Beyond the barbed-wired fences of Zaatari refugee camp in northern Jordan, where 80,000 Syrians fleeing the civil war are living in tents and corrugated steel shelters in the desert, Ziad Ebrahim Abu Oun is reciting a poem to his doctors and fellow patients at the Médecins Sans Frontières (MSF) facility.
Abu Oun, 50, is confined to a wheelchair — he lost his left leg after barrel bombs were dropped in front of his house in Daraa, southern Syria. But as he gazes intently at his audience, there is a sparkle in his eye and hint of a wry smile at the corner of his mouth. “I was a normal Syrian citizen, who had a family and a house and a very peaceful life,” says Abu Oun.
He was brought to MSF Zaatari in July last year, leaving his family in Syria, after doctors were forced to amputate his leg at Ar Ramtha Hospital, Jordan, near the Syrian border.
“When someone gets injured, he suffers from many mental problems, he thinks about himself, about his country and his family,” says Abu Oun. “The staff, thankfully, they give me a lot of support. They have very specific and high-level techniques that have helped me to get over my sadness and missing my home, my family, my life,” he says.
MSF’s 40-bed, post-operative care facility at Zaatari, which is just 20 kilometres from the Syrian border, looks after war-wounded patients who have lost limbs or been paralysed from the Syrian war. Many of the patients are from Daraa, where the revolution first began in 2011. The vast majority at the facility have come via Ar Ramtha Hospital, where MSF has an emergency unit that performs surgical procedures for victims of the civil war. At the Zaatari facility, patients are given follow-up care, as well as mental-health support and physiotherapy.
“Patients will first go to Ramtha, be operated on there, and once they are in a much more stable condition and they need rehabilitation, they’re sent to MSF Zaatari. Then, if the patient needs any reconstructive surgery, they will be sent to MSF Amman,” says Dr Ahmad Ashraf Ali Mandal, medical team leader at MSF Zaatari.
“[In Zaatari] we have a team of physiotherapists and mental-health counsellors. If a patient who gets injured in a traumatic episode suffers from PTSD [Post Traumatic Stress Disorder] they go through certain phases,” says Mandal.
“Maybe a person with a missing upper or lower limb will have to come to terms with that reality, which may lead to depression. They may also have anxiety for their family who are back home or caught somewhere in the middle,” he says.
After interviewing a patient in the ward who was paralysed after being ambushed and shot in Daraa, Mandal’s point is evidenced as the young timid patient tells doctors that he has changed his mind, and doesn’t want his story to be published — fearing for the safety of his family in Syria and those trying to make their way to Zaatari.
Ziad Ebrahim Abu Oun turns to poetry to overcome his pain
At the MSF Zaatari facility, mental-health counselling is a key element to the rehabilitation process, so “once patients say no, we don’t push them [to tell their story],” says Mandal.
Counsellors often work with those who have suffered trauma through one-to-one and group therapy sessions, allowing them to confront their traumatic experiences through discussions, calming techniques, such as slow breathing, as well as various forms of self-expression, including drawing, poetry or simply sharing their stories.
“In the beginning ... we make our relationship with the patient strong, so that they trust us,” says Amani Al Mashaqba, mental health counsellor at MSF Zaatari. “After that, we talk with the patient about the injury, we use a lot of techniques, such as relaxation through deep breathing. We give the patients a lot of communication skills, life skills, we help them to talk with the other [patients],” says Al Mashaqba.
Inside the group therapy room, Abu Oun and another patient, Walid Abadi (name changed), are taking part in some slow breathing exercises with Al Mashaqba. After some time, Abadi begins to talk about his experiences.
“I was in my home when people came knocking on my door in an unusual way. My brother was in a battle in a nearby village, and I could hear the bombs there. When I answered the door, I found my brother’s friends. They told me that my brother was injured in a field hospital in Daraa, so I went with them to find him,” says Abadi.
Children throng an aid worker at the Zaatari camp
When Abadi reached the field hospital, which was jam-packed with injured people after the area had been bombarded by regime forces, he found his brother surrounded by doctors — his condition was critical; he had lost one of his legs in the attack. From here, the doctors transferred Abadi’s brother to an ambulance outside the hospital, where there was still a helicopter circling and attacking the area.
“People were saying that they were going to attack near the hospital again. They told us to go inside the hospital and turn off the lights,” says Abadi. “Everybody went in, but I refused, I wanted to stay near my brother in the ambulance.”
While Abadi was sitting near the ambulance, the helicopter attacked again, and this time the 29-year-old was caught in the explosions. “They transferred me to another field hospital as the other one was too crowded. I waited for a doctor for 18 hours. My leg was fractured with an open wound, and I was in severe pain. My leg was getting colder and colder.”
Abadi was then transferred to another field hospital near the Jordanian border, where he was told that his leg would have to be amputated. His leg tissue was dead, the main vein had been cut and no blood was getting through. Abadi was then taken to Ar Ramtha Hospital, where the amputation was carried out.
“When I found out, I was really depressed. I never expected to lose my leg, because I was not involved in the conflict. I was living in my village, which was safer than other villages,” he says, sitting in a wheelchair in the group therapy room.
“Thanks to God my condition has improved. I have accepted it as God’s wish. What affects me is to be away from my family and my country. Currently, the biggest wish for me is to be fully treated, and given a prosthesis so I can begin to get back to a life as close to normal as possible and return to my family in Syria.”
Médecins Sans Frontières facility at the Zaatari refugee camp
For patients such as Abadi, and many others who have come from Ar Ramtha Hospital, the post-operative rehabilitation performed by the physiotherapists at Zaatari is crucial in order for them to take steps towards returning to their lives back home. “We prepare amputees for their prosthesis, and for spinal-cord patients, we help them with everyday activities, such as moving from their beds to chairs, and back from chair to bed,” says Noor Al Deen Thyabat, physiotherapist at Zaatari MSF. “The patients become like a friend, we have patients who — when they first came here — were suffering from depression and isolation. Maybe when they first arrive they can’t move and are completely dependent on others, but step by step, they see themselves improving and progressing, which really has a positive effect on their psychology,” says Thyabat.
The doctors, physiotherapists and mental health counsellors here work together as a team. Their goal is non-political. They are here to help those who, in many cases, have lost everything in the space of just a few moments.
Abu Oun reads from his book of poems:
They plant in us the hope
They water the flower of happiness...
Thank you and a thousand thank yous
To those who treat us and share our feeling
Syria is a bloody wound
But its people should return
As the group therapy session in the small portacabin in the desert of northern Jordan comes to a close, Abu Oun talks of how the psychological therapy, and in particular sharing his poetry, helps him get through the more difficult times at the camp.
“My poetry can sometimes be tough, and at other times sad, and from psychological pressure I sometimes feel as if I want to criticise everyone,” says Abu Oun.
“But this pressure inspires me to write about my country, my alienation, and also takes me back to life before the war. It makes me think about how we lost our dreams ... how our children’s future has been destroyed, and all of that because of a regime that we consider to be a dictatorship.”
Faris Al-Jawad is a writer with GN Magazines.