centers were looking at the spillover from the Syria conflict across different locations. There were people in Lebanon, Turkey and western Iraq, but there weren’t many projects in Jordan, even though there was a continuous influx of people coming into Jordan from the southern Syrian border.
We visited with the Syrian refugee community in Jordan – refugees registered in camps and those living outside the camps – and with the help of Syrian doctors we identified three health care needs as immediate priorities that weren’t being adequately addressed.
The first was continuing medication for people with chronic illness. There are quite a few people with illness like asthma, diabetes and high blood pressure who don’t have access to their medication and are therefore experiencing complications with chronic diseases. The second pressing need was assistance with complicated maternal delivery, and the third was treatment for those injured by war.
The months of the assessment were the bloodiest months of 2012 and 2013 in southern Syria. It was a particularly heavy month for war-wounded coming into Jordan. The hospitals in Jordan were completely overwhelmed. When Syrians were coming over the border, they were taken to border hospitals and then were funneled to different hospitals in the capital. Most of the injuries were quite serious and required long recovery periods, so the hospitals were getting backed up and there were fewer available beds for new patients.
This was happening for a couple months and was in all likelihood going to continue, so we felt the most pressing need was treating those injured by war.
Syria Deeply: How did MSF initially get such a big operation off the ground in Jordan?
Alayyan: We identified Ramtha Hospital as a base for our operations because most of the war-wounded went there. We refurbished an empty building inside their compound and turned it into our in-patient ward. In Ramtha, MSF ran two operating theaters with 33 beds and two wards at the Ministry of Health hospital.
It took a while for us to get our operations going. We had to get all of our supplies and equipment from Jordan and were faced with very strict importation laws. Normally we are able to import basically an entire hospital.
We followed a regulatory process that would ensure the highest standard of quality and care, which, for MSF, includes surgery and mental health care, access to recovery and physical therapists, and continuous outpatient care and follow-up.
We were also concerned about infectious diseases related to the war wounds. There is a huge issue in the Middle East with antibiotic resistance because so many people take antibiotics, so drugs that would normally be able to cover these wounds needed to be scaled up. These antibiotics are incredibly expensive and require that a patient take them for a long time. It was an added layer of complication for us.
Syria Deeply: Describe an average day.
Alayyan: We were dealing with the war-wounded, so if the war hit a certain village near the border and people were able to make it across the border, we would see a huge influx. There was a time in February when our unit saw 32 patients in one day.
Most of our patients were in their 20s and 30s. Some were civilians; some were fighters. We saw women, children and men of all ages. We treated kids of just a couple months. Our pediatric and women’s units were always full: 15 percent were children and 15 percent were women.
The wounds that were coming in were unlike anything we had ever seen. It wasn’t just one limb that was wounded by blast injuries; multiple parts of the body had been injured. It was really horrific. The recovery period for these types of injuries is incredibly long. The body has to clean out these wounds on its own. You can’t just sew up gaping wounds.
There can be several processes going on at once: you go in a surgery for one limb and then another, multiple times over. Multiple people can have up to 10-20 surgeries just to clean out one wound. This process can take months.
Our patients left Syria with only the clothes on their backs. On top of their injuries and the pain they were experiencing, they had to contend with the healing process in the face of the fact that they didn’t leave Syria and their families on their own volition.
Imagine it. You’ve lost everything. You can’t see your family and you are dealing with massive injuries that take months to heal. It is incredibly overwhelming. They have no registration and identity and are unsure of how long they are going to be in the hospital. Along with not being able to walk, they have to decide if they are going to return to war-torn Syria or stay in Jordan and live in a refugee camp or unregistered in the community.
It’s like choosing from several evil options. Do you want to go to a camp, or go back to a war zone where the health system has collapsed and diseases like polio have returned? Most of our patients had follow-up procedures scheduled so they stayed in Jordan out of necessity.
The majority of our patients would love to go back to Syria, but not the way it is. Most of our patients have an amazing capacity for resilience.