Fixing bodies broken in years of Arab world violence

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Media captionAbdullah Dawoud has been attending the clinic since it first opened in 2006

Six years ago a group of surgeons opened a temporary clinic in Jordan to operate on Iraqis with injuries untreatable in their home country. But recent violence in Libya, Yemen and Syria has led to the project being extended and expanded. After the horrors of war and torture, the patients are given a chance of a normal life.

Abdullah Dawoud lies in a hospital bed, barely flinching as a nurse removes stitches from around his artificial eye.

In 2006, while attending a family funeral in the Iraqi capital Baghdad, he lost the left side of his face and his left leg in a bomb blast which also killed several of his relatives.

Since then he has endured 25 separate operations. And he is only 12 years old.

"He doesn't complain at all," says his nurse. "He's very polite and very quiet."

Abdullah is being treated in a special wing of a hospital in the Jordanian capital, Amman, where a group of doctors from the charity Medecins Sans Frontieres (MSF) perform advanced reconstructive surgery on victims of violence from around the Middle East.

Image caption All of the patients at the MSF clinic were injured in violence and unrest in the Middle East. Imad, from Yemen, lost his wife and two-year-old son in a rocket attack on his car. His treatment includes moving a bone from his leg to his arm.
Image caption Qusay, pictured here with his father, was blinded in a bomb attack in Basra. The 23-year-old, who was an ambitious young business manager at the time, says the perpetrators "have taken away his future".
Image caption One in 10 of those attending the clinic are children. Before treatment and in between operations they rest in a hotel.
Image caption A school has been set up in one of the hotel rooms for the children, many of whom have missed months of education because of their injuries. Here we see nine-year-old Hussein, whose face and body were burned in a Baghdad bomb.
Image caption Khitam (on the right) was playing in her garden in Falluja when she was caught in an explosion aimed at US troops. She, like Hussein, is awaiting skin grafts.
Image caption Three-year-old Yemeni boy Abdel Malek was shot twice in the abdomen and once in the foot. His father, also pictured here, tried to get him help in Egypt, selling his car to pay for treatment. The team in Amman is expanding Abdel's abdomen to provide skin which can be used to reconstruct his intestine.
Image caption Six-year-old Saja was burned as a toddler when the blast from a bomb in Mosul tipped a heater on to her face as she slept. Thanks to the MSF team she is now able to close her eyes for the first time in four years.
Image caption An explosion outside 16-year-old Wasan Ared's house in Baghdad last year killed her brother and shattered her leg. The MSF team provides her only hope of avoiding amputation.
Image caption Abu Husam, an anti-government protest leader from southern Syria, says his injuries come from having hot coals put on his feet and boiling water poured into the wounds during interrogation.

When the clinic was set up in 2006 it was only meant to be a temporary project offering treatment to patients wounded in Iraq whose injuries were too complex to be dealt with in their own country.

But, with last year's political convulsions and continuing unrest across the region, the clinic has in fact been forced to expand to cope with demand and is now inundated with patients.

Over the past few months, as well as tending to Iraqis like Abdullah, it has treated Yemenis, Libyans, Palestinians and Syrians.

"We have increased our capacity by 45% since the Syrian crisis began," says Antoine Foucher, the head of MSF in Amman. "And we'll have to expand again."

The hospital - unique in the region - is the only place willing or able to treat the patients, many of whom have survived unimaginable horrors.

To spend time on the wards is to witness extraordinary bravery and resilience in the face of terrible suffering.

"All the patients have something in common," says orthopaedic surgeon, Dr Majd el-Rass, who is originally from Syria. "They have been terrorised - by explosions, by bullets, by catastrophe. I admire my patients, they are great. They are strong."

The admiration and respect that staff and patients feel for one another is palpable.

"Dr Majd is a hero," says Sa'id, a 27-year-old Syrian bus driver who has just had his leg amputated after being shot by a pro-government sniper last year.

Too scared to seek treatment, he hid on a farm for seven months, unable to sleep because of the pain, before he managed to smuggle himself out of the country.

Image caption Demand for places is so high that the waiting time for Yemeni and Iraqi patients is one year

"If I had come here earlier my leg could have been saved," he says.

Along the corridor, in another crowded ward, lies Abu Husam, a 43-year-old Syrian, who was arrested after he led younger men in demonstrations near the southern town of Deraa, then interrogated and tortured.

Abu Husam says he refused to agree to his interrogator's demand that he make a televised confession and admit to accepting weapons from abroad. "I couldn't do that," he says. "I would have lost all credibility."

As punishment, hot coals were put on his feet, and boiling water poured on to the wounds. He also had rubber bands tied around his penis so he could not urinate, causing a kidney infection.

Abu Husam says that knowing he was a marked man he smuggled himself and his family out of Syria.

But it is only the walking wounded who are, at the moment, making it to the MSF hospital. Staff know that there are many more Syrians who may need their help, if and when they are able to get out of the country.

And in Iraq and Yemen the waiting time for patients to get treatment at the clinic is already around one year.

