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“We had expected an attack to happen”


    Hama Central/Sham Hospital was an important referral facility in southern Idlib and northern Hama governorates in Syria, supported by Médecins Sans Frontières (MSF) with regular monthly donations of drugs and medical supplies.

    The hospital’s director spoke to MSF on Wednesday 27 September 2017 about the circumstances and consequences of the airstrike on his hospital. He asked us not to publish his name. This is his account and his plea to the world:

    Our hospital began in 2012 in the outskirts of Hama. It was a small hospital, with one surgery room and a recovery room. It was not very developed as a hospital, with most of the financing and support coming from the community. Our main goal at the time was to treat war-related injuries: people wounded by shelling and airstrikes. It was hit twice by rockets and was destroyed in 2013.

    The entire staff had to move elsewhere and we established a new facility - bigger in size, it had different types of specialized surgeries, and had more capacity to handle a larger influx of patients. That hospital was hit three times, with the last strike, in 2014, comprehensively damaging it.

    After that attack, the staff and I moved our work to a cave which was supported by MSF. While working in the cave hospital, the medical staff and doctors in the area were keen to establish a more proper hospital. We bought land and with support from NGOs, we started building an underground hospital. It was in a basement three floors underground, with all the services that a hospital can have.

    Busy but precarious

    We worked in this hospital for more than six months, providing crucial help to the people in the area. On average, we were treating 6,000 patients and conducting 500 surgeries per month -surgeries of all types, from eye to bones to heart. Then, last year in 2016, it was struck by an airstrike and we were forced to move back to the cave hospital while we renovated. However, the cave was also hit, and we had one staff who was killed from that attack. We decided to move back into the basement hospital while the renovations were taking place.        

    On the morning of last Tuesday, September 26, at around 6:30 in the morning, the hospital and its vicinity was hit by three missiles. One of the missiles exploded through the top floor and went all the way down to the bottom, destroying equipment and damaging the surgery, x-ray, and Intensive Care Unit rooms.

    Mass casualties

    Luckily, we were prepared as we had expected an attack to happen. A week earlier there was an increase of attacks which had destroyed three other hospitals in the area all on the same day. As those hospitals went out of service and other closed down in fear of being bombed, we were the only hospital in our region receiving patients. In the last days, we were getting a constant stream of mass casualties. The town of Qalaat al-Madiq came under attack and on the first day we received 60 wounded at once; on the second day 50 at once.

    An airstrike does not discriminate between a child or an elderly person, a man or a woman.

    We get children and elderly among the wounded, the youngest being around one year old to the eldest being over 70 years old. An airstrike does not discriminate between a child or an elderly person, a man or a woman. Over the five years of our work, we got used to mass causality situations, dealing with these large influxes, triaging and screening which patients can be saved or which cannot be saved.

    The two most important things

    From my perspective, as a director of a hospital in these circumstances, the two most important things to me are: how to receive patients and make sure they are treated, and how to protect my staff. You cannot imagine how is it to receive 50 injured while you only have 30 staff members on call. Theoretically you would need 150 staff to assist the 50 injured. Therefore, you have to be prepared and make sure that everyone is motivated and ready, and that you are connected to a network to call in the staff during an emergency and then make sure they leave immediately once their work is done since it is no longer safe to be spending too much time in a hospital.

    At the end of the day when you see that you have saved patients from death you become relieved and happy.

    Being exhausted is natural in such circumstances, but what keeps us going is that we are saving lives. At the end of the day when you see that you have saved patients from death you become relieved and happy. Saving a life is not a simple act. This is the feeling prevalent among not only the doctors and nurses, but all the staff in the hospital. 

    But now our hospital is out of service. It needs to be rebuilt and we want to ask organizations to support our rehabilitation.

    Bombed more than ten times

    We also hope that there are negotiations ongoing that can put an end to the airstrikes. In our experience alone, and by my count, we have been struck by more than 10 airstrikes throughout the different stages the hospital went through since its establishment in 2012.

    In general, the healthcare provision in the area is very limited in terms of services and infrastructure. This was true even before the war and now, adding war into the equation, it is declining terribly. This is causing medical personnel to leave, especially in the past few months, and we do not know what the future holds. It is all linked to politics and war, but our job is to continue treating the patients as best we can.

    I still have hope. To paraphrase a poem, ‘What is a human being without hope?’

    I still have hope. To paraphrase a poem, ‘What is a human being without hope?’ There is hope, but people have immense needs. They think about how not to die and how to earn a living to survive.

    I do not know what my message to the world is. Our messages have been sent out many times and for a long time and nothing has changed.  The most important thing to say is that the first victims of this war are the children, then the civilians as a whole. Let this war stop. Let us live normal lives.

    MSF in Syria

    While not the primary support organisation, MSF had been supporting this facility with regular monthly medical supply donations since 2014. MSF directly operates four health facilities and three mobile clinic teams in northern Syria, has partnerships with five facilities, and provides distance- support to 73 health facilities countrywide, in areas where MSF cannot be directly present. No MSF staff are present in supported facilities. MSF’s activities in Syria do not include areas controlled by the IS group since no assurances about safety and impartiality have been obtained from their leadership, nor can MSF work in government-controlled areas since MSF’s requests for permission have to date not resulted in any access.

    To assure independence from political pressures, MSF receives no government funding for its work in Syria.

    Find the press release