Ballour, as manager, would supervise their treatments, jumping in to perform emergency surgeries herself and making house calls for patients too sick to come to her, all the while remaining composed and human. It was also on her to find ways to keep the hospital a safe haven, ordering fortifications above ground when needed and scrounging for resources. With Ghouta under siege by government forces, the hospital survived on financial aid from medical nonprofits, while supplies of medicine, food and milk for children were all cut off and had to be smuggled in, Ballour said.

Every day, Ballour and her largely-female team of doctors and nurses grappled with the kinds of challenges that medical professionals in other parts of the world rarely face: What to prescribe a sick, malnourished baby when there’s no food? How do you perform a surgery without anesthetics? How do you keep a hospital running smoothly to the deafening soundtrack of bombings above ground and wailing parents below?

The most difficult thing, Ballour recalled, was choosing which ones to help with the few resources they had. “All of them have the same symptoms; all of them are suffocating,” she said. “But I had to choose: I will work with this child and the other will die.”

“I always think about that. I feel I am guilty.”

Ballour, the second youngest of two brothers and three sisters, was always “stubborn.” Her eldest sister was married off at the age of 13, but when Ballour entered her teenage years, she insisted on finishing her education and going to college.

“I wanted to do something different,” she said. “Before I started studying medicine, I wanted to be an engineer.”

Her family refused to support her because in their eyes engineering was a man’s job. So she switched plans, focusing instead on becoming a pediatrician, which seemed more palatable for her family, she explained.

Later in her career, despite having proved herself as both a skilled doctor and a strong leader, she nevertheless constantly bumped up against the deep-rooted limitations of being a woman in a religiously conservative society.