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Like ‘Working in a Prison’: Six Years in the Hell of Syria’s Hospitals

EntertainmentLike ‘Working in a Prison’: Six Years in the Hell of Syria’s Hospitals

ELAZIG, Turkey — “This is my little hero,” the surgeon said, showing off a photo of a baby drinking from a bottle, her head heavily bandaged.

The picture was no family snapshot, but a memento of one of the youngest patients Dr. Omar Ibrahim, a 32-year-old Egyptian neurosurgeon, had saved during six years volunteering in the war in Syria.

Six-month-old Fatima had arrived at his field hospital in the besieged city of Aleppo comatose and in spasm, with a shrapnel injury to her brain, he said. “It was my first time to do this type of operation,” he recalled. “It was just me. I was nervous. What if she died or if I injured her brain?”

After six years working in basements under bombardment in one of the world’s most dangerous war zones, Dr. Ibrahim has been granted entry into Turkey and is finally taking a break. Drinking tea on a wooded university campus in the town of Elazig in eastern Turkey last month, he flicked through photos and videos on his cellphone, recalling the worst and best moments working just yards from the front line.

Fatima survived, and he carries a second photo on his cellphone showing the moment she emerged from a coma, opened her mouth, and yelled. “Babies’ brains are very flexible,” he said. “We had amazing recoveries of babies, really amazing.”

The son of an accountant from the middle-sized city of Sohag on the upper reaches of the Nile in Egypt, Dr. Ibrahim never planned to go to war. He had thought to go to Britain to pursue a career as a neurosurgeon.

But the Arab Spring intervened.

He was still in medical school in Sohag and watched from the sidelines when Egypt was convulsed by demonstrations that brought down President Hosni Mubarak in 2011. Later, he joined meetings and helped treat wounded demonstrators when clashes broke out with the police.

“We all felt something had to be changed,” he said.

Egypt offered little to his generation of graduates. “Corruption, the health system, education,” were all concerns, he said. Low salaries and a lack of equipment and drugs in Egypt meant that most doctors looked abroad to pursue a career, he said. None of his four brothers, all college educated, found permanent employment in Egypt.

In 2013, when the revolution was crushed and President Mohamed Morsi and his supporters were jailed, Dr. Ibrahim joined an exodus of young, educated Egyptians. “We all felt the revolution was finished,” he said. “There was a huge wave of depression.”

He was 26 and halfway through his residency at Sohag University Hospital when he saw an appeal for doctors in Syria. Protests in Syria against President Bashar al-Assad had by then developed into a full-scale armed conflict, and he saw an opportunity to help.

It was not the career move that Dr. Ibrahim had planned, but he took it. “I wanted to take the risk to start somewhere to achieve something good,” he said.

It was an easy two-day trip to the war zone. In Aleppo, with medical personnel fleeing, an extra surgeon was welcomed and he settled in.

He missed home cooking and lost weight, though. “They use a lot of lemon and don’t like salt,” he complained of Syrian cooking. He kept in touch with his family, but never told them he was in Syria. “I said I was on the Turkish border helping refugees.”

For the first few months, with no equipment, the doctors could only stabilize patients with brain injuries and send them by car to Turkey, a dangerous drive of several hours. Most patients died on the way, or overnight awaiting transfer, he said.

That changed when he and his colleagues found and repaired an old CT scanner. “It was like from the 19th century,” he said. The machine took 15 minutes to produce images — modern scanners take two to three minutes — but it allowed him to start operating on skull fractures.

In January 2014, the Syrian American Medical Society, which was supporting one of the field hospitals, hired him and began to help with equipment. A few months later, he conducted his first brain surgery, extracting skull fragments from a patient’s brain, with a senior surgeon observing.

He had planned to stay only a few months, but put off leaving. “I had to stay,” he said. “It was getting worse: more injuries, more doctors leaving.” Crossing back into Turkey along smuggling routes also became dangerous. “I was procrastinating,” he said. “I am not a very risky person.”

But as the Syrian government closed its grip on the city, Aleppo became one of the most dangerous war zones on Earth, and hospitals and medical clinics became frequent targets of government bombs. He lived and worked in three field hospitals, operating underground for two years.

The medical staff learned the rhythm of the bombing — jets and helicopters began at 9 a.m. and eased off at nightfall — and would venture upstairs for an hour to eat, before shelling from nearby government posts sent them back underground.

For a few months there was a cease-fire and he found respite visiting Syrian friends in the countryside outside Aleppo. He even got engaged, after a friend introduced him to Joud, a 23-year-old social worker who worked in the administration of a charity.

As the bombing intensified, casualties rose. A month after their engagement in 2016, Joud was killed in a bombing on her way home from work. Dr. Ibrahim withdrew into himself for a few days in grief and anger. “I did not feel like talking to anyone.” Soon, though, he returned to work. “Other people lost more than me,” he said.

The hospital was swamped by the wounded in the last months of the siege. “I could not go out of the hospital for a few minutes, because any second a shell might fall on us,” he said. “I was someone else. Not sleeping. Not walking. Like you are in a prison and working in a prison.”

The hardest day was when he was forced to operate on the floor of the intensive care unit, as the beds and operating rooms were all occupied. “The hospital was very crowded — I needed to do surgery immediately,” he said.

The patient was comatose with a brain injury and one of his pupils dilated, an indication of life-threatening pressure from bleeding on the brain. “Every minute counts,” Dr. Ibrahim said. “I drilled a small hole and the patient stabilized.”

He never knew the man’s name, but the patient visited him two months later for a checkup. “I was standing like stone,” Dr. Ibrahim recalled. “I did not expect him to survive.”

In December 2016, after Turkey and Russia negotiated an end to the siege of Aleppo, Dr. Ibrahim helped evacuate 50 patients from the hospital and then joined doctors and civilians in the first of a convoy of buses carrying the last survivors.

“We left Aleppo destroyed. It was not the Aleppo that we knew,” he said. “Some people burned their houses, because they knew they would not come back.” He used a medical term to describe his own feelings as he left the hospital and his instruments behind: “Flatline.”

He ended up in Idlib, the last opposition-controlled province in northwestern Syria, along with several million displaced Syrians, and after a few months began working in a provincial hospital.

But the Syrian government, intent on reasserting its control throughout the country, began an offensive against Idlib this spring. The daily bombing brought back all the horrors of Aleppo, and once again he began operating underground.

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