Life And Death Inside An Underground Syrian Hospital

The dark, damp emergency room in the field hospital of besieged Homs
The dark, damp emergency room in the field hospital of besieged Homs
Yazan al-Homsy
Yazan al-Homsy

HOMS – This city in western Syria is nearing 500 days under siege, with no supply route in or out. Medical equipment and supplies are nearly impossible to find. There are no alternatives for the medicine, be it for chronic illness or for wounds sustained during daily shellings of the city. There are few medical personnel on the scene.

In Old Homs, a critical wound becomes more terrifying than death itself. A doctor might need to amputate a limb to save a patient’s life. In more critical cases, the lack of medical facilities means the only option for patients is death.

During clashes between the Free Syrian Army and government soldiers, the designated points for providing medical assistance in besieged neighborhoods fill up, mainly with wounded civilians. Emergency medical points are covered with pools of blood, in the small spaces unequipped to handle large numbers of injured.

Often, a medic in the field does not have time to immediately attend to a patient’s wounds. His sole focus is to get the injured person and himself out of the line of fire and to safety. There are few ambulances and stretchers, so the mode of transportation could be a small cart previously used to sell food.

Only simple injuries can be treated at the designated medical assistance points.

Patients with critical cases are transferred to the central hospital, which is barely functioning. Another arduous journey begins, in which patients take underground tunnels and travel through trenches in attempts to avoid regime fire. Too often, the injured die before arrival.

Two beds

And then, there is one hospital inside the besieged neighborhoods – but it has just two beds. Patients often wait hours to see a doctor, and some die waiting. A stench tells of a lack of proper sterilization, and the small, damp space is below ground, devoid of sunlight, but relatively safe from shelling.

Usually, three doctors from different specializations are at the cellar field hospital. Some have graduated from medical school, while others did not have the luxury of completing their studies. Instead, they have learned on the job at field hospitals over the course of the revolt. Many doctors started off as medics, and then became practicing nurses who were able to administer first aid, extract surface-deep shrapnel, stitch up wounds and stop bleeding. Most Homs doctors either fled at the beginning of the fighting or left for fear of arrest for treating civilians and rebels; only the dedicated few remain.

In many cases, a specialized surgeon is needed. Doctors without that training now perform surgery and try to consult with specialized physicians over the Internet.

Sometimes they perform emergency blood transfusion without any prior experience. Yet the patient’s life is in his hands only.

Abu Obeida began as media activist and medic in one of the field hospitals. “When you’re under siege, you have to learn to do everything yourself: you cook, wash dishes and clothes, take photos and put out media reports, administer aid and nurse the wounded,” he said. “There is no other solution.”

Mohammad is a medical student who did not get the chance to finish his studies. He constantly checks in on the wounded at the cellar hospital. He said he believes that the recovery of patients hinges on their psychological state and on their being transported outside of Homs for treatment.

“Hope is the only cure now,” he said. “These patients can’t be treated with our limited medical capabilities. A temporary solution to their ailments is administered to keep them alive for now. We have to give them hope that they will recover, that they will be able to walk again and resume their lives.”

Abu Abdu is one of the doctors who treated patients suffering from alleged Sarin gas attacks in Khaldiyeh neighborhood. He recounted a day when, he said, the regime dropped the poisonous gas.

“We didn’t know what happened that night. We were in shock,” he said. “Dozens of patients were suffering from asphyxiation and physical convulsions. They all arrived at the center at the same time with symptoms of being exposed to poisonous gas. We had no time to think; every moment that passed without doing anything meant more casualties. That was the first time I handled such cases. It was a long and difficult night. We tried to limit the loss of life with what we had available.”

Final sacrifice

Some doctors have lost their lives while on the job, including Bilal, who died three months ago, and Abu Obeida, who died one month ago. Both were killed while accompanying rebel fighting groups.

Abu Yasser, another Homs doctor, was shot when he was making house calls to check up on patients who had undergone surgery.

Medical personnel said they had been regularly harassed by government security forces, through kidnapping and by the shelling of medical centers. The regime considers transporting medicine and medical equipment to civilians and rebels within liberated areas to be an act of terrorism punishable by death or death under torture.

Activists in Homs have continuously pleaded with the international humanitarian organizations to intervene and evacuate the injured. Supplies, inevitably, are bound to run out.

This article was translated from Arabic by Naziha Baassiri.

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Iran-Saudi Arabia Rivalry May Be Set To Ease, Or Get Much Worse

The Saudis may be awaiting the outcome of Iran's nuclear talks with the West, to see whether Tehran will moderate its regional policies, or lash out like never before.

