By Ronny Linder-Ganz | Oct. 26, 2013
“Do something, write, tell the world,” cries out Dr. Arieh Avidan, deputy director of the ophthalmology department at the Rebecca Sieff Hospital in Safed. He is still haunted by the image of a 15-year-old boy who arrived at the hospital in recent days with a missing hand and both eyes shattered.
“I was here during both the first and second Lebanon wars, treating the wounded, but I never witnessed such sights. His eyeballs were totally destroyed. There was nothing we could do. He’s completely lost his vision,” adds Avidan. “For God’s sake, he’s only a child! Tell the world, not so that people will say how humane we are, but to rattle someone so that the message reaches decision makers at the level of [President Barack] Obama, of leaders in Europe, Russia or the United States. Something must be done!”
While the Israeli public and media have been immersed these days in municipal elections, the appointment of a governor to the Bank of Israel and repeated earth tremors, staff at the northern hospital are living in a sort of bubble.
“We feel as if we’re in a war without actually being in one,” says Dr. Hussein Amar, head of the emergency department, defining the atmosphere at the hospital.
For the last eight months, the facility’s spacious, well-equipped trauma center has received a steady flow of casualties from the Syrian civil war, with wounded arriving every few days and sometimes several times a day. These include men, women and children, some with injuries so severe that hospital veterans who treated wounded soldiers and civilians in Israel’s wars cannot remember encountering anything similar.
“They arrive with what is known as high-energy injuries, wounds with severe and extensive local damage sustained by intense localized release of energy that seriously damages soft tissues,
creating holes in limbs and torsos. In many cases, one person has multiple wounds of this nature,” says Dr. Alexander Lerner, head of the orthopedics department.
The hospital director, Dr. Oscar Embon, adds that “Israeli soldiers are usually injured while wearing helmets and protective vests, with most wounds caused by bullets, shrapnel or artillery shells. Here we encounter injuries we have never seen before. A few days ago a father and son arrived here after their house was hit by a shell that set it on fire. They arrived with both shrapnel and burn injuries. And there are many more such cases.”
Charred clothing
The first group of wounded Syrians arrived this past February.
“The army notified us that we were to receive seven casualties, six severely wounded and one critical,” Embon recalls. “This was a multiple casualty event. Each wounded person required three doctors and three nurses in the first stages, just to stabilize their condition. This was followed by hospitalization in the intensive care unit and two to four further operations. Medically, we are investing in these patients exactly what we would invest in Israeli casualties.”
Since then, the flow of casualties has continued and even intensified, with 144 Syrian patients treated so far at Sieff. The Israel Defense Forces transports them there, sometimes on the day of injury and sometimes a few days later. When the hospital decides after treatment the patient is strong enough to return home, the army transports him or her to the border.
“We take in a shattered person and return him as a human being,” says Embon. “However, we don’t know what is in store for these people, where they go or whether their wounds will become infected. It’s not easy.”
“At first, we received young men who apparently were involved in the fighting, but gradually we started receiving women and children, as well,” Amar explains.
Some of the wounded have arrived unaccompanied, with only charred clothing on their bodies. Hospital staffers have to work without any basic information − such as sensitivity to drugs, prior treatment the patients may have received, whether they are immunized, etc. Some arrive after going through preliminary triage at an IDF field hospital on the border. A few arrived with a faded note attached to their clothing, written by a Syrian doctor who had treated them in the field. One such note read: “Greetings to the honorable surgeon. This 28-year-old patient was injured by a bullet that entered his chest and broke some ribs, and by some shrapnel that damaged his liver and diaphragm. The chest and peritoneum were opened to stop the bleeding in his liver.
There was no possibility to suture his liver, and pressure bandaging was applied to his stomach. Please do what is required and thank you in advance.”
