Underground medical expertise refined in Syrian crucible #Syria
By Ivan Watson and Kareem Khadder, CNN
February 22, 2012 — Updated 0258 GMT (1058 HKT)

Idlib Province, Syria (CNN) — At first glance, it looked like movie night at the neighborhood mosque. Dozens of teenage boys sat mesmerized on the carpeted floor, staring at a screen mounted on the wall.

But the show wasn’t a comedy, a cartoon or a Hollywood action film. Instead, the boys’ attention was captured by a locally produced instructional video demonstrating how to provide first aid to people who had abdominal injuries and appeared to be shot.

“You have to check for entry and exit points,” a narrator explained in Arabic, as a medic used gauze to wipe away fake blood from a volunteer’s bare stomach.

Not all of the demonstrations were simulations. In one segment, a male nurse narrated as he cleaned and stitched the hole in a man’s scalp, the result of being grazed by a soldier’s bullet.

“I have operated on six similar cases [over the past year],” said the nurse, who asked not to be identified for his own safety. “In my 30 years as a nurse, I’ve never seen injuries like this.”

The video was part of a first-aid course that activists and local medical workers have provided for free to hundreds of men, women and children in this opposition-controlled town in Idlib Province. (In order to protect people interviewed for this story from reprisals, the exact location is not being identified).

In between lessons on how to bandage wounds and carry unconscious victims, the presentation included snippets of amateur activist video, showing bleeding, badly wounded demonstrators being carried down Syrian streets.

According to the Local Coordination Committees of Syria, a network of opposition activists, more than 8,000 people have been killed since the Syrian security forces began their crackdown on anti-government protests 11 months ago.

The cycle of violence in Syria has been so deadly for so long that opposition activists have taken matters into their own hands. In addition to trauma treatment lessons, they have established what could be described as a parallel shadow system of health care for their communities. Several doctors told CNN they operated secret clinics to treat patients wounded in clashes with security forces along with invalids suffering from common ailments.

The underground medical networks sprang up because many residents deemed it too dangerous to travel through government checkpoints to the main provincial hospital in the nearby city of Idlib. That contested city periodically echoes with bursts of heavy gunfire as rebels and government forces engage in deadly skirmishes.

But doctors and residents also say they have seen a pattern of government reprisals that seemed to target health workers.

“I have to hide my medical bag because what if they (Syrian authorities) find them? They would shoot me,” said a Syrian dentist in another town in Idlib province.

He had ample reason to be scared. As the number of protests and subsequent casualties grew last year, the dentist began using his small dental clinic as a first-aid station for wounded activists and bystanders. Instead of drilling teeth, he struggled to save men suffering from gunshots to the stomach.

Then, one day last summer, he said Syrian soldiers knocked at the door of his clinic.

“As soon as I opened the door, the soldier took a Kalashnikov [rifle] and hit me in the face with it,” the dentist said. He said he was beaten, blindfolded and dragged out to the street, where three other doctors were being beaten.

Later, captives were dragged to a car, where the dentist said a soldier sat on top of three doctors and put out cigarettes on the prisoners’ hands and backs.

“I thought, they must be from another country. They couldn’t treat their own people this way,” the dentist recalled.

The dentist spent the next 45 days in a prison unit built for 60 people but crammed full of 130 prisoners. Every couple of days, he said, he was taken in for interrogation and torture, which included beatings, near-drownings in buckets of toilet water, and electric shocks to his genitals.

“They started beating me and asked me, “Who did you help?’” he recounted. “I said, ‘I helped an old lady.’ Then they started beating me even harder.”

According to a recent report by the humanitarian organization Medecins Sans Frontieres (Doctors Without Borders), the dentist’s case is not an isolated one.

“The Syrian regime is conducting a campaign of unrelenting repression against people wounded in demonstrations and the medical workers trying to treat them,” the report concluded, adding, “Medicine is being used as a weapon of persecution.”

The Syrian government has repeatedly denied accusations that it is targeting civilians. It insists that its forces are fighting in self-defense against “armed terrorists.”

But doctors who have seen their colleagues arrested and tortured for treating wounded people disagree.

