Syrian prosthetic clinic brings hope

Abdul has taken his left leg off for a while. He sits on a plastic chair in the corner of the workshop and watches his older brother Ahmed make some modifications to it.

The routine prosthetic maintenance is taking place in the National Syrian Project For Prosthetic Limbs (NSPPL). Housed in a new two-story building , the centre rests on the outskirts of the Turkish border town of Reyhanli. Both brothers now work there, Ahmed as a technician.

From a distance, the clinic is not easy to spot – located halfway down a wide, dusty road leading off the main highway into town past a lonely bus stop where dogs eat from overflowing rubbish bins. Even up close, there is little to identify the freshly whitewashed building besides a sheet of paper taped to the inside of a ground floor window. It is, however, well known among those in need of its services.

Cars collect and deliver a regular stream of patients and families to its door. Inside the noise of electric tools mingles with animated conversation 11 hours a day, six days a week.

The NSPPL opened in February and with its staff of 10 technicians and trainers has provided prosthetic legs to 300 single or double amputees injured in Syria’s civil war, says the centre’s manager Raed al-Masri, formerly a mathematics teacher in Homs. Despite being newly established and not widely publicised, it serves around ten patients per day and has a waiting list of 600 people.

The violent trauma in the region inflicted by bombings, rocket attacks and automatic weapons fire means there are many more in need of care. NSPPL board member Dr. Mahrous Alsoud estimates that at least 10,000-20,000 people have lost upper or lower limbs since hostilities began in 2011.

Caught in the crossfire 

Abdul, 19, was one of the project’s first patients. Originally from a village in Syria’s Idlib governate, he was injured some months before the clinic opened. While travelling from Damascus to Idlib , he was pressed up against the tailgate of a pick-up truck truck carrying several other men, women and children. Ahmed was driving and another brother was squeezed next to Abdul. There were clashes in areas west of the road, and regime forces had set up roadblocks in the area. The group missed a turn off and inadvertently drove towards one. When the soldiers there saw them coming, they started shooting.

As they raced away, bullets flew past the truck and the men attempted to shield the women and children with their bodies. Abdul saw shots passing close by reflected in the surface of the truck. At first, he says, it felt like he was in an action film. “I was in an emotional vortex. It was the first time I’d seen and heard gunshots and machine gun fire so I was so scared, I didn’t know what to do or what to feel.”

The shooters adjusted their aim and bullets smashed into the back of the truck. Abdul and his brother were both hit, he in his left shin. “I looked down at my legs, and felt they were hot and bleeding and I looked at my brother and saw him bleeding too,” he recalls. “At that moment, I thought to myself that maybe my life would end soon.”

Ahmed sped towards a Free Syrian Army barricade close by. From there, Abdul was taken to hospital. As the adrenaline wore off, the real pain started and he began to scream.

Prosthetic process

After receiving basic treatment for his badly damaged leg, Abdul, was moved back to his home village in several stages. He stayed there for three weeks, but the limited medical services available were not adequate for his ongoing care, so his family arranged for him to cross the border into Turkey.

At the checkpoint by the red earth and olive groves of Atmeh refugee camp, Turkish border guards were sympathetic and even called for an ambulance from a local hospital in Reyhanli to pick him up. He was treated there, then nearby Antakya and eventually Ankara, where he was bedridden for a month and a half.  

It was incredibly frustrating. Once extremely active, Abdul was now heavily medicated and unable to do anything for himself. Eventually, he told Ahmed to ask their father to arrange for his badly damaged leg to be amputated. Ahmed, he says, was furious, but “grabbed his anger and hid it away”.

The entire process of fitting, manufacturing and adjusting the prosthesis takes place in the at the clinic between one to two days [Leylend Cecco/Al Jazeera]

Doctors finally scheduled an operation, although for some time, Abdul did not know what kind. The day before, Ahmed visited, gave some gentle hints and eventually told him that they were going to remove his leg. By then, the infection had begun to spread and Abdul’s amputation would be above the knee. ” I wanted to cry and scream,” Abdul says. “But I didn’t do anything,” Before the operation, he took a picture of the leg on his phone. A final memory, he says, of what it felt like to be a whole human being.

He woke up from the operation in an anaesthetic-haze unable to remember what had happened. Ahmed was there, crying. “I saw my brother next to me in tears, and I didn’t know why. I knew we’d had a discussion about something, but I couldn’t recall what.”

He could still feel pain where his leg once was and, too weak to move, asked Ahmed to remove the sheet covering his lower half. At first, his older brother refused. An hour later, he relented and AbduI looked down at what was left of the limb in a mixture of anger, disappointment and sadness. “Even if I had wanted it to be amputated,” he says. “I didn’t know how to prepare myself for the next stage of my life, I felt like I would be as immobile as I was before.”

Rumours about NSPPL circulated long before it opened. For a while, nothing happened and Abdul resigned himself to the idea that nothing would.  When the centre was finally up and running, however, Abdul was among the first to be fitted with a prosthesis.

The entire process of fitting, manufacturing and adjusting the prosthesis takes place in the NSPPL over a day or two. In different, screened off areas of the clinic, measurements are taken, casts of the injured limbs are made and the replacement is constructed. Finally, the recipient learns to walk on their new leg, or legs, in the rehab section while further minor adjustments are made.

Many patients visit the centre from Syria, often staying with family or friends in Reyhanli, which is now home to tens of thousands of refugees. If they have nowhere to sleep, there are living quarters upstairs, where some of the staff also live.

Care is free. The centre – which was founded by a group of Syrian doctors – is financed primarily by the NGOs Syria Relief,  the Syrian Expatriate Medical Association (SEMA) and Every Syrian. Training for Ahmed and the other technicians, none of whom had a medical background, was provided initially by S. Naya Qadam Trust, a foundation formed to aid those left physically disabled by the 2005 Pakistan earthquake. Further instruction was provided by teams from universities in Ankara, Turkey and Manchester, Britain, and training will continue with the help of other international experts. While initially the technology was basic, it now matches European standards, Alsoud said.

Pushing forward

Abdul has since gained both mobility for himself and employment for his brother. “I came for the first time to get a limb for Abdul,” said Ahmed, who had been about to complete an English degree before the war started. “Afterwards, though, I stayed to work.”

Ahmed quickly developed a good reputation among other staff and one day, when Abdul was sitting upstairs in the clinic while his leg was adjusted, doctors asked if he would be willing to take on an office and reception job. He agreed.

There are now plans to expand the clinic’s operations. “God willing”, al-Masri says, this will include the provision of upper limbs too. For now though, the priority is reaching more patients – he estimates that 90 percent currently come from the northern areas of Syria such as Idlib, Aleppo and Ar-Raqqa.

The mobile clinic made from a converted bus, will operate inside Syria from early next year, according to a spokesperson for Every Syrian, an aid organisation that will be contributing to the new operation’s set up costs and covering its monthly expenses.

It will be staffed by Syrians like Almarsi, Ahmed and Abdul, who, along with many others, have faced up to and embraced the unanticipated changes of a war has thrust upon them. Instead of buckling under the trauma of a fiercely violent civil war, they have dedicated themselves to improving the lives of their countrymen in whatever way they can. “I love it here,” says Ahmed – who planned to teach English after university – gesturing around the clinic with a broad smile. “We have to help our brother Syrians in everything we can do.”