War Diaries Of A Syrian E.R. Doctor

An Aleppo ear-nose-and-throat specialist had to suddenly face the treating of war's horrific injuries, especially after a government barrel-bomb offensive began there in December.

A Syrian nurse caring for a little girl after her house was bombed by Assad militias, in November 2012.
A Syrian nurse caring for a little girl after her house was bombed by Assad militias, in November 2012.
Karen Leigh and Bushra al-Homsi

ALEPPO — Working in the Aleppo province since the start of the conflict, one doctor says the number of injuries increased exponentially after a government barrel bomb offensive began there in December.

Dr. Abdallah Safwan, a Syrian from Aleppo, was an ear, nose and throat specialist working in the province when the conflict began in March 2011. He spent the next three years working in clinics and hospitals in Aleppo’s countryside and the city suburbs. Safwan was one of a handful of doctors who remained as violence worsened.

The doctor is working with Hand in Hand for Syria, a U.K.-based aid agency that takes medical and humanitarian aid into Syria. He is currently in the U.K., on a six-week clinical training with the organization.

I used to work in the province of Aleppo, the entire province, and at times in the suburbs of Homs or in the city of Hama. I was there from the start of the crisis. I only left a month and a half ago. So I was there for around three years. I was educated at the University of Aleppo.

I had been living in Syria. I was an ear, nose and throat (ENT) specialist, had a clinic and was working in a hospital. So I was there before the crisis started. When it began, I stayed. I decided to stay because at the time, it wasn't as dangerous as it is now, of course. As a doctor, when you see things like that happening, you can’t just leave. When you take an oath as a doctor, when you see injuries, you have to help.

We were working in secrecy to begin with, because doctors are targeted by the government, in retaliation for aiding rebel fighters or activists. There were only 22 doctors in the whole Aleppo province at the time, so it was dangerous to stay — we were visible targets. I was 42, and I was one of only four or five doctors there who had finished school and declared a specialty. Eight of them had not graduated from school yet or finished their medical training, and 14 had finished but had not specialized. There was a tiny number of medical staff who had specialized and who could help in the way that I could help.

A doctor treats a policeman wounded during an explosion at a hospital in Aleppo, in February 2012. Qin Haishi/Xinhua/ZUMA

There was a threat posed by shelling from the start, but we always knew it was a problem, and fear didn’t stop us from doing anything. When an area I was in was falling, there was chaos up to the point where you couldn’t tell who was on your side or working against you. This is where it started to become very dangerous. Kidnapping was the biggest threat, because you don’t know where or when you’re safe.

Indescribable injuries

At the beginning of the conflict, for example, a mortar shell would fall and injure seven or eight people, and there would be four or five deaths. That was the situation we were dealing with at the start. Then things began to change. In one area, there was a chemical attack, then there was a change in the type of weapons used, and this led to more injuries.

But a real change we saw in the four months before we left was the TNT (barrel) bombs falling, taking down two to three buildings at a time. You can imagine the number of injuries. There would be 40 to 50 injuries from one barrel that would fall. They would fall on densely populated areas with no discrimination whatsoever. There were horrific scenes. We would walk into a hospital, find people and blood everywhere, and not know where to start. In those last four months, we saw the most chaotic things, and the injuries coming in were indescribable.

We were always put in very difficult situations, because while we had two operation rooms, out of 40 or 50 people who would come in, there were 10 children who needed immediate treatment. So we couldn’t help everyone and had to prioritize one person’s life over another. Sometimes, we would send people to other hospitals if we thought they could hold onto life. Or we transferred them to Turkey, but people would die on the way. Some people were treatable outside of operating rooms because they had simple wounds like broken limbs. But for the other 50, due to a lack of supplies and equipment, there wasn’t much we could do to help. At some points we felt so helpless we wanted to cry.

A lot of the Syrian medical staff, especially nurses, weren’t nurses before the conflict. They were engineers or something, and they were prepared and trained during the crisis. They came voluntarily, so they had the persistence and hope that someone forced into it wouldn’t have had. It was inspiring to see, and it helped them overcome a lot of mental trauma.

But the most difficult thing for all of us was when another hospital would be hit, and its crew would be taken to ours for treatment. We were treating people we knew, treating people who had just been treating others. And if they died, we would fall into depression. We wouldn’t be able to eat. Because these were people who were saving lives, and now we couldn’t save them.

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Ecological Angst In India, A Mining Dumpsite As Neighbor

Local villagers in western India have been forced to live with a mining waste site on the edge of town. What happens when you wake up one day and the giant mound of industrial waste has imploded?

The mining dumpsite is situated just outside of the Badi village in the coastal state of Gujarat

Sukanya Shantha

BADI — Last week, when the men and women from the Bharwad community in this small village in western India stepped out for their daily work to herd livestock, they were greeted with a strange sight.

The 20-meter-high small hill that had formed at the open-cast mining dumpsite had suddenly sunk. Unsure of the reason behind the sudden caving-in, they immediately informed other villagers. In no time, word had traveled far, even drawing the attention of environment specialists and activists from outside town.

This mining dumpsite situated less than 500 meters outside of the Badi village in the coastal state of Gujarat has been a matter of serious concern ever since the Gujarat Power Corporation Limited began lignite mining work here in early 2017. The power plant is run by the Power Gujarat State Electricity Corporation Limited, which was previously known as the Bhavnagar Energy Company Ltd.

