(Top photo: patients at the Médecins Sans Frontières reconstructive hospital in Amman, Jordan. All photos by the author)
In the Middle East's only reconstructive surgery hospital for the war-wounded, bodies and minds are rebuilt, only to be sent straight back to the conflicts they came from.
I'm in Amman, the capital of Jordan – a relatively small, dry desert kingdom. It's home to the ancient city of Petra, known as the spot where Indiana Jones discovered the Holy Grail. It's also surrounded by chaos. To the north is Syria. Israel and the West Bank border the east. Iraq and Saudi Arabia lie to the west.
"It's one of the last stable countries in the region," says Médecins Sans Frontières mission head Marc Schakal, explaining the positioning of the hospital.
Over 10 years, at least 10,000 operations have been carried out here on 4,500 patients, who usually stay for about six months for long term care. Some patients are bedridden, in wheelchairs, or at risk of amputation. Others are covered in marks of torture.
This month a 3D printer will be installed in Amman. The objective of the 3D workshop is to design custom-made upper limb prostheses.
The region's many conflicts can be traced through the hospital's patients. Originally the majority were Iraqis, Schakal says. Now, most patients are Syrian, though Yemenis, Iraqis and Palestinians are all regulars.
Over the decade the hospital's been there, the scars of war have remained the same. Shattered bones or patients missing half their face are commonplace. Weapons, bullets or a collapsed building still cause the same catastrophic injuries, even when the perpetrators are different. Some of those perpetrators may be in the building. Schakal says they don't necessarily ask for a lot of background information on patients, who travel from their homes after being referred by local doctors. Some of them could be militants, he admits, though the majority are certainly civilians – bakers, electricians, builders; women and children as well as men.
The eight-storey hospital includes two floors for pre-operation patients and another two for recovery. There's a physiotherapy gym and an isolation ward, but the function of the top floor is less immediately evident.
"We don't talk about pathologies here. These are normal reactions to abnormal situations in their country," says psychosocial manager Elisa Birri, sitting in a bright office with a far-reaching view of the city.
A skinny Italian wearing Adidas tracksuit bottoms, she's in charge of mental care for patients – both tackling the symptoms caused by past experiences and building resilience for future trauma, which she is certain most will face. "Common symptoms are flashbacks, nightmares, anxiety or depression," she says.
At the moment, her department is treating 160 patients as well as running a school – the first MSF has ever opened. It's time-consuming but necessary, she says. Children struggle without regular activities.
Birri has worked with MSF all over the Middle East, including in Syria and Libya, and says the reactions to war and the trauma it causes are the same everywhere: "After six months when they don't decrease it's [defined medically as] a pathology, but with people from Syria or Iraq we're not only speaking about one trauma. There might be a bomb one day and another bomb one week later."
Outside her office, a counsellor and a physiotherapist help an adolescent boy to walk using a frame. He takes one tentative step forward, then another, eyes fixated on the ground. Both staff members urge him on encouragingly. Watching them pass, Birri says: "There is nothing magic for sure. But as humans, we are very strong."
In therapy, the staff try to create a "safe space" to teach coping strategies, like reminding patients their families depend on them. Sometimes religion is mentioned – but is it right to tell conflict survivors to trust in a god?
In the long-run, faith may be a better bet than drugs for mental issues, the hospital staff say, because the patients can't procure pharmaceuticals at home.
However, knowing the discharged are being sent back to place with "no borders" is taxing, Birri admits; you don't know what will happen to them, or even what they might feel driven to. "It's very difficult to go through for us as staff as well."
Ginger-haired, tracksuit-donning Akram has been living in the Amman hospital for six months now. His brows furrow as he talks; his body's still except for his right hand, which circles from the wrist. To him, the rooms feel like vacuums – beige walls and orange door frames and regular silence. So quiet his crutches clack on the sterile floors as he roams the corridors.
It's nothing like southern Syria, where he's come from – where he remembers the noise of the streets or the bombing the night his house was shelled and his body was permanently damaged. The 34-year-old was in a coma for six hours. When he woke up he could no longer walk. After seven surgeries in Syria, his leg became infected. The doctors in Syria said there was nothing more they could do.
A friend helped him cross the border to Jordan, where he registered with MSF. After hip surgery and a long course of physiotherapy he's at least hobbling again. Akram also participated in group therapy focused on pain management; he readily dispenses advice.
"We learned how to classify pain, how to deal with it: make yourself busy, don't be isolated and chat with other people," he says. "This will also help reduce bad thoughts."
Akram's home city, Daraa, became known as the "cradle of the revolution" – it's where at least 15 children were arrested and tortured in 2011 for scrawling anti-government graffiti on a school's walls. Despite the atrocities he's witnessed, Akram is preparing to return. As his injuries repair, the emotions of what he's missing seem more physical and almost unbearable. His wife, siblings and parents are all still there.
"It's very heavy for me," Akram says, convincingly. "I'm thirsty to go back."
One month from now he will cross over the Syrian border.
"I have no choice."
13/03/17: An update was made to reflect the fact the 3D printer will be used to make upper limb prostheses, rather than prosthetic ears and eyes.