Emergency surgical programme in Al Ramtha Hospital treats hundreds of war wounded patients from Syria – MSF
December 10, 2013
“I was going to get something from the car, I heard the sound of shelling and bombing, then I said to myself I have to get inside. Before I managed, .the area was bombed. I couldn’t breathe for almost a minute, and then I started screaming and calling my dad. He carried me to the field hospital. I don’t remember anything after that. I was in so much pain, I was hitting my face from the pain” MSF Patient Qusay 12 year-old boy, from Dara. Syria, who lost both his legs.
Ramtha town in Northern Jordan borders Dara’ Governorate in southern Syria, which sees some of the heaviest fighting in the conflict. The majority of war wounded arriving in Jordan go to the Ramtha Hospital, a Ministry of Health structure, less than 5 kms from the nearest border.
MSF’s Emergency Surgical Programme inside the Ramtha Government Hospital has two operating theatres and recovery rooms, and two wards – with a total of 33 beds.
Since opening in September 2013, MSF has conducted306 life-saving surgeries on over 140patients, including people needing multiple amputations and with severe abdominal, chest and orthopaedic injuries. We provide surgical care for our patients including orthopaedic and chest injuries. We offer physical therapy and mental health services and general inpatient care. So far a total of xxx mental health consultations have been carried out.
“I have 4 daughters and 2 sons. It was almost 5 pm. We wanted to sit in front of the house with some friends, and then to go to pray in the mosque. After 5 minutes a nearby location was bombed by rockets. We heard people screaming and crying so we went to provide some first aid, and while we were there we were hit by another rocket. I woke up and found myself in Jordan. I didn’t know what happened after the attack. My left leg was amputated. My hands and my right leg are fractured. I thought I was dead. I didn’t imagine I would be still alive now. I don’t know even who brought me here. All my family still live in Syria, I don’t know what happened to them. I didn’t even manage to call them. My family thought I was dead “ 41 year old male from Dara’ governorate, Syria
Most patients are first seen by one of 14 field hospitals in Dara’ governorate, operating in a war zone, and short on many essential supplies. Patients usually come to MSF through a network of Syrian doctors based in Ramtha providing logistical support to get patients into Jordan, and in direct contact with the field hospitals.
“This is a project for victims of war, specifically war wounded who cross the borders from Syria into Jordan, said Ramtha Medical Team Leader, Dr. Amber Alyan. “Patients cross the borders after being wounded as a result of the war, they go through a sort of triage at the border where it is determined if they can cross or not into Jordan. MSF receives around 80% of the cases coming into Ramtha from the border. When we started this project, we expected that patients would need one to two surgeries initially. But, as we are treating such severe cases many patients are needing 4-5 surgeries.”
Long term needs for patients often include rehabilitation such as prosthetics (artificial limbs) and physiotherapy. MSF is referring patients with such needs to Handicap International, many patients also have long term mental health needs, some are being met by other NGOs in Jordan.
War wounded patients admitted to Al Ramtha Government Hospital are not registered as refugees in Jordan. Once discharged from the hospital, some return to Syria if they don’t require further medical follow up. Others seek refuge at one of the refugee camps in Jordan, Namely Al Za’atri in Mafraq. Or, if they are sponsored by a Jordanian family they are permitted to reside in a host community.
Patient stories gathered by MSF tell of their injuries, and their hopes and fears for the future:
Eleven-year-old boy from Dara’, Syria
“I was aware of the whole incident, and how I got injured. A bomb hit an area close to our house. Shrapnel hit the wall next to me. And I started wondering where I should hide. I tried to hide myself behind the motor, then I realised it was about to explode, then I saw the car but it was about to explode as well. So I decided to hide behind the pillar, but another bomb hit the pillar. The pillar was taken off from its place. From the explosion I was thrown up into the sky, and I got stuck on an electricity pole. And then I fell down onto the floor. People came to help me, they took me by bus to the field hospital, but one of my father’s friends was saying ‘’this kid is dead this kid is dead”. But I was aware of everything. And I could hear people talking about me. I managed to scream and that’s when people realised I was still alive. We went to the field hospital. And after that I went into a coma. They cut my hand and my leg but I could feel that it was so painful I started to scream. Then they sent me to Jordan for more treatment.
What can I do? It’s god’s will. There is nothing I can say. I will stay in Jordan until I get a new hand and leg, then I’ll go back to Syria. I’m afraid to go back to Syria because of all the shelling and bombs. But I would love to go back. I want to go back because all my friends and family are still there. I have no one here. My dad is with me now only till I recover. I have four brothers and one sister. When we left Syria, I didn’t want to come to Jordan – but my dad told me we’ll stay only for 2 to 3 weeks. But he said that so that I would agree to go to Jordan and get the treatment. Now we have to stay more than 3 months.
