DR Faculty Seminar in Israel—“Medicine has no borders” at Ziv Hospital, Zafet

This guest blog post comes courtesy of Lydia Nussbaum (UNLV).

This afternoon we visited the Ziv Medical Center in Zafet (aka Safed, Tzfat), a small hilltop town located on the hills above the Sea of Galilee. Although Zafet has a long history and is well known for being the center of Jewish mysticism (Kabbalah), our purpose in visiting Zafet was to visit its hospital, which serves as one of three hospitals in Israel providing humanitarian medical treatment to Syrians caught in their country’s brutal civil war.

Zafet is located 19 miles from the Syrian border and 7 miles from Lebanon. Ziv hospital is the only hospital in the Upper Galilee and the Northern Golan Heights. Because of its location, the Ziv hospital serves a region with a diverse population of more than 250,000 people—Jews, Christians, Muslims, Circassians, Bedouin, and Druze. Serving this culturally diverse region has been a part of Ziv hospital’s mission since its founding in 1910.

Modern history has added a new kind of diversity to Ziv hospitals’ patients. Since the outbreak of the Syrian Civil War in March 2011, more than 500,000 people have been killed and more than 1.5 million people injured. We learned that, during the past 6 years of conflict, more than 70% of the medical community in Syria fled and much of the country’s healthcare facilities have been damaged or destroyed, leaving behind a population of civilians who have become not only the targets of military attacks but who also lack access to basic medical services and preventative medicine.

The Ziv Medical Center began receiving patients from Syria in February, 2013, two years after the civil war began. The program came to Ziv hospital because its current director had been a physician in the Israel Defense Forces (IDF) and had started a military program for Syrian civilians who lacked access to basic medical care because of the war. When he took over directorship of the Ziv hospital, he brought the project with him. Since the program began, Ziv hospital has treated over 1000 Syrians and, at times, half of all the available beds in their Intensive Care Unit were filled with Syrian civilian casualties.

The humanitarian aid project is organized and overseen entirely by the IDF. (And therefore funded by Israeli public funds with some private fundraising for prosthetics.) Under IDF supervision, patients come to Ziv hospital in one of two ways. First, Syrian civilians seeking medical treatment travel to the Israeli border at night, often by foot, horse, or donkey, and are picked up by IDF security forces.  We learned that most of these patients find out about the option of receiving medical treatment in Israel by word of mouth, from friends or family. The IDF screens them for medical need and, presumably, safety risks, and then transports them to Ziv for medical evaluation and treatment. Some of these patients are young men who have been involved in the fighting and the IDF maintains an army guard for them in the hospital and also limits their contact with family in Syria. We had the opportunity to meet some of these men—more on that below.

Second, once every two weeks, the IDF busses in Syrian children and their mothers to spend the day receiving outpatient care at Ziv hospital. The children and their mothers arrive in the morning receive medication and treatment, and then return to Syria that night. We learned that patients rarely, if ever, want to stay in Israel. Most want or need to return to Syria, either to rejoin their families or to continue on in the fighting.

The vast majority of patients receiving medical attention are male (90%) and, because of bombing and battle casualties, more than 70% require orthopedic care for shattered legs, shrapnel wounds, and amputated limbs, some of which can be fitted for prostheses but not all. The remaining 30% of patients receive care for a whole host of other medical needs—pediatrics, maternal health and OB/GYN, ophthalmology, craniofacial injuries, as well as preventative care for diabetes and oral health problems. They often arrive with scant medical histories and no medical records, leaving Israeli medical teams to puzzle through each patient’s circumstances.

Much of the heavy lifting of caring for these Syrians is done by the hospital’s social workers, who provide social services and Arabic translation to try and empower patients in their medical treatment. We met one social worker, F., a young Palestinian Arab man, who shared with us that he began working with Syrian patients after only two months on the job at the hospital. He said that many of the men, women, and children with whom he works are so deeply traumatized by the war that he takes special care to ensure that their treatment at the hospital does not become an added traumatic experience. He labors to educate them about their medical condition, translating the doctor’s diagnoses and proposed treatment plans into understandable terms, and making sure Syrian patients are the ultimate decision makers, particularly when it comes to bad injuries requiring amputation of limbs. Additionally, he spoke about how his male patients feel particularly helpless, lying in bed, unable to move around or tend to their daily functions with privacy.

F. introduced us to four men currently receiving treatment at the hospital.  One, an older man in his late 40s, was a farmer working in his field when a Syrian army tank came on his land and began shooting.  He was wounded in the leg and came to Ziv hospital where his leg was amputated. Another man was a school teacher in his late 20s, teaching in a Free Syrian Army school that was bombed by Syrian army forces almost two years earlier. He came to Ziv hospital to have shrapnel removed and fractured bones re-set. Two other young men, aged 19 and 22, were fighters in the Free Syrian Army, one was shot in the hand and lost a finger and the other was shot in the leg. Both men had wives and children waiting for them back in Syria. All four of these men would be returned to Syria as soon as their doctors gave clearance.

The four men spoke about the war and geopolitics with impressive sophistication. They talked about their disappointment that Obama had not acted after it became clear Assad used chemical weapons and crossed “the red line.”  They wanted to know what the deal was with Trump and we all shared a moment of common bewilderment. F. told the four men that we were law professors from the United States. When we asked if they had any messages for United States, they said “bring a case to the Hague.” They wanted Assad and his regime to answer for the crimes committed against the Syrian people. We asked the men what it was like to come into Israel, viewed as a long time enemy of the Syrian people, and they shared that it was difficult. They had been taught not to trust Israel and Israeli people, to keep their distance. These men did not say whether or not their experience at Ziv hospital had changed their views of Israel and Israelis. Whether or not Syrian patients prove grateful for their care, the Ziv hospital and its staff are committed to treating Syrian casualties of war for as long as needed.

After our visit to Zafet, we traveled across the Golan Heights and reached the Syrian border. Damascus was only 40 miles from where we stood.

A UN peace keeping compound dating from after the 1967 war can be seen in the foreground. We heard echoes of bombing and artillery fire in the distance.

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