Field Hospitals in Syria and Tremendous Efforts to Protect the Wounded from Permanent Disability

Thursday, 11 October 2012

Dr. Scheherazade al-Jundi

مستشفى-ميداني-سورية

The recovery room in one of the houses, which hosts the wounded of the revolution, is the final stage of the patient’s movement from the “tayyar [flash] hospital” [1] to the “field hospital” to a “nearby house” to  a “house further away”, and so on …. The idea of ​​the tayyar or the makeshift hospital came at the beginning of the Syrian revolution, where the Syrian Security forces entered some of Daraa’s hospitals and finished off the wounded. Then the revolutionists decided they needed a safe place to treat patients.

 The demonstrators utilized the tayyar or makeshift field hospitals instead of government hospitals or even private hospitals which are under the surveillance of the authorities.  A number of young people in the protesting neighborhoods donated to find appropriate residential houses away from the eyes of the State Security and Shabiha [regime militia] so the wounded can be treated in a safe place and also to avoid arrest.

The tayyar and makeshift field hospitals are still a new experience for Syrians, for getting treatment from bullets that penetrate their bodies after being fired by the state security forces in an attempt to disrupt the dreams of liberty and freedom from the regime of tyranny. A large number of Syrians are turning to people with permanent disabilities by Syrian bullets and the Syrian Army and Shabiha. Nevertheless, a large number of those wounded return to demonstrate without fear or thinking of backing away from the demands of the Syrian people.

This is not confidential information. The Syrian Intelligence or the “responsible authorities” as they are called know all this information which was posted on social networking sites and YouTube pages.

What is the field hospital or tayyar hospital?

The field hospital is in reality a tayyar hospital since the patient is moved among more than one place probably in the space of one hour for the fear of informers who deal with the Intelligence and dope in people, and who are deployed in the neighborhoods and reveal the place of the injured to the State Security.

In the Syrian countryside the tayyar hospitals operate under much more difficult circumstances compared to those in the big cities, especially considering that informants are more knowledgeable about them. The villages are small and news of any injured or wounded as a result of a fire shot will be known all over the village.

It is also difficult for activists during periods of heavy shelling to supply hospitals with medicines and basic materials from other cities. Thus the hospitals lack the most basic necessities: sedatives, sterilization materials, anti-inflammatory medication and even needles and other basic consumables.

The Syrian Security forces are not only opening fire on protesters, but are also chasing the wounded to hospitals and beating some and killing others. This prompted medical crews in Syria to work in field hospitals, to volunteer to treat the wounded and to establish field hospitals. While doctors and volunteer paramedics are trying to work secretly they began setting up operation rooms in some hot spots. The emergency operations lack essential equipment, which are impossible to obtain, as well as the medicines necessary to treat the wounded.

In regards to the treatment of the wounded from gunfire by State Security forces, one of the doctors explains that “field hospitals” that were created in areas which witnessed extreme violence by the Syrian regime can be classified into three categories: Fully equipped hospitals set up inside houses and capable of surgical operations by specialist surgeons. Secondly are field hospitals that were established only to treat wounds that do not require surgery or rehabilitation or follow-up after an operation. Finally there are mobile paramedics equipped with first aid bags for emergency cases.  Currently a number of small, medium and large medical bags are being prepared for distribution to hotspots and rebellion areas. These bags contain first aid kits with equipment for performing mid-level surgical operations.

The number of those injured by fire arms is overwhelming (up to 73,000) and there are a lot of children wounded by shrapnel in the abdomen, head and chest or injured when their homes collapsed on their heads as a result of the bombing by the Syrian forces. The situation becomes tragic in the case of a cut to the arteries because the treatment is difficult in the absence of a specialist physician so the patient either loses a limb or dies.

The activists who work in emergency medical aid could not develop their places of work.  Their success differs between one region and another and the extent of which a town or city is “liberated” from the regime forces plays a role in this. All attempts to secure a place well equipped with tools, basic materials and medicines would end in failure if discovery by the State Security forces who raid, steal and arrest those who established it. Inspections and roadblocks are it impossible to operate a true mobile (vehicle-based) field hospital.

One of the key difficulties faced by the medical team is access to areas where the injured are located due to the lack of transportation and knowledge of the local side streets. In addition, in many cases the communication lines are cut in rebellion areas. Also there is poor coordination between involved parties.

The field hospitals which have been established out of necessity by brave doctors and nurses have been set up in a hurry. Therefore it is only natural that they are very modestly equipped. What prevented the development of field hospitals on the ground in the revolution’s hotspots is the regime of course. The security conditions and the army control prevented medical workers from preparing a place fully equipped with all the needs to become a true field hospital, capable of treating all minor and medium injuries. Also those working on rescuing patients are directly threatened with death. Therefore they carried out their work either in houses or sometimes in narrow alleyways or orchards, in conditions that do not provide the minimum levels of sterilization or a clean and healthy environment needed to protect the wounds from infection, and to protect the wounded from amputation of the affected limb, thus protecting them from disability for life.

Government and private hospitals

Nowadays in all cases the demonstrators who are demanding freedom do not trust any government hospital, because the State Security forces completely control those hospitals. We heard a lot of tragic stories of people entering the hospital alive with minor injuries and left the hospitals soulless on stretchers.

Doctors confirm that none of those who were sent to government hospitals in their area managed to avoid arrest from within the hospitals. Alternatively they were killed in the same hospitals under the supervision of the State Security forces. All this necessitated the doctors to treat the wounded secretly in private hospitals, or to establish field hospitals away from the eyes of the State Security and the Syrian authorities.

Going to a public hospital is no longer an option for many people. The army controls the main hospitals and activists believe it is full of Syrian State security personnel. One doctor said “I saw wounded fighters arriving in one of these hospitals and being beaten and detained before receiving treatment.” There was an ambulance parked in front of a field hospital with its left side penetrated by bullets.

Assaults on medical personnel

The Syrian Security forces are repeatedly attacking medical personnel and doctors sympathetic to injured protesters. The revolutionaries and the people talk about how the State Security authorities are arresting doctors and paramedics. One said “they arrested four doctors, a nurse and pharmacist. They were taken off in a brutal manner without any respect, and their offense was that they treated patients and provided them with medication in a field hospital”.

In addition, the security forces assaulted the crew the Red Crescent in the city of Homs several times and arrested its paramedics after they were shot at, which led to the death of one of the organization’s paramedics. The Red Crescent has since called on the Syrian authorities to investigate the case.

Also, all the doctors who the Syrian authorities discovered caring for wounded protesters were subjected to prosecution and detention. Dozens of doctors are known to have been arrested in the city of Damascus, including heads of departments and directors of private hospitals who treated the wounded without notifying the security forces.  The same repressive security forces amputated the hands of two surgeons just because they were treating the wounded, in order to spread fear and terror among medical personnel to refrain them from giving emergency treatment to the wounded.

The doctors stressed that the Syrian security forces have attacked the injured in government hospitals, and beat some of them to death and stole the organs of others. One witness said that one of the wounded was shot by one of the doctors, while two wounded civilians in critical conditions were killed after being injected with high doses of potassium, causing cardiac arrest so it looked like a natural death.  This forced a lot of injured protestors to hide their injuries and did not declare them until after several weeks which led in some cases to the discovery of several serious injuries. The spokesman for the Coordination of Damascus Doctors says: “We had to amputate the limb of one of the injured after the wound got infected”.

Hospitals turned into instruments of torture

These statements come after Amnesty International accused the Syrian government of converting public hospitals to “tools of torture and repression,” in its quest to eliminate the opposition and prosecute it. This accusation was denied by the Syrian Ministry of Health, calling it “null and void”.

The organization said in a report that in at least four Syrian government hospitals the injured were subjected to torture and other types of miss-treatment, and that some members of the medical and non-medical staff participated in such violations. The organization’s report also pointed out that some members of the medical staff in those hospitals, who treated patients injured during demonstrations, also came under arrest and torture.  The organization also pointed out that many of those wounded fearing treatment in public hospitals, have been forced to seek treatment in private clinics and hospitals, or in makeshift field hospitals, which lack adequate equipment and medication.

Lack of proper medical treatment leads to permanent disability

A young man from Kesweh just outside Damascus whose  right leg was amputated on Monday in Amman, Jordan  after getting an infection caused by an explosive bullet eight months ago, but remained “on the run” without  treatment in fear of the security forces which he says have arrested the wounded in hospitals and those wounded ended up either dead or missing.  A few hours before the operation to amputate his leg he said “the demonstrations were subjected to a sudden heavy fire which caused many participants to fell wounded. I remember that we conveyed between forty and fifty wounded, and we transported them to a doctor’s office which he turned it into a field hospital. While [transporting patients] on board of a pickup truck, I was surprised by a sniper on the roof of the government clinic in the town. He shot me in the right leg”. He continues, “The guys took me to the doctor’s clinic and there he told me that my injury is caused by an explosive kind of bullet and I must be transferred to the hospital. He splinted the wound and I was sent back home. The security forces were besieging all entrances to the town so no one can enter or exit.  The young man speaks of his suffering from his injury throughout the day until he was transported to a private hospital through dirt back-roads to a private hospital.  He continues “I entered Jordan through the border unofficially and there I was welcomed by Doctors Without Borders and they treated me for the infections but decided in the end to amputated my leg above the knee, he continues,” my life will not stop because I lost my leg, I’m going to get a prostheses and join the free Syrian army” He adds, “on the day of the fall of the regime I will reclaim my leg, I will get married and then life would begin on that day”.

This case sheds light on the suffering of the wounded inside Syria because of their unwillingness to go to hospitals. Medicins Sans Frontiers media officer in Amman says that 80% of the injured who were treated by the organization suffered medical complications as a result of their fear of going for treatment. She stresses that “the case of the young Syrian could have been simple if he received the appropriate treatment, but his fear of arrest made the wound become infected and it worsened with time making treatment become impossible”. She added, “We have received 48 cases of Syrians, the majority of their injuries are in the bones due to bullets, and surgery was performed on all of them, but the crucial problem is that following their injuries they were treated with non-sterile tools and in a primitive way, which led to complications, and many of them lost a limb and became disabled for life”.

There have been a lot of disabilities as a result of the lack of first aid and hospitals in a large number of areas, and thus the wounded would be smuggled to Jordan using primitive transport methods.  Many of the youth who became disabled spoke of the methods used to smuggle wounded and injured Syrians across the border to Jordanian hospitals, in a trip that could last for days, despite the short distance that does not exceed ten kilometers, using means of transportation such as donkeys and sometimes even carried by others on their shoulders in order to cross farms and valleys to arrive at the safe lands of Jordan.

One of the wounded says:  When I woke up from the coma I was surprised that one of the Air Force Intelligence officers was sitting over my head and has put cuffs on my feet and my hands, even though I couldn’t move.  I was paralyzed because of a spinal cord injury, but the officer was blackmailing my father after he learned that my father will pay everything for my life. The officer began to request money for untying me and my father responded to his request and gave him money. The next day a security officer came to the hospital to interrogate me, and to torture me he pulled the IV catheter line in my hand and violently took out the device that regulates my bodily waste output causing me a great deal of pain. My parents then decided to take me to another hospital so we went to Damascus. Over there I was treated the same way in terms of the torture and the interrogation which prompted me to flee to Jordan. My father and uncle took turns carrying me on their shoulders to cross the barbed wire fence “the Syrian regime installed to prevent people from escaping”. The process took about two days. I did not feel a great pain because of my hemiplegia, but the length of the journey and the movement between the valleys and mountains had its toll on me and on those who carried me. Now I’m in the hospital and have received treatment.

A young resident of Baba Amr says that he arrived in Jordan on the back of a donkey after a three hour journey, but his and his father’s ignorance caused him hemiplegia following a spinal cord injury from the way he was laying on the back of the donkey. The young man, who makes a living out of selling vegetables, adds that he was about to go to his small store and while walking the Syrian army opened fire. He fell on the ground soaked in blood and was taken to a house after his father refused to take him to the hospital after we saw cases of torture of the injured in the hospitals. The only option was to go to the field hospital.

Other young people say they couldn’t get to field hospitals or flee the country for treatment: despite their sufferings they are the lucky ones! The reason is that their relatives or friends were able to take them on either stretchers or on their backs to Turkey or Jordan across bumpy roads to save them from death and ensure their treatment away from the eyes of the security forces.

This is the case of our youth struggling for freedom. They are lucky if they find someone to treat them or smuggle them outside the country for treatment. But the delay in the initial treatment, the lack of proper treatment and the lack of sterilization, medicines and other essentials leads to disability for life, so we find that there are a large number of people whose hands or legs have been amputated due to the delays in treatment and lack of proper sterilization and medicine after being injured by explosive bullets..

Field hospitals are doing a tremendous job to save what can be saved of our young revolutionaries who are demanding freedom. Disability may be the price of freedom. This is what was repeated by a large number of doctors working in government hospitals who were saying to the wounded “Do you want freedom?  Take freedom. We will amputate your hand or leg for freedom and we will not treat you until you know the meaning of freedom that you want” Yes! They are shabiha physicians and Amnesty International and Medicins Sans Fronteirs have confirmed the existence of such physicians in their reports about the conditions of hospitals in Syria.

How can you help?

The wounded resort to the field hospitals, which is the only hope of saving them from death, but we don’t  want to transform them to people  with permanent disabilities, we want to save them so they can return to normal life.

In the shadow of the military war the Assad forces have resorted to, to suppress the revolution of the Syrian, and the spread of sniping operations, shootings, and the indiscriminate daily shelling on most  Syrian provinces, the daily number of wounded is dramatically increasing too. Dozens of wounded per day, and the impossibility of transferring them to government and private hospitals which have been turned into detention, torture and kidnapping centers, making health one of the most important aspects when it comes to supporting the Syrian revolution.

Rebellious areas need secret and secure field hospitals. It also requires continuous support, and high priority should be given to support the Syrian people in terms of establishing and equipping field hospitals, medical stores, and refrigerated blood banks.

Yes! One of the priorities in the support of the Syrian people today is to ensure that the most basic human right, the provision of medical treatment and the prevention of disability. The right to live and the right to access medical care and the right to human dignity. The right to treatment and rehabilitation during crises  and wars. To provide all sorts of support is essential to the continuation of the revolution. We need financial support for field hospitals….. We need support  to provide medical and first aid supplies and medical equipment … We need doctors, nurses, physiotherapists and psychologists to support field hospitals … We need opportunities for treatment outside the country for complicated cases that are non-treatable in field hospitals … We need to support people with disabilities and especially those who suffer from amputation in one or more one of their limbs in terms of providing prostheses and wheelchairs etc.. and to provide rehabilitation programs … We need to coordinate the efforts among all organizations working on the ground and those outside Syria to provide them with appropriate support. Yes, we need a lot of sympathy and encouragement, attention and support of all kinds.

Medical staff are doing medical miracles to save the lives of our young people and protect them from permanent disability…. and here I would like to stop to say on behalf of all the activists. “We stand to pay tribute and respect to those medical personnel who have put their lives in danger and exposed themselves to disability in order to provide medical treatment and emergency services to our people … There are no words; no language to express their loyalty and devotion to this nation. The nation will never forget greeting the angels of mercy who work to protect the angels on the earth”.

Original article in Arabic was published by Disability Rights Syria

[1] Tayyar Hospital refers to a flash/temporary makeshift field hospital that can be setup, dismantled, and moved to another location at a moments notice. The Arabic word tayyar is also used to describe a flash demonstration were a small number of protestors agree to meet at a predetermined place and time to demonstrate for a very short time (few minutes), make their voices heard, record their protest, and then to quickly disperse. To the best knowledge of the Free Syrian Translators the tayyar hospitals and demonstations first appeared in the Arab spring during the Syrian revolution and their creation was of necessite due to the iron grip of State Security and the extreme difficulty of demonstrating and treating the injuried under such a repressive regime whose despotism exceeds that of all other Arab dictators that have being already toppled during the Arab Spring.

4 responses to “Field Hospitals in Syria and Tremendous Efforts to Protect the Wounded from Permanent Disability

  1. I am an amateur Japanese musician. I do believe in the power of Music, Art. When I imaging the harshest reality you are confronting at this moment, I feel insane. Please tell me what I can do.

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