Sat peacefully on a hillside in the North East district of Marka within the Hashermite Kingdom of Jordan’s capital Amman is the Medecine Sans Frontieres/Doctors Without Borders Specialized Hospital for Reconstructive Surgery. First established as a surgical project within a wing of Jordan’s Red Crescent to care for victims of war from Iraq in 2006 it has broadened its mandate to receive patients from Gaza, Yemen and most notably Syria. Additionally since the 8th September 2015 it established itself, at new premises, as a fully-fledged medical facility devoted solely to reconstructive surgery, physiotherapy and psychological support for victims of war. The MSF Hospital of Al Mowasah on Tirmizi Street in Amman is unique in offering a comprehensive care package for its patients free at the point of delivery. It is the societies biggest single annual financial commitment with an expense of some €10 million per year and a departure for the organization from a solely disaster response role to one that incorporates and offers ‘a life rebuilt’.
“At this Hospital we start again. We give them a second chance.” Jean-Paul Tohme a Lebanese born French national and project coordinator for Medicines Sans Frontiers Hospital for Reconstructive Surgery comments when asked to outline the distinctive character of the Al Mowasah and what it delivers to its patients: “We have patients who are victims of war. You will usually find them in military hospitals. They’re not hot cases (referring to immediate life saving surgery) but we have what we call cold cases. They are patients in need of reconstructive surgery. Physiotherapy and Psychological support to allow them to live again.” In between sipping hot sweet Arabic coffee flavored with cardamom Jean-Paul, seated in his office with in the MSF facility, continues: ”Most of our patients are Iraqi or Syrian. They’re traumatized already by what they have witnessed and been through in their long journey to safety here in Jordan.” Just before being called away to a meeting with fellow members of staff Jean-Paul adds: “At the initial point of contact with the wounded no one has the means to do more than patch them up and hopefully save their lives but here we’re about rebuilding.”
Testament to this is Saha a dignified and unassuming 35-year-old single Syrian woman originating from the Saladine district of the war ravaged city of Aleppo. While resting in one of the full time accommodation rooms MSF offers to its patients during their stay at the Hospital Saha starts to recount her story starting in 2012. Her mother Amira sits patiently on an adjacent bed listening to her daughter: “Before the war I was living a very simple life. I worked in a shopping mall and I come from a middle class and comfortable family in Syria. It was between 7 and 8 o’clock in the evening during Ramadan (this is in the ninth month of the Islamic calendar and is observed by Muslims as a month of fasting from daybreak to sunset) and I was walking to my sisters in the Kallaseh district of Aleppo when shells started to fall around me. I sort refuge in a house along with several other women and children. With in 2-3 minutes of being inside one of the shells hit the house and the woman next to me who was standing was killed instantly and I received shrapnel wounds to my hand and legs and broke 3 of my ribs. I remember a flash of light and an explosion and I could see my arm flapping about in front of me when I tried to move it. I was screaming-my legs my arm- but I never passed out and I was eventually wrapped up in a blanket by other survivors and carried to the nearest clinic at the ‘Abdel Aziz Hospital’ and then moved later to the ‘Al-Razi Hospital’ where surgeons tried to save my leg.” It’s been a long journey for Saha. She’s endured 19 operations so far to try and correct the damage done to her. She’s suffered complications with infections to her wounds. The incorrect setting of her arm in Aleppo damaged the nerve endings in her fingers inhibiting recovery and the additional tragedy of the death of her father in Syria, also as a consequence of shell fire, shortly after her own injury.
In the 2 months she has been with MSF she is slowly returning to health. Physiotherapy is restoring functionality to her hand and her left leg is being gradually extended at 1mm per day to reach parity with her right leg to aid walking: “I have at present no plans for my future apart from being able to walk again with out a limp and be healthy. I want to live a life without pain.”
Beginning in 2006 and formalized as a self contained dedicated unit in 2015 the MSF Hospital to date has received in excess of 3,700 patients and undertaken 8,238 surgical procedures. It has also concluded more than 134 thousand physiotherapy appointments and over 454 thousand psychological sessions. But with the numerous wars in the Middle East seemingly having no end in sight the Hospital presently has a 4 to 5 month waiting list for new admittances. Paradoxically, as the intensity of the violence increases in Syria, Iraq, Gaza or Yemen then so does the case load and need for what Al Mosawah can offer. Marc Schakal, head of MSF in Jordan, in a recent interview with the Associated Press made the case of: “One hospital is not enough.”
Set away, down a side corridor, from the Hospitals main entrance but still on the ground floor is the Learning Room. Here is where 29-year-old Psychology Counselor Talha Ali along with his colleagues endeavors to restore the shattered emotional lives of children. On first impressions the room is a place of happiness. Brightly colored drawings adorn the walls and toys and games sit invitingly atop tables. Its not until you take a second look at the 15 or so children that are busily playing within its walls that you start to register the missing limbs. The abundance of wheelchairs and crutches, small arms held in slings and the severe facial and body burns some of the children exhibit. “Many of the children haven’t been to school for many years.” Explains Talha: “Even before their injuries. We try to focus mostly on reading and writing and simple mathematics.”
