Underground medicine

In my work on attacks on hospitals in Syria I’ve drawn attention to the remarkable Central Cave Hospital (see also here and here) – and to what it says about a war when hospitals have to be excavated deep into the ground in a desperate attempt to protect them from airstrikes.

That hospital – formally, the Al Maghara (Dr Hasan al Araj) Hospital – was excavated in the side of a mountainside at Kafr Zita in Hama and opened in October 2015.  The Syrian-American Medical Society had originally proposed to build the hospital in the heart of the city, but local residents feared that doing so would turn them into targets for airstrikes.

Yet going outside and underground provided only limited protection: the hospital was repeatedly targeted by Russian and Syrian aircraft (see here and here and the videos shown by Jake Godin on Twitter here).

But as Saving Lives Underground noted (in a report co-produced with SAMS, dated May 2017), there were other cave hospitals in Syria.  Compared to basement hospitals, the cave hospital is

‘a more effective protective model, in which medical facilities are built into caves carved into the side of a mountain. This model provides reasonable protective measures, but has limited feasibility as it can only be constructed in environments that contain mountains. It requires securing the entrance to the hospital, creating an emergency exit, and ensuring ventilation, but is a comparatively inexpensive model as it relies on the existing base structure of the mountain. This model has proven to be effective when designed properly and laid out with attention to details… The largest cave hospital in Syria is the Central Cave Hospital, which is 500 – 600 meters large, contains three operating rooms, and houses a range of services…’

(The most expensive model involved ‘building a new, completely underground facility. A hospital is built several meters below the surface, has a thick, reinforced concrete frame, and is covered by protective ground backfill to create the additional layer of safety. The advantage of this model is that it can be replicated anywhere with few modifications because of its standard design. However, as it involves the construction of a completely new structure, it is the most expensive model and requires the longest time to completion.’)

So there have been other cave hospitals.  Now the Toronto International Film Festival features a new documentary by the co-director of the award-winning Last Men in Aleppo, writer-director Feras Fayyad, called The Cave.  This was shot at another Cave Hospital in East Ghouta between 2016 and 2018 (for background, see my posts on the siege of Ghouta here and here).

Here is the Q&A with the cast and crew at TIFF:

The Cave should be shown in theatres in the fall, and (as you can see from the trailer below) is co-sponsored by National Geographic and will appear in its new documentary line-up:

The Cave follows another documentary on the work of doctors, nurses and patients under siege in Assad’s (and Putin’s) Syria, For Sama: see my notice here.

Like For Sama it too draws attention to the multiple ways in which gender and patriarchy play out in these desperate circumstances.  The Cave is run by a woman, Dr Amani Ballor, and one reviewer notes: ‘When one man shows up to get medicine for his wife, he lectures the staff that women should be “at home with the family,” not running a hospital. “We voted twice,” says a male doctor on staff. “She won both times.”’

Or again, in a detailed review of the film, Eric Kohn writes:

What makes this determined young woman tick? Speaking through a voiceover that guides the narrative along, Amani recalls growing up under “a racist and autocratic regime,” and how the war drove her to “respond to the terrible reality” through her work. At one point, a male relative of one of her patients confronts her, demanding a man be in charge. When one of Amani’s peers comes to her defense, the showdown serves as a keen snapshot of the doctor’s struggle on several fronts. Beyond encapsulating the city’s devastation, “The Cave” is an implicit critique of a war-torn society still at the mercy of antiquated values. Even in this desperate moment, her selfless acts face backlash from stern traditionalists. With nothing to lose aside from the hospital itself, Dr. Amani has no qualms about speaking her mind. “This religion is just a tool for men,” she says.

Writing in Variety, Tomris Laffly describes Dr Amani working with two other women, Dr Alaa and a nurse Samaher, as a vital thematic arc of the film:

In the end, it is the feminine camaraderie and understanding that stands tall as the backbone of the film and perhaps even the entire operation. Despite having their physical safety incessantly threatened — above the ground, there is nothing but a wasteland of a city nearly flattened by bombs — and capability repeatedly questioned by male patients, the trio of women somehow manages to carve out an alternative space for themselves. In that, they criticize religion as an enabler of falsely perceived male superiority and work side-by-side with male colleagues as equals, even if their parity comes as a consequence of the desperate aboveground circumstances.

Much to think about here, clearly: another of the essays on which I’m still working, converting these various posts into long form (and always, so it seems, into very long form!), recovers the genealogy and the geography of hospital attacks in modern war – from the bombing of hospitals on the Western Front in the First World War (there’s a preliminary version here, but I’ve since done much more work) right through to the US bombing of the MSF Trauma Centre in Kunduz (see here and here) and the continuing attacks on medical care in Syria.  I’ll do my best to keep you posted.

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