Al-Marj clinic is one of the most important Médecins Sans Frontières-supported medical sites in East Ghouta, an area of besieged towns near Damascus. Marj is geographically quite isolated. This area has been neglected by most medical and humanitarian aid, so when international aid convoys are permitted into eastern Ghouta, Marj is usually excluded. After suffering a series of tragedies, Dr. Abu Yasser*, a GP and director of the medical department of the clinic, describes the newest challenge: no more ambulances.
Yesterday [Monday 05 December], a strike hit near our clinic and destroyed our two ambulances and two other hospital cars. For major emergencies, we would refer patients to other medical facilities Now, with no more ambulances, we are concerned for patients that present with major injuries. I have been working in the Marj clinic since the war began. This clinic has been hit a number of times over the years - it could possibly be one of the most hit. There are holes in the walls and ceiling, and we tend to work in the basement for surgeries. Around two years ago, the manager of the clinic and another colleague were killed by the entrance by a shell hit. This was one of our greatest losses because that doctor specialized in emergency and complicated surgeries.
"This clinic has been hit a number of times over the years - it could possibly be one of the most hit. There are holes in the walls and ceiling, and we tend to work in the basement for surgeries"
Over a two-year period we lost seven of our staff: two doctors, a cleaner, the head of training, and three nurses. Yet, even with these difficulties, we still continue working because providing medical care is so important for the people. In mid-2015 a bomb dropped by a helicopter hit the clinic and destroyed ambulances, the pharmacy, and the burns unit. Eventually we rebuilt the clinic – which we were able to do thanks to support from local organizations and Médecins Sans Frontières. The clinic now has x-ray capabilities, a lab, surgery, maternity and used to have ambulances available 24 hours a day.
Last month, the violence intensified again. Areas that were considered ‘safe’ and hosted displaced people have been bombed and shelled. Yesterday, a family was brought in; the mother and aunt are in the Intensive Care Unit, while the two children died at the clinic. One of children was impaled through her head, and we couldn’t do anything; she died this morning. There needs to be more mental health support for medical staff, but especially for families who are really traumatized. I remember a girl who had died due to a large loss of blood. Her sister was next to her and couldn’t understand that she was dead. Children have nervous breakdowns when they hear planes in the sky. I can’t even begin to imagine the amount of mental health support that children, adults, and doctors will need after all of this.
"One of children was impaled through her head, and we couldn’t do anything; she died this morning."
Despite the fear, there is perseverance. Once we had a meeting, and we told the staff that if they want to stop working its absolutely fine and we can provide them with paid leave. No one accepted. I was astounded. Everyone wanted to continue to work despite the dangers. These people who have seen horrible things, survived shelling and massacres, wanted to continue because most of them are from this area, they have families here, and they understand the importance of providing health care to the population. There is always hope. But unfortunately the events on the ground are not telling of a positive end. But for now, what is important is to sustain the medical care for the people. This must continue - and we will continue to try our best.”
* Name changed at the doctor’s request for security reasons