Presented is a short companion piece which, taken together, make a strong case for the use of health services and health education to bring stability and trust-building to a conflict zone during a complex emergency. In asymmetric engagement, health can be a potent tool to focus on the future with hope.
People ask me what it was like being a doctor in eastern Aleppo. I ask them to imagine walking into combat unarmed with no protection.
Bombs from the Syrian government’s air force demolished buildings and set families on fire. They’d land so close to the hospital and you’d get knocked off your feet. The targeting of homes, schools, grocery markets, and hospitals was all fair game. Many of the children that we treated were burned or crushed beyond recognition. Unidentified and unclaimed, they were taken to be buried. Mothers and fathers would comb local hospitals looking for remnants of their loved ones—backpacks, shoes, and such—to confirm if they were killed. Snipers intentionally shot children in the head and adolescents in the genitals in order to mutiliate and punish civilians who were living in rebel-held areas. I witnessed schoolchildren who had the bone fragments of their obliterated classmates embedded in their skin after an airstrike.
I remember one child whose face was burned off and his left leg was shattered after an airstrike decimated a nearby market. About 30 people were killed that day, and scores more were wounded. These attacks happened so often that they all blur together in my mind. But I remember that child specifically because he was still alive, and he clutched his intestines which spilled out of his belly while others died around him. He died a few days later in our ICU. There was very little we could do to save him in a basement field hospital.
I remember another teenager who lost both legs to a barrel bomb. He lost so much blood and showed up in shock. Medics saved his life by ligating blood vessels and giving him blood transfusions. When he woke up, he discovered his legs were missing. He saw the blankets flatten near his knees. His first reaction was to hyperventilate, and then he vomited.
That is the Syria that I walked away from. That is the Syria that I never forget. You leave a piece of yourself behind with every trip you make—knowing all those people were simply being left to suffer and die.
That is the closest I’ve ever been to sustained terror and dread—where the threat of death and dismemberment was pervasive and tangible. I was the last American doctor to leave Aleppo the day that it was surrounded by the Syrian government in July 2016. The vehicles that tried to follow us out on the Castello road were incinerated or they turned back. What ensued was a months-long medieval siege of starvation and bombardment, and then the fall of Aleppo.
The local Syrians with whom I worked gave me hope—the nurses, the doctors, the schoolteachers—men and women who knew full well that the world had abandoned them. They, however, refused to abandon their local communities and worked in underground schools and hospitals until the very end.
One morning a man brought his brother to the hospital for help. A bomb blast had obliterated the patient’s leg. His knee joint was an empty, open hole with no bones present from his thigh to his ankle. The only thing holding his leg in place was an external fixator. The wound was purulent and gangrenous, and I anticipated that he would lose his leg in a matter of days. I apologized to them both: there was nothing we could do. The soft tissue and osseous damage was too devastating. The man’s brother asked me why I had a strange accent. When he found out I was an American, he thanked me for my medical opinion. Then he thanked the United States of America for sending doctors to help inside his war-torn country at a time when Syrian doctors were being arrested and killed. His reaction to my presence resonated strongly with me. I was simply a surgeon born and raised in Chicago who showed up to help out and stand in solidarity with a good group of people. He was not the first Syrian to tell me this, but every time I go back I hear it. It makes me proud to be an American, and proud of the principles for which this nation stands. It taught me that there are ways to fight terrorism and oppression that don’t require bombs and bullets. Sometimes all you have to do is show up, help out, and represent.