A girl slips through the corridors of the hospital’s fifth floor with her friend, the pair bright-eyed and shy. Today is her last chance to wear her sparkly new shoes, bought for a party last week. Tomorrow, the 12-year-old Iraqi will have a leg amputated.
The operation was due two weeks ago but the surgeon, who had tried not to weep as he broke the news that amputation was necessary, agreed to delay surgery. She wanted the chance to wear her new shoes to the party first.
Her 11-year-old friend is from Yemen, and her scalp glistens with the plastic-like sheen of burn scars. Her arm and shoulder were also damaged in an accident four years ago when an overcrowded truck crashed while carrying refugees fleeing Saudi fighter jet attacks on their villages.
Victims of different wars, they are among up to 110 war-wounded patients who are treated at the Médecins Sans Frontières (MSF) Mowasah hospital in Amman, Jordan, at any one time. A further 400 are on the waiting list, with 8,500 surgeries already under its belt.
It is a centre of excellence for reconstructive and orthopaedic surgery combined with physiotherapeutic and psychological care, and its staff are entirely focused on getting the best possible outcomes for the war-wounded.
“The nationalities reflect the wars of this region,” says the hospital director, Roshan Kumarasamy, a veteran of MSF work in global conflict zones. “Our patients are from Syria, Iraq, Libya, Yemen, Somalia, Gaza. Almost all have PTSD or some kind of survivor guilt.
“There is not another surgical place like this hospital in the world – we are uniquely specialised,” he says. “This is not the MSF lifesaving frontline operation per se; this is quality of life in the aftermath.”
MSF is one of three charities supported by the Guardian and Observer’s 2024 appeal in aid of victims of conflict, alongside War Child and Parallel Histories. The appeal has so far raised over £1m
At Mowasah, the injuries are from improvised explosive devices (IEDs), flames, shrapnel, barrel bombs, rockets, bullets, sniper drones and exploded apartment blocks.
Taha Saleh, a Yemeni cameraman, has bubbling scars behind each ear where a bullet passed through his head as he was filming in 2015. “There were so many injured in the attack that they were prioritising patients, so they left me on the pile expected to die,” he says.
“For nine years, I struggled to get treatment in Yemen. It was difficult to eat. I had shooting pains constantly in my head.”
After a month here at Mowasah, with physiotherapy and mental health support, Saleh’s cranial tension and constant nightmares have reduced. “Now I have hope, and I am blessed to soon return to Yemen,” he says.
He met his friend Ahmed Jalal here. Jalal was injured in an explosion that killed five people. His life was saved at an MSF hospital in Aden, Yemen, but war zones have no specialist care, and he was left without the use of his arm. Here, he had bone-lengthening treatment, went home to heal (while connecting to the physiotherapy team by phone), and is now back for his final surgery.
“I feel very lucky. Now I will be able to find work and to marry,” Jalal says.
Behind all the injuries lie many personal stories. But they are stories that orthopaedic surgeon Dr Hanna Janho doesn’t always ask for any more. “The stories can begin to weigh on you,” he says. “At the beginning you ask, but there are only so many injuries and incidents. I concentrate on the injury now, on what can be done.”
Janho is running his clinic today, seeing a succession of people he has already operated on, perhaps multiple times: bone grafts, and tendon and nerve injuries in the main. Bullets can make a real mess of bones, and snipers are fond of aiming at femurs and pelvises.
People are referred by MSF doctors in their home countries. The team here will consider each case, and those they think they can help will be flown to Amman.
The overwhelming common denominator in Janho’s patients is quiet gratitude – at pain relieved, at limbs that move again, at bones that have seen growth and re-fused.
“Usually, we will start to see the people about two years after the cessation of fighting,” Janho says. “So now we have a lot of Yemeni people. Some patients live in rooms in the top floors while their treatment is ongoing, and others will go home and return.
“The worst we see? Probably after the barrel bombs were being dropped on people in Syria.”
Da’ed Almneaid is a clinical psychologist who runs the multi-disciplinary mental health team from an office adorned with the artwork of past patients and smelling strongly of roses.
“Ah, that’s our perfume makers,” she says with a smile. “We have started doing occupational training alongside therapy, adult education too, and the patients empower each other. We have a lot of integration here.
“There is a mindset, especially in Arab cultures, that is: we try to keep silent because everyone is suffering. To speak is to add to someone else’s burden. So we have to break down the stigma – to guide people that it is OK to not be OK.”
This applies to the staff too. Almneaid says: “We worked together step by step with the 12-year-old facing amputation. She is well prepared and the surgeon was well supported.”
Mowasah hospital was the brainchild of a group of Iraqi doctors. Dr Rasheed Fakhri was one of them, and is credited as an inspiration by many of the staff. He says: “MSF is always acute emergency; the wound and the acute trauma is treated, the patient has survived. So just two weeks after we opened in Amman, we shifted the criteria – the needs are not what we first thought.
“The surgeons on the frontline will stabilise and save, but the patient is left with [the need for] soft tissue, tendon or nerve repair. No one can do anything because there is no time and no place for it. So that is what we do here.”
Even in a hospital of pioneers like Fakhri, Samar Ismail is holding her own. She is in charge of the 3D printing of prosthetics and works with burns and scars. Today she is helping Janeyah Ahmad, a Yemeni teenager with facial burns, fit a transparent facial mask to help her skin repair.
“Customised assisted devices, finding solutions for people’s problems … it means we really need to think imaginatively,” she says. “Sometimes I wake up in the night and am thinking about some problem or other. We started 3D printing in 2017, so it was self-learning: if we failed, we tried again, and we are sharing the knowledge now with others.”
She shows a square device with a pencil sharpener sealed inside. “This is a good example. We had a little boy who lost his hand, and we made a prosthetic for him. But he still didn’t feel normal because at school he couldn’t sharpen his pencil like the other children. So we designed this – he puts it on his prosthetic finger and it holds tight so he can sharpen his pencil.
“He was so happy,” she says, putting it back with a smile. “That’s what we do.”
