Healing Raqqa

In the outskirts of the city liberated from ISIS, there is a clinic offering free healthcare, thanks to European funds and an Italian NGO. The future of northeastern Syria depends on its patients: two-thirds of whom are women. Francesca Sironi writing in La Repubblica newspaper’s colour supplement ‘D’ on 25 May 2019.

There is a word in the Kurdish language for the small tornadoes which form in the desert when the wind changes. It sounds like ‘aghiagh’ although this ancient word defies accurate transcription. Today there are many of these sand twisters on both sides of the main road to Raqqa:  there are no obstacles here, nor in the town itself.

The devastation is too vast, the horror is too recent. First ISIS, then torture, the terror, followed by the bombing campaigns of the allies which destroyed whatever was left. To enter the town, you have to overcome the oppressive presence of rubble and death. And look at the present: the first are metal shutters, shops selling tiles or food starting to open again, people cooking lunch on the rooves. Stella is sitting with the other women all wearing the niquab. She is singing a lullaby to her youngest son: it tells the tale of a nightingale who wants to fly away; they are waiting in the open-air waiting room of the hospital. She travelled here from Aleppo, just to come to this three-story clinic in the outskirts of Raqqa. Because this is a special place: one of very few places offering free healthcare in Syria.

Faith Traeh was born and bred in the English countryside, daughter of two teachers. She has a British accent with inflections learned in Welsh schools and university in Glasgow, Scotland. This doctor was included in the Forbes list of people under 30 who could change global healthcare. Her mother relates how at the age of 5, after watching a TV report on UN peacekeeping missions, she was full of questions. 20 years later, she is on the frontline, working for the Italian NGO Un Ponte Per… with one goal: to create projects which tackle the two basic – and often conflicting cornerstones to humanitarian work. They are dealing with crisis situations, and building a better future. Training workers and the sustainability of long-term projects.

It was vital to provide immediate assistance in the form of concrete, reliable and safe initiatives for patients and staff alike. This clinic for emergency healthcare assistance in the outskirts of Raqqa was made possible by European funds. It is always open and over 8 months it has provided healthcare, attention and medicine to 34,403 patients. Munir is the director. As people come and go through his office, he explains: “I come from a largely Kurdish town in the north. Here we wanted mainly Arabic staff, ideally from this area. This helps staff connect with patients, their traditions and the suffering they have been subjected to,” both during the Islamic State occupation but also  during the devastating fight for liberation with its terrible consequences for the civilian population. Munir also experienced the war. He was working as part of an ambulance crew. He says he will never forget the nightmare of trying to help some of the burns victims. But he is adamant: “Now we must rebuild. We have to think of the future.”

Sabrin has never left Raqqa where she was born and went to school. Only in the most terrible moments did she seek refuge with her relations, outside her hometown. As soon as possible, she would come back home. This morning she is wearing a bright yellow shador. She has been working as the clinic’s main social worker for some months now. The most common diseases are respiratory (mainly caused by the toxic dust particles from destroyed buildings), or the gastric infections or epidemics that sweep through refugee and IDP camps, and more than 65% of the patients are women. They come here to give birth or to access paediatric healthcare. “My goal is to provide information and basic knowledge of womens’ health. The role of the gynaecologist is still taboo for many, with a function limited to the actual child birth. And only when required, otherwise an obstetrician can help.”

One conversation at a time, Sabrin is confident she can encourage women to get a better understanding of their own needs, and accept family planning. By overcoming stereotypes: “I was here when the first baby was born, the mother was angry because she wanted a boy. All the women want boys. But we talked and eventually she changed her mind. She started smiling and we celebrated together.” Her favourite poet is Imru’al-Qais, one of the founding fathers of Arabic pre-Islamic poetry. From behind her little green table on the ground floor, she recites one of his most famous verses: “Stop now and let us mourn the memory od a loved one and a dwelling that lay where the dunes finish”. “People are coming back to the city, they are getting back to work. This place is part of that rebirth, “ she states.

This is a rebirth starting with women. Brown-eyed obstetrician Jwhaida wears a green apron and a black veil, came back to work as soon as possible. During the war, she recounts how she helped women give birth under trees, in corridors, in cellars. “ Now we just have to convince them to stay in hospital after giving birth, at least for one day, instead of the usual two or three hours.”

Upstairs, new families are sitting on the beds and eating together. “I find the resilience and determination of my Syrian colleagues incredible,” says Faith. “Even during the war, they found ways to help others and continue studying. Now despite the new divisions, they treat everybody in the same way – whether they are friends or relations of the Islamic State fighters. Helping people is their priority and that goes beyond the wounds of war.” Faith’s main focus at the moment is to combat malnutrition. “Children under the age of 5 are very vulnerable and many deaths could be prevented. I am trying to set up better support services for breastfeeding and related issues. This is my goal in the next few weeks, in collaboration with our local partners. I hope that extended breastfeeding will reduce diarrhoea and malnutrition and therefore the infant mortality rate.

