“Each new case is a challenge and each wounded patient is incomparable to another."

Dr. Ali Al-AniMSF surgeon
April 29, 2014
The ongoing conflict in Iraq has had a profound impact on the lives of Iraqis across the country. Médecins Sans Frontières/Doctors Without Borders (MSF) offers reconstructive surgical care to victims of violence from all over Iraq. But the security situation is posing huge challenges.
MSF has treated Iraqi victims of violence in its Reconstructive Surgery Project in Amman, Jordan, since 2006. The project offers orthopedic, maxillofacial and plastic surgery, and often treats complex cases. Physiotherapy and psychosocial support are also offered.
A network of doctors inside Iraq refers cases to the Amman project. They identify patients, arrange their travel, and conduct post-surgery follow-ups once patients return to Iraq.
Since 2006, more than 2,000 Iraqi patients have received treatment at the Amman Reconstructive Surgery Project. This number includes 297 from Anbar province alone, and the waiting list of patients from Anbar is growing.
An MSF doctor in Anbar says: 
‘’The security situation in Anbar is complex and difficult. The conflict has led to the displacement of many families from Fallujah, Ramadi and the surrounding areas. Tens of thousands of families have been displaced to other provinces.
The security situation is hindering patients’ access to MSF doctors and makes medical follow-ups for patients who have returned to Iraq more difficult. Tightened security has made movement to and from the cities hard for civilians. 
Doctors in Anbar are trying their best to be neutral in dealing with all sides of the conflict. Elective surgeries are now on hold in Anbar, with only emergency procedures taking place. In some hospitals there are shortages of medical supplies and staff.”

Interview with Dr. Ali Al-Ani, orthopedic surgeon

My name is Dr. Ali Al-Ani and I am from Iraq. I moved with my family from Iraq to Amman in 2005 because the security situation was very dangerous and it was impossible to live a normal life. I began working with the Amman Reconstructive Surgery Project as an orthopedic surgeon in 2007. 
What kind of patients do you see? 
Our patients are victims of conflict in the region. For the first two years of the project, we received only patients from Iraq. In 2008, we expanded and started to accept patients from other countries affected by violence in the region – we’ve since received patients from Gaza, Yemen and Syria. The majority of the cases that we deal with are complicated.
What kind of cases can be accepted on the project?
Our selection criteria cover three specialties: orthopedic, maxillofacial and plastic surgery. Many of our patients have bone infections, requiring lengthy treatment procedures. We also receive patients whose broken bones have not fused properly, as well as patients with bone loss, nerve injuries, and associated physical deformities as a long-term consequence of untreated trauma.
Due to the nature of conflict-related injuries, each new case is a challenge and each wounded patient is incomparable to another.
How are you affected personally by your work?
I am a surgeon but I am also a human being and affected by what I see in my work. I feel pain when I am face to face with innocent children and older men and women whose lives have been forever changed by conflict. 
But as a surgeon, I am in a position to treat these vulnerable people, to make them smile and enjoy a sense of independence again. I feel proud that this project has relieved the suffering of so many patients – by reconstructing their injured bodies and helping them to regain functionality – especially as those who are referred here may not be able to afford such care otherwise.
Each patient has their own story of a life affected by war. But the story of a seven-year-old Iraqi boy who was admitted to the project in 2009 touched me most. Wael was on his way to visit his grandparents when a roadside bomb exploded. His mother was killed and Wael was badly injured. He lost his right leg and his left leg was severely damaged. Despite the complexity of the surgeries, over the course of several operations the surgical team was able to reconstruct his damaged leg sufficiently for it to bear weight, and to attach prosthetics, so that Wael was able to walk again.
What difficulties do patients face when they return to Iraq?
The main difficulty is access to follow-up treatment back home. This includes psychosocial support and physiotherapy. Although we try to finalize treatment in Amman, these injuries often require a lot of follow-up after surgery, and this is a big challenge. 
What are your hopes for the future of the Amman Reconstructive Surgery project?
The project has expanded considerably since 2006, and we have positive plans for the future. We will soon be moving to a new facility which will improve the quality of care and increase the project’s technical capacity and scope. It may also allow us to add new types of surgery.

Diya, patient from Anbar 

Diya, 29, is from Anbar province. He was injured in 2009 and was admitted to the Amman Reconstructive Surgery Project in 2012.   
Diya was returning from a family visit when a bomb exploded directly under the car he was driving. The explosion killed his mother, wife, brother and son. Diya was the only survivor. 
“It was like a nightmare,” he said. “I lost my one-year-old son, my wife, my mother and my brother. I also lost the desire to live.”
Diya had burns all over his body, head injuries, severe fractures in both legs, and injuries to his lower jaw. At the Amman project, he was operated on by MSF surgeons and supported by the MSF physiotherapy and psychosocial teams. 
“I still have memories of the day of the injury,” Diya says. “I attempted suicide several times because I had lost the desire to live. I miss my family and even after all these years, I can’t overcome this feeling. 
“The MSF psychosocial team helped me a lot to regain my passion for life and to ask God’s mercy for the soul of my son Qutaybeh who I miss the most.” 
Diya has successfully completed his treatment at the Amman project and was discharged in February 2014. Now back in Anbar, Diya is unemployed and depending on his grandfather’s support. He hopes to one day open his own barber shop, but with the deteriorating security situation and the difficulty in finding an income, his dreams are currently on hold. 

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