13-year-old Iraqi child Mohammad Nagi Mashala is intent on catching Talha’s attention while he grapples with the meaning of some Arabic lettering written on the blackboard. As Talha talks to him Mohammad sits with his crutches placed to the left of his chair. The story of how he came by his injuries is not exceptionable by the standards of the children in the room. It has unfortunately become part of the norm. On the 8th of July 2012 while he walked to the local mini-market from his home in a suburb of Baghdad a roadside bomb exploded. Shrapnel tore through both his legs causing extensive damage in particular to the right leg. It’s Mohammad’s 4th admission to the MSF Hospital and he will require on going surgery and physiotherapy until he stops growing at around 18 in order to enable full use of his legs and return to ‘normal’ walking. Mohammad’s grandmother Rasmir is in attendance with him during his long stay at the hospital: “It’s been more than 3 years since Mohammad was injured and in all the time we have been here at Al Mowasah we’ve received nothing but respect and care. It’s more than very good what we have been given. It’s like once we were dead but now we have the chance to rise again.”
Down in the basement of the Hospital is the Psychology Department’s main office. Talha while writing up some notes from the day and now out of ear shot of the youngsters in the Learning Room confides: ”When I go home I can cry for the children as victims of war but when I’m here my job is to focus on getting the children well again. To enable them to trust the world once more.” Telling a very poignant story of a young Syrian boy they have in their care who has extensive facial and body burns Talha continues: “I asked Sayid if he would draw a picture of himself and he went away and came back with a picture of a monster. I told him he was not a monster but he was a hero.” Patiently Talha tries to explain the long process of psychological acceptance and acknowledgement his department attempts to foster within the children: ”For most of us when something goes wrong in your life you usually have two options. You either try to fix it or to live with it. We can’t fix the burns to these children’s faces or the loss of limbs, so we have to cultivate understanding and acceptance. Sayid needs to know that he is a hero with all that he has endured.” In parting Talha ads another reflective thought:” If you raise a healthy child you raise a healthy nation.”
Orthopedic surgeon Dr Ali AlAni is making his ward rounds on the second floor of Al Mowasah. This morning he and his surgical support team are checking the well being of 10 patients in the medical wing. An Iraqi by birth he left Baghdad in 2005 when the situation in his nations capital became -“Just too dangerous.” - for him to stay and he’s been working with MSF since 2007. The previous day Dr Ali had been in surgery and the day prior to that he’d attended the ‘Validation’ meeting when all the surgeons in the hospital come together to review potentially new patients admittance to the surgical program. Several of today’s ward patients are in isolation due to infections from operations prior to entrance to the MSF facility. The team don extra gowns and rubber gloves before entering these rooms: “I start from zero with my patients” Dr Ali explains: “I clean everything with in the wound and start over again.” Adding: ”It can be very primitive treatment in the war zones. You have field hospitals that have to deal with huge numbers of wounded. So the ones who manage to get themselves to us here at MSF are the lucky ones.”
On finishing his rounds at 10.30am he descends the stairs from the operating theatre’s recovery rooms and makes his way to the ground level where his day will continue processing some of the first appointments to the hospital and assessing these patients’ needs. Walking along the corridors he’s greeted by some of his former patients and they’re eager to show their gratitude and admiration by shaking his hand as he passes. Indeed later in the day in a consultation room Dr Ali is given a joyful kiss by a thankful patient on the news that his wound is now in full remission: “These things, these successes sustain you through the times of exhaustion.” Dr Ali comments after the man has left the consulting room. 3 other team members always accompany him in these sessions of patient review. A fellow Orthopedic Surgeon to concur on surgical treatment a General Practitioner and a Physiotherapist in order to undertake a full and comprehensive assessment of medical need.
A small fragile 7-year-old Syrian girl with pink ribbons tied in her hair enters the consultation room she’s accompanied by her mother. Paralyzed in her right hand by an explosion in her home city of Damascus on the 1st September 2015. Shrapnel had pierced her shoulder and the team is assessing the remaining mobility she has left and what the action plan should be. An MRI scan is ordered and continued Physiotherapy is advised at this stage. She’ll be returning the following week for further assessment. Jordanian General Practitioner Dr Zaid Sabeeleish, married with a young 4-month-old son is one of the consulting rooms attending physicians. When asked how he comes to terms with some of the heartbreaking cases they all have to encounter at the Hospital he recounts his story: ”As the GP I take the full history of a patient when they first come to us. It can get very emotional, as they have to recall all the events that lead to there wounds. Patients often break down re-living the experience. Before I came here I was a GP at a general hospital. On my first day here my first patient was a victim of an explosion and had full facial and body burns. Even as a doctor I was shocked. The next patient had no lower jaw, blown away by bullet fire. It was then that I knew that this job was going to be a tough one.”
Across on the other side of the Hospital in the Physiotherapy Department Moayed Srour a 29-year-old Law Student from Al-Shaykh Maskin City in the Darah region of Syria is learning to walk again with the aid of an artificial leg. Zuher Hizzy, one of the hospitals physiotherapists is putting Moayed through his paces with his prostheses: “He’s a slave driver.” Moayed says with a smile, in reference to his physiotherapists, as he’s encouraged to put more of his own body weight on to his artificial leg while supporting himself on the parallel bars. “I’m preparing myself for another year of this but Zuher believes it will take another four.” Moayad was hit by a tank shell while sheltering behind a wall with some of his friends in December of 2014. Loosing consciousness with the injury he woke up 7 days later in Amman with is right leg below the knee amputated. He then spent 4 months in the Zaatari refugee camp on Jordan’s northern border awaiting his turn to come to the MSF Hospital: “I can’t remember how many operations I’ve had so far. Maybe 14 or 15 but it would of taken me forever to recover without this place.” He adds before returning to the disciplined task of his own recovery.
It is with out a doubt a long and painful process that the war wounded who come within the sphere of Al Mowasah’s medical care have to go through to reach any semblance of full recovery. Jean-Paul makes the sobering but essential point about the need and work undertaken by the dedicated staff within the Hospitals walls: “Who will help them, if we do not.”