Syria: Frontline sharing from MSF anaesthetist

“Some arrived too late to be saved”

Kelly DILWORTH, an MSF anaesthetist who has worked for MSF for nine years, has returned after a month on mission in Syria. She recalls the pain of the wounded people she was treating and the severity of their injuries in a context where it’s difficult to get appropriate care in time.

I arrived a short time after MSF started treating people, and was involved in about 100 operations. Ninety per cent of these surgical procedures were for injuries linked to violence, predominantly from explosions and shelling. We were also seeing a significant number of gunshot wounds. However, the victims of heavy artillery were particularly striking because of the scale of their injuries, the extensive fragmentation wounds caused, and the fact that civilians are indiscriminately involved.

Given the hospital’s capacities, the arrival of even a small group of severely injured patients was enough to threaten to overwhelm us. In these situations we had to pull out all the stops, multiple our efforts, and literally multiply ourselves… Along with others in the team, I worked in the emergency room, operating theatre and post-operative wards. Simply resuscitating and operating on injured people does not mean the job is done. We also need to ensure that we give the best post-operative care possible; good analgesia, intensive care for critically ill patients, deep vein thrombosis prophylaxis, nutrition, etc.

On arrival the injured were often in terrible pain, with all its consequent risks: we were seeing patients with stiff limbs and joints, mobility problems and serious respiratory complications.
Some came from far away, having travelled up to 150 km to reach us. A good number arrived long after the initial injury had occurred rather than in the acute or semi-acute phase, some arriving simply too late to be saved. Among them were patients who had not been able to have any post-operative care after their surgery, patients who received inadequate care and others who hadn’t received any medical care at all.

One fourteen year-old boy was admitted with respiratory failure and fluid overload. He had had a laparotomy and splenectomy and was in a really bad way, having not been able to have timely and adequate care. He arrived literally “frozen” in position on a stretcher, but happily left smiling a few days later.

I also remember another wounded person in a terrible state when he was admitted. He had been operated on several days beforehand but had to flee immediately after the operation because there was a threat of bombing in the area. It had taken him two or three days to get to our hospital. He also pulled through.

These delays aggravate the problem of infection. When you’re dealing with a bullet or shell wound, you need to prescribe antibiotics and not close the wound in the first instance. A secondary closure should be done three to five days later, the exact timing according to the case.

Well, many of the injured people we saw couldn’t get proper care because of a lack of available resources in and close to the areas where the fighting was going on. This results in serious complications.

A fifteen year-old adolescent arrived in septic shock due to a traumatic intestinal perforation. He had been injured two days before by a tank shell and hadn’t received surgical care. In such cases, the cascade of complications triggered in the body can rapidly carry off the patient. In spite of the surgery and all the intensive care we had to offer, he died two days after the operation.