Thomson Reuters Foundation / Reuters Young girls, severely burnt and maimed by explosions in Yemen, Syria and Iraq, play puzzles as an occupational therapist assesses their cognitive development inside a Medecins Sans Frontieres hospital in Amman, Jordan, November 20, 2016.

As soon as the bombs exploded outside his house in the Iraqi town of Falluja, Rachid Jassam rushed onto the street to rescue the injured.

As the teenager ran out, another plane swooped overhead and dropped more bombs, the shrapnel tearing his right leg so severely local doctors wanted to amputate it.

His father refused the amputation to spare his son from a life of disability, and opted for basic surgery instead.

“When I got injured, I didn’t lose consciousness. I witnessed the whole thing when the people came and took me to the hospital. I remember everything,” 15-year-old Jassam said through an interpreter at a Medecins Sans Frontieres (MSF) hospital in Amman in Jordan.

“I lost five centimetres of my bone from my right leg and I couldn’t move it anymore.”

More than 20 per cent of all patients at the MSF hospital are children just like Rachid - blown apart, severely burnt and disfigured by conflicts in Iraq, Syria, Yemen and Gaza.

Since it opened in 2006, the hospital has treated almost 4,400 patients free of charge, and remains the only hospital in the Middle East to perform advanced reconstructive surgery on victims of war.

But as conflicts rage across Middle East, hospital staff say resources have been stretched in recent years, with most patients coming from Syria and Yemen.

For Jassam, the clinic has been his lifeline. Sitting on his hospital bed in the Jordanian capital after receiving specialized surgery on his leg, he smiles broadly as he holds onto his crutches.

“Thank God, it’s God that preserved my leg.”

“YOU SEE WAR EVERY DAY”

Not all children are so lucky.

In a small pink room on the upper levels of the hospital, young girls with disfigured faces and missing limbs grow increasingly agitated as they try to solve puzzles and play board games.

“Sometimes the trauma affects their memory skills or problem-solving, and it also has psychological effects like low attention span. They can get frustrated easily and they have low self-esteem,” said occupational therapist Nour Al-Khaleeb, 24, who is part of a team of mental health specialists.

“You see war every day, you see their injuries, you see how it’s affecting their lives - and sometimes it has an effect on you too,” she said, talking loudly over the girls’ screams and chatter.

“Maybe they will remember that someone did something good for them, and this will give them hope later on in life.”

Around 60 people, mainly young men, undergo complex orthopaedic, facial and burn reconstructive surgery at the hospital each month, according to MSF. They also receive psychological care and counselling during their stay.

Mohammed, 11, said his family was fleeing the city of Homs in Syria by car when an airstrike hit, injuring him and his two brothers. He watched as his mother died in the explosion.

“A part of the bomb went into my leg and fractured my bone into pieces - it cut into my nerves and tendons,” he said through an interpreter, insisting he wasn’t scared when the bombs fell overhead.

Hobbling down the hospital corridor on crutches after a recent operation on his leg, Mohammed said he will get on with his life when he is discharged, and return to join his family in Jordan’s Zataari refugee camp, which hosts almost 80,000 Syrian refugees.

RESILIENCE

Clinical psychologist Elisa Birri, who heads the mental health team, said it was common for children in the hospital, especially boys, to put on a brave front.

But sooner or later, psychological symptoms like bedwetting, depression, anxiety, aggression and insomnia can crop up, said Birri. At the severe end of the spectrum, patients can experience flashbacks, panic attacks and disassociation, where they lose their sense of reality.

“Children show in their drawings and during free play what they have experienced, it’s like a mirror. For example, they will draw themselves playing with guns because of the war context they came from,” said Birri, adding that children will sometimes regress to an infantile state to cope with the trauma.

But having worked in Libya and Syria, the Italian psychologist added that the maturity and resilience of children living in war-torn countries were beyond their years.

“They go through really big events, but you see them smiling every day, playing every day. They never stop having motivation to go on.”

This rings true for 15-year-old Jassam. Even after being severely injured and besieged by Islamic State militants for eight months, Jassam said he can’t wait to return to Falluja once he leaves the hospital.

“I want to go back to Falluja, I miss it. I miss everyone there,” he said, smiling and nodding his head in excitement.

“I have a goat and it’s the only surviving goat and she has given birth, so there are babies waiting for me.”