Day 6

Meet the shadow doctors overseeing surgery in Aleppo from 4,600 km away

This week, Staffan de Mistura, the United Nations envoy to Syria, said that Eastern Aleppo could be in total ruin by Christmas. Russian and Syrian forces appear to be targeting hospitals and there are now just 30 medics for 250,000 besieged people. Dr. Mounir Hakimi is part of a group of "Shadow Doctors" supporting those medics, giving life-saving advice on complex procedures via text message.

by Brent Bambury (@notrexmurphy)

Only the truly desperate would think of going to a hospital in Aleppo.

Since the siege on the city began in July, there have been 23 specific attacks on the eight remaining facilities. This past week, according to the UN, barrel bombs and cluster bombs fell on the largest remaining hospital. From September 28 until October 3, it was hit five times. It's no longer usable at all.

But people keep coming because the bombs are also falling on their streets and homes, killing and injuring civilians. They arrive with family members bearing grave injuries. Surgeries take place on the floors of facilities that are partially destroyed.

In Aleppo, Health care persists under unimaginable circumstances.

Syrians await treatment at a make-shift hospital following air strikes on rebel-held eastern areas of Aleppo. (Karam Al-Masri/AFP/Getty Images)

Dr. Mounir Hakimi has performed surgeries in the decimated operating rooms of broken, bombed out hospitals and cared for the sick and dying people of Aleppo.  Now he lives in Manchester with his family but he grew up in Syria. He's one of the so-called shadow doctors of Aleppo, providing advice and complex medical information electronically to practitioners trying to save lives torn apart by the siege.

Expertise from a world away

"We use social media, we use WhatsApp, we use Skype", he told me on CBC Day 6, "And when there is a complex operation, the doctor there takes a picture, sends it to us and we have a group of doctors with the expertise and we discuss what is best."

Dr. Hakimi, along with his colleague Dr. David Nott, has been advising Syrian practitioners so they can do shorthand surgeries on trauma patients who would otherwise die. Doctors are talked through procedures they've never been formally trained to do. Sometimes a patient with severe trauma waits as the doctor receives instruction via text message. 

Practicing medicine in Aleppo means doing whatever needs to be done to keep a person alive. Amputations become routine if a leg is damaged, because otherwise the patient will likely die waiting for a specialist to stop the bleeding. 

"If this happens in the UK, in the U.S. or in Canada -- anywhere in the civilized world, this patient, his leg will survive and they will be walking again. But in Syria, that's not possible."

"It's so painful, not only to the patient but to the doctor."

How to do open heart surgery

Dr. Hakimi says he and other doctors have been doing as much as possible to impart their skills to people on the front lines of Syria's health care. In the summer of 2013, Dr. Hakimi and some Syrian doctors witnessed a lifesaving operation performed by David Nott on a teenager in an Aleppo hospital.

Dr. Mounir Hakimi (centre) helps get supplies and training to medical professionals in Aleppo, Syria. There are now just 30 medics assisting 275,000 civilians in the war-ravaged city. (Said Foundation)

The boy arrived in the operating room with no vital signs.

"The doctors there tried to save him but I realized that because of the (lack of) skills, we are about to lose him."

He sent for Dr. Nott.

"David walked down and saw the condition.  He said to the doctor 'Open the chest! Open the chest!' "

"And the doctor, because he was panicking - and this is where the skills come in - David just took the blade and just opened his chest and blood poured onto our faces."

Dr. Hakimi was holding a camera, documenting the procedure as David Nott found a bullet hole on a ventricle of the boy's heart.

"When David opened the chest and he put his finger on the hole in the middle of the heart to make the heart stop bleeding, the patient came back to life."

A documenting witness

Medical staff are not only risking their lives in Aleppo, they are also losing them.  Physicians for Human Rights and other observers say the Syrian regime has deliberately targeted health care facilities since the beginning of the conflict. Now the doctors inside Aleppo and others assisting them are witnessing a grim endgame.

Dr. Hakimi remembers an incident from two weeks ago.

"Two of our ambulances were trying to save civilians," he says. "Unfortunately the ambulances were targeted by an air strike and we lost the two ambulances, the two drivers.  Four nurses and civilians have passed away."

It is a violation of the Geneva Convention to attack a hospital or an ambulance in a war zone and that convention is routinely breached in Aleppo. 

Dr. Hakimi is frustrated by the world's inaction.

"All of these doctors there, they are there to save lives. And they don't understand why the Geneva Convention has been broken here."

"I hope that anyone who's taken part in this immolation, in this genocide I think they should be taken to justice."

"The world", he says, "has let the Syrians down."