On Syria's front lines: A night in the field clinic

SALMA, Syria — The shout came from the rubble-strewn street outside the rebel medical clinic in the Sunni village of Salma, in the strategic northwestern Syrian province of Lattakia. "It's one of the Alawites! It's one of the Alawites!" a man yelled, referring to a member of Syrian president Bashar al-Assad’s minority sect, which makes up the majority of the population in this coastal mountain province. 

The clinic's director, Dr. Rami Habib, 43, heard the cry through the sandbagged window of his dark basement office, and ran toward the nine-bed, street-level emergency room. A little girl was carried in by her captor, a young jihadi foreign fighter in beige military fatigues, who carefully set her down on the sapphire-blue plastic sheet covering a bed. 

The child was a rebel prisoner, one of the 105 Alawite women and children snatched by Islamist Sunni rebels when they captured 11 Alawite villages in early August (the regime regained all of the villages by August 19). The captives — some 40 women, the rest children — were being held by Katibat il Muhajiroon, or the Battalion of Emigrants, a jihadi group of foreign fighters led by a Libyan, Abu Jaafar il Libi.  

A few days earlier, Dr. Rami had treated one of the pregnant Alawite women, who was sent to a hospital closer to the Turkish border some 30 kilometers away, to deliver via elective Caesarean. He later checked on mother and son, before returning them to their captors. 

"Uncle, please don't hurt me!" the girl, a 6-year-old named Reema, told the doctor as he reached for her bandaged left foot. Its bloodied dressings were stained brown. She was clad in clean three-quarter-length pink leggings and a pink t-shirt. Her hair was short, her brown bangs swept up into a tiny ponytail that sprouted like a mushroom atop her head. 

"Don't be scared. We need to change these bandages," Dr. Rami said. 

"Uncle, it hurts a lot," she cried. "I'm scared."

A MiG jet roared overhead before the doctor could reach for a pair of scissors. Rebel anti-aircraft fire thundered from several positions around the clinic, prompting the little girl to scream. Her captor (who was unarmed except for a knife) gently patted her ponytail in a bid to calm her, while another doctor fetched a packet of biscuits and offered her one, which she declined. She called out for her mother, but she had not been allowed to accompany her. "Bring me my mother, quickly!" she yelled. There was an explosion outside. The little girl was now wailing, interspersing her screams with "Uncle! Uncle! Uncle!"

Several of her toes were dark brown. Large parts of the skin on the top of her foot had sloughed off, revealing red, raw flesh, which was bleeding. Dr. Rami changed her dressing and took aside the young jihadi fighter who had brought her in.

"Tell your emir [leader] that I say hello and that this girl needs to go to a hospital because her wounds must be cleaned under general anesthetic," he said. 

The foreign Arab jihadi nodded. "What caused this?" he asked, pointing to the freshly bandaged foot. "Probably shrapnel," Dr. Rami said. The jihadi swept the child up and quickly left the clinic. 

The 1-year-old clinic is in Salma, just a few kilometers from the frontline in northwestern Syria. It's one of the two closest medical facilities to the front. Its four doctors and 10 nurses live and sleep where they work. Almost 10 months ago, the six-story building was hit by a barrel bomb, an improvised explosive packed into a large barrel dropped from a helicopter gunship. It blew out most of the windows and pancaked part of the two upper floors, spewing chunks of crushed gray cinderblocks onto the rose bushes below. The pink flowers, however, still bloom. 

There's no running water or electricity in the facility, which relies on several diesel-run generators to power medical equipment including a digital X-ray machine, an ultrasound and a portable ventilator. The clinic, which is funded by U.S.- and U.K.-based charities, is well stocked, unlike many facilities in the field, which lack basics like anesthetic and even bandages. Water is obtained through a pipe that dips into a spring on higher ground three kilometers away. 

Dr. Rami returned to his small office, or "control room," as he calls it, and sat on one of the thin mattresses around its perimeter. A 10.5 mm handgun in a brown holster was tucked into the space between the mattress and the wall. A TV sat in one corner, near two walkie-talkies set up to interact with the only other field clinic in Salma. "I miss normal life," the doctor said. "I miss watching a movie."

His last day off was three months ago, when he traveled to Turkey to meet his wife, who still lives in Leicester, U.K., where Dr. Rami was based for seven years. A Syrian-trained physician, he was in the U.K. to specialize in pediatrics when the Syrian uprising kicked off. He has seen his wife only three times in the two and a half years since . "I told her I have to do this, and she accepted it," he said. "Of course without her support I couldn’t have done it — peacefully," he added, laughing. 

He was dressed in charcoal-colored jeans and a black long-sleeved crewneck shirt, unlike the other doctors, who were clad in scrubs. His curly hair was short; so too was his neatly trimmed black beard, which was graying at the chin. He reached for a pack of Red Gauloises cigarettes. There was an explosion outside, which tossed small bits of rubble into the room through the glassless window. It was followed by another explosion two minutes later that shook the room. "Allah Akbar," Dr. Rami said with every explosion as he and several of his colleagues rushed into the narrow hallway.  

"Ashaf!" "(Emergency)!" The call came from the street above. Dr. Rami rushed out again, past the dusty operating room covered in aluminum shutters normally used to cover the outside of windows but placed along all the walls so that they could be hosed down. 