Faith and her colleagues are keen to highlight the importance of collaboration. The key local partner for Un Ponte Per… is the Kurdish Red Crescent (Heyva Sor a Kurdistané), an independent health service that operates throughout the northeast of the country.

Beyond the Assad-controlled areas of Damascus, it works closely with all the autonomous administrations of the Democratic Federation of Northern Syria. Priorities must be established on the basis of the needs of the inhabitants, doctors and local administrators, rather than on external inputs,” explains Faith, “Especially at the start it was important that we weren’t seen as yet more untrustworthy Westerners, given that over the years there had been many unfulfilled expectations. I spend a lot of time talking with my local counterparts, explaining that we can’t explain everything. But that if we work together we can achieve a great deal.”

Shared means and skills. More than 200 Kurdish Red Crescent health workers have been trained in standard medical protocols, from psychological first aid to decontamination in chemical warfare and the protection of the most vulnerable, with specialised services for victims of violence, designed to protect children and women from abuse by health workers or volunteers, by establishing clear complaints mechanisms. “This is fundamental,” Faith explains.

Here in Syria we work mostly with professionals and experienced staff. I remember my first humanitarian experience, in Greece. I had to look after small mobile dentistry clinics. I was working with very young and enthusiastic volunteers, from all over the world. Their passion was remarkable but they didn’t have the necessary technical training.  “While it is imperative, especially in the field of healthcare, that each situation is approached properly, for the sake of the patients and the doctors,” Faith continues. “But dealing with trauma, serious and unexpected emergencies, challenging circumstances is very difficult and you need to be able to be equipped to handle the burden. You can’t decide to lose yourself completely and be a superhero. That is why, one of my main goals as a doctor is to use my knowledge and principles in the world of volunteering,” Another problem is maintaining a balance: “Even though there are lots of us working together in the office, solving problems with Excel spreadsheets, but even so, every day you witness pain, poverty, knowing that you have the luxury of being able to leave. That you will go back to the west  every two or three months, in keeping with our policy.” Making a quantum leap every time. “You take three planes, you are awake for 24 hours until you get offf the plane and see London’s bright lights and all the shops with too many choices, supermarkets with too much food. You feel the culture shock. And to stay balanced, you have to remember one thing: the results.

The results. In the room overlooking the courtyard there are three new incubators, two if which contain tiny babies. Everything is pink inside and the floors have been polished. This is “Darna” – our house – the maternity and paediatrics wing of Raqqa public hospital, rebuilt by Un Ponte Per…, with funding from the Italian Agency for Cooperation and Development. It is the most important healthcare reconstruction project in this city which has become the symbol of military devastation in Syria. The top floor roof has a hole from a bomb, the external walls are covered in bullet holes, the balcony overlooks nothing but rubble. But inside, patients are being cared for. Darna provides free healthcare to an average of 300 people every day. It also runs a mobile health clinic and two ambulances to help people in rural villages, providing free check-ups to 80 children a day. They also distribute hygiene kits with soap, detergent and sanitary products to 8,500 families, for a total of 42,500 people, or around 40% of the current population. “In the private practices that are being opened all over Syria,” say a group of nurses in the corridor “they would have paid us more, but this where we can really help people. We are helping our own people and that is what counts.”

SAFETY IN WORDS

Adla is a nurse from Ras al-Ayn, a town which backs onto the wall built by Turkey along the border. It is patrolled day and night, a reminder of Ankara’s hostility towards the autonomous territory of northeastern Syria, but also as the furthest frontier of an armoured Europe.

Alda however is busy breaking down other barriers.Those surrounding gender-based violence. She is one of hundreds of experts and volunteers trying to break the male oppression inherited by villages and cities liberated from war, by arming women with knowledge and tools. “We don’t use the word ‘violence’ in our leaflets so that husband don’t get suspicious. We emphasise the word ‘Safety’ and suggest our meeting rooms as places where young women can come to talk,” she says, “it is difficult to convince men to let us claim our freedom. But we have started doing it.” They are creating a network through hospitals, caffès and ‘Mala jin’ (women’s houses) and other places in an attempt to offer concrete tools: from prevention courses to opportunities to share experiences, from mobile units that connect remote areas to the new maternity wing. Manbij is another small border town. “ The hospital was completely burned down, and surrounded by mines.  Now there are fully functioning maternity and paediatrics wards, with programmes against gender-based violence in the city,” say Luca Magno and Giacomo Baldini, who have been following Un Ponte Per…’s Syria projects from Iraq. Jihan is 45 years old and is the co-president of  Manbij’s healthcare committee: Over the past year and a half, we have managed to reduce the number of Caesarian births from 60% to 20% in hospital, for us this also means.