D r Zaher Sahloul has been here before. He has worked in hospitals where medical staff die because they are not protected, where wards are so overloaded with critical patients that the corridors fill with beds, and where doctors have to make decisions about who lives and who dies because they cannot save them all.

He saw it all during his many humanitarian missions to his native Syria, throughout the country’s devastating nine-year civil war. But now, he is going through it all again in his hometown of Chicago on the frontlines of the fight against the coronavirus.

“I never imagined that we would be facing in the US what we've been facing in Syria,” says the Syrian-American, who works as a critical care specialist at two Chicago hospitals. “It’s ironic. These are things we’ve been shouting about for years there, we’re now seeing it at home.”

Syria has often been described as the most dangerous place in the world for medical professionals. The deliberate bombing of hospitals by Syrian and Russian forces has devastated a healthcare system already ruined by years of war.

In the past few weeks, as hospitals across the US have become overwhelmed by the coronavirus, some frontline doctors and nurses have compared the wards in which they work to a warzone. It’s a comparison that Dr Sahloul, who has seen both, agrees with.

“It feels like a war zone. There are many parallels between Syria and what is going on in the US,” he says, listing the shortages of medical supplies, of personal protection equipment and ventilators, the difficulty of allocating resources, to name a few.

Today, 55-year-old Dr Sahloul is using his experience working in Syria’s conflict zones to help the city of Chicago battle its worsening pandemic. As a pulmonary and critical care specialist, he is intimately involved in shaping his hospital’s response to the pandemic. The wards there quickly are filling up with coronavirus patients — some 80 per cent of emergency room admissions are Covid-19 victims.

This influx has forced hospitals to adapt. Much of the work Dr Sahloul did in Syria — as president of MedGlobal, an organisation that sends medical teams to disaster regions — was focused on helping frontline doctors and healthcare facilities to continue operating in times of crisis. That involved training physicians on how to deal with limited supplies and equipment.

“In some areas in Syria, we were under siege and didn’t have enough resources. They may have two ventilators for an influx of 20 patients who will need care. So we would ask, how do you manage that? How do you adapt? How do you conserve? How do you reuse? How do you reallocate your resources?” he says.

“For example, how do you preserve oxygen and dialysis? Instead of doing dialysis for your patients three times a week, you do it once a week. So we're doing the same thing now in the hospital.”

Those decisions about how a facility must change the way it operates in a time of crisis can sometimes mean making extremely difficult choices.

“These ethical questions would come up a lot in Syria, where you would have an influx of many patients and you would have to decide how to direct your resources. So you might have someone who, in peacetime, you can take to surgery and spend time saving them, but in a time of crisis you cannot afford that, and you have let them go,” he says.

“And that's what we are struggling with right now here in the US and Chicago. We are deciding which patient should maybe not be placed on ventilators because we don't have an unlimited number.”

On Monday, the US marked a grim milestone as the death toll from the coronavirus outbreak passed 10,000. Hundreds of medical professionals have fallen ill from the virus in the course of treating patients — at least three have died in New York alone.

Again, there are parallels with Syria — if not in scale, in the details. The lack of protective equipment for doctors treating victims of chemical weapons attacks there has caused illness and in some cases death.

“I remember one doctor, he was a surgeon, his hospital was inside the cave for protection but it was hit with a chlorine bomb. He continued to operate on this patient and by the time they took him to the nearest hospital that has a ventilator, he died. He had a cardiac arrest,” he says.

“Right now we're struggling to provide protections for physicians here.”

Then there are the hidden dangers for physicians treating coronavirus patients. Managing the psychological impact on medical staff as they work through a prolonged crisis is something doctors in Syria have grappled with for some years. Extended periods of operating in a dangerous environment, and losing colleagues, takes its toll.

“What we've seen during the Syrian crisis and other disasters that healthcare professionals are affected like the patients. If you do not give them the tools to be more resilient every day, when they're seeing many patients who are dying or very sick and they are struggling with making difficult decisions, then it will affect their mental health,” says Dr Sahloul.

“Burnout syndrome was a real thing within the critical care community before this crisis. So we’re providing tools to doctors and nurses to help them deal with the situation and prevent long term consequences.”

While there are parallels between the work being done on the coronavirus frontlines and doctors in Syria, there are many more differences.

More than 900 medical professionals have been killed throughout Syria’s war, and hospitals continue to be targeted by the Russian and Syrian governments.

Dr Sahloul calls Syria “the worst humanitarian crisis of our lifetime,” which makes comparisons difficult. But he adds: “A disaster is a disaster.”

Inside Idlib: Syrians caught in the crossfire Show all 24 1 /24 Inside Idlib: Syrians caught in the crossfire Inside Idlib: Syrians caught in the crossfire Aftermath of an airstrike in a chicken farm in the town of Maarat Misrin, Idlib, Syria, March 2020. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Six displaced families were living in the farm, at least 16 people died in the late night attack. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Maarat Misrin attack in Idlib. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Maarat Misrin attack in Idlib. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Maarat Misrin attack in Idlib. (Photo: Yusuf Sayman) Yusuf Sayman Inside Idlib: Syrians caught in the crossfire IDPs are seen in a central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Hundreds of families live in the basement and car park of the stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire IDPs in central Idlib stadium. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire A scene from the Idlib market. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire A scene from the Idlib market. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire A scene from the Idlib market. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Suleyman Suleyman, a 24-year-old Arabic teacher, is seen in the al-Barayeem primary school, which was hit by an air strike on 25 February. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire The strike killed 3 adults, forcing the school to close. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Assadollah, a fighter just returned from the battle to recapture Saraqeb, poses for a photograph in the town of Binnish. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire A building hit by an airstrike few days ago in the town of Binnish. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Building in Binnish town. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Yousef Ramadan and his son are seen in the rubble of their apartment complex that was hit by an airstrike in the town of al-Fua, north of Idlib four days ago. (Photo: Yusuf Sayman) Inside Idlib: Syrians caught in the crossfire Nine were killed in the attack. (Photo: Yusuf Sayman)

And yet, the coronavirus pandemic has reached into Dr Sahloul’s home life in a way that perhaps the Syria crisis did not. Like many other healthcare workers on the frontlines of the pandemic, he has had to distance himself from his family at home.

Every time he enters the emergency room in the Chicago hospital, he faces a different kind of danger than he faced in northern Syria.

“My family in Syria worries about me more now,” he says. My mum and dad still live in Syria and they call me every day. They say, ‘Are you safe? Please take care of yourself’. Because they see the news and the number of cases in the US, and they know that I'm on the front lines of treating this disease,” he says.

“And it’s the same thing with my family here. I mean, I can tell you that my family here is more worried about my health than when I used to go to Syria, I don't know what, maybe it's the media that is the, you know, showing what's happening to the virus every day. In Syria, the crisis was ignored.”

Still, even as he treats patients in Chicago, Dr Sahloul wants people to think about those distant and desperate places that are yet to face the full force of the coronavirus and will do so with far less resources than the US.

“You know, my hospital in Chicago has more ventilators than in Idlib province in Syria and Gaza Strip combined. If the coronavirus spreads in these areas, it will be beyond catastrophic.

“The concept of social distancing is very difficult to enforce in a displacement camp or refugee camp where you have 15 people in one tent, and people do not have access to clean water and soap to wash their hands frequently. So be aware of them,” he says.