In Syria today, there are many storms and relatively few moments of calm. I was enjoying a rare moment of peace, a time to exhale. It was a hot, balmy late afternoon on 26 August and I was sitting on the hospital balcony overlooking the olive groves. The sun was tipping into descent promising respite from its heat. Away from my comfort zone as an emergency medicine doctor in London, I was working in a northern Syrian hospital under the umbrella Hand in Hand for Syria – an aid group – and being followed by a BBC Panorama team, that was looking into the impact of the war on children.
Drinking my tea I was getting to know my Syrian colleagues. I don’t speak Arabic but they had some broken English. We laughed at jokes we couldn’t understand and at each other’s sayings. I admired them for having stayed when so many others had left – medical staff are high-value targets here. The sudden screech of a truck pulling into the hospital courtyard was the only alert we got that a patient had arrived. I ran down the stairs to the sparse “re-sus” room – the patient was an eight-month-old baby. His face looked scalded and the left leg was red. The exact cause of injury was unclear, the initial translations mentioned a car crash.
As I worked a young boy appeared to my side. He looked ghostly covered in a white ash moving slowly and quietly. On the right side of his head a large laceration so deep his skull was exposed. “Where shall I go ukhti (sister)?” A multiple pile-up, I wondered? Holding him upright, looking for another trolley I turned the corner of re-sus. This was bigger than a car crash – we were in the middle of a mass casualty situation. Within minutes the hospital was overflowing. The only space left for patients was on the floor, propped up against the wall in the reception area.
A boy sat on a chair, with his hands outstretched, shivering and quiet. Ahmed, 15, was naked apart from underpants. I looked at his hands – the skin was falling off as if he had been peeled. A scream pierced the general noise. It was that of a young girl, 17-year-old Seham, lying on a trolley in absolute agony, where even a light touch was beyond what she could bear. She had suffered burns all over her body, including her face – the pain unimaginable.
A nearby private school, the Iqraa Institute had been hit by a thermal bomb. This is opposition-held territory; the bomb came from the government. In those initially chaotic moments we thought the hospital was under attack. Not such an unlikely thought, as hospitals have been hit previously in this war, as outlined in a recent report by the UN’s Independent Commission of Inquiry on Syria (Icis).
Last week, The Lancet published a letter signed by 55 prominent doctors from around the world calling for protected access to healthcare in Syria. It describes a limited healthcare system with 37 per cent of Syrian hospitals having been destroyed. Icis describes the Syrian regimes targeting of healthcare as a “weapon of war”. Staff mobilised but chaos ruled, their faces hidden under white masks in the belief that the bomb was chemical a one. Panic filled the air. I wasn’t wearing a mask, carrying on in auto-pilot until a nurse forced one on to my face. The injured walked like zombies, holding burnt limbs away from their own bodies.
Among the almost film set-type horror, I spotted the BBC Panorama team capturing images later broadcast to the outside world. Their footage was first aired a few days later, just as MPs in Westminster were voting against UK involvement in military action. “This is not the first or the worst scenario and probably it won’t be the last – but maybe this time someone will listen because the camera is here,” one doctor told me.
One of my patients, Anas Said Ali, 18, was so badly burnt his hair had melted, his body still emanating heat. “I want to sleep,” he kept saying. His father stood by, patient and quiet – himself in shock. Anas was tall, just like his father and the only boy in his family with three younger sisters. Had just one of these patients arrived to our London hospital they would have been instantly transferred for specialised burns care, but here with nearly 40 victims and only the basics to offer, I felt so useless.
One girl spoke to me in English. I was humbled by her efforts despite her terrible pain. “How bad is my face, ukhti?” Her mother cried by her side. The girl, composed and calm but in obvious pain asked. “Do you think they can fix my face?” She continued in Arabic, speaking to Dr Rola Hallam my fellow British colleague, who is of Syrian origin. “I was just at school studying… because I want to be like you – a doctor to help people.”
They had been in class in a quiet relatively affluent residential street lined with white houses. The first bomb had hit a nearby building penetrating three floors and injuring my first patient, the baby. Everyone ran to help. Parents had rushed to the school on the first hit to take their children home. Anas had come for his 14-year-old sister – a student. She was saved but he was so terribly burnt. One of the teachers, Abdullah put out the flames on another student, Mohammed Fakhouri, 17, alight in front of him, with his own hands. But the burns were too severe – his last words were caught by Abdullah – “La ilaha illallah” – “There is no God but Allah” – the Muslim declaration of belief. Three students were killed instantly – their charred bodies brought to the hospital. I was told they were girls – but I would never have known. Mohammed Abu Omar, the head teacher, described the flames falling like rain incinerating everything in its way; reducing humans to strange mannequin-like beings, with toughened, hardened skin – impenetrable to our efforts to place intravenous lines for those still alive. Other equipment I needed just wasn’t available.
One boy was unidentifiable but alive. We sedated him and placed a tube down his throat so he could breath. He was fixed in a position, not able to move his arms, legs or even face. I could not find a single patch of unburnt skin to place an intravenous line. His entire body was covered in third degree burns. Only his eyes were moving – registering that he was alive and terrified. He died on the way to the Turkish border and was brought back to the hospital – laid to rest unnamed, his family unaware.
I visited the bomb site a couple of days later. The smell, heavy, strong and sickening was hanging over the school. I had smelt it in the hospital that day – clinging to my patients mingled with the smell of burnt flesh. A student’s workbook lay at the bottom of the crater left by the bomb - charred – the writing still visible. The student who wrote that herself was dead. In a classroom the half-taught French lesson still on the board – the teacher who wrote it himself now in a special burns care unit in Turkey. Such was the intensity of the impact and the heat – none of those who died stood a chance. We saw a white gel, clinging to the walls. This same jellied fuel stuck to the students’ skin, increasing the level of injury. Sara, eight, ran out to see us at the school gates. Her hair hung in a rough bob above her shoulders. She told us that her long hair had been cut because it had caught fire that day. Never mind, we told her, it will grow back. She escaped the worst but she remains vulnerable to similar attacks. No child is safe in Syria today.
A week later I travelled to Turkey to see my patients and there, at the local hospital where some of the victims had been taken for specialist care, I learnt that three of the young victims had already died. Severe burns in children have a poor outcome. Walking into the intensive care unit, I was overwhelmed. There in front of me was Anas covered in bandages, unrecognisable. His father, quiet and attentive as before stood by his son, trying to give him sips of juice through a straw. The jellied fuel had stuck to his face, burning deeper and longer. He had a hole in his throat, where a tracheostomy had earlier been removed. To talk his father pressed the hole. In a painful whisper he spoke to me. “I remember you.” Unprofessionally, I cried at the bedside.
A week later, we received a call from one of the teachers. Two more students had died of infection, one of them was Anas. His father remained dignified in his grief. “We all have to die, whether now or later,” as he took the body of his only son home. We now know 19 students suffered severe burns that day, requiring transfer to Turkey and a further 10 have so far died from their wounds.
'BBC Panorama - Saving Syria's Children' – 10.35pm BBC One