Orjuwan’s father – 33 male from Dara’ governorate.
“Our house was bombed by two tank rockets; five families had been living in the building. I think that most of the families in the building died. My daughter Ourjwan and myself are the only ones still alive. Ourjwan’s mum and her younger sister Yara (10 months old) passed away.
When the rocket hit us I thought everyone in the building died, because I didn’t hear any voices or any movement from anyone. After 30 minutes people came to give us first aid. I was surprised some of the guys here in the hospital showed me a picture on the mobile asking me if this was my daughter and telling me that she is still alive. Thank god she’s still alive, but I wish god had allowed me to die as well. It would be more comfortable to me than living like this. I will be living in misery after what happened. My wife used to tell me ‘please let us leave Syria’. I was against it, and I was always saying that hopefully things would get better, but they didn’t.
I was almost unconscious when I moved from Dara to get into Jordan. When I woke up after the bomb I felt my leg was amputated, and my hand all my fingers were broken. When the guys came I started screaming and saying I’m alive, they came and saved me from under the shells. Fighting was still going on, on the road while we were moving from my house to Jordan. It was very difficult for me; I was so much in pain.
When I saw Ourjuwan alive I forgot my pain she’s a kid what of this is her fault? I need to take care of her. I didn’t allow them to leave Syria, I should’ve fled Syria. Destiny was faster than my decision to leave.
Hanan – six-year-old girl who has lost her leg, she is being cared for by her grandmother
“I was standing behind the window with my mum looking at the problems outside and then I fell down and I got injured. Then they took me to the hospital. I’m good now, I don’t feel pain. I spend my days here drawing people around the hospital. I don’t know where my mum is but my grandma is with me here.”
“ Hanan’s case has affected me the most, she’s a child with an amputated leg - and her mum is not around. The first two days she was here she was in shock, her mum wasn’t with her and no one from the family and she didn’t know where her parents were. The first day she stayed asleep all day, but whenever she woke up she would scream “my leg, my leg”. We started counselling her. We try to see what makes her happy and what gets her attention in the hospital. We found out that she loves drawing, so the coping strategy with Hanan was through paintings and colors. Slowly she started to recover. She will draw anyone who comes into the room. Before, she didn’t want to talk to anyone. Now she talks to other patients, and to the medical staff. Ibtasim … MSF Mental Health Officer talking about a patient.
Female 20-years-old from Dara’ governorate Syria
“We were sitting behind our house. My mum, me and my baby brother, who was sitting on my lap. My dad came to tell us “they are bombing the neighborhood let’s go inside”. We were bombed before he finished his sentence. I didn’t feel anything in that moment. I thought I was under shells, but my body is fine. When I opened my eyes I saw my mum lying severely injured next to me; my younger brother survived- nothing happened to him. But my dad was injured. As for me I got shrapnel in my back, legs all of my body had shrapnel. My dad started shouting for people to come and help us. When they came to see me I was telling them ‘don’t worry leave me, I’m good’. I didn’t feel that I was injured until I got to the field hospital and the doctor was treating me. Then they decided to send me to Jordan because I had injuries all over my body. But I didn’t want to leave; they forced me to leave as I need further treatment that they can’t provide in the field hospital. So I’m in Al Ramtha hospital, and my dad is in another hospital in Jordan, my young brother is still in Dara with my uncle, and my mum passed away.
We got used to this. Everyone in Syria is passing through the same thing. In the beginning when the conflict started we used to get scared from the sound of bombings, but after that we stopped feeling this way. It became somehow normal to us. But now after being injured, I feel terrified.
I was injured around 11:00 am. At 3:00 pm I was in Jordan in the hospital; the help they provide me here in the hospital is great I feel like I am surrounded by family. I’m still in pain now, I can’t sit still because I got injured in my back, but I’m feeling much better than before the treatment here.
After this I don’t know if I’ll be going back to Syria, mine and my father’s treatment will take some time. But if they bring my two brothers from Syria here, and my dad agrees to live in Jordan then we will stay here, otherwise we’ll go back to Syria.
Until now they have given me 4 surgeries, to take the shrapnel from my body, I feel so safe and secure here. I take my treatment regularly; I had mental health, and psychotherapy sessions. I needed the mental health support. I felt that my mum passed away, but I wasn’t sure. My family tried to hide this information from me, then they decided to tell me and it was a major shock to me. It’s not any easy thing to deal with the loss of my mum.