"Unfortunately, we're going to be very busy," says Abdullah Dawoud's plastic surgeon, Dr Ashraf al-Bustanji. For him, and all the doctors, most of whom are Iraqi, it is the maiming of young children which is hardest to witness.

Image caption The hospital offers complex surgeries unavailable anywhere else in the Middle East

"I don't know how a child can experience what Abdullah experienced and carry on. He was so traumatised that I swear that for an entire year, I didn't hear his voice," Dr al-Bustanji tells me. "But Abdullah is lucky that he didn't lose both eyes. Abdullah is lucky that he can still walk and talk."

The 12-year-old walks on a prosthetic leg and still has no upper teeth, but his face is being painstakingly rebuilt. In one extremely complicated operation, rarely performed anywhere in the world, a muscle from his back was transferred to his mouth to help rebuild his lip.

One relative is allowed to stay with each of the children while they are treated at the clinic. They are put up in a hotel, where the patients also stay during breaks between operations.

Abdullah is accompanied by his uncle Qais, who left his business in Baghdad to look after him.

"Abdullah is brave. He accepts what happened to him, he has got used to it. He goes out now and he looks at himself in the mirror," Qais says. "For us Abdullah is beautiful. The doctors have already made a big difference. And anyway, it is the beauty of a person's spirit that counts."

Children make up 10% of the patients and in room 502 of the hotel a makeshift school has been set up for them.

Image caption The clinic also tries to improve the patients' mental well-being through group activities and interaction

Abdullah, who has missed out on much of his education because of his injuries, has just started attending classes there.

His fellow students include nine-year-old Hussein, whose face and body were burned in a bomb in Baghdad, and 12-year-old Khitam from Falluja - one of the most troubled towns in a country where thousands of children have been disabled and disfigured over the past decade.

Khitam was caught in an explosion aimed at US troops last year when while playing in her garden with her sister-in-law. She recalls, with no hint of self-pity, how the flames from the car bomb "engulfed" her, badly burning her face.

Both Khitam and Hussein are now waiting for further skin grafts.

"I like it here," says Khitam. "I like the fact that it is calm and there are no explosions."

As well as being a refuge from dangers in their home countries, the project is also a uniquely supportive environment where doctors and psychologists see their patients emerge from the shells into which they retreated after their injuries.

"Some of them at first refuse to go out," says psycho-social counsellor, Muntaha Mashayekh, who works with children and women, many of whom have been divorced by their husbands because of their disfigurement. "We need to coax them to do normal things."

Image caption The doctors work long hours treating complex war injuries not usually seen in such concentrations

Imagine being a six-year-old so badly burned that you frighten your schoolmates. Saja Khairullah was injured when an explosion in her hometown Mosul knocked a heater on to her face as she slept.

The MSF doctors have just operated to allow her to close her eyes at night for the first time since she was two years old.

And, although she cannot smile fully yet, her lip is no longer fused to her nose and you can see the sparkle in her eyes as she giggles whilst playing.

Her father Ahmad Khairullah is almost overcome with gratitude. "I can't thank the doctors enough," he says. "They've given us so much. Psychologically and physically she's doing much better now and, God willing, the doctors will make her like she was before."

The doctors work long hours, under intense pressure, treating complex war-related injuries not seen in such a concentration anywhere else in the world.

"We are learning all the time," says surgeon Ashraf al-Bustanji. "At the beginning, we couldn't reconstruct lips. Now we can."

But they cannot perform miracles. One doctor admitted to taking sleeping pills when the weight of responsibility keeps him awake at night.

"The patients come and they have big hope in us," says Dr al-Bustanji. "All we can do is give them a satisfactory result so they can go back and hopefully become active members of their communities, and not hide from people any more. But they still believe we can do something extraordinary, which is not the case."

Image caption Dr Majd el-Rass says he prays to never have to treat another wounded patient

They cannot bring back Imad's beloved wife and two-year-old son, who were killed in front of him in a rocket attack on his car in southern Yemen last year.

Doctors are transferring bone from one of Imad's legs to his shattered left arm. But the grief-stricken 27-year-old Yemeni, who says that he has "known no peace" since the attack, needs constant psychological oversight.

Teamwork from the hospital staff is key to the patients' recovery.

"I love them," says Imad. "I see them like family - like father and brothers."

He had four operations in Yemen which each cost him around $10,000 each, to no avail, before he was referred to the MSF hospital.

For many of the patients, the MSF team in Jordan is their last hope of treatment.

"If this hospital didn't exist it would be a catastrophe for them," says Imad's surgeon, Dr Majd el-Rass. "I pray every day not to receive the wounded. If I didn't have to perform surgery again I'd be very happy," he adds.

Then the busy consultant moves away to get on with examining his next group of patients.

Watch Caroline Hawley's full report on the Medecins Sans Frontiersclinic in Amman on Newsnight on Monday 21 May at 10.30pm on BBC Two, then afterwards on the BBC iPlayer and Newsnight website.