Janet Loughran

I grew up in Northern Ireland in the 1970s, when the Troubles were never off the television. Behind those headlines there were lots of people and small communities just trying to get on with their day to day life. This thought crossed my mind frequently when I was working in northern Syria.

I studied medicine at Queens University in Belfast, and moved to Australia in 2003 to pursue anaesthesia training. Although I had worked with Médecins Sans Frontières/Doctors Without Borders (MSF) previously in Papua New Guinea and Nigeria, I was quite anxious about going to Syria. Our place of work was a large house which our logistics team had converted into a functioning hospital. It was a bit rough and ready but we had all the essential equipment, including an operating table with requisite light, monitors, and suction. We also had a full range of drugs, sterile bandages and dressings. Having these essential resources in a war zone is only possible thanks to the generosity of members of the public as MSF has chosen not to accept any government funding for our Syria programmes in order to remain fully neutral and independent in such a politically complex environment.

We worked for nearly 12 hours a day, six days a week, which was exhausting but very rewarding. The morning and evening ward rounds gave us a chance to interact with our patients who were extremely grateful we were there. There was also a deep sense of respect and trust between the local people and the hospital staff; all this made me feel safe.

Our hospital developed a specialty in treating burns, which are the forgotten war injury. Most people think of gunshots or shrapnel wounds but many Syrians are sustaining severe burn injuries as a direct and indirect consequence of the conflict. At an alarming frequency in the overcrowded IDP (internally displaced persons) camps, children were accidentally tripping into pans of boiling water or fires that their mothers had set for washing and cooking. More unexpectedly, many of our adult male patients suffered burns when trying to source fuel. After nearly three years of war, petrol is a scarce commodity but crude oil is more easily available and people heat the crude oil to try to extract an impure form of petrol. A significant percentage of our patients sustained serious burn injuries through this dangerous activity.

We were generally alerted to the arrival of a new burn casualty by the ambulance sirens outside the hospital…or by the patient’s screams. Managing burns is extremely intensive; immediately we would set about the process of resuscitation – giving oxygen, fluids and pain relief – and then taking them to theatre for cleaning and dressing of their wounds. Other patients arrived a few days after their burn injury, having been treated at home or elsewhere. They would come in with seeping, foul-smelling wounds which had become infected. Cleaning the wounds was frequently so painful that the patients had to be given an anaesthetic. Some required skin grafting and blood transfusions.

One patient who particularly stands out for me was a six-month-old baby girl. She was brought to the hospital after the car she had been travelling in with her family had been hit by a bomb. Both her parents were killed in the blast. She was extremely pale and didn’t seem to be breathing. We unwrapped her blankets to find her right leg had been almost ripped off by shrapnel and was just hanging on by a thin filament of skin and muscle. Immediately we started resuscitation and then brought her to theatre. Unfortunately, we couldn’t save her leg and had to amputate it. After she came out of the anaesthesia, she wasn’t doing well and appeared very lethargic. Despite our best efforts with bottled milk, she refused to feed. We put her on a drip of glucose-containing intravenous fluids to stop her becoming dehydrated.

After 48 hours, she was still refusing to eat or drink. Miraculously on the third day during morning rounds she finally began to feed. Many of the other patients on the ward had children themselves and, having watching our failed attempts with the bottle, during the night a mother who was breast-feeding her own child started to nurse the orphaned baby. The kindness of this woman and the other patients played a vital role. Eventually her aunt came forward and agreed to take her home when she was fit for discharge. For me, this one baby’s survival and the combined support of the other patients, was one of the most rewarding moments.

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