“The regime knows no humanity. Bashar [al-Assad] is a doctor in name only,” said one young doctor, who volunteered as a quick responder with the Syrian Red Crescent. He was referring to the Syrian president, who trained as an ophthalmologist in Britain before being propelled into the presidency by the death of his father, Hafez al-Assad, in 2000.

In the case of the dentist, 45 days of detention and torture in prison appeared to have only pushed him further into the Syrian opposition movement.

“When I was released, the whole town was waiting for me in the street — children, adults and old people,” he said in an interview with CNN. “I immediately forgot all about the torture. And that confirmed one thing for me: that I have to help the people even more.”

He no longer uses his dentist’s chair to treat the wounded. Now, the dentist was working with a small, secretive network of other health-care professionals to set up a network of underground field hospitals in their town in the event of a military assault.

They also had gathered hundreds of first-aid kits equipped with serum, gauze and bandages and quietly distributed them to hundreds of homes in their town.

“We are preparing for the threat of a battle,” said the Red Crescent doctor. “This is something natural after what we saw in Homs.”

Rebels in Idlib province fear that after the Syrian military destroys rebel neighborhoods in Homs, the regime could turn its attention to opposition enclaves in the north of the country.

One group of doctors told CNN they were preparing for such an emergency by setting up their own underground blood bank.

They have little other choice. According to Doctors Without Borders, all of Syria’s blood banks are under the control of the Ministry of Defense.

So in one rebel enclave, activists have compensated by compiling a list of potential blood donors, who have all been tested for blood types and to ensure they carry no blood diseases.

Even the most careful planning, however, ran up against the obstacle of shortage of medical supplies. The activists had only succeeded in securing 100 blood container bags for a community of tens of thousands.

“There’s not enough medicine,” said the dentist. “I’ve been trying to stockpile medicine. But when I treat one sick person I use almost all of it up. … if there is a battle here and 100 people are wounded, what will we do?”

Source: CNN

Homs, city of torture #Syria (Donate for aid: SyrianReliefCare.com)

Author Jonathan Littell tells of Assad’s security forces targeting medical personnel and how he was smuggled to the heart of the Syrian conflict

Jonathan Littell

guardian.co.uk, Monday 20 February 2012 23.50 GMT

A member of the Free Syrian Army wounded in clashes with government forces. Photograph: Tomas Munita/New York Times/Redux/eyevine

In Bashar al-Assad’s Syria, it is not just forbidden to speak, demonstrate and protest: it is also forbidden both to give medical treatment, and to receive treatment yourself. Since the beginning of the uprising, the regime has been waging a merciless war against any individual or institution capable of bringing medical aid to the victims of repression. “It’s very dangerous to be a doctor or a pharmacist,” a pharmacist from the Baba Amro neighbourhood of Homs tells me. Medical personnel are imprisoned – like the nurse in the nearby district of al-Qusayr, arrested the day after he showed me around his hidden emergency-care centre, its carpets covered with plastic tarpaulins to protect them from blood – or killed, like Abdur Rahim Amir, the only doctor in that centre, murdered in cold blood in November by military security, while he sought to treat civilians wounded during the army’s assault on Rastan to the north. Or tortured.

In Baba Amro, a nurse from the Homs National Hospital, imprisoned in September, describes the tortures he was subjected to by miming them: he was beaten with a club, blindfolded, whipped, suffered electric shocks, and hanged from the wall by a single wrist, on tiptoe, for four or five hours – a common practice that has its own name, ash-shabah. “I was lucky, they didn’t treat me so badly,” he insists. “They didn’t break my bones.” Sometimes, the regime’s forces just insult them. A Red Crescent nurse, in her ambulance, was stopped at a checkpoint: “We shoot them, and you save them!” the soldiers berated them.

The two city hospitals, the civilian (called the “National”) and the military one, are under the thumb of the security forces, and their rooms and basements have been turned into torture chambers. The private clinics, last resort for the wounded of the insurrection, are subjected to permanent assault. In one, in the heart of the old city, two nurses show me the impact of bullets in the windows, walls and beds, fired by the army from the nearby citadel. Aside from these two nurses, the clinic is empty. “We can only accept emergency cases and we don’t keep anyone for more than a few hours. The security forces come here regularly and arrest everyone they find. The doctors have had to sign a pledge not to take care of demonstrators.”

