MUST READ ! : Syria’s Civil War Forces Doctors to Choose the Rebels or the Regime

Physicians, Medical Residents Open Secret Clinics to Fill Void Left by Conflict

By – Nour Malas – 19.12. 2013 – Wall Street Journal – Dr. Adnan Ismail was on duty for the worst chemical weapons attack in the last 25 years. When bodies began arriving at his hospital near Damascus, he filmed the carnage, then fled the country so he could show the world. WSJ’s Nour Malas reports.

Adnan Ismail worked as a doctor in a Syrian government hospital. But civil war led him to a farm field where he and friends labored nights in secret to build a makeshift rebel-run clinic. For a year, Dr. Ismail helped dig walls and stairs to fashion an underground bunker that was eventually equipped for surgery, he said.

Dr. Adnan Ismail led a secret life tending to Syrian rebels and civilians hurt by government forces. Ayman Oghanna for The Wall Street Journal

In wheat fields and olive groves, at private homes and in the backs of trucks, Syrian doctors like him have cobbled a health-care network of medical students, nurses and civilians to supplement hospitals lost in the conflict. Most of these workers aren’t trained for the trauma injuries they see. They are short-handed, lack supplies and are targets of government forces. But without them, according to medical organizations monitoring the crisis, many more Syrians would have died in a conflict that has claimed an estimated 125,000 lives.

“I always requested from God an adventurous and fulfilling life,” said Dr. Ismail, a 29-year-old man of slight build who wears the neatly cropped beard common among Syria’s rebels. “I think he may have taken me too seriously.”

Samer Attar, a Syrian-American orthopedic surgeon, saw some of this work firsthand during a leave from Northwestern Memorial Hospital in Chicago to volunteer this fall at a hospital in the rebel-held section of Aleppo.

Syrian medical residents were essentially teaching themselves trauma surgery, Dr. Attar said. “They function as full-time surgeons,” he said, recalling the stream of wounded: “People missing limbs…faces pebbled with shrapnel. A few times, people holding their bowels in their hands.”

Makeshift clinics have proliferated in the rebel-held north, but shifting battle lines have made it harder to keep them hidden from government forces or separated from rebel operations, said Syrian doctors and international medical groups.

Five of the six field clinics in the north were hit by government airstrikes this fall, doctors at three of the hospitals said. The al-Bab Hospital, which sits in a town in Aleppo province now controlled by al Qaeda-linked rebels, has been bombed five times, medics at the hospital said. Its medical staff has relocated from one building to another so many times they now keep much of their equipment in ready-to-move boxes.

Some 50 international doctors, including the heads of global medical bodies, warned that Syria’s health services were at “a breaking point,” in a letter published in the medical journal The Lancet in September. The war, doctors said, is restricting medical care for millions of Syrians on all sides.

“Systematic assaults on medical professionals, facilities, and patients are breaking Syria’s health care system and making it nearly impossible for civilians to receive essential medical services,” the letter said. Attacks on hospitals in rebel-controlled regions were described in the letter as “an unconscionable betrayal of the principle of medical neutrality.” Attacking hospitals violates the Geneva Conventions and constitutes a war crime, said international experts on human-rights law. United Nations investigators said both sides have targeted hospitals, with no regard for civilian casualties.

The U.N. Commission of Inquiry, which documents abuses in Syria, said in a September report: “Evidence collected by the Commission leads to an overwhelming conclusion: Government forces deny medical care to those from opposition-controlled and affiliated areas as a matter of policy.”

A Syrian government official said hospitals in rebel-held areas, usually located in battle zones, aren’t appropriately marked as medical facilities and are often used by rebels to store ammunition or launch attacks. “It’s the rebels taking advantage of it being a hospital and saying to the media: ‘Look, they are shooting at a hospital,’ ” said Reem Haddad, an official at the information ministry in Damascus. “There is no way the Syrian army will know whether this is a hospital or not.”

Ms. Haddad said opposition forces have targeted clearly marked hospitals in government areas, including Tishreen Hospital in Damascus and al-Kindi Hospital in Aleppo, which she said were hit by mortar shells on Wednesday.

Dr. Ismail is among thousands of doctors who faced an agonizing choice: Treat only patients approved by the government of Bashar al-Assad, or throw their lot in with the opposition. For a time, Dr. Ismail did both, he said. By day, he worked as a gynecologist at a government hospital. At night, he treated wounded rebels and civilians under the nom de guerre, Dr. Abulqa’qa’. He is now in Turkey, his cover blown, anxious to return home, where, he said, his skills are needed. He said his mother and two brothers were recently hurt in government attacks.

“My whole life, everyone would call me doctor,” said Dr. Ismail, the oldest of eight children. He recalled being first in his class growing up in Qasamiyeh, a village about nine miles outside Damascus in the Ghouta region, the agricultural suburbs now under government siege. The high expectations of his family and neighbors, he said, motivated him to become the only medical student in his village of 7,000 people.

Dr. Ismail studied medicine in southeast Ukraine, where he lived for seven years. He learned Russian and some English. In his spare time, he taught Arabic and played soccer. Living abroad, he said, helped shape a more critical view of his country.

During visits home, he was greeted by honking horns from a convoy of cars filled with family and friends. The doctor-to-be often stole the limelight at village events. He got a standing ovation when he arrived as a guest at one wedding and some people mistook him for the groom, he recalled with embarrassment.

Dr. Ismail returned home after completing medical school in 2010, and he specialized in gynecology at the Greater Damascus Mujtahid Hospital.

