Caesarean sections by phone light: One doctor’s experience delivering babies underground in East Ghouta

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A newborn child in East Ghouta this month. Photo courtesy of SAMS.

In an underground shelter just east of Damascus this week, with the sound of nearby bombings echoing around him, Doctor Bakr Abu Ibrahim delivered a child. He had only the light of a mobile phone to guide him.

Abu Ibrahim, a general surgeon, and a team of five other medical professionals are working to deliver babies and perform caesarean sections at a makeshift medical point in a shelter in East Ghouta since fleeing their homes and the hospital where they worked in the town of Saqba last week.

The doctors are among thousands of residents of the opposition-held eastern suburbs of Damascus who are taking refuge in a network of basements, cellars and tunnels as pro-government forces press an aerial and ground assault that has left 1,700 people dead and many more injured.

Working underground at an undisclosed location in East Ghouta’s central sector, Abu Ibrahim says his team has delivered more than 40 infants over the past week alone, using basic equipment and supplies they brought with them from Saqba. The doctor asked not to be referred to by his full name for security reasons.

Many of the challenges present while operating in a makeshift medical point are not new to Abu Ibrahim. His former hospital, the Saqba Maternity Hospital, faced not only shortages of supplies, staff and equipment, but was also attacked four times since the Syrian government’s latest assault began in February, the doctor says.

Underground, the greatest challenge is posed by the generators that provide light in the dark shelter. “At any moment, they might cut out and trip us up,” Abu Ibrahim tells Syria Direct’s Alaa Nasser.

When that happened earlier this week, a mobile phone provided enough light to continue. Other obstacles could be deadly.

“If I need an incubator—God forbid—I won’t be able to do anything about it,” he says

Q: Are patients coming to the shelter where you and your team work, or do you go to them?

[After leaving Saqba], we set up a medical point inside the shelter, and we are working here. I perform cesarean sections [C-sections], alongside another doctor [and an anesthesiologist], and we have three midwives who go to shelters where pregnant women are staying to assist natural births.

In some cases, we are forced to leave and go to [the patient]. For example, we go to the patient when the bombing is intense and she is not able to move easily. Most of the cellars are connected by [winding] tunnels, and she would have to climb up and down dozens of times before reaching our medical point.

Q: What equipment were you able to bring from the hospital in Saqba, and is it enough to conduct caesarean sections if necessary?

We took emergency drugs and supplies with us, such as anesthetics, surgical sutures, some serums and essential bandages. We are afraid it will run out.

We couldn’t move the medical equipment because of the intense bombing, except for a cautery, a suction [machine] and monitor—these are the things we need for the operations.

Most C-sections don’t require complex equipment, and we use local anesthesia, except in special cases that require general anesthesia and an anesthesia machine.

Q: Were there any cases this week in which you thought your patient might not make it?

We have seen extremely difficult cases that required special care both before and after the birth, but God is watching over us.

We almost lost one woman on Tuesday. She gave birth in one of the cellars and, six hours later, her family came back to us. They felt that something was wrong.

I went to the woman and found her bleeding. She went into shock and fell into a coma. Thank God, we gave her a blood transfusion and medication to stop the hemorrhaging. Everything was alright. Had she not responded to the treatment, she would have needed other equipment, which is not available. We would have lost her.

[Earlier this week], our anesthesiologist had just anesthetized a patient for a C-section when the electrical generator stopped working. I had to finish the whole operation with just the light from a mobile phone. We stayed with the patient after the operation, comforting her until the anesthesia wore off completely.

The generators are the greatest difficulty we face now. At any moment, they might cut out and trip us up. But at any moment, we could also save a patient’s life. So, despite the circumstances, we try our best to save the patient by any means available. If we can’t save them, then it was God’s will. God does not burden a soul more than it can bear.

Q: How do you reassure women who are giving birth in such difficult circumstances?

Giving birth can be extremely distressing [under normal circumstances], so try to imagine what it’s like for a woman who is already suffering nausea and fatigue because she is pregnant, and then the atmosphere around her is all bombings, terror and death. She’s waiting for her own death at any moment.

As doctors, we try our best to cultivate a safe space and to reassure the women that they will be okay. We ask them to repent, read the Quran and ask God to ease their deliveries.

I’m seen as a lifeline, so it really upsets me when I have to turn away a pregnant woman [who wants a C-section] but whose time hasn’t come, because even coming to the medical point is a gamble. [In such instances,] I’ll try to console her, saying: ‘It’s not time yet, and it’s better for the health of the fetus in your womb [if you wait],’ since we don’t have incubators. If I need an incubator—God forbid—I won’t be able to do anything about it.

Q: How has the current situation affected you emotionally?

We are working in one of the most dangerous areas in the world, and I am proud of this. But at the same time, our means are extremely limited and we are facing critical, nerve-wracking situations because we fear for the life of the patient.

Frankly, I am devastated inside but trying to appear strong, especially in front of my staff and my family. I am so tired.