In June, a Syrian Army helicopter dropped an explosive barrel on a residential neighborhood in the Syrian city of Kfar Nabl. Four people died immediately in the resulting explosion, while seven were wounded. One of the wounded was eight-year-old Khaled al-Qasem.
Khaled’s father, Mohammad, a 40-year-old construction worker, picked up his wounded son and asked a passer-by to rush him to Al-Hikma hospital in Kfar Nabl. About 30 minutes later, his son was on the emergency room table. The doctors found that a piece of shrapnel had penetrated the boy’s brain. He needed treatment that was not available locally.
A surgeon, Abdel Ilah, recommended Khaled be transported by ambulance across the border, to Turkey, to the Orient Hospital in the town of Atmeh, about 90 minutes away.
But Khaled didn’t make it, and died on the way to Turkey. His father blames Khaled’s death partly on the long drive, and the fact that the ambulance did not have the necessary life support equipment.
“The ambulance wasn’t even equipped with a respirator,” he said. “The ambulance trip reduced his chances of survival.”
The next day, Mohammad al-Qasem made the journey back to Kfar Nabl to bury his son Khaled.
In southern Idlib Governorate, all the critically wounded are taken by emergency transport to hospitals on the Turkish border. Although there are 11 hospitals in the area, there are only 40 doctors for a population of about 400,000 people. The area is subject to regular shelling from regime forces, and it is controlled by over 10 different armed opposition factions.
At the Dar Al-Hikma hospital in Kfar Nabl, Dr. Rifaat, 34, says his hospital, like others in the area, lacks equipment and medical staff, so he sends critical cases to hospitals on the border. Dr. Rifaat also points to the need in local hospitals for specialized neurosurgeons, for neurosurgical tools, and for respirators, as well as for CT scanners, MRI machines, and endoscopic devices, all of which are diagnostic tools crucial for accurately identifying critical injuries.
But the arrival of such tools and equipment to areas controlled by armed opposition forces has become increasingly difficult. Most medical supply companies prohibit work in areas they deem unsafe, according to a woman, Aisha, who runs a medical supplies and equipment office in Maarrat Al-Numan and represents the Turkish company “TBS.” The company specializes in procuring medical plates, bolts and steel rods. Aisha said that she has none of the required supplies at the moment, and that the difficulty of delivering them to the area makes them much more expensive. The company recently closed its office in the area due to lack of security.
The scarcity is also felt in the pharmaceutical sector, especially when it comes to Anesthesics and vaccines, according to pharmacist Zaher, 40, who works at the Central Pharmacy in Kfar Nabl.
Some active relief organizations, among them Medical Relief for Syria and the Union of Syrian Medical Relief Organizations, have been trying to secure humanitarian and free medical aid to the area.
The distance from the countryside south of Idlib to the Turkish border is over 120 kilometres, and the journey takes at least two hours according to paramedic Ibrahim, 41, who works at the External Emergency Office in Kfar Nabl.
Ibrahim says many patients die during the journey to the border, and some patients sustain even more injuries on the trip. Shartah says that the border hospitals are charity-run, the most important of which are the Orient Hospital in Atmeh, Ras Al-Husn Hospital, the Barisha Eye Clinic, the Kuwaiti Hospital in Aqrabat, and Bab Al-Hawa Hospital.
The Internal and External Emergency Office in Kfar Nabl and Western Countryside of Maarrat al-Nu’man operates the majority of all emergency transport, covering the areas around southern Idlib, northern Hama and eastern Latakia.
The head of the Emergency Office, Badr, 45, claims that his organization has transported 3,200 wounded from the area to the border hospitals in the last two years.
“Over fifty wounded died during these emergency transports,” he said.
He also said that the office, which receives aid from the non-profit organization Medical Relief for Syria, has only 30 ambulances in its emergency fleet, and though they are not as well-equipped as he would like, they all function. Of the 15 paramedics who work for the office, only six of them hold internationally-recognized certificates, while the rest were given local courses over the duration of a few days and then deemed nurse’s aides or orderlies.
In August, 19-year-old Mahmoud was transported from Dar Al-Hikma Hospital in Kfar Nabl to Orient Hospital in Atmeh, where one piece of shrapnel was removed from his kidney and two pieces from his bladder. Nevertheless, he would have preferred to be treated at the local hospital, due to the severe pain he suffered from the rough roads between Kfar Nabl and Turkey.
“I felt I would die, and at some points, I wished for it,” he said.
20-year-old Bilal al-Hazaa, a fighter in the Sham Hawks Brigade, an opposition faction, was injured a month ago and taken by emergency transport to a border hospital. He also emphasized the difficulty of the journey.
“Just getting there is a form of suffering in itself,” said Hazzaa.
A former doctor at the government hospital in Maarrat Al-Numan, who preferred to remain anonymous, asserted that the regime carries the bulk of the responsibility for the necessity of medical workers having to transport the wounded to the Turkish border, for it is forbidden for those injured in the opposition-held areas to be taken to the national Idlib Hospital, which is equipped to deal with all cases, but is located in a regime-dominated area.
But a nurse named Amani who also previously worked at the district hospital in Maarrat Al-Numan places most of the blame on the armed opposition forces, for after seizing power, they allowed thieves to loot much of the medical equipment and supplies at the hospital. “The hospital used to be equipped to deal with the most critically injured, during times of peace and of war,” she said.