As they speak, a bullet slaps into the room next to ours. Everyone laughs. “Ever since the Free Syrian Army (FSA) established itself in the neighbourhood,” continues one of the nurses, “the wounded can be brought here.” The rebel army also transports doctors for operations, when it’s possible. Five days earlier, the clinic received a man with his belly torn open: a first surgeon was able to operate, but needed a specialist to complete the procedure. The neighbourhood, however, was sealed off, making it impossible to bring the specialist in and impossible to transfer the patient to another hospital. “In the end he died,” concludes the nurse.

Abu Hamzeh, a highly trained surgeon, tries to care for the wounded who arrive daily at an emergency first aid point in the city. He is so desperate about the lack of resources – his centre has no anaesthetics, no medical imaging equipment, he can’t operate on anyone, just bandage them and give them saline drips – that he wants to give up medicine and take up arms. “I’m useless here,” he mutters bitterly in front of a man with his abdomen perforated by a sniper bullet, “completely useless.” When the uprising first began, Abu Hamzeh was working at the Homs military hospital, and he witnessed the tortures inflicted on wounded demonstrators, sometimes even by nurses or doctors, whose names he carefully recorded. When the head doctor of the hospital tried to forbid such practices, they simply became more discreet. “One day, I treated a patient in the emergency room. The next day he was sent to the CT room for a brain trauma he didn’t have the previous day. That’s how I discovered that they did things to him at night. After two days the patient died from his brain trauma. He would not have died from the injuries I treated the first day.”

Horrified, Abu Hamzeh managed to procure a camera-pen in Beirut, and secretly recorded, with the help of a nurse, four short videos in a post-operative care room. In the clips you can see five patients, completely or nearly naked beneath the sheets, blindfolded, one ankle chained to the bed. The doctor’s hand uncovers their bodies: two of them bear large fresh red marks on the torso, the result of flogging. Lying on a table are the torture instruments: two supple whips, rubber straps cut out from tyres and reinforced with duct tape, and an electric cable with a plug on one end and a clamp on the other, to be attached to the fingers, feet or penis. One of the injured men groans incessantly. “They had blocked their catheters,” Abu Hamzeh exclaims. “When I came in they begged for something to drink. I opened the catheters and changed the urine bags, which were full, but two of the patients went into a coma because of kidney failure. When I changed their bandages, I noticed gangrene on one of the patients; I told this to the orthopaedic section but wasn’t able to follow up. Three days later I heard they had cut his leg off above the knee.”

Abu Hamzeh, who recently resigned his position in order to join the opposition, was quickly sidelined. But the practices he describes have only intensified over the past months. In Baba Amro, we are taken to meet R, a wounded man whose leg has been amputated, and who was just released from the military hospital. In late December a shell fell in his street, killing five of his neighbours and relatives. In the little video they show me, you can see R bundled into a vehicle, his leg half-torn off, just held in place by a hastily tied scarf. The first private clinic where he was brought was overwhelmed with wounded, and they tried to transfer him to another one, along with his 28-year-old nephew, whose left arm was attached by nothing more than a few scraps of flesh. But the ambulance transporting them was intercepted at a security forces checkpoint, where the two wounded men were arrested, placed in an armoured vehicle, and taken to the military hospital. There, without receiving any medical attention, handcuffed to their beds and blindfolded, they were tortured for eight hours. “They hit me with food trays, on my head and body. They tied ropes to my wounded leg and pulled in all directions. They did many other things to me, but I don’t remember them.”

The men torturing him weren’t even trying to get information, they just insulted their victims: “Ah, you want freedom, well here’s your freedom!” His nephew died from the torture; finally, R was transferred to the operating room for surgery. Afterwards, he was imprisoned, without any post-operative follow-up: his leg got infected, and six days later it was summarily amputated by a military doctor. I am shown a picture of him upon his release: his skin sallow, his cheeks sunk, skeletal, but softly glad to be alive. “They killed me, back there,” he concludes, his eyes shining. “I should never have come out alive.”

