REYHANLI, TURKEY — This was not part of the plan.
Not when time is precious and it is only a few kilometres to the Syrian border. Not when there is a trunk full of medical equipment and contacts anxiously waiting in Syria, ready to whisk Toronto pediatrician Jay Dahman and Ammar Zakaria, a doctor who has defected from the Syrian military, to a field hospital where they can deliver the much-needed supplies and training.
But with a Turkish police officer’s wave of the hand our car is pulled over and passengers ordered out. Passports examined. Every bag unloaded and unpacked.
When an officer discovers Dahman’s flak jacket, helmet and GPS, reinforcements arrive. In Turkish, Arabic and English the word “doctor” is mentioned again and again. The mood is cordial, but this is going to take time.
Since the Islamic State began luring thousands of foreigners into Syria, Turkey has been under pressure to enforce its 800-kilometre border with Syria. Everyone is suspect. Our small car, packed with passengers and knapsacks, appears ominous.
Eventually the encounter ends with handshakes and apologies, but too much time has passed and too many curious onlookers have stopped.
“It’s OK. We always have a Plan A, a Plan B and C . . . ” says Dahman.
Cancel Plan A — word may have reached inside Syria about the doctors’ travel plans, so the trip across the border today is not a good idea. Syria’s regime targets medical staff. Al Qaeda’s branch, Jabhat al Nusra, and the Islamic State kidnap foreigners for bargaining pawns or ransom. Then there are thugs and thieves.
They are on a mission to save lives — but many want them dead.
FOR NEARLY three years, Dahman and Peterborough paramedic Mark Cameron have been stealing into Syria to help medical workers. They’ve escaped attacks by MiG fighter jets and sniper fire, and narrowly missed being hit when caught between two rebel groups fighting on the same side who then began fighting each other.
Syria once had the best-developed health-care system in the Arab world but since the conflict began, doctors have not only been caught in the crossfire, they’ve been specifically targeted. New York-based Physicians for Human Rights (PHR) has been documenting the deaths and reports that 599 medical personnel have been killed, and 175 medical facilities attacked since 2011. The regime loyal to President Bashar Assad has been responsible for 98 per cent of the attacks, according to PHR. That translates to one medical worker killed every other day in Syria.
“Medical professionals are often targeted because they, like journalists, are often the first to witness and document human rights abuses,” said Vesna Jaksic Lowe, PHR’s deputy director of communications.
Dahman and Cameron’s project started modestly, with a trip to Turkey in 2012, where they met Zakaria and Syrian doctor Khaled Almilaji. Since then, they established the Canadian International Medical Relief Organization (CIMRO) and are awaiting word from the Canada Revenue Agency about their application for charity status.
In the meantime, they have relied on donations from personal connections in the medical community, or their own resources — which have been depleted. Dahman has likely spent more than $100,000 in travel, logistics and equipment. And Cameron joked, “I’m the only 45-year-old guy who I know who borrows money from his father.”
The toll isn’t just financial, as repeated trips into Syria have made work and home life hard. Dahman is a pediatrician at Humber River Regional Hospital and Cameron, an advanced care paramedic. Together they teach at Sunnybrook hospital and train Canadian Forces members on advanced life support.
On their cellphones, they carry dozens of photos and videos of the children their team has treated in Syria. “Just today I posted on Facebook an article about two monkeys dying from the cold, from hypothermia, in the Louisiana zoo and as much as I love animals . . . it’s so sad that it ends up as an Associated Press piece and we don’t hear about the kids dying of hypothermia in Syria, or in neighbouring country refugee camps,” said Dahman.
None of their trips into Syria — or Turkey where CIMRO now has an office — are ever the same except perhaps when they begin, at the Pearson airport gate for Turkish Airlines where attendants at the check-in know them by name.
Which border crossing they use changes often, given who is in control in Syria. They used to travel farther into Syria, into Aleppo, but now a journey to a field hospital just 10 kilometres across the border can take 90 minutes and military precision to plan.
But in Syria’s intractable conflict, where there are no easy solutions, what they have been able to accomplish with little outside help is a rare good news story.
Consider the EZ-IO Intraosseous Vascular Access System, a hand-held drill that can insert a needle directly into the shoulder or any major bone and quickly deliver blood, medicine or life-saving rehydration. The IO, as it is known, can be used instead of an IV (intravenous therapy), which can be difficult if not impossible to administer in a war zone.
“When we started, we asked, ‘What problems can we assist you with?’ One of the first things that came up was the fact that some people could not start IVs well, or couldn’t start them on really critical patients, which is a problem. Even nurses in Canada, just because they can start IVs up on the floor, doesn’t mean they can do it on a guy who has lost three-quarters of his blood volume,” said Cameron.
“We thought we could teach anyone to do the intraosseous needles.”
Teleflex, a Pennsylvania-based medical equipment company that developed the IO, has donated boxes of needles, which Dahman and Cameron have brought with them to Syria, training as many medical personnel as they can reach.
Then there is the drug TXA, tranexamic acid, which stops bleeding in critical patients and gained popularity among British forces during the war in Afghanistan. It is inexpensive and highly effective — but was unheard of in Syria.
