‘To see a child in trouble is like being struck directly in the heart’ — The doctor operating on Syria’s broken bones

There is a medical centre in northern Lebanon that is unique in the world. A medical centre that treats people who have been maimed by conflict and then forgotten.

In this moving piece, surgeon Richard Villar gives an insight into life at the Red Cross’ Weapon Traumatology Training Centre.

They say that as a doctor, you are a window on society. Nowhere is that truer than in Lebanon, neighbour to war-torn Syria. Take one Lebanese clinic and I wager the stories that abound within those walls will change you forever.

I saw 20 patients yesterday. One by one they entered and one by one they left. Each was defenceless. Each had been made homeless by conflict many, many miles away — Aleppo, Damascus, Homs and places in-between.

Abdul was my third patient of the day. He arrived dressed in nothing other than rags, his mother beside him. Abdul is only 27. And yet, looking into his eyes I could see the glint of intelligence, the sparkle that rag-like clothes cannot hide.

So it was no surprise to hear that Abdul had once been top of his university class in engineering. He had been spotted by one of his country’s top firms and earmarked for rapid promotion. He was on a roll, his whole life ahead of him. All this, just a few years ago.

Until that fateful Tuesday, when the mortar shell landed.

The shell killed his father, brother, two sisters, and completely destroyed his house. Within moments everything Abdul possessed, everything he stood for, every ambition that lay within his young, muscular frame, had been decimated.

In 2016, the Red Cross performed 560 operations at the Weapon Traumatology Training Centre — ©ICRC/GhaysTahtah

Abdul had been fortunate to escape with his life. A single piece of shrapnel, no more than two centimetres square, had entered his left side. It passed through his intestine, perforating it seven times, and lodged in his right hip.

The joint had been shattered into a thousand pieces — at least it looked like a thousand on the half-torn and faded X-ray that he offered me in explanation.

As an orthopaedic surgeon, my area of expertise is bones, not bellies. Abdul’s belly had been looked at in a field hospital in Syria, a hospital where two young Syrian doctors, neither much older than their patient and neither a fully-trained surgeon, had done their best to patch-up Abdul’s gut.

Abdul had been their 40th patient that day. Forty individuals on the sorry conveyor belt of misery that forms the staple diet of a field hospital. I say hospital, but it could be located in a tent, or a cellar, maybe the back of a burned-out bus.

It took Abdul and his grief-struck mother more than half a year to reach us at the Weapon Traumatology Training Centre (WTTC) in Tripoli, Lebanon’s second largest city.

The pair had journeyed by taxi, stolen car, foot and even donkey. They had lived off the land, they had been robbed — both at gunpoint and by machete.

So by the time they had entered Lebanon all they had was gone; all that remained were memories and the pain in Abdul’s hip.

For Abdul and his mother, their total existence was in two plastic bags. Somehow the bags had survived half a year of hell.

As I looked at Abdul in my clinic, I glanced towards his mother. Through the tiny slit in her burka, I could see the tears. Tears of worry, or perhaps tears of grief.

And yet with escapees like Abdul — yes, I call them escapees not refugees, as escape is what they have achieved — I am constantly surprised how little they say and how bottled up they have become.

It is the trauma of war, for certain. War is not something of which you brag.

How can you boast when all that remains of a once thriving existence are two battered and faded plastic bags?

Hiba, six, was wounded in Syria where she received preliminary treatment. Red Cross surgeons later operated on her leg — ©ICRC/HusseinBaydoun
Hiba completed a physical rehabilitation programme at the WTTC — ©ICRC/MarwanTahtah

The WTTC, run by the International Committee of the Red Cross (ICRC), is seriously impressive.

Founded in 2014, it is located in Dar el-Chifa, a hospital in Tripoli, and offers comprehensive care through reconstructive surgery and physical rehabilitation. In 2016 alone, 560 operations were performed at the WTTC.

It was created to deal with the after effects of weapon wounds and to transfer the Red Cross’ expertise in surgery and rehabilitation to more surgeons and health professionals.

There is, quite simply, nowhere else like it. The patients who pass through its doors have nothing.

Their wounds are festering, their spirit sapped, their family and life decimated. These are forgotten people.

The world associates the Red Cross with treating casualties in the middle of horrendous conflict. Yet often overlooked is what happens to the wounded after their initial patch-up.

Where do they go? Who looks after them then, especially when they have no home, money, house or family? That is where the WTTC comes in.

If you have a wound that does not heal — many of them do not due to infection — then help can be found at the WTTC. Here the medical staff have the time and world-class expertise to spend as long as it takes to return a patient to some vestige of normality.

It is an often forgotten, but critical part of war surgery: looking after the wounded well after they have disappeared from the headlines — both in the physical and psychological sense.

It is difficult medicine, too. Weapon wounds are some of the most complex injuries to treat and operate on. It can take a long time to return a patient to normality, if indeed such an end point is ever achievable.

Six months or more would not be an exaggeration. Such injuries don’t just leave behind physical scars, but mental as well.

This is why the WTTC also provides psychological and emotional support to its patients through one-on-one sessions or group activities.

Ahmad was terrified of doctors when he came to the WTTC, but a few sessions with Red Cross psychologists put him at ease — ©ICRC/HusseinBaydoun

The children are especially hard to handle. Not so much their medical problems, but the fact they are children at all.

To see a child in trouble, to a medic, is like being struck directly in the heart.

Yet, I am so often overwhelmed by the resilience of children. Somewhere deep inside they have an in-built survival gene. How well the WTTC shows this.

On my first day at the centre, I walked down one of its long and polished corridors to seek out some of the patients. I was trying hard to appear confident when in fact I knew zero.

My mind was everywhere, and I was glancing nervously around me as questions danced through my head.

I glanced briefly into one room. The patient’s gentle snoring was unmistakable. Definitely do not disturb. I made a mental note to return later and began to turn gently on my heel.

It was then that I felt the football hurtle past my left ear. It was so close I twitched involuntarily.

“Sorry, meester!”

A young, male voice, he could not have been more than 12 years old. What I saw was astonishing.

I know him now as little Ahmad, but at the time I had no idea. He had lost both legs below the knee in Syria when a mortar round fell on his house.

Ahmad was wounded in Idlib when a mortar fell outside his house where he was playing — ©ICRC/HusseinBaydoun

He had received rudimentary surgery near to the incident, but like so many others, his stumps had become infected and he had ended up at the WTTC several months later.

His journey to reach us would have made a Hollywood movie as the little lad should definitely have been dead.

Yet thanks to his age — children can heal in ways that adults can only dream of — Ahmad had recovered well, physically at least.

Here he was, running up and down the ward corridor on his amputation stumps as if they were full-length legs. He was giggling, laughing and joking with the other wounded, some of whom were at least four times his age.

It was clear that everyone had a soft spot for little Ahmad. Despite his amputations, he had taught himself to thump a football with unerring accuracy and had so far opted not to use artificial limbs.

His laughter was infectious and his spirit irrepressible. Little Ahmad was showing the way.

Sadly, Ahmad and Abdul are two of many. There are hundreds like them, thousands, millions.

These are people whose lives have been destroyed, annihilated to such an extent that nothing, absolutely nothing remains.

I frequently ponder how I might have handled such a situation had the jets been flying over London rather than Aleppo, Damascus or Homs.

I realise that I most likely would have been found wanting.

The strength required to escape a conflict-ridden Syria and to make it as far as northern Lebanon, let alone through Europe and beyond, is a strength that few possess.

Richard Villar, from London, at work at the WTTC — ©PaulLey

Find out more about how the Red Cross is helping people affected by the Syria crisis.