Such practices are in no way isolated cases, individual initiatives fuelled by sadism or overzealousness, outside of any control. On the contrary, they are codified and regulated by a set of procedures far older than the current uprising, as Abu Salim, a military doctor who served for two years in the mukhabarat, the Department of Military Intelligence, before defecting to the opposition to run a makeshift clinic in Homs, testifies: “What is the mission of a mukhabarat medical doctor?” he calmly asks as my tape recorder runs. “I will explain it to you. Firstly: to keep alive the people subjected to torture so that they can be interrogated for as long as possible. Secondly: in case the person being interrogated loses consciousness, to attend to him so that the interrogation can continue. Thirdly: to supervise the use of psychotropic drugs during the interrogation. We used chlorpromazine [an anti-psychotic drug prescribed, usually, for schizophrenia], valium, and rubbing alcohol – for instance, by pouring a litre into the nose, or else by subcutaneous injection. Fourthly: if the person being tortured has reached his threshold of resistance and is in danger of death, the doctor can request his hospitalisation. However, the doctor cannot make the decision: he must write a report and the officer in charge of the interrogation then decides whether or not to grant the transfer. Before the revolution, almost everyone was transferred; now, it’s only the important prisoners. The others are left to die.”

How I made it into Syria undercover

Morning. Rain is falling hard. One of the two Lebanese smugglers, at the wheel of a mini-van, is driving us down the small streets of Mount Lebanon, avoiding the Lebanese Army posts, out on to a large rocky plain. Syria is right in front of us. At a bend in the road, three boys are waiting for us on motorbikes. They aren’t professionals either, just local farmers, their hands red and calloused. They take us through muddy paths between houses and fields; we pass dirty, ragged children, a few beehives, some horses, until we reach a house where smiling farmers serve us coffee.

A radio call: the road is free, so we leave for another house, further on in the village. At that instant, a text message from the Ministry of Tourism, in English, appears on the cellphone: “Welcome to Syria.” We have passed through to the other side of the mirror.

The trip from Qusayr on the border to Homs, about 30 kilometres, will be made in the same way: by going from one house to another, from one vehicle to another, from one hand to another. A wide network of civilians helps the Free Syrian Army and the revolution. At every stage, a vehicle or motorbike goes in front to check if the road is free. And when we move, there are always people in front, around, behind us; cellphones are continually ringing to transmit the latest news.

Everything happens as if, faced with the police and security grid of the Ba’ath party and the mukhabarats – a grid that has dominated the life of the country for decades – society had in these past few months put in place a counter-grid, almost as effective, made of civilian activists, notables, religious figures, and, more and more, armed forces – the deserters who form the FSA. This counter-grid resists the other one, circumvents it, and is even starting to absorb it in part. When you travel between the Lebanese border and Homs, it becomes visible. There has, of course, always been a passive resistance to the regime’s grid, but now this second grid has completely broken away from its ties to the former. As if Syrian society, since the spring, had split in two, and as if both parallel societies were coexisting in the country, in mortal conflict.

• First published in Le Monde. Translated by Charlotte Mandell. (c) Jonathan Littell.

Source: Guardian

#Syria frontline dispatch: wounded flood into makeshift hospitals near Homs

By , Middle East Correspondent, Near Homs

6:06PM GMT 09 Feb 2012

Down the road ahead, their provincial capital is being ruthlessly pummelled into submission, by tanks, mortars and what looked from the blast damage to be heavy duty artillery.

But however outnumbered and outgunned they may be, the revolutionaries of Homs are fighting back, and they are paying a heavy price.

In villages around the city, liberated areas have sprung up, with a patchwork of front lines defended by the loose confederation of amateurs and defectors who like to call themselves the Free Syrian Army.

On Thursday, a steady stream of them poured into a makeshift field hospital set up in a tumbledown, traditional Arab farmhouse, plastic tarpaulin protecting the “operating room” from the bare rafters and cane roof.