Military parade in Tehran, Iran, on Oct. 3


LONDON — The Iranian Foreign Ministry spokesman Saeed Khatibzadeh said earlier this month that Iranian and Saudi negotiators had so far had four rounds of "continuous" talks, though both sides had agreed to keep them private. The talks are to ease fraught relations between Iran's radical Shia regime and the Saudi kingdom, a key Western ally in the Middle East.

Iran's Foreign Minister Hossein Amirabdollahian has said that the talks were going in the right direction, while an Iranian trade official was recently hopeful these might even allow trade opportunities for Iranian businessmen in Saudi Arabia. As the broadcaster France 24 observed separately, it will take more than positive signals to heal a five-year-rift and decades of mutual suspicions.

Agence France-Presse news agency, meanwhile, has cited an unnamed French diplomat as saying that Saudi Arabia wants to end its costly discord with Tehran. The sides may already have agreed to reopen consular offices. For Saudi Arabia, the costs include its war on Iran-backed Houthis rebels fighting an UN-recognized government in next-door Yemen.

The role of the nuclear pact

Bilateral relations were severed in January 2016, after regime militiamen stormed the Saudi embassy in Tehran. Amirabdollahian was then the deputy foreign minister for Arab affairs. In 2019, he told the website Iranian Diplomacy that Saudi Arabia had taken measures vis-a-vis Iran's nuclear pact with the world powers.

It's unlikely Ali Khamenei will tolerate the Saudi kingdom's rising power in the region.

He said "the Saudis' insane conduct toward [the pact] led them to conclude that they must prevent [its implementation] in a peaceful environment ... I think the Saudis are quite deluded, and their delusion consists in thinking that Trump is an opportunity for them to place themselves on the path of conflict with the Islamic Republic while relying on Trump." He meant the administration led by the U.S. President Donald J.Trump, which was hostile to Iran's regime. This, he said, "is not how we view Saudi Arabia. I think Yemen should have been a big lesson for the Saudis."

The minister was effectively admitting the Houthis were the Islamic Republic's tool for getting back at Saudi Arabia.

Yet in the past two years, both sides have taken steps to improve relations, without firm results as yet. Nor is the situation likely to change this time.

Photo of Iranian Supreme Leader Ali Khamenei in 2020

Iranian Supreme Leader Ali Khamenei in 2020

Riyadh's warming relations with Israel

Iran's former ambassador in Lebanon, Ahmad Dastmalchian, told the ILNA news agency in Tehran that Saudi Arabia is doing Israel's bidding in the region, and has "entrusted its national security, and life and death to Tel Aviv." Riyadh, he said, had been financing a good many "security and political projects in the region," or acting as a "logistical supplier."

The United States, said Dastmalchian, has "in turn tried to provide intelligence and security backing, while Israel has simply followed its own interests in all this."

Furthermore, it seems unlikely Iran's Supreme Leader Ali Khamenei will tolerate, even in this weak period of his leadership, the kingdom's rising power in the region and beyond, and especially its financial clout. He is usually disparaging when he speaks of Riyadh's princely rulers. In 2017, he compared them to "dairy cows," saying, "the idiots think that by giving money and aid, they can attract the goodwill of Islam's enemies."

Iranian regime officials are hopeful of moving toward better diplomatic ties and a reopening of embassies. Yet the balance of power between the sides began to change in Riyadh's favor years ago. For the kingdom's power has shifted from relying mostly on arms, to economic and political clout. The countries might have had peaceful relations before in considerably quieter, and more equitable, conditions than today's acute clash of interests.

If nuclear talks break down, Iran's regime may become more aggressive.

Beyond this, the Abraham Accord or reconciliation of Arab states and Israel has been possible thanks to the green light that the Saudis gave their regional partners, and it is a considerable political and ideological defeat for the Islamic Republic.

Assuming all Houthis follow Tehran's instructions — and they may not — improved ties may curb attacks on Saudi interests and aid its economy. Tehran will also benefit from no longer having to support them. Unlike Iran's regime, the Saudis are not pressed for cash or resources and could even offer the Houthis a better deal. Presently, they may consider it more convenient to keep the softer approach toward Tehran.

For if nuclear talks with the West break down, Iran's regime may become more aggressive, and as experience has shown, tensions often prompt a renewal of missile or drone attacks on the Saudis, on tankers and on foreign shipping. Riyadh must have a way of keeping the Tehran regime quiet, in a distinctly unquiet time.

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