Middle East

Aleppo: Treating trauma on the frontline

The BBC's Ian Pannell visits a hospital in Aleppo overwhelmed with trauma victims of Syria's civil war, where doctors work under fire to keep people alive.

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Media captionWarning: Ian Pannell's report contains distressing images of injury and death

An artillery shell had just landed and the hospital entrance was a grotesque tableau of blood, bodies and tears.

A small team of doctors set to work against a soundtrack of bombs and bullets.

The hospital lies in one of the southern districts of Aleppo city close to one of the city's many front lines.

The staff asked us not to identify its name or location in case government troops attack it.

It is a well-placed fear - the building has already been hit 12 times.

The doctors say it is seen as a "legitimate target" by the army because they treat rebel fighters as well as civilians.

Bloodiest battle

What began as a largely civil protest movement in Syria has degenerated into a civil war. More than 20,000 people have died according to the United Nations. Activists say it is more than 30,000.

Aleppo is now perhaps the defining battle in this conflict and, along with Homs, it is certainly one of its bloodiest.

Hospitals here must treat an incessant flow of casualties. Some are fighters wounded in battle but most are civilians injured by artillery or strikes by jets and helicopters.

The hospital admits more than 100 trauma patients every day. With fewer than 10 doctors and a shortage of proper medical equipment, the staff struggle to cope.

Not only do they work under fire but also some of the medics have been detained and executed according to Dr Othman, one of the surgeons.

With a mixture of fatigue and fatalism he says he has no reason to be afraid anymore.

"We've lost everything; we've lost our country, we've lost the peace, we've lost more than 30,000 people. We have nothing left to lose".

Image caption Doctors continue to operate despite the hospital being repeatedly attacked, and medics threatened

Gaping holes

The upper floors of the hospital have been smashed by artillery.

Gaping holes have been punched into the walls and valuable operating equipment lies strewn across the floors, buried beneath rubble.

Image caption Surgeon Dr Othman says that Syrians have nothing left to lose

There are now just two beds left where the surgeons can operate and with the constant threat of attack, the entire hospital has been condensed into the reception area and the basement.

Two-year-old Ahmed screamed in terror and agony as a surgeon sewed his scalp back into place.

His head had been torn open when a rocket landed on his house and pools of blood gathered in his mouth where his lip had been smashed.

Lying next to him was a badly injured teenager who was fighting for his life, his hands caked in dried blood.

Every few minutes more casualties were rushed in; a grim procession of patients, victims of a remorseless campaign of air strikes and artillery.

Half a dozen badly wounded people were brought in after an artillery shell struck a neighbourhood nearby.

Ali Abu Mohammed moaned in pain as a veterinarian started work on pulling shards of shrapnel from his body.

"There aren't enough human doctors," the vet said, preferring not to give his name as he explained why he was volunteering in the hospital.

Trails of blood lead to the operating room where Ali's son had been taken. The surgeons tried their best to save seven-year-old Hamoud but it was too late.

Amid the blood-soaked bedlam the little boy died. He was cradled in the arms of a neighbour and carried out of the hospital.

With no time for sentiment, the dead have to quickly make way for those still fighting for life.

A wounded rebel was taken to the bed where Hamoud had just died. And so the struggle to save another life began.

Grief and anger

There are few facilities here to treat the living and no room for the dead. Two bodies draped in a blanket lay unceremoniously on the pavement outside the hospital, waiting to be collected. Hamoud was placed among them.

Ali was still being treated; unaware that his son was dead. A group of men gathered around the small body - fighters and neighbours. Some of them wept quietly, leaning forward to kiss the boy's forehead, others paced restlessly in grief and anger.

"Bashar al-Assad is a child killer," said one, referring to the Syrian president.

The government accuses its opponents of being members of al-Qaeda, in the pay of foreign governments. With bitter irony one of the fighters asked, "What did this child do? Is he a terrorist? Was he armed?"

The conflict is now more than a year and a half old and, throughout, it has been civilians who have paid the heaviest price.

They are often trapped between the rebels and the army and many of them feel abandoned by what they see as an indifferent world.

Saving lives has never been so important and rarely so difficult and dangerous.