'SCARRED forever?'

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A Syrian nurse treats a girl wounded by Syrian Army artillery shelling at Dar al-Shifa hospital in Aleppo, Syria Wednesday. (CP)

ALEPPO, Syria -- The injured arrive at the hospital in taxis or in the back of pickup trucks, to the blare of car horns and shouts of "Help!"

Sometimes, they are battle-hardened rebels with gaping wounds. Sometimes, they are children, peppered with shrapnel and screaming in pain.

Those who die are left on the sidewalk outside, to be claimed hours later by relatives.

An Associated Press team spent 24 hours at Dar al-Shifa hospital in Aleppo and witnessed the frantic work by overtaxed doctors and nurses to save those wounded in the battle for control of Syria's largest city.

The AP first visited the hospital last month and returned this week to get a fuller impression of how its staff is coping amid Syria's civil war. The routine is as simple as it is brutal: A barrage of shelling echoes over the city, and about 15 minutes later, the wounded flow in.

The medics work amid the wails of traumatized children, badly wounded men shouting Islam's declaration of faith in their final minutes, and rebel fighters holding RPGs mourning dead comrades, with tears streaming down their gunpowder-blackened cheeks.

Blood is everywhere. Orderlies mop it up as more wounded arrive. Amid the din of groans and cries for help, a worker spots a severed limb on the floor and tries to break the tension with some black humour.

"Anyone missing a foot?" he asks.

Once a private clinic owned by a businessman loyal to President Bashar Assad, Dar al-Shifa hospital has been taken over by volunteer doctors, nurses and aides united by their opposition to the regime and the need to give medical care to civilians and rebels.

The seven-storey hospital stands only 400 to 500 metres from the front line in a neighbourhood that is heavily shelled. Nearly three months into the rebel offensive in Aleppo, the facility has taken at least six direct hits, mostly affecting the upper stories; its staff uses the bottom three floors.

Most of the surrounding apartment blocks are badly damaged and deserted, with the only evidence of life being the fluttering of clothes on laundry lines or an occasional resident stepping onto a balcony to get a better cellphone signal.

Dar al-Shifa has only seven doctors, two of whom are trained for emergency duties, and two nurses. The atmosphere is a bizarre and somewhat unnerving mixture of urgency, nonchalance, resolve and anger