His life changed the following year, when demonstrations erupted against the Assad government. On April 22, 2011, protesters gathered near a mosque in Qasamiyeh and surrounded a statue of Hafez al-Assad, the former president and Mr. Assad’s father. Dr. Ismail joined the protest despite pleas from his parents, and the crowd brought the statue down. Security forces fired; eight people died and more than 50 were injured. That day, Dr. Ismail said, his parents’ living room “practically turned into a field hospital,” with the administering of stitches and sutures to the injured.

As protests spread in the Ghouta suburbs, the number of deaths and injuries grew. Dr. Ismail and a friend—a first-year medical student—turned a vacant farmhouse into their first field clinic. The doctor and antigovernment activists collected antibiotics, gauze, splints, suture kits and other supplies. Villagers would ask Dr. Ismail to make house calls because they feared arrest if they ferried injured loved ones to the clinic. Five days after the first patients were treated, Dr. Ismail said, the clinic was bombed. For much of 2011, Dr. Ismail worked at a hospital in a government-held region of Homs, sneaking out to protests between shifts. He met local rebels and volunteered with the Free Syrian Army, treating injuries and delivering milk and medicine to besieged neighborhoods.

As Dr. Ismail went on riskier assignments, he adopted a rebel name, Dr. Abulqa’qa’, after a legendary Islamic fighter known for bravery and physical prowess. He said he would overhear medics talking about a mysterious rebel doctor who secretly crossed the front lines to treat the injured. During those conversations, Dr. Ismail said, he would nod or pretend to be preoccupied.

In January 2012, rebels launched attacks on the capital from the suburbs and government forces responded. As casualties grew, Dr. Ismail began his most ambitious project with two men, a friend and the owner of a plot of farmland. They pooled funds to start building the underground clinic and drew the first outlines in the dirt one night with tree branches. “We worked painfully slow,” Dr. Ismail said, to avoid detection. Their first patient was a man who needed eye surgery to remove shrapnel. Dr. Ismail recruited two eye surgeons, two anesthesiologists and a nurse. The volunteers arrived blindfolded, he said, to keep the clinic’s location secret. In a different part of the Damascus suburbs, Dr. Ismail worked at a clinic in a building that also housed the local rebel military council. The clinic was later struck in a rocket attack.

By midyear, Dr. Ismail had quit his job at the government-run hospital in Homs, and was working with a first-year surgery resident to serve 10 villages in rebel-held areas. He said they took on more difficult surgeries, including chest operations and amputations. Around that time, Dr. Ismail negotiated with a driver working for a private hospital in Damascus to secure an ambulance. The doctor arranged for the man’s family to move to a neighborhood guarded by rebels. The ambulance was guided slowly through a minefield. Then rebels beat the man, Dr. Ismail said, so authorities would believe the vehicle was taken by force.

By the start of 2013, Dr. Ismail had only the ambulance and the underground clinic, still under construction. Between February and May, the front lines moved closer. They performed three eye surgeries before government forces retook the region in June. “We just needed two more months and a little more money, and we would have been able to finish it,” Dr. Ismail said. He moved to a small clinic nearby, one of the last working medical facilities in the Ghouta region.

On Aug. 21, he was winding down his shift when bodies began arriving from a chemical gas attack that killed more than 1,400 civilians, according to U.S. estimates. The first patient that night was a 5-year old girl in cotton pajamas whose limp body was dumped into his arms. “She was dead,” he said. “I just couldn’t absorb that.” Working with a medical student and 15 nurses, Dr. Ismail turned on garden hoses to flood the clinic floors. They dragged the bodies through the water. Soon, the dead filled the clinic’s two rooms. About 4 a.m., Dr. Ismail passed out from the chemicals. He said he was revived with an atropine injection.

By 10 a.m., the doctor said, he had tallied 200 dead. “The worst part was the wailing” of grieving families, he said. Dr. Ismail recorded videos on his Sony Ericsson cellphone. In one viewed by The Wall Street Journal, a veiled woman in a brown trench coat is seen stepping over bodies. “Where is God?” she is heard saying. “Where are you my children?” The doctor said he spent the next two weeks in a daze. Activists reached him on Skype, saying Western governments, particularly the French, wanted witnesses to give testimony about the gas attack. Several countries, including the U.S., were debating a military strike against the Assad regime.

On Sept. 10, Dr. Ismail left with hair and blood samples, traveling through the deserts of Deir el-Zour in the east and then north to the border with Turkey. He and two travel companions were hosted by tribal families for most of the 10-day trip. Dr. Ismail crossed the border in a truck smuggling fuel and generators. He said he was held by Turkish authorities for two days over a misunderstanding over who should get the samples, and whether his companions—who didn’t carry passports—could cross into Turkey.

Turkish intelligence eventually took the samples, he said, which were destined for the French Embassy in Ankara. One French official said national intelligence agencies coordinated efforts to get survivors and witnesses of the sarin-gas attack out of Syria, and the details were largely kept secret. A spokesman for Turkey’s foreign ministry didn’t return a request for comment.

As Dr. Ismail waits to return, he moves among various homes of activists and rebels. He has crossed into Syria three times but has been forced back by the constantly shifting battle lines. He assumes if he is caught by government forces, he will be killed. Yet he said he was eager to again tend to the wounded—disappointed that his mission took him out of Syria and failed to draw Western intervention. “I’m not a taxi driver. I didn’t come out here to deliver samples,” Dr. Ismail said. “I came out because I thought I was serving a greater cause than the one I was serving inside.”

—Mohammad Alakraa – in Beirut and Sam Dagher in Damascus contributed to this article.