Old Homs is nearing 500 days of a siege, with no supply route in or out. Medical equipment and supplies are nearly impossible to find. There are no alternatives for the medicine, be it for chronic illness or for wounds sustained during daily shellings of the city. There are few medical personnel on the scene.
In besieged Homs, a critical wound becomes more terrifying than death itself. A doctor might need to amputate a limb to save a patient’s life. In more critical cases, the lack of medical facilities means the only option for patients is death.
During clashes between the Free Syrian Army and government soldiers, the designated points for providing medical assistance in besieged neighborhoods fill up, mainly with wounded civilians. Emergency medical points fill with pools of blood, the small spaces unequipped to handle large numbers of the injured.
Often, a medic in the field does not have time to immediately attend to a patient’s wounds. His sole focus is to get the injured person and himself out of the line of fire and to safety. There are few ambulances and stretchers, so the mode of transportation could be a small cart previously used to sell food.
Only simple injuries can be treated at the designated medical assistance points.
Patients with critical cases are transferred to the central hospital, which is barely functioning. Another arduous journey begins, in which patients take underground tunnels and travel through trenches in attempts to avoid regime fire.
Sometimes the injured die before arrival.
This is the one hospital inside the besieged neighborhoods, and it has just two beds. Patients often wait hours to see a doctor, and some die waiting. A stench tells of a lack of proper sterilization, and the small, damp space is below ground, devoid of sunlight, but relatively safe from shelling.
Usually, three doctors from different specializations are at the cellar field hospital. Some have graduated from medical school, while others did not have the luxury of completing their studies. Instead, they learned on the job at field hospitals over the course of the revolt. Many doctors started off as medics, and then became practicing nurses who were able to administer first aid, extract surface-deep shrapnel, stitch up wounds and stop bleeding. Most Homs doctors either fled at the beginning of the fighting or left for fear of arrest for treating civilians and rebels; only the dedicated few remain.
In many cases, a specialized surgeon is needed. Doctors without that training now perform surgery and try to consult with specialized physicians over the Internet.
Sometimes they perform emergency blood transfusion without any prior experience. Yet the patient’s life is in his hands only.
Abu Obeida began as media activist and medic in one of the field hospitals.
“When you’re under siege, you have to learn to do everything yourself: you cook, wash dishes and clothes, take photos and put out media reports, administer aid and nurse the wounded,” he said. “There is no other solution.”
Mohammad is a medical student who did not get the chance to finish his studies. He constantly checks in on the wounded at the cellar hospital. He said he believes that the recovery of patients hinges on their psychological state and on their being transported outside of Homs for treatment.
“Hope is the only cure now,” he said. “These patients can’t be treated with our limited medical capabilities. A [temporary] solution to their ailments is administered to keep them alive for now. We have to give them hope that they will recover, that they will be able to walk again and resume their lives.”
Abu Abdu is one of the doctors who treated patients suffering from alleged Sarin gas attacks in Khaldiyeh neighborhood. He recounted a day when, he said, the regime dropped the poisonous gas.
“We didn’t know what happened that night. We were in shock,” he said. “Dozens of patients were suffering from asphyxiation and physical convulsions. They all arrived at the center at the same time with symptoms of being exposed to poisonous gas. We had no time to think; every moment that passed without doing anything meant more casualties. That was the first time I handled such cases. It was a long and difficult night. We tried to limit the loss of life with what we had available.”
Some doctors have lost their lives while on the job, including Bilal, who died three months ago, and Abu Obeida, who died one month ago. Both were killed while accompanying rebel fighting groups.
Abu Yasser, another Homs doctor, was shot when he was making house calls to check up on patients who had undergone surgery.
Medical personnel said they had been regularly harassed by government security forces, through kidnapping and by the shelling of medical centers. The regime considers transporting medicine and medical equipment to civilians and rebels within liberated areas to be an act of terrorism punishable by death or by death under torture.
Activists in Homs have continuously pleaded with the international humanitarian organizations to intervene and evacuate the injured. There is growing concern here among doctors about what will happen to their patients when supplies, inevitably, run out.