Syrian girl Salam Rashid, 14, is prepared for surgery at MSF Hospital for Specialized Reconstructive Surgery, run by the international charity Médecins Sans Frontières (Doctors Without Borders) in Amman, Jordan. Three years ago, her lower legs were blown off by a tank shell outside her home in Khirbet Ghazaleh in southern Syria. Her older sister Thaleq, who was with her at the time, was killed. Salam now walks on padded stumps that end below her knees. — AP photos They are among the most tragically wounded from the Middle East's multiple wars. A 14-year-old Syrian girl whose lower legs were torn off by a shell. A 15-year-old Iraqi boy who was severely burned in a car bomb explosion. To treat such patients, the international charity Médecins Sans Frontières (Doctors Without Borders) next month officially inaugurates its new reconstructive surgery hospital for war victims, which it says is unique in the region. The Amman hospital gathers together battle-tested surgeons, counselors and physiotherapists specialized in war victims. It will eventually offer 3-D printing for hand and face prostheses. The eight-story building is also envisioned as a learning center where surgeons from the region and the West can teach each other new skills. “It's a very new approach of war surgery,” says Marc Schakal, head of MSF in Jordan. The need for the facility is also testimony to how the region's conflicts become more horrific. MSF doctors began running a reconstructive surgery program in a wing of Jordan's Red Crescent facilities in 2006. At that time, the focus was on treating casualties from the Iraq war. Now, it's Iraq, the civil war in Syria and repeated Israel-Hamas conflicts in Gaza, all of which take a terrible toll on civilians. Associated Press journalists spent several days at the MSF Hospital for Specialized Reconstructive Surgery, which has been operating for the past five months on a test basis. Heart-breaking cases Dr. Mukhalad Saud, a plastic surgeon, treats burn patients. There are many in his native Iraq. He says he can't allow himself to be overwhelmed by the sheer number of heart-breaking cases. “As a surgeon, you have to have a hard heart and a sharp knife,” he told AP. On a recent morning, he saw one of his long-time patients, Ahmed Khalefeh. When a car bomb exploded outside a school in the Iraqi town of Kattoun in 2010, the fifth-grader suffered severe burns over much of his face and body. Now 15, Ahmed has undergone almost a dozen surgeries, Saud said. Ahmed has gone back and forth between Iraq and Jordan multiple times. Most recently, Saud implanted a balloon-like device near Ahmed's clavicle that is being expanded gradually to grow skin to replace Ahmed's scarred neck tissue. That will allow him to move his neck more easily and hopefully have the extra effect of straightening Ahmed's mouth, which droops on one side — but if it doesn't, Saud will do another procedure to fix that. But it will be at least another month before the neck surgery can be done, Saud tells Ahmed. Ahmed says surgeries no longer faze him, but the waiting is hard. His latest stretch in Jordan has already lasted 14 months. He has years of schooling to catch up on. Ahmed and other patients and their caretakers — usually a relative — live at a nearby hotel, their travel and residency costs paid by MSF. They cook in a communal kitchen and gather around a TV in the evenings, especially to watch soccer matches. For Ahmed, football is a welcome distraction. Some evenings, he and other burn victims his age — all close friends — play on a lot across the street from the hotel. The boy exudes confidence, saying he can do almost everything he was able to do before the attack, except heavy lifting. “It's just the appearance now,” he says, smiling. MSF referrals Administrators and doctors meet once a week to decide which patients to admit from among the many referrals from MSF clinics in war zones around the region. Photos of patients and their medical reports flash on a screen as surgeons from different specialties — orthopedic, plastic, maxilla-facial — discuss the cases. Criteria are strict: Only patients whose abilities can be improved with surgery. Aesthetics are considered secondary. More than 8,200 surgeries have been performed as part of the program since 2006. The MSF hospital has a capacity of 200 — it's at 180 children and adults currently — and the need is immense. In Syria alone, more than 1 million have been wounded in the war since 2011, the World Health Organization recently estimated. Figures from Iraq and other conflicts are harder to come by. “One hospital is not enough,” says Schakal. Counselor's supervision Among the new arrivals at the Amman hospital is 14-year-old Salam Rashid. Three years ago, her lower legs were blown off by a tank shell outside her home in Khirbet Ghazaleh in southern Syria. Her older sister Thaleq, who was with her at the time, was killed. Salam now walks on padded stumps that end below her knees. On a recent afternoon, she quickly made her way down a hospital hallway on her stumps, heading to a playroom. There she hoisted herself onto a low chair and joined other children coloring under the supervision of a counselor. In contrast to her rambunctious playmates, Salam kept quiet. A few days later, she lay on a gurney ahead of surgery to reshape the stumps so doctors could fit new prostheses. She trembled slightly as she was wheeled into the operating theater. From another operating theater, a young man coming out of anesthesia could be heard shouting, like he was having nightmares. Anesthesiologist Dr. Abdel Raouf Ahmed says that happens a lot: violent hallucinations as a patient returns from unconsciousness. Staff's darling Mustafa Abdullah, a 4-year-old with big brown eyes, is the darling of the hospital staff. His hip was broken in an airstrike that killed his parents last summer on his home in eastern Syria. He has been undergoing intense physiotherapy, trying to graduate from a tiny walker to crutches. “The whole hospital loves him,” says his grandmother Fadila, who cares for him. When a rumor spread that he was being discharged, a crowd filled the reception area for hugs and good-byes — though it turned out not to be true. Love from strangers may not be enough to heal the emotional trauma. Mustafa didn't speak for days after the airstrike. “His father had been carrying him. He flew from his father's grip, and his father was killed,” his grandmother said. Hospital psychologist Bilal Budair says most of his young patients have at least one symptom of Post-Traumatic Stress Disorder, such as bed-wetting, nightmares or acting out. But play therapy can bring great improvements. It also helps to befriend other children with disabilities. “Most children here have good resilience,” he said. “In Arab culture, the family support helps a lot in improving resilience.” — AP