“We have had 30 people so far today,” said Dr Kasem. “Of those, five were children and three were women.” He was the most experienced surgeon present, but with these numbers anyone with any medical training joins in. Inside, a nurse was resting briefly after operating on a man with a bullet wound through his chest.

The numbers tell a story: the first is that the mortars and worse being fired into this particular village from the army position half a mile away are indiscriminate in their effect.

The second is that the sharp retorts of rifle fire, interspersed with the reverberating explosions of light artillery coming from nearby, are those of real battle, being engaged with fatal results for the men involved.

As Dr Kasem spoke, volunteers showed the gruesome footage of that morning’s work on their mobile phone videos: a man with half his head blasted off by a sniper, brains hanging out, dead; another, seemingly in a similar condition but still alive in a speeding vehicle. After a brief triage it sped on again, and he was, they had heard, successfully smuggled to the border for better treatment for better treatment abroad.

The army’s artillery assault on the suburbs of Homs, which continued yesterday, has obscured the full scale of the guerrilla insurgency which has gripped much of the country.

With the forces ranged against them, it seems impossible that the Free Syrian Army can make much of an impression on the Assad regime. In this area, none had more than Kalashnikovs, grenade launchers, and a few rusty mortar shells.

Estimates of the numbers of the FSA range from the 40,000 claimed by its leaders, based over the border to the north in Turkey, to the mere 5,000 suspected by sceptics. The rebels and their sympathisers say that everyone is a potential member of the FSA, dodging the question.

But near Homs, there were clearly hundreds of rebels, with some level of organisation and communication, controlling quite large areas of land.

For mile after mile small towns and villages that dot the fields and orchards are empty of government forces, armed rebels standing on street corners of several with impunity.

The rebels are also united and improvise quickly.

As Dr Kasem spoke, there came the screeching tyres of another emergency. As in Libya, this is a war being fought not only by ordinary people but by the anticlimactic paraphernalia of peacetime, as small Honda sedans become ambulances overnight.

The stretcher bore a bearded man panting heavily, an army first lieutenant now fighting his former comrades. In the operating room, his shirt was ripped off to reveal bullet wounds to his stomach.

A French surgeon volunteer set to work, methodically removing his innards, disposing of bullets and damaged flesh, sewing up an almost comically circular hole in an intestine. The patient seemed stable, but the surgeon was concerned as he continued to lose blood from an internal wound he could not find.

As the lieutenant had bags of blood poured into him, two men in the next room were busy replenishing the stocks.

As more and more men with bullet wounds were stretchered in during the afternoon and early evening, a portable X-ray machine and an ultrasound were brought into service. The majlis – meeting room – of the house served as storeroom for the basic supply of medicines, as a canteen, and as a triage room. Finally, when the numbers were too many, a drip was set up for a man with blood pouring from his forearm and a bandage round his chest.

The rebels are nonchalant in the face of combat. In the street outside, sniper fire rang out from the right and a mortar exploded simultaneously out of sight 100 yards or so away to the left.

Asked where the government forces were, with fire coming from both sides, one young man pointed in both directions simultaneously and said “There and there”. Then he paused, pointed his arm up the road, and said “There, too”, and then pointed to the fourth point of the compass and said “There too, but further away”. They were, he thought, roughly surrounded.

But the nonchalance is fatalistic. A man with a Kalashnikov, his head wrapped in a red and white keffiyeh, or headscarf, pointed to the heavens as another shot rang out. “God decides where it will land,” he said.

Shortly before, another car had pulled up outside the gate of the field hospital, sparking the usual rush with the stretcher to the street. There was a brief consultation by the open door, and then they trooped back in.

“A martyr already,” a nurse, who until recently was working at the main government hospital nearby, said.

The man was the field head of the local rebel forces; Commandant Ahmed they called him. The rebels seem to expect their commanders to lead from the front rather than from a point of safety.

How much longer such losses can be sustained is the question. The government army has retaken territory elsewhere, and as nightfall approached, the shelling seemed to be getting nearer.

The rebels are also aware that the regime has been emboldened by its support from elsewhere. “I was trained in Russia,” Dr Kasem said. “I am ashamed to say that now.

Source: telegraph.co.uk