“Ammar (Zakaria) used to tell patients who were about to die, he’d say, ‘I’m just going to put you in this quiet room by yourself. You’re bleeding very badly but we’re going to give you medicine that stops the bleeding and you’re going to be OK,’ and then he would let them die in peace,” said Cameron.
When he introduced him to TXA, Zakaria was amazed. “He told me, ‘I’ve been telling patients we have a drug that stops the bleeding,’ and he said, ‘Are you kidding? You really do?’ ”
Zakaria is trained as an anesthesiologist, Almilaji specializes in otolaryngology (ear, nose and throat), but with their country at war, they have become trauma specialists, as have their colleagues still living inside Syria.
Aside from the emergency medicine, perhaps the most miraculous of achievements has been the polio vaccination program, which Almilaji spearheaded.
Although polio has been nearly eradicated worldwide, and, not seen in Syria since the 1990s, cases of the highly contagious disease were discovered in mid-2013 in rebel-held areas, regions with poor health care and where the government had withheld vaccinations.
Last year, the World Health Organization declared Syria’s polio outbreak a global threat and while international health organizations raised the alarm, they were left largely powerless, confined to government-controlled Damascus.
The only way to contain the crippling disease is to vaccinate the entire population — and three rounds of the vaccine are required. Unlike Ebola — which is difficult to spread — polio is nearly impossible to contain and can live on surfaces for hours, in sewage for months.
“No one in the World Health Organization believed we could do it,” said Almilaji. “But if you know how to approach the locals, the groups in charge, and you prepare adequately, it can be done.”
Quietly, in a door-to-door campaign with the help of 8,000 health workers, more than 1.4 million children were vaccinated. Some of the vaccines were smuggled past government checkpoints on milk trucks. Many doctors were killed in airstrikes. Since the vaccine needs to stay refrigerated, it would be kept cooled in underground bunkers as the doctors worked quickly, delivering the doses over six days.
The Polio Control Task Force was supported by various Syrian groups and the Turkish Ministry of Health, and reached areas that Islamic State controlled.
“Our guys approached them and said, ‘If you want us to continue we will. Otherwise we will stop and go on to other houses,’ ” said Almilaji about negotiating with the Islamic State.
Remarkably, they allowed them access.
Preparations are underway with CIMRO’s help to deliver the next round.
DAHMAN, 45, was born in Toronto but attended medical school in Syria, his parents’ birthplace. He was practising quietly in Canada, living with his wife and teenage son in 2011 when the Arab Spring protests erupted across the Middle East and North Africa. Peaceful demonstrations were brutally suppressed in Syria, as they were in Tunisia, Egypt, Yemen and elsewhere.
It is hard to remember as Syria’s war enters its fifth year, with more than 200,000 dead and no end in sight, that it began with a simple rallying cry from the streets: “We are all Hamza Al-Khateeb.”
The death of Hamza, a pudgy-cheeked 13-year-old Syrian, galvanized regions fed up with Assad’s dictatorship and brought thousands onto the streets. The boy had been arrested at a demonstration, tortured — his penis severed — and killed while in custody.
Dahman watched from Canada, sickened.
“It was boiling inside of me. ‘We got to do something. We got to do something. We got to do something,’ ” he recalled.
Zakaria was still in the military when Hamza was killed, working at a hospital in Damascus. While military service is mandatory, Zakaria hailed from a career military family, his father a high-ranking general.
Hamza’s death marked a personal turning point. “I saw his body . . . it was by accident that I was there,” Zakaria said. One of his military patients had died and he needed to complete an autopsy report at the military forensic branch when Hamza’s body arrived. “He was a child, just a child,” he said.
Zakaria’s mind was made up, but convincing — and then defecting with — his entire family was not easy, especially since his father was a general. When they arrived in Turkey in 2012 their defection was huge news — and a boost to the Free Syrian Army.
Soon after, Zakaria was working at the rehabilitation hospital in Reyhanli when he met Dahman and Cameron for the first time.
The meeting did not go well.
“We were helping out and Ammar started yelling at us, ‘Who are you? What are you doing?’ ” recalled Dahman. “But it didn’t take long and we were all best of friends.”
ZAKARIA’S fourth-floor city apartment is damp and chilly, except for the wood stove where the doctors are invited to hang their coat and socks to dry.
This is Plan B. If the Canadians can’t cross into Syria this trip, the Syrian doctors will come to them.
It is not ideal. Only a couple of physicians can come to get training and take the supplies back, as opposed to the dozens of medical workers the pair would have taught, not to mention the patients they could have helped treat on a two- or three-day visit.
“We didn’t want to remove physicians from their field hospitals. We’re talking about war here, mass casualties and you don’t want to take away their resources,” said Dahman. “But we just do what we can. The situation is always fluid.”
The training will be done quickly so they can cross back into Syria by nightfall. Dahman already has a drill and needle ready, along with sheep bones to practise on, when the doctors arrive.
One is a surgeon seeing an IO for the first time. Dahman leads him through the process.
A few days later, Dahman and Cameron will be on their way home to Canada, already planning their next trip back.
A few days later, the surgeon has sent a video back from his field hospital, where an 8-month-old baby is being resuscitated, an IO needle in his thigh.