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Four health worker accounts of working in a war zone

15 Aug 2017
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Aleppo, Syria. Credit: Sana Tarabishi/ICRC

Attacks against health workers in conflict areas are on the rise. According to the World Health Organisation, 863 health workers were injured or killed in attacks in 2016, an increase on the year before. Despite the growing dangers, doctors, nurses and other health care workers continue to brave tremendous risks to treat the wounded and heal the sick. We spoke to four doctors in Afghanistan, Nigeria, Syria and Yemen to find out what it is like to work in some of the world’s most challenging conflict zones.

To mark this year’s World Humanitarian Day on 19 August, we are calling on all leaders to ensure that civilians in conflict are #NotATarget, including health and workers.

Credit: Yasmina Guerda/UNOCHA

Dr. Abbamusa Kyari, Rann, north-eastern Nigeria

Dr. Abbamusa Kyari is a community health worker in Rann, a town in north-eastern Nigeria. He used to manage 50 health workers at the International Committee of the Red Cross Health Centre, and provided antenatal care, nutritional support, immunizations, general consultations and health-education campaigns.

But all of this work came to an end when Boko Haram attacked the area in 2014, forcing Dr. Kyari, his two wives and nine children to flee to Kousseri in neighbouring Cameroon. They lived there for almost three years, and Dr. Kyari joined a private clinic. When he returned to Rann in December 2016, he found the health centre destroyed.

“I cannot explain the feeling of sadness that took over me when I came back [to Rann]. Everything had been destroyed, including our Health Centre. All the cars had been burned, the school was reduced to dust, the telephone tower had been torn down, there was nothing left.”

Nevertheless, Dr. Kyari stayed in Rann to work. “Despite the hardship of living in Rann, it is not difficult for me. The knowledge that I’m helping my people keeps me going, as they are suffering a lot. I need to persevere no matter what, because this is where I’m needed,” he said.

“Providing quality health care in Rann is extremely difficult because the roads are often inaccessible due to the continued fighting nearby, and heavy rains.”

“It’s heart breaking. We cannot refer patients who need secondary care, like women who need Caesarean sections, because we cannot get anyone out of here safely. We have to watch them die, and we cannot do anything.”

“My biggest hope is for the fighting to stop so we can rebuild our home and the entire town. I want a chance to pass on what I know so that when I die, I know I left something important for my people to build on.”

Dr. Yousefzai in his clinic. Credit: Ismail Amn/UNOCHA

Dr. Yousefzai, Jalalabad, Afghanistan

Dr. Yousefzai is a medical officer in charge of the Basic Health Care Centre in Jalalabad. He manages the health facility, outpatient treatment, staff training and reporting.
“Our daily life is full of uncertainty and stress. Close by recently, an old man was killed by a stranger; someone living next door to the health centre was killed; and a judge living in the same street was also killed. We are all worried.”
“Recent conflict in neighbouring districts has forced more people to seek safety in the city of Jalalabad. Every day we do consultations for more than 200 patients, about one quarter of them are newly arrived displaced people. This puts lots of pressure on our small health centre. Whenever there is an explosion in the neighbourhood, I and all the other staff members try to get to the health facility as quickly as we can because we know that people will come in needing our help.”
The conflict is not only creating an increase in caseloads at the health centre; it is also endangering the lives of the staff working there. “I live in the city, but I am still worried every morning when I come to work, not only for myself but also for my family and most for my children,” Dr. Yousefzai says. “One of my colleagues was killed, a vaccinator in Terili Basic Health Centre in Chaparhar district. Armed men entered the health centre and asked for him. Then they shot him. They also warned the midwife not to come back to work in the clinic.”

“I tell my family that they may not let the children outside of the house. I take a different route to and from work every day and I change the time I leave. My family is not happy that I travel back and forth through the whole city every day, but there is no other option.”

Credit: Ahmed Ben Lassoued/UNOCHA

Dr. Belqees Hamoud Al Khalaqi, Sana’a, Yemen

Dr. Belqees Hamoud Al Khalaqi is the Head of the Emergency Unit in As Sabain Hospital in Sana’a. She is currently in charge of clinical support, and also helps with UNICEF’s nutrition activities in the hospital for children and breastfeeding women.
“The war has affected all aspects of our life here in Yemen. Health staff here have been affected psychologically, socially and financially. Our working conditions are getting worse and we need all the help we can get to keep on providing medical services. We’ve been without pay for months as we want to help our fellow citizens, but we cannot do that forever.”
Half of Yemen’s health services have shut down because of the conflict, and the other half are working with very limited capacity. Public hospitals are facing increasing demands, but they do not have the necessary capacities to cope; salaries have stopped and medical supplies are in severely short supply.

“I know of several hospitals in the capital and in other governorates that have been attacked in air strikes. I have known patients and medical staff who have been killed.”
“When air strikes targeted areas near our hospital, I was at work. I was more frightened than I have ever been in my life — I was scared half to death. The feeling that I got during the air strikes was unspeakably bad. There were deaths, injuries, and the hospital was almost empty for a couple of weeks, as everyone was too frightened to return.”
“My biggest hope for Yemen is that it will return to how it was before the war, and people — all people, including the poor — get the medical treatment they need.”

Dr. Maher Saifo with his staff at Albairouni University Cancer Care Center

Dr. Maher Saifo, Albairouni University Cancer Care Center, Damascus

Dr. Maher Saifo is the Chief of the Breast Cancer Service at Damascus University and has headed Albairouni University’s Cancer Care Center throughout the Syrian conflict, which started in 2011.
“The war in Syria has resulted in a deepening socioeconomic crisis, deteriorating medical services and life-threatening conditions. As well as hundreds of thousands of deaths and injuries, we must count patients with chronic illnesses, including cancer, who might have been saved had they been able to access treatment.”
“The Albairouni University Cancer Center is located near the front lines of conflict. Many of my patients must risk bombing, shelling, sniper fire or the risk of kidnapping just to seek treatment. Even when receiving chemotherapy treatment, patients can hear bombs and explosions going off around them.”
Dr. Saifo used to receive patients from all over Syria, but many people are displaced or can no longer access the centre. The conflict has also brought some cancer services to a halt, and has hindered the procurement of chemotherapeutic medicines. “Radiation treatment is continually interrupted by power cuts, and we have insufficient diagnostic equipment, which makes it more difficult to accurately evaluate cancer stages.”

“My biggest hope is to deliver the best healthcare and treatment to our patients. And I feel we can, given that we have been standing up through seven years of destructive war.”