Damascus orthopedics resident describes overcrowding, medicine shortages and the power of wasta

At the 12 public hospitals in Damascus, there are more patients who need treatment than available beds, and not enough doctors, nurses and specialists to treat them.  

Six years into the war, Syria’s medical infrastructure is “greatly diminished…by destruction of hospitals and clinics, reductions in the numbers of health care providers and shortages of supplies,” the Syrian American Medical Society reported in 2016.

More than 70 percent of practicing physicians have fled the country, the report concluded.

Although the policy at Damascus Hospital is to prioritize the most urgent cases, “the rules are often bent for patients who have connections,” Mustafa, an orthopedics resident at Damascus Hospital, tells Syria Direct’s Mohammed al-Haj Ali.

As a result, soldiers, security officials or their relatives are given preference for hospital beds and treatment—sometimes at the expense of other patients whose conditions are worse, says the resident.

“We always try to meet patients’ needs despite the shortage in supplies and the unfortunate existence of wasta [connections] inside the medical sector,” he says.

“In this way, the hospital has become like the government or business sector—devoid of humanity.”

Q: Which patients are given priority? Who decides this?

Hospitals in Damascus are filled with patients, many of whom are displaced residents from other provinces. We always try to prioritize patients who need urgent surgery or intensive care.

The hospital administration or department heads decide which patients to treat first. They’re doctors as well, so they always try to give priority to critical cases.

Although this is the general policy, the rules are often bent for patients who have connections. Of these patients, most have ties with army or security officers.

Also, a decent amount of soldiers are treated in civilian hospitals because the military hospitals are so full. Most military patients are in very bad condition—they need orthopedic or neural surgery. Many get placed in intensive care.

Q: Can you give examples of when one patient was given priority over another?

This happens a lot. Three months ago, the intensive care unit was under a lot of pressure. There were no empty beds in the department. A 50-year-old man with a blood clot in his brain came to the emergency room. He needed to be transferred to intensive care, but there was no space for him in the clinic. Staff informed the patient’s son that his father needed to be transferred to another hospital. The son started yelling and threatening the staff, demanding them to move his father to intensive care.

“Watch out, I have friends in high places!” the son kept saying.

After a huge argument, the hospital director called the intensive care unit and ordered them to transfer the most stable patient to another department, so this 50-year-old blood clot patient could take his place. The director told staff that if they didn’t make room for this patient, his son would “kick us all to the curb.”

Another time, about two weeks ago, a soldier in his twenties who needed non-urgent leg surgery came in. Everyone knows that in government hospitals, patients with non-urgent surgeries are put on a waiting list. This patient didn’t need surgery urgently, and doctors informed him that he needed to wait one to two weeks. This soldier called the leader of his fighting unit, who then paid a visit to the hospital director.

After the meeting, the soldier was scheduled to get surgery the next day. He replaced some patients who had been waiting for more than a month to have surgery. They had to reschedule their surgery date.

Q: If you have to delay a patient’s surgery, what do you tell him?

We don’t directly tell the patient the reason we have to delay his surgery. We tell him that his operation has been delayed because he needs more treatment, even though he’s completely ready for surgery. This has a big impact on patients’ morale, especially heart disease and cancer patients who require major surgeries.

Q: What reason do you give patients for transferring them to another department?

If we have to transfer a patient to another department, we tell him that he no longer needs to be in his current unit, even if he actually does. Sometimes a patient who needs machines such as respirators and cardiac monitors is transferred to a department without them.

Q: How does constantly turning patients away affect you personally?

At first, I refused to speak directly with patients. I’d ask one of my colleagues to inform the patient on my behalf. But I got used to it over time. Unfortunately, it’s become a routine occurrence. We’re all used to it.

We always try to meet patients’ needs despite the shortage in supplies and the unfortunate existence of wasta [connections] inside the medical sector.

In this way, the hospital has become like the government or business sector—devoid of humanity.

Q: Describe the situation at the hospital. With a shortage of staff, medicine and supplies, how are you treating patients?

Things really aren’t going well. There’s a shortage of cancer medication and vaccines. In addition, we’re tight on medical staff. We have a good number of general practitioners, but they’re not specialists. These doctors often have to perform surgeries or supervise patients who need specialists. We need more neural and orthopedic surgeons.

In light of this medicine and staff shortage, we treat patients in a number of ways. Sometimes we substitute medication for another kind that is equally—or almost equally—effective.

Q: Why is there a shortage of medical staff?

Most doctors who were in Damascus emigrated because of the war. There is also a shortage of doctors because of an influx of patients. The population of Damascus multiplied over a very short timespan because residents from other provinces fled to the capital. As a result, there aren’t enough doctors.

[Ed.: Up to 8 million residents now live in Damascus, Syrian pro-regime daily Al-Watan reported in 2016, quoting the Damascus Provincial Council.]

Neural and orthopedic specialists, whom the majority of our patients need, were rare even before the war started.

Q: Why did you decide to study medicine in the first place? Do you believe that you’re achieving your goal with your current work?

I used to dream of joining an international health organization such as the Red Cross or Doctors without Borders so I could treat patients from all over the world. But unfortunately, a year after I graduated, the war in Syria began. I decided to stay in Syria to treat my fellow citizens because they need me at this time.

I do think that I’m achieving my original goal through my current work. It’s no different from working with an international organization. Every day, we treat displaced patients from all over Syria who are now living in Damascus.