G., 15, lies in the pediatric ward, accompanied by his 13-year-old brother. One of G.’s legs was severed in Syria, but doctors at Sieff managed to save his shattered arm. The boys say they went over a land mine on a tractor on their way to a Syrian army base to deliver water to soldiers. After the explosion, soldiers brought them home and their father took them to the border with Israel. There, they were received by the IDF, which transferred them to the hospital on the same day. G. lay unconscious in the intensive care unit for four days. He remembers nothing of the incident in which he lost one of his legs, which was severed above the knee.
G.’s younger brother also arrived with serious injuries − with shrapnel wounds all over his body, with particularly severe wounds in his legs. However, he fared much better. After several operations and some skin grafts, he is running up and down hospital corridors. The only reason he is being kept there is to help with his more severely injured older brother.
“What do you miss?” they are asked, and reply in unison “our mother!” When asked if they want to return to Syria, they nod emphatically, stating decisively and unambiguously that they are not afraid of going back.
Lerner showed us a slide show with photos of the wounded that arrive in the hospital’s trauma unit. There are shattered organs and limbs that are barely attached. A few slides later we see fingers that can move, and a leg that was totally shattered now reconstructed and walking, although shorter than before and full of supporting metal rods.
Embon tells us that his colleague Lerner specializes in saving limbs that anyone else would have given up on and amputated, especially in the case of war injuries, where there often is a tendency to do so: “In wartime, there is usually not enough time to deal with serious limb injuries, so they are amputated. These casualties are lucky to be treated by an internationally renowned trauma specialist such as Dr. Lerner. He employs a special method for external setting of fractures, which saves the limb.”
There are military policemen outside the rooms of the Syrian patients, checking the identity of anyone entering and generally keeping an eye on things. Patients are not allowed to contact relatives in Syria while hospitalized, although the staff tries to do this through the Red Cross, whose representatives make periodic visits. Outside guests are not allowed to photograph or name the patients, out of concern that they or their families will be harmed on their return to Syria.
“One injured woman left a breast-feeding baby behind. She was desperate to find out what was going on at home. I was willing to let her call, but the army did not permit it,” says Embon.
Longing to return
The military and security concerns derive partly from the great sensitivity among Israel’s Arab and Druze populations with regard to the Syrian civil war, say hospital staff. There were cases in which Israeli Arabs supporting President Bashar Assad came to the hospital and complained that it was treating wounded who, according to them and not necessarily correctly, were associated with the rebels. “We can’t even allow Arabic-speaking volunteers to help, since the army does not authorize it,” adds Embon.
One of the wounded with whom the staff formed a close relationship was S., a 15-year-old girl who arrived at the hospital with very serious injuries after a bombing raid near her house in Dara’a, in southern Syria. Her brother, grandmother and cousin were killed in the attack.
S. arrived at the Safed facility four days after she was wounded, having undergone an operation in a Syrian field hospital. One of her legs was severed and she had multiple shrapnel wounds in her other leg, as well as stomach injuries. She had several operations at Sieff to save her other leg and treat her stomach injuries. After only two weeks, she stood up on her one leg and started walking with the help of special crutches.
“She went through a terrible crisis here,” says Fares (who asked that his surname not be published), the Arabic-speaking social worker who attends to all of the wounded. “At first, she was very closed, but when she got to know me and not fear me, she opened up. In one of our talks she asked me tearfully: Who will want to marry me? Who will want a dysfunctional woman?”
S. and her mother spent a month and a half at the hospital. They left with S. wearing a prosthetic limb that was donated by a private donor Fares managed to find.
Fares has become the key figure in the logistic and emotional support given to these patients. Only a year after becoming a social worker, he serves as a surrogate parent, translator, fund-raiser and companion to the wounded. He hurries back and forth among them, managing to extract smiles − even from the boy who lost his sight.
Fares: “I first assess whether the patient is in post-traumatic shock that requires professional psychological or psychiatric treatment. After that I slowly try to establish a connection, to talk and laugh with them, to listen to their stories. Each morning they ask me what is happening in Syria and when they will go home.”