A Syrian fighting in the adjacent village of Doreen closer to the front had been hit by a large piece of shrapnel. His legs were barely attached to his torso. "He won't be alive for long," Dr. Rami said, before ordering his staff to place him in the clinic’s once-white, now mud-smeared ambulance (the mud is to make the vehicle harder to see from the air). He was to be driven to a larger facility closer to the Turkish border some 30 kilometers away. A doctor in blue scrubs asked if a physician should accompany the man. "There's no need," Dr. Rami said. 

A man knocked on the control room’s open door. He was one of the few civilians still braving the relentless air and artillery strikes on the area. He asked about vaccines for his young child. The doctor told him they’re not available here, in "liberated Syria," only in regime-held areas where the Health Ministry still functions, and from international aid organizations that only deal with governments. The man left, visibly dejected, as a local farmer walked in with a bag of fresh green beans, a donation to the clinic. 

It was early evening. Dr. Rami set out to check on the clinic's two inpatients on one of the floors above. There were 10 beds. "‘We don't usually keep people here for more than 24 hours," he said. "It's not that safe."

The two men, both Arab foreign fighters, had been brought in three hours earlier. One had shrapnel in his right leg. The other, who was dressed in a gray shalwar kameez (trousers and tunics common in the subcontinent but not in Syria except among some Islamist fighters), had a perforated tympanic membrane. He didn’t need to be in the clinic, but stayed with his friend, who lay under an orange sheet. 

"Is there food here?" the first man asked. 

"Of course, we’ll bring you something right now," the doctor said before continuing to check on two of his colleagues, male nurses wounded on the front line. The clinic assigns medics to join the fighters so they can apply first aid before the wounded reach the facility, and these two men had been caught in the crossfire.

A car honked outside. "Emergency!" A wounded man with a shaved head and bushy beard in green military pants was brought in on an orange stretcher. He was lying on his stomach, his back bleeding. There was a bullet in his lower right back. His name was Abu Ismail, and he was from Doreen. He leaned over the hospital bed and vomited. A white kitten with beige spots ran through the ER. Seven minutes later the man was back on the orange stretcher, being transferred to the other clinic in Salma, which had a general surgeon. 

A young Syrian Islamist fighter, Abu Odai, in full camouflage uniform, including an ammunition vest, was waiting for Dr. Rami in his control room. He was yelling because he couldn’t hear well. He mans an anti-aircraft gun and was complaining because he couldn’t shoot down the planes. "Maybe the Chechens will bring us a Cobra," he said, referring to an anti-aircraft missile. He had news. Three cars full of fighters were struck on a nearby road. Two charred bodies were still in the vehicles. "We're mining the road now," he said. 

Another fighter solemnly walked in and asked for a large bag to place his cousin, who had died that morning in Doreen. It was almost 8.30 p.m. but he hadn’t been able to retrieve his remains, because of "constant tank fire" and because his cousin was in pieces. "His leg is in a tree," the man said. The doctor told an assistant to fetch a body bag. 

The night was still nowhere near over. Abu Ammar, a white-haired, balding FSA commander from the town of Jabal al-Zawya in the province of Idlib, needed to find an outpost in Salma, and requested Dr. Rami's help. His men, including two of his sons, had been fighting in Lattakia since shortly after the front reopened in early August. He’d sent for reinforcements — 40 men — but needed a place near the front to house them. "My guys are clean," Abu Ammar said. "I have FSA IDs for all of them. I once caught two looting a home and I kicked them out."

"Salma isn't safe," Dr. Rami said, before listing the recent casualties, which included more than 25 members of an Al-Qaeda-linked group who were wounded when a barrel bomb hit their outpost a few days ago. 

While they were talking, a young man from the Salafi Ahrar al-Sham brigades requested stocks to replenish his first-aid kits for the front. He'd come from one of the nearby Alawite villages now in Islamist hands. The doctor suggested he include clotting agents in his kits. 

"God willing, you won't need them," he told the fighter. Later in the evening another man, who had traveled from a town close to the Turkish border, requested and received a lengthy list of supplies for a female midwife who was treating women in his town. 

Suddenly, somebody in the hallway yelled that there was a plane in the air. The doctor and Abu Ammar continued their conversation discussing possible locations to house the reinforcements. Ten minutes later there was another explosion outside. 

It didn't take long for the call to come from the rubble-strewn street: "Emergency!" There were two men already on the sapphire-blue plastic sheets covering the beds, a Syrian belonging to Abu Ammar's group who had shrapnel in his left foot, and a Chechen foreign fighter who had been brought in by a few of his countrymen. Three other men were ferried directly to Turkey. 

The Chechen, Abu Khadija, had been shot twice in the right leg. His countrymen were all dressed the same — short hair covered with green skullcaps; beards; short, loose pants, so short they rode halfway up their shins. A redheaded Chechen was translating for him from Arabic. 

"What brought you here?" one of the Syrian medical personnel asked the wounded Chechen. 

"We came for God's name," he replied in formal, stilted Arabic.  

Both men were patched up and sent to clinics further north, away from the front. Dr. Rami returned to his control room. The clinic had seen about 30 fighters and almost as many civilians that day. 

"You know what we forgot to do today?" Dr. Rami told a colleague reclining on a thin mattress. "Send the tractor to dig more graves. We'll need about 10 by tomorrow, and then another 20 or 30."

The colleague nodded. "Yes, we forgot to do that." 

The doctor lit up another cigarette. "It's a slow day today, thank God," he said. Outside, the sounds of explosions continued, near and far.