Ramtha, Jordan - In a sun-faded hospital room in northern Jordan, a weary father recalls the day his youngest son's heart stopped beating. "The first field hospital said he needed amputations but they couldn't treat him. So we rushed to a second field hospital and they told us, 'You can't cross into Jordan from here and we can't amputate,'" he said.
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The boy had found an unexploded mortar in the garden at his grandparents house in Deraa, southern Syria. It exploded. Five-year-old Ziad caught a face full of shrapnel and his legs and right arm were shredded. "The third field hospital covered his wounds and called the border. They said it was an emergency - five minutes or my child would die," the father, who didn't give Al Jazeera his full name, said.
Ziad was thrown in his father's car for a final rush through wartime Deraa, and the 15km journey was stretched to 60km by checkpoints and destruction. The boy's heart stopped along the way, and the paramedics in the Jordanian ambulance dispatched to meet him assumed the boy was dead.
From the border it was just 3km to an operating room at Ramtha Government Hospital, where Ziad's life was saved by a team of medics working with international medical charity Medicins Sans Frontieres.
Three weeks later, the boy is on the move in a child-sized wheelchair donated by Handicap International. Soon, he will be fitted for prosthetic limbs, but for now he's learning to live with just one hand. Today's task: opening and eating a bag of potato chips.
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"There's no average day here. One day we can see one patient, and the next we see 10. The busiest day this year, after the bombing in Yadouda, we received 32 patients," says Michelle Mays, an American nurse who manages MSF's Ramtha Surgical Project.
Mays' charges fill two of the hospital's five operating theatres as well as an adjacent 11-bed ward for especially acute patients. There's also a second multi-storey building housing a men's ward, another for women and children, several rooms for isolation patients, and not a single elevator. Staff in scrubs and MSF vests carry stretchers and wheelchairs up and down the stairs.
"We've got 33 beds, but we can usually squeeze in about 37 patients," she says.
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Patients typically come via field hospitals where Syrian doctors working covertly in undersupplied - and often underground - make-shift facilities will have done what they can to stabilise crush and blast injuries before sending patients to the border.
"None of these patients get to us within the first hour post-injury," says Paul Foreman, the head of MSF in Jordan. "The Syrian field hospitals have 100 percent ownership of that golden hour."
Tamara Kaileh, a 32-year-old Jordanian surgeon in her seventh month on the project, recalls a patient arriving with a chest injury that required the insertion of a tube to prevent pressure from building up. The doctors at the field hospital, presumably out of sterile plastic tubing, had adapted the narrow end of a plastic pickle jar and saved the patient's life.
Another surgeon was stunned when a patient arrived with a pair of scissors sticking out of his chest, neatly stitched in place to stop a complicated injury from bleeding out.
The Ramtha doctors say they can sometimes tell which field hospital a patient has come from by how they have been patched up. Despite never meeting the people who take a first pass at the broken bodies they go on to mend, there is a sense of closeness, of kindred purpose. "I hope they keep up the good work," says Kaileh. "They are creative. They must be very brave people."
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The Ramtha project has been running since late August 2013. It's a hard-won partnership between an apolitical humanitarian organisation and a cash-strapped government wanting to do the right thing for neighbouring civilians, but desperate to stay out of an increasingly complicated war.
MSF funds the entire programme, which lists in-country expenses (excluding international staff) in excess of $5.3m per year.
"This war is taking more effort from the medical team and from the community," says Dr Yousef Tahat, the director of Ramtha Hospital. He estimates that 35 percent of the hospital's effort is expended on Syrians, which has knock-on effects for Jordanians who often find their scheduled surgeries delayed, or certain treatments unavailable.
Dr Yousef, as he is known, says his hospital has served 24,000 Syrians in the past year. The MSF project has admitted a total of 469 patients since it began; far more wounded Syrians are admitted into Jordan than can be absorbed by the programme.
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Dr Hasan Hyasat, Jordan's minister of health, told Al Jazeera that the country has spent 37 million Jordanian dinars ($52.2m) treating 264,891 wounded Syrians from the beginning of 2012 until the middle of 2014. With the average 24-hour non-surgical hospital stay costing 150-200 dinars ($211-282) per person, the bills are mounting.
"Jordan is suffering severely from a lack of financial resources to continue providing service and care to wounded Syrian refugees," Hyasat said.
He said that a lack of funding in Jordan's health sector and a shortage of facilities willing to provide care is placing an untenable strain on Jordan's public healthcare system. "International support is essential," he added.
And as the Syrian conflict has spread into Iraq and arrived on Jordan's doorstep, the pressure on MSF and its Jordanian partners has ratcheted up even more.
Mohammad al-Momani, Jordan's minister of state for media affairs and communication, confirmed that Jordanian border security has been stepped up along the Iraqi and Syrian borders - a cost that will affect spending elsewhere. Momani told Al Jazeera that a security screening process is in place when patients arrive at the Jordanian border, but didn't provide concrete details.
But these challenges don't deter the medical staff. "It's about being there for people in that moment of vulnerability," says Mays, of MSF's Ramtha Surgical Project. "Giving them medical care, but also a shampoo and fresh clothes - so they can feel that sense of normalcy. We coordinate that happening."