The longing for their family and homeland are usually stronger than their fear of returning. But 15-year-old S. was an exception: Her mother was with her throughout her hospitalization. However, most of the injured, including small children, typically arrive here unaccompanied. They are isolated from family and friends, even while dealing with severe trauma and injury in many cases.
“An Israeli child who comes here has a mother and father, family and friends, and he is continually supported throughout his stay. These children are entirely alone. When they are in pain, they have no one to lay their head on, and no one is here to hug them when they cry at night. This role is filled by the nursing staff, social workers and even by doctors,” says Dr. Amram Hadari, deputy director of the surgery department and head of the trauma unit.
The wounded arrive with nothing, wearing torn clothes: “They don’t even have a toothbrush or spare underwear,” says Fares.
At first, the staff collected clothing and other items for the wounded. When their numbers grew, a bank account was opened for donations, and funds were raised from kibbutzim, the Red Cross and private donors. The hospital now has a warehouse full of donations, from winter coats to hygienic items for women to stickers and crayons for the children.
Who are the injured kids who went to supply water to Syrian soldiers? What was their families’ involvement in the war? Who are the wounded young men who come to the hospital from the border? Why do these arrive, and not others, out of tens of thousands of wounded in the Syrian civil war?
“As a doctor, such questions are meaningless, since my duty is to treat them as I find them, not as I would wish them to be in an ideal world,” Hadari explains. “I don’t inquire as to where they came from, what their personal, social or religious background is. I don’t have time for that in emergency medicine.”
Occasionally, though, politics and the war do invade the medical scene. Once, a stretcher-bearer found a live grenade in the pocket of a severely injured man in the trauma unit. “We had to call a police sapper and evacuate everyone else, except the anesthetist, who refused to abandon the wounded man,” relates Embon.
In another case, one wounded man tells us that his grandparents were refugees who were expelled from Safed in 1948.
Embon: “I have never heard any political statement of any kind from a staff member. Outside the hospital we do hear occasional remarks such as ‘Why are you treating these terrorists?’ or ‘You should look after our own first.’ I tell them, paraphrasing the sages, that whoever saves a single life saves a whole world.”
Hadari adds that sometimes when he goes home, “I cannot avoid making certain analogies. I feel for the children who are cut off from their parents, not knowing if they will ever see them again. It reminds me of my mother at the age of 13 and my father at the age of 16, when they parted from their parents on a railway platform in Berlin at the end of the 1930s, not knowing that they would never see them again.”
Who pays the bill?
Wounded Syrians receive treatment in Israeli hospitals that is equal in quality and cost to that received by Israeli patients, but payment is a different story altogether.
“The bill for treatment of the wounded is already approaching NIS 10 million, but to date we haven’t received a single agora,” says Dr. Oscar Embon, director of Rebecca Sieff Hospital. Israeli patients’ care is paid for by the health maintenance organizations, but it is not clear who is supposed to pay for the Syrians’ treatment.
According to Embon, “Not a single government body is taking responsibility for it: We’re getting the run-around between the Health Ministry and the Defense Ministry, and at the moment the subject is on the desk of the Prime Minister’s Office, which is supposed to decide.”
The hospital was recently told that the Health Ministry would pay 50 percent of the expenses, but this information was only transmitted orally to Embon, and he is very skeptical.
Hundreds of wounded Syrians have already been treated in Israel, many of them children.
“The expenditure on the wounded is particularly high,” explains Embon. “Treatment of trauma involves considerable manpower, expensive tests like the CT scan, many operations, intensive care, expensive medication, blood transfusions, very expensive antibiotics, and more. For us, they are an immunization mystery because we have no idea which vaccinations they have received, so they receive expensive vaccinations and medicines costing thousands of additional shekels.”
The bottom line, say staff at local hospitals, is that the expenditure of millions of shekels on treatment of the Syrian wounded adds to the “ordinary” budgetary burden of hospitals on the periphery, causing them severe financial stress. “Someone,” says Embon, “has to take responsibility for it.”
[Haaretz->http://www.haaretz.com/weekend/week-s-end/.premium-1.554424#
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