Syria's health care system is collapsing after 21 months of revolt. According to a new report by the World Health Organization, half of the country's public hospitals have been destroyed in the fighting.
Pharmacies are running out a medicine for even the most basic care. In rebel-controlled areas, field clinics and hospitals are overwhelmed. A group of Syrian-American doctors has stepped in to help, bringing in crucial supplies and providing training.
In a hotel ballroom in Antakya,Turkey, Dr. Mazen Kewara in a blue surgical gown, slices open a dead sheep with a sharp surgical blade.
"We will make clamping, like [for] a man," he says.
Kewara is surrounded by Syrian doctors, who watch as Kewara, a vascular surgeon, demonstrates how to stitch a torn blood vessel. These surgeons have seen plenty of the real thing.
A Shortage Of Supplies
One Syrian doctor attending the course, who identified himself as Dr. Khobatt, works in a new field hospital in northern Syria on the Turkish border. He describes how his patients are often rushed in from the city of Aleppo where air strikes and artillery shells tear bodies apart.
There are 29 Syrian surgeons attending the course. Some asked not to be identified because they work deeper inside Syria. They are here to carry back supplies and learn everything they can from this American team.
Dr. Ahmad Nassr, a spinal surgeon who works at the Mayo Clinic in Minnesota, leads a workshop on shattered bones.
"One of the things they desperately need is anesthetic supplies and they just don't have them," Nassr says.
He shows them how to use something called a fixator with pins that screw right into the fracture so the patient can be stabilized and moved.
"I am teaching them techniques how to put fixators on without any numbing medication and it's a pretty cruel way to do it, but the anesthesia should really be kept for patients who really need it, for invasive procedures," says Nassr.
These American surgeons have learned, too, about how to adapt trauma medicine practiced in well run U.S. hospitals for Syrian surgeons who now often operate without electricity or running water.
"I think given the resources that they have, they're extremely creative and extremely gifted," Nassr tells NPR.
But, he says, even a week of intensive workshops only slightly changes the odds.
Providing The Basics
"There will be patients that will die that would not die in any civilized country and it's not because these are not good doctors, it's because they don't have the resources to take care of these patients, even the most basic things," Nassr says.
Some basics come along with the course. The Americans arrived with suitcases filled with surgical scissors, bandages, splints, and portable ultra sound machines.
Dr. Mohammed, 29, is a neurosurgeon from the town of Kafr Anble. He says he's the only neurosurgeon left in all of northern Syria and he says even these basic tools can make his practice better.
"Yes, of course, of course, like the drill for the [brain]," he says. "I didn't have one and it's a manual, but right now, i get it. I hope I can help people to live and that's the main goal that we are working for."
Helping people to live - that's the goal that all of these doctor's share. One of the Americans, Luay Al Kotob, is a cardiologist from Michigan.
"For people who have heart attacks," he explains, "I'm the guy who goes in the middle of the night to open the blood vessel. It is not very glamorous."
He says he's been moved by the bravery of these doctors, working for more than a year without pay, taking the same risks as their patients. He is also outraged, he says, that the international community has done so little to help.
"The question is, why is it so hard to get supplies to those hospitals? It's hard to get the supplies in," Al Kotob says. "It's hard to get the money for the supplies, and that part is truly, truly devastating."
Rima Marrouch contributed to this report