Vasudev Gohil, a 43-year-old resident of Badi village says that though the dumping site is technically situated outside the village, locals must pass the area on a daily basis.

"We are constantly on tenterhooks and looking for danger signs," he says. Indeed, their state of alert is how the sudden change in the shape of the dumpsite was noticed in the first place.

Can you trust environmental officials?

For someone visiting the place for the first time, the changes may not stand out. "But we have lived all our lives here, we know every little detail of this village. And when a 150-meter-long stretch cave-in by over 25-30 feet, the change can't be overlooked," Gohil adds.

This is not the first time that the dumpsite has worried local residents. Last November, a large part of the flattened part of the dumpsite had developed deep cracks and several flat areas had suddenly got elevated. While the officials had attributed this significant elevation to the high pressure of water in the upper strata of soil in the region, environment experts had pointed to seismic activities. The change is evident even today, nearly a year since it happened.

It could have sunk because of the rain.

After the recent incident, when the villagers raised an alarm and sent a written complaint to the regional Gujarat Pollution Control Board, an official visit to the site was arranged, along with the district administration and the mining department.

The regional pollution board officer Bhavnagar, A.G. Oza, insists the changes "aren't worrisome" and attributes it to the weather.

"The area received heavy rain this time. It is possible that the soil could have sunk in because of the rain," he tells The Wire. The Board, he says, along with the mining department, is now trying to assess if the caving-in had any impact on the ground surface.

"We visited the site as soon as a complaint was made. Samples have already been sent to the laboratory and we will have a clear idea only once the reports are made available," Oza adds.

Women from the Surkha village have to travel several kilometers to find potable water

Sukanya Shantha/The Wire

A questionable claim

That the dumpsite had sunk in was noticeable for at least three days between October 1 and 3, but Rohit Prajapati of an environmental watchdog group Paryavaran Suraksha Samiti, noted that it was not the first time.

"This is the third time in four years that something so strange is happening. It is a disaster in the making and the authorities ought to examine the root cause of the problem," Prajapati says, adding that the department has repeatedly failed to properly address the issue.

He also contests the GPCB's claim that excess rain could lead to something so drastic. "Then why was similar impact not seen on other dumping sites in the region? One cannot arrive at conclusions for geological changes without a deeper study of them," he says. "It can have deadly implications."

Living in pollution

The villagers have also accused the GPCB of overlooking their complaint of water pollution which has rendered a large part of the land, most importantly, the gauchar or grazing land, useless.

"In the absence of a wall or a barrier, the pollutant has freely mixed with the water bodies here and has slowly started polluting both our soil and water," complains 23- year-old Nikul Kantharia.

He says ever since the mining project took off in the region, he, like most other villagers has been forced to take his livestock farther away to graze. "Nothing grows on the grazing land anymore and the grass closer to the dumpsite makes our cattle ill," Kantharia claims.

The mining work should have been stopped long ago

Prajapati and Bharat Jambucha, a well-known environmental activist and proponent of organic farming from the region, both point to blatant violations of environmental laws in the execution of mining work, with at least 12 violations cited by local officials. "But nothing happened after that. Mining work has continued without any hassles," Jambucha says. Among some glaring violations include the absence of a boundary wall around the dumping site and proper disposal of mining effluents.

The mining work has also continued without a most basic requirement – effluent treatment plant and sewage treatment plant at the mining site, Prajapati points out. "The mining work should have been stopped long ago. And the company should have been levied a heavy fine. But no such thing happened," he adds.

In some villages, the groundwater level has depleted over the past few years and villagers attribute it to the mining project. Women from Surkha village travel several kilometers outside for potable water. "This is new. Until five years ago, we had some water in the village and did not have to lug water every day," says Shilaben Kantharia.

The mine has affected the landscape around the villages

Sukanya Shantha/The Wire

Resisting lignite mining

The lignite mining project has a long history of resistance. Agricultural land, along with grazing land were acquired from the cluster of 12 adjoining villages in the coastal Ghogha taluka between 1994 and 1997. The locals estimate that villagers here lost anything between 40-100% of their land to the project. "We were paid a standard Rs 40,000 per bigha," Narendra, a local photographer, says.

The money, Narendra says, felt decent in 1994 but for those who had been dependent on this land, the years to come proved very challenging. "Several villagers have now taken a small patch of land in the neighboring villages on lease and are cultivating cotton and groundnut there," Narendra says.

They were dependent on others' land for work.

Bharat Jambucha says things get further complicated for the communities which were historically landless. "Most families belonging to the Dalit or other marginalized populations in the region never owned any land. They were dependent on others' land for work. Once villagers lost their land to the project, the landless were pushed out of the village," he adds. His organization, Prakrutik Kheti Juth, has been at the forefront, fighting for the rights of the villages affected in the lignite mining project.

In 2017, when the mining project finally took off, villagers from across 12 villages protested. The demonstration was disrupted after police used force and beat many protesters. More than 350 of them were booked for rioting.

The villagers, however, did not give up. Protests and hunger strikes have continued from time to time. A few villagers even sent a letter to the President of India threatening that they would commit suicide if the government did not return their land.

"We let them have our land for over 20 years," says Gohil.

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