Helping the casualties of civil warfare

Syria - Paul Stewart assesses a patient before splinting the wrist
Syria - Paul Stewart assesses a patient before splinting the wrist
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When you have looked into the eyes of a three-year-old girl disfigured and bereaved by a bomb it’s hard to see anything “civil” in Syria’s war.

It’s even harder to walk away from a long line of refugees who have lost loved ones, homes, livelihoods, and are trying to rebuild broken lives.

They have lost or injured limbs, suffered head wounds, nerve damage, and endured emotional as well as physical trauma.

The conflict in Syria is now in its third year. Seventy thousand dead, thousands maimed, hundreds of thousands fleeing sniper fire, car bombs, shelling, ballistic missiles, cluster bombs and now - reportedly - chemical weapons.

Victims include children, some used as porters, runners and human shields. UNICEF has warned Syria risks “losing a generation”.

So when a team of physiotherapists from Blackpool Teaching Hospitals flew out to Turkey last November to assist refugees on the borders they vowed to go back and fast. They have just returned from their latest mercy mission – this time to the small Turkish town of Rayhnil, where the population has soared from 60,000 to 160,000 since the start of the Syrian conflict. It is very close to the border.

The trip was funded by charity Syria Relief, set up in September 2011, and by the volunteers themselves, Joan Donald, clinical lead occupational therapist, Yvonne Allen, amputee senior physiotherapist, James Fitzmaurice, senior physiotherapist, Paul Stewart, clinical lead physiotherapist in orthotics, Deirdree McCormick, consultant physiotherapist and Suzanne Lane, extended scope practitioner in physiotherapy.

The Trust granted the team two days of study leave – but the rest of the week (and additional 
travel time) was taken in the form of annual or unpaid leave. It is a labour of love, a compassionate use of their time and skills and funds. Suzanne explains: “We were asked to go back by Dr Mounir Hakimi from Syria Relief – set up to provide help and support to families in need.”

It took 16 hours to reach the remote town. The team were soon off to review patients and priorities.

“Most the Syrian nationals seeking refuge have been severely injured in the conflict. Since our previous trip the number of rehabilitation centres has doubled, three centres relocated from the nearby town of Antakya, in response to unrest in that area.”

The physios, accustomed to orderly appointment systems and ready access to medical aids, found a “notable lack of therapy staff to deliver appropriate rehabilitation for these patients.”

First stop was a small centre for 20 patients largely injured by sniper attacks, with broken bones and associated nerve injuries to upper and lower limbs. The team gave the one doctor in attendance advice on progressive rehab, and provided splints.

At two new centres most patients had spinal cord injuries, or significant head trauma, as a result of localised shelling or alleged use of high velocity Scud missiles. Suzanne says: “The nature of these injuries meant patients were either paralysed or presented with stroke-like symptoms. In the absence of a lead therapist at the centre, we taught relatives techniques to enable patients to sit out in their wheelchairs without risking further injury to themselves or their carers.”

On the third day they returned to the unit they visited in November – and found therapists carrying on the good work, using the equipment brought and the skills taught. Further funding has provided two more physiotherapists. “We worked alongside and offered guidance with complex cases.”

At the worst equipped, and final centre, they provided exercise regimes and helped the doctors. There they met a three year old girl whose mother and brother had died when their car drove over a bomb, her left arm and hand permanently disfigured by the impact.

Occupational therapist Joan stressed the importance of keeping the arm mobile and offered help on how to manage the scarring. “Seeing the effect of the conflict on someone so young was definitely one of our most moving experiences,” adds Suzanne. While amputee specialist Yvonne helped train refugees to measure, make and fit artificial limbs, other physios visited outpatients to assist other patients – including paralysed patients unable to accept they would never walk again.

Suzanne concludes: “Despite the severity of their situation, the Syrian people we met never failed to accommodate our every need, and the therapy staff proved exceptionally receptive to any teachings we provided.

“As therapists, we have developed immensely, professionally and personally from our experiences within these centres, whether it be how to work effectively with limited resources or deal with such emotive situations.”

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