We visit the only hospital in the Middle East dedicated to free reconstructive surgery for people injured in war.
The Sarhan family often wake up early in the morning to a fearful reminder of what they escaped.
The one-bedroom house that Lama shares with her husband, Hasan, and their six children in the Jordanian town of Ramtha is a few kilometres from the Syrian border. In the early hours, they often hear the thuds and cracks of intense fighting.
“We hear the bombings in Syria every day,” Hasan told Al Jazeera. “Sometimes the shells even fall over here.”
Two years ago, their home in the southern Syrian city of Daraa was destroyed in an explosion. The attack seriously injured two of their young daughters: Shahd, who was four years old at the time, and Duaa, who was just one.
“Shahd’s knee was broken; it was shattered. They wanted to amputate her leg but I refused,” said Hasan, sitting on the floor of his sparse living room and pointing to the jagged scars on his older daughter’s knee. “But Duaa lost her leg instantly when the bomb hit our house – it was gone.”
She had been playing in the street with water, he said. “We found her under the rubble.”
The girls had life-saving operations in a field hospital in Syria, and soon afterwards the family fled to Jordan. They are now among the nearly 630,000 Syrian refugees registered here, around one in 20 of whom are wounded, according to the charity Handicap International.
“Most of the countries around us can at least offer emergency surgeries at a good level, so most of the patients are well treated in the beginning,” said Rasheed Fakhri, a surgeon with the international medical charity Doctors without Borders (MSF) in Jordan. “But after that they are neglected.”
Injuries from explosions are often complex, including severe burns, bones shattered in multiple places or missing altogether, and a high risk of infection from debris entering the wounds. Regaining functions such as walking and talking can take years of specialist medical care. This is nearly impossible to find in Syria, where hospitals have become military targets, and many medics have fled.
For Duaa and Shahd, recovery has involved taking a bus to the Jordanian capital Amman every week for the past two years, to an unusual medical centre where they live five days a week.
Set up by MSF in an abandoned private hospital, it is thought to be the only medical centre in the Middle East dedicated to providing free reconstructive surgery and rehabilitation for the region’s war victims.
Since 2006, more than 3,700 patients from Syria, Iraq, Yemen, Egypt, Libya, and the occupied West Bank have come here for long-term care for complex war injuries. Patients are referred to the hospital by front line medics from across Jordan and the wider region, and are accepted based on the severity of their disability, and on the hospital’s ability to treat them.
In a bustling morning outpatient clinic attended by maxillofacial surgeon Ashraf al-Bustanji, patients come for checkups. He specialises in facial reconstruction – most of his patients were hit by shrapnel in the mid-face or jaw. Those struck elsewhere in the head or neck are unlikely to survive.
Mohamed Abdel-Muhsen, 19, and his father Hamad travelled more than 300km from the north of Syria to reach Jordan after Mohamed’s chin was blown off in Homs.
“We tried to take him to Turkey three times, but they sent us back,” his father told Al Jazeera. “So we paid a middleman from the regime side. He managed to smuggle us south and we continued our way through the desert to Jordan.”
“For five months I was only eating fluids. I was lying on my back to eat,” said Mohamed, his voice muffled by a bandage covering the lower half of his face. He shows a photo on his phone of himself two days before the injury, smiling and holding his niece.
Since Mohamed arrived in 2014, Bustanji has operated on him six times – including rebuilding his lower jaw with a titanium plate and transplanting soft tissue from his chest to his chin. During Al Jazeera’s visit to the hospital, bone from Mohamed’s pelvis was transplanted to his lower jaw, in order to allow for eventual tooth implants.
Patients like Mohamed are treated for free until they have received the maximum benefit from the hospital’s services. For people with facial injuries, this includes cosmetic surgery to give them the best chance of being accepted back into society.
“You might give the patient the function he had before, but still he is not happy; he is psychologically not functioning,” Bustanji told Al Jazeera.
“Some of the patients, they don’t want to leave the project. They are here with people like them, with distorted faces, with amputated limbs, with burns. We have also to give the patient confidence and self-esteem.”
On the other side of the hospital, Duaa is having her first physiotherapy session with her new prosthetic limb. She is now three and rapidly outgrows the prosthetics. An old one is fetched from under the bed for comparison, toes scrappily painted red with nail varnish.
Duaa has had prostheses since she was only 20 months old. “She sleeps with her prosthetic leg and she doesn’t let anybody touch it,” said her father, Hasan. “It’s like her doll.”
Both sisters are having physiotherapy and psychosocial care at the hospital, and Shahd still needs further operations on her leg. But their parents say that once the girls have finished treatment, they are considering going back to Syria.
“It’s very dangerous, but it’s difficult to live here too,” Lama said.
“Food is very expensive,” Hasan said. “Rent is very expensive.”
Syrian refugees are not allowed to work, and four years into the conflict, most families who had any assets have by now sold them.
Groups such as Handicap International, which also provides rehabilitation for disabled Syrian refugees, refer people to organisations such as the UN World Food Programme for help with basic necessities.
But the World Food Programme has announced it will have to withdraw all food aid to the 440,000 Syrians in Jordan living outside of refugee camps in August, unless it receives immediate funding.
“We expect to see an increase in people returning to camps and even to Syria, despite the horrific situation there,” said Andrew Harper, UNHCR’s representative in Jordan, who has launched an appeal for cash donations for Syrians in Jordan.
Despite an uncertain future, for the moment, Hasan is just happy to see his daughters recover. In the physiotherapy room, Duaa, dressed as Minnie Mouse, is already charging around on her new prosthetic leg. She kicks a ball to the physiotherapist and then starts climbing up a wooden ladder as Hasan looks on.
“I think that because she’s a smart girl, she will have a bright future,” Hasan said. “And I hope that God will give her a better life than what she lost.”
Follow Sylvia Rowley on Twitter: @SylviaJR