Ramtha, Jordan: Emergencies Abound

The war is never far away in Ramtha, a city in northeastern Jordan just three miles from the Syrian border and only a little further from the Syrian town of Daraa. Explosions echoing in the distance are one indication of the conflict’s proximity. The steady stream of wounded arriving at MSF’s trauma surgery program at Ramtha Hospital is another.

Dr. Haydar Alwash, an MSF surgeon, hardly needed a reminder, but he got one anyway when he tried to use an unexpected afternoon lull to conduct a training session for hospital staff. Drawing on past experience in MSF surgery programs in Liberia and Libya—not to mention the work he and MSF had been doing since opening this program in September 2013—Dr. Alwash was talking about putting casts on fractured arms and legs, injuries the teams were seeing frequently. Before he could finish, however, a call came in saying that three badly wounded patients were on their way from the border and that there were children among them.

Dr. Alwash had already performed a surgery that morning and had others scheduled for the next day. He and his team had performed doz­ens in the weeks prior as well. “All our patients are newly injured in this conflict,” he says, usu­ally by bombs or gunshots. “Our work mainly concentrates first on saving lives—surgical procedures that can save lives or save limbs.”

In Ramtha, MSF runs two operating theaters with 33 beds and two wards at a Ministry of Health hospital. MSF gets patients through a network of medical professionals inside Syria who run field hospitals but cannot provide all of the surgical and post-operative intensive care that severely injured people need. Instead, they steer them across the border to waiting ambulances that transport patients on to Ramtha.

When the ambulance arrives on this day, the team learns that there are two patients rather than three, but that one, a child, has already died. Another, a man with shrapnel in his leg, has a ruptured artery and has lost a great deal of blood. He is rushed into surgery.

Dr. Alwash hurries into the operating theater as well. Originally from Babylon, Iraq, he was himself a refugee after the first Gulf war in the early 1990s. While living in a squalid, overcrowd­ed camp, he got support from MSF to open a clinic for his fellow refugees. He was thrilled that he could offer assistance and he later deter­mined that he’d find a way to work with MSF in the future, “to repay the favor,” he says.

On this morning, Dr. Alwash started his rounds around 8:30. Among the first patients he saw was Sami, 22, who had undergone four surgeries since he was admitted a month ear­lier after being shot in the leg. Then there was Malik, a 14-year-old boy who lost one leg and suffered serious injuries to an arm and his other leg when his house was bombed during a wed­ding party. “I didn’t feel anything,” Malik says.

There was also a 23-year-old man with injuries to his eye, leg, hand, and chest who is expecting to be here at least five more weeks, and a young girl, an infant, who lost a leg when her house was hit by a tank shell that killed most of her family, including a baby sister. “What has this child done to deserve this, that she has to have her leg amputat­ed?” asked her aunt, who was staying with her while she was in the hospital, and who lost her own 16-year-old son to the war.

Dr. Alwash later reached the bedside of a girl named Rukaya, 14, who was out walk­ing with her mother and a neighbor in their hometown when a shell hit nearby. She remembers that it felt like her legs were melting but not much else until she woke up in Ramtha, where she learned that she’d lost both legs and her mother was dead. Seven surgeries followed, and Dr. Alwash will perform another tomorrow as part of the process of preparing her for the prosthetics she will have to use for the rest of her life.

Rukaya smiles when she talks to the doc­tor, and she smiles once more when asserting her determination to be happy again one day. Other patients also show uncommon fortitude given their circumstances. Malik, for instance, is usually up for a game of chess with anyone willing to play, patients and MSF staffers alike. Others say they hope to return home as soon as they can walk again.

Their resilience helps mitigate, to some small extent, the difficulty of seeing the injured and maimed arrive one after another. On one particularly hard night, Dr. Alwash says, three children—a six-month-old baby boy, a two-year-old girl, and an eight-year-old girl—arrived in the same ambulance, “all of them with severe injuries,” none of them with any relatives.

The baby boy had severe head wounds. “He passed away a few minutes after he arrived,” Dr. Alwash recalls. The team stabilized the two-year-old and managed to resuscitate the older girl, who was almost completely white due to blood loss. Still, her legs were mangled and one had to be amputated. She was in shock, terrified, and there was no one there from her family who could help explain what was happening. With her life at risk, the team had no choice but to operate. Later, they worked with contacts in Syria to bring her grandmother to Ramtha to be with her.

Though that patient has a long road of rehabilitation ahead of her, she is now in good condition, Dr. Alwash reports, and though he is visibly rattled when he recounts that night, the story also reminds him why he and MSF are there. “You are doing an activity that the patient needs now, not tomorrow, not [in] an­other week,” he says. The work is grueling, but “these projects, the surgical projects for war wounded, they stand alone, because you see exactly the importance, the vital importance, of the services you are doing.”

On this day, he finishes with surgery in the late evening and heads home around 8pm, hoping to get some rest before another busy day. At midnight, however, he gets a call updating him on the status of this afternoon’s surgery patient. And at 2am, he gets another call telling him that two teenage boys are on their way from Syria with serious blast injuries.

As of June 1, 2014, MSF teams in Ramtha had carried out 1,315 surgeries on 430 pa­tients arriving from Syria in the nine months since the project opened. MSF is also assist­ing Syrian refugees in Jordan at the Al Zaatari refugee camp in Mafraq and a maternity project in Irbid. What’s more, since 2006, MSF has run a a reconstructive surgical project in Amman for war-wounded from across the Middle East; over the past year, 43 percent of the patients there have come from Syria.