The following guest post was written by Yehudit Reishtein, who took part in a special HonestReporting field trip in October 2017 to hear about and meet with Syrian patients being treated in Israel’s Ziv Medical Center.
Healthcare in Syria is almost non-existent after six years of civil war. Fares, an Arabic-speaking social worker at Ziv Medical Center in Tsfat (Safed), cited a few illustrative statistics: “Their medical system is 70% destroyed. About a million people live in the border areas, but there are only seven doctors.” One doctor for every 143,000 people? The number was shocking.
We were on an HonestReporting field trip to learn more about how Syrian casualties were receiving care in Israel. Ziv’s program has evolved in response to a need.
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When the civil war started in March 2011, the IDF had a policy of watchful waiting. On Saturday, February 16, 2013, seven badly wounded Syrians crossed the border into Israel. IDF medics evaluated them and then transported them to the nearest hospital. Ziv doctors were called to come in for an emergency. They had no idea who the patients were or what the problem was until they reported for duty and met the wounded Syrians.
Syria has been at war with Israel since May 1948. These wounded men were our enemies. But the doctors did not hesitate—an injured person is a person in need of care. The men were treated. When they recovered, the IDF took them back to the border and sent them home. Since then Ziv Hospital has treated more than 800 patients who have made their way over the border.
We were instructed not to take any photos. Photos could endanger the men and their families. We never learned any patient’s name. All newspaper and TV stories about treatment of Syrians in Israel change patients’ names and either blur their faces or photograph them from an angle that does not reveal their identity.
We met with Prof. Alexander Lerner, the Director of the Department of Orthopedic Surgery. He first described the care of a young bearded Syrian man whose left arm looked like it was caught in a metal cage. This external fixation device is a relatively recent innovation in medical science which makes it possible to save and repair limbs that would otherwise have to remain permanently deformed or even amputated. Israel has done a great deal of innovation in improving this technique in recent years and applies it to many of the Syrian patients. Dr. Lerner explained that the man’s elbow joint had been destroyed. The hinge in the middle of the device was locked to keep the reconstructed joint still. As the bone and muscle start to heal, therapists will release the lock to perform physical therapy. Later, the patient will also need a skin graft.
Like many of the wounded who are treated at Ziv, this young man will probably go back to Syria with the external fixation device still in place. The devices cost $2,000 to $3,000 each. For local patients the devices are returned and re-used. But Syrian patients do not come back to the hospital for follow-up; the expensive devices are not returned and Ziv Hospital absorbs the cost, knowing from the outset that this is part of the unavoidable expense of treating Syrian patients.
Another young man walked out of the room with his left leg in a cage-like fixation device. Because the device was longer than his leg, his foot hung in the air several inches above the end of the device, which rested on the floor. Despite the disparity in the lengths of his legs, the device enabled him to walk and is acting to lengthen his bone structure, which will eventually make it possible for him to walk almost normally, despite severe injury to his leg.
He had arrived at the hospital with a partial amputation of his leg. When he recovers from the leg elongation procedure, he will be given a special shoe to enable him to walk.
Both Fares and Dr. Lerner pointed out that they know nothing about these patients. Unless the Syrians themselves choose to reveal something, the medical staff have no idea if they are civilians or fighters. Many of the men say they were injured in an accident and leave it at that.
The lack of medical history is a serious problem. Previous injuries, chronic diseases, even allergies are all unknown. The doctors can only hope the patient is not allergic to needed antibiotics.
Complicated trauma frequently results in infection. Dr. Lerner said that similar injuries treated at Walter Reed Hospital in Washington have an the infection rate of 17%. However, the Syrians at Ziv are all infection-free by the time of discharge. It’s not just a matter of antibiotic use. Dr. Lerner believes the difference lies in continuity of care. By the time injured US military personnel arrive at Walter Reed,they have already been treated at a field hospital, a local military hospital, and the military hospital in Germany. At each point, they are cared for by a different doctor with a different approach.
At Ziv, one doctor directs all care from initial admission until discharge. He plans the first surgery with follow-up care, future operations, and rehabilitation in mind. He can follow those plans throughout the patient’s hospital stay.
Someone asked what Dr. Lerner had learned caring for these patients. Had he published anything about such complex trauma?
The doctor smiled. He proudly showed us a photo on his phone of his latest book, Complicated War Trauma and Care of the Wounded, which he co-edited with Salman Zarka. It describes not only orthopedics and other surgical treatment, but also psychological therapy and ethical issues involved in treating soldiers and civilians from an enemy country.
As word spread that free medical treatment was available in Israel, more and more Syrians started showing up at the border. They always arrive at night; it is impossible to safely cross the border during daylight. The IDF carries out initial stabilization of patients and transports them to Ziv or to Poriya hospital for treatment. Because they arrive at night, it is often easier to get time in an operating room than during the day. The patients arrive with nothing. After an incident when a fighter pulled a weapon hidden in his clothing, the hospital only accepts patients in their underwear. The Red Cross provides them with clothing, a toothbrush, soap, and other necessities.
The patients are unaccompanied. No family member or friend can visit during their entire hospital stay, which can last several months. The only exceptions to this rule are children; a parent accompanies patients less than 18 years old.
Recently, Ziv has opened a free one-day pediatric clinic. Every three weeks a bus brings Syrian children from the border. Each child is accompanied by a parent. The clinic provides standard well child checkups as well as treatment for more complicated problems. Most of the children return to the border at the end of the day, although occasionally one does need to stay for further treatment. Although they come during the day, like the wounded men, they probably travel to the border under the cover of darkness.
All patients are given a summary of their medical treatment when they return to Syria. The summary is written in Arabic, on plain paper, with nothing on it to indicate they received the treatment in Israel. I suspect the Syrian doctors know where patients were treated. Injured people could not have found the sophisticated treatment in their home country’s collapsed medical system. And they could not have afforded care in Lebanon or Jordan.
The injured Syrians are not charged for their care. It is paid for by the Israeli government, Ziv Medical Center itself, and by individual contributions to Ziv. The medical center brochure we received points out that contributions to Ziv are tax-deductible in both the US and Israel. (Friends of Ziv Medical Center, Inc. is a registered 501(c)(3) charity.)
We’re not the only visitors who have come to observe the treatment of Syrians at Ziv. A few weeks ago Conan O’Brien stopped in during his tour of Israel. His team was allowed to film in the Syrians’ room, on condition that they not show any of the patients’ faces. His hospital visit became part of his Israel show. A short excerpt from the show can be viewed below.
