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.

Siege on film

Two new films about sieges in later modern war…. tragically not the contradiction in terms you might think.

The first is a documentary about Syria, For Samawhich won the prize for Best Documentary at Cannes this year (and has garnered a host of other awards, including the Special Jury Prize for International Feature Documentary at the Hot Docs Festival).

Here is G. Allen Johnson in the San Francisco Chronicle – and, given my work on the Assad regime’s systematic attacks on hospitals and medical care you will see why this is so important to me:

The civil war in Syria is horrific, is killing innocent civilians and is an ongoing humanitarian crisis. It could make you lose your faith in humanity, and who could blame any residents there if they did?

And yet, out of the ashes of conflict comes “For Sama,” a remarkable documentary  … about a doctor struggling to care for civilian war casualties in a makeshift hospital in the Syrian rebel stronghold of Aleppo, his journalist wife who documents it, and their infant daughter.

It is hard-hitting and graphic — some scenes cause you to look away. Yet it’s also loving and warm, a remarkable blend of reporting, cinema verite and essay not to be missed.

Waad Al-Khateab, who sent footage and reports from Aleppo to Channel 4 in London, also shot much personal footage. She and British filmmaker Edward Watts, who is credited with her as director, shaped the footage into the story of her family in the form of an essay. Her narration speaks to her daughter Sama — an explanation of why she and her husband Hamza stayed instead of taking her to safety.

“I need you to understand why your father and I made the choices we did,” Waad says.

The answer is they believe in freedom and humanity. Waad began covering the outbreak of civil war as a student in 2011. Hamza is a doctor who must save every life he can. “This is our path, this is our life,” he tells Waad.

The bulk of the film takes place in 2016, when constant bombing by forces loyal to Syrian President Bashar Assad— which include Russian aircraft — turn much of the city into rubble. The dead and wounded number in the thousands.

So there are intense, bloody scenes in the E.R., where lives are lost and saved. Meanwhile, Sama is being raised with the constant sound of exploding bombs. Waad does her best to comfort and raise her.

The family loses their beautiful home in the shelling, and eventually Hamza’s hospital is also destroyed (Assad’s forces specifically targeted places such as hospitals). Hamza and his team locate a building that would not be on Assad’s maps that would be suitable as a makeshift hospital — and home, as they will all live there — buttressed by thousands of sandbags as buffer against bombs.

Teo Bugbee in the New York Times adds:

“For Sama” provides a coherent account of a humanitarian crisis from the perspective of the wounded and displaced.

But just as crucially, and perhaps more compellingly, al-Kateab’s reflexive filmmaking provides an uncannily relatable example of the mundane experience of war. Profound bravery exists alongside profound ordinariness; friends still gather for dinner, they still tell their children bedtime stories, they still have to cook and clean and sleep.

The activists of this film, including al-Kateab herself, don’t speak in the language of philosophers or politicians. Their quotidian aspirations — to build a garden, to send their children safely to school — demonstrate the brutality of the government’s response, but they also invite viewers to picture themselves in the shoes of these modest political dissidents. Unselfconsciously, “For Sama” prompts audience members to ask themselves: How long would you defy tyranny if your world was coming down around you?

You can find a conversation with the film-makers here and (especially) here, and more reviews at the Intercept here and from the great Roger Ebert here.

The second film is Garry Keane and Andrew McConnell’s Gaza:

It’s hard to imagine anybody living a normal life in the Gaza Strip. Frequently labeled as the world’s largest open-air prison, it makes an appearance on news reports every time a confrontation erupts between Israel and Hamas. From TV sets thousands of miles away, this tiny piece of land has been reduced to an image of violence, chaos and destruction. So what do the people do when they’re not under siege?

The Gaza which is seldom seen is ordinary, everyday Gaza, a coastal strip which measures just twenty-five miles by six and which is home to an eclectic mix of almost two million people. Gaza cannot be understood in a purely political context or by analyzing tragic sound bites during conflict. It can only be understood by immersion, by living amongst its people and by recognizing and exploring its rich social diversity and cultural subtleties.

 

GAZA will introduce the audience to the surprising and the unexpected, the unfamiliar stories that portray its true face. It takes an atypical approach to finding out what makes this remarkable place tick as it introduces to the world extraordinary stories of everyday characters leading ordinary lives.

GAZA depicts a people plagued by conflict but not defined by it and as we journey through the physically broken and battered landscape, we let our cast of characters speak for themselves. Through them we gain a nuanced understanding of what life is really like for its citizens and by extension, grow and foster a rare familiarity and affinity with this truly unique place, as we build towards a tender portrait of a beleaguered humanity.

 

More here and here and (especially) here.

I’ve written about siege warfare in an extended series of posts (here, here, here and here). You can find my posts on Gaza by using the GUIDE tab (above), and I really recommend Ron Smith‘s excellent work on siege warfare in Gaza: Healthcare under siege: ‘Geopolitics of medical service provision in the Gaza Strip’, Social science and medicine 146 (2015) 332-40; ‘Isolation through humanitarianism: Subaltern geopolitics of the siege on Gaza’, Antipode 48 (2016) 750-759; ‘Israel’s permanent siege of Gaza’. Middle East Report 290 (2019) here