When I travelled to Aleppo Governate, the most striking thing, once inside Syrian land, was the apparent calm. The landscape is mostly pastoral, and even peaceful if not for the presence of a couple of checkpoints. Médecins Sans Frontières / Doctors Without Borders (MSF) has settled in a small village a few kilometres from a bigger urban site.
Our medical activities here are organised around a field hospital of 25 beds, with an emergency room, operating theatre, in-patient department, out-patient department and maternity department. While I was there I mainly worked as an emergency room (ER) doctor but I also participated in ward rounds, seen patients for consultations, and contributed to the maternity medical activities.
The personnel are highly dedicated, even though at times there is lack of medical staff and everybody is stretched. There has been a "brain drain" of medical specialists from Syria and of the remaining medical staff, many are physicians who were still in training when the conflict started.
Now they have to cope with the gruesome consequences of the conflict. It’s deeply disturbing to see, for instance, babies come in with serious malformations. During the ten days I was in our hospital, we received an unusually high number: three babies were brought in with severe birth defects, possibly resulting from a lack of folic acid. We cannot draw conclusions from these three cases, but even for myself, a trained paediatrician with twenty years experience, it was a shocking illustration of the collapse of a society that used to enjoy a sophisticated system of healthcare.
The story that stays with me most is that of the two pregnant ladies. It happened on a sunny, warm day. Towards the end of the morning we heard planes roaming above our heads. A few minutes later I heard the sirens; two women were rushed into the ER. One was as pale as a white-board, breathing with difficulty, with a shrapnel wound to the left thorax. She was six months pregnant. Her oxygen saturation was decreasing dramatically. We quickly stabilised her in the ER and rushed to the operating theatre for a chest tube. She was fighting to breathe for the rest of the day, while we gave her transfusions and oxygen. We closely monitored her. The next day, she had won the battle for her life. Sadly, the baby had died.
The other woman was six months into her pregnancy as well. She was screaming with pain; she had an injury to her left ankle, a hole the size of a tennis ball, with major loss of tissue and bones. The surgical team took her into the operating theatre, reconnected blood vessels and put in place an external fixator. Her foot did not win the battle; it had to be amputated below the knee the next day but her baby survived.
It was a sunny day and two pregnant ladies were going to the market. An everyday event, that brought home the horrors of this devastating conflict.