Tamaris Hoffman is a general surgeon who worked in Northern Syria.
I was working in a surgical project in the north of Syria, mostly doing war surgery on people who had injuries due to gunshots. There were two broad categories of injuries –orthopaedic injuries [injuries to muscles and bones] and abdominal injuries. Many orthopaedic injuries were unsalvageable and I performed five amputations, including an amputation of an arm. Gunshot wounds to the abdomen also caused a great deal of damage and I performed nine laparotomies [abdominal surgery] for these injuries alone.
One young man I remember well was a 19-year-old who was hit by rocket fire and unfortunately sustained extensive burns. He wasn’t a fighter, just a civilian who happened to be in the wrong place at the wrong time. He had extensive, full thickness burns to his arms and legs. He’d also sustained shrapnel injuries to his pelvis, so I had to remove his entire bowel and give him a permanent stoma. When he woke up and I told him he now had a colostomy bag, at age 19, he was devastated. You begin to wonder whether you’ve done the right thing by the patient. But there were few other options for this young man. We also had to graft his burns, and he ended up spending four weeks in the hospital. I would often think how terrifying it must have been for him, being hit by a rocket in Aleppo and running down the street with such serious burns. He’ll have that in his memory forever.
A brave young boy
As well as the war surgery, another large component of the work was surgery among children who had been accidentally burned as I was in Syria during winter, and families were using fuel for heating. One boy who made a big impact on me was aged 12, with extensive burns from playing with fuel. He had burns on the back and front of his trunk, on his legs, feet, arms, hands and face. I thought he might not make it. He needed anaesthetic every time he had a dressing change, and sometimes he’d wake up from the anaesthetic and think I was his mother, so he’d hold my hand and want to kiss me! We dressed his burns every second day for three weeks, and his wounds healed beautifully. He eventually left hospital without needing any grafting, which shows what a good job nature does on children. When I said goodbye to him I cried… it was awful! He was a lovely little boy and very brave. He put up with those dressing changes without any complaint.
We responded to one mass casualty event when I was there, after fighting around Idlib. There were heavy casualties on both sides, plus a number of prisoners were freed from the local prison. We received about 30 patients in all, including patients from the prison, from the rebels and from the regime. As soon as they walked through the door, they were just patients – there wasn’t any problem at all that they were from different sides of the conflict. I don’t recall any conflict in the wards whatsoever. We also had a no-weapons policy that was strictly enforced and worked very well.
"I would often think how terrifying it must have been for him, being hit by a rocket in Aleppo and running down the street with such serious burns. He’ll have that in his memory forever."
A lost generation
In Syria I operated for 10 to 12 hours a day, for 35 days straight. I kept a log of all my operating and overall I did 219 operations on 80 patients, 75 of whom were men. The average age of patient was 24. The problem is, you wonder about the future of the country when so many young men have been killed, and many of those who survive will be disabled. There’ll be many families without a means of support, and there won’t be a fit workforce to rebuild the country. Part of my role was working with and training Syrian staff. I was impressed with how well trained the Syrian theatre assistants were. We learnt a lot from each other, and chatted about our lives outside the hospital. The Syrian staff had a huge thirst for knowledge of the outside world and wanted to know all about my home and family in Australia.
Adapting to limited resources
The hospital was located in a two-storey house in the centre of the village. On the ground floor we had a resuscitation room, an X-ray facility, a sterilising area and the operating theatre. If a patient needed an emergency operation they came through the system very quickly. Upstairs, we had three wards and an office, then an open rooftop with our laundry. I had to adapt to not having the same resources that I’m used to in Australia, such as a CT scanner, or a mobile X-ray machine. But it didn’t make much difference managing patients. We worked on first principles (basic clinical facts and knowledge in the absence of elaborate diagnostic investigations) and I think it made me a better surgeon in some ways. It makes you aware that you can cope with just about anything. It builds your confidence.
I was mostly confined to the hospital and the house. We had a 50 metre walk between the two, so I saw nothing else of Syria. That confinement was difficult to cope with; it drove me mad actually! That was the most challenging aspect of my time in Syria. The most rewarding thing was realising that people want the same things from life, no matter where they are in the world. In Syria, which has such a different culture to Australia, people want a secure place for their family, they want education for their children and they want to make sure they can provide for their family. You realise that no matter what religion you are or what colour you are or what language you speak, people all want the same basic things.