The New England Journal of Medicine
“Where’s my mom?” a boy asked as he woke from surgery. Both his legs had been amputated when a missile hit his home in Aleppo, Syria. His mother had died in the blast. It didn’t take him long to realize the answer.
Every time I have volunteered to work in a field hospital caring for Syrian patients, I witness similar horrors and come back with nightmares. It gets worse with each trip. And whereas I never stay more than a month, Syrian physicians have endured these conditions for years — many working in caves and basements under persistent siege and bombardment. Each day is the same: cleaning mutilated wounds, amputating obliterated limbs, and watching people die in overcrowded emergency rooms with pitiful resources.
If we have two critically wounded patients and only enough blood to save one, we decide which one to save and which to watch die. What do we say to the family whose child we let die, knowing that we could have saved that life ?
How do we answer the teenager who asks if he will walk again? He was paralyzed from the neck down. Shrapnel from a barrel bomb had transected his spinal cord.
How do we comfort a mother sitting in a crowded room next to her 12-year-old son, his left arm amputated, both legs with exposed muscle, and his abdomen open with a colostomy bag? He had been playing outside on a day he thought there wouldn’t be any bombs dropping.
When a father whose 5-year-old son was shot in the head by a sniper asks, “Who would kill an innocent boy? Why didn’t he just shoot me instead?” how do we respond ?
What do we tell the family whose daughter died coughing and choking on her own blood? The bleeding wouldn’t stop; the blood pooled on the floor. No matter how many lines and tubes we placed, we couldn’t save her.
How do we console the father whose 13-year-old son’s skull was blown open above his right ear? When I saw the boy, his exposed brain was covered with gauze and his eyes were swollen shut. He winced and grimaced now and then in response to pain, but he did not last very long.
How do we care for the 70-year-old grandmother who presented with her abdomen lacerated open, her left foot amputated, and her right leg crushed? How is she expected to survive?
On a recent visit to a border hospital in Jordan, I entered one room that held two little girls with traumatic brain injury from shrapnel and concussive bomb blasts. They sat with expressionless faces, vacant eyes, and contracted limbs. How do we console the parents who asked why this had happened to them — and whether their children would return to talking, playing, and laughing?
Next door were three young siblings who’d been severely burned when a rocket hit their home. Two of them required amputations; all three were scarred for life.
One morning, I saw a mother carry her son into the hospital. They had just survived an air strike. They were covered in blood and caked in gray dust. The son was bleeding from a torn artery in his left arm. His life and his limb were saved by blood transfusions and emergency surgery. The mother said that she’d been holding two of her sons before the bomb landed — the other one had died in her arms. She’d felt his intestines in her hands from an open wound in his abdomen. He wasn’t moving. She had to let go of him in order to save her other son.
The scariest moments have involved children delivered on bloodied stretchers, eyes wide open, making no sound and only flickers of movement, barely clinging to life. Children should never be silent when they are hurt. It’s difficult to witness: they’ve lost so much blood and have only so much breath left for fighting before they finally let go.
As medics, we would go to sleep hoping that when we woke up, the previous day would turn out to have been only a nightmare. No one should ever suffer like this. Yet we’d wake to the truth, and the nightmare day would repeat itself: mangled limbs, dismembered bodies, dead children.
My experience is merely a glimpse of the systematic campaigns of torture, starvation, aerial bombardment, and chemical weapons deployment that are still threatening the Syrian people in their homeland. They have been ongoing since the civil war started 5 years ago. Civilians, homes, schools, hospitals, and markets are deliberately targeted. To date, hundreds of thousands of people have been killed, and millions more have been displaced.
I cannot claim to have the solution to the war, but I know that there are good people in Syria trying to make a difference. There is still some humanity amid all this brutality and madness. Paramedics brave sniper fire to rescue the wounded. White-helmeted rescue workers dig through rubble with their bare hands to find survivors. Doctors and nurses in bombed-out basement hospitals use cell phones to illuminate operations when the power goes out. These good people will be the ones to pick up the pieces if and when this horrific war ends. They don’t plan on abandoning the helpless, and they need all the help they can get.
All I can do from here is bring attention to the suffering of the Syrian people, raise awareness for the exhausted medical workers who care for them, and continue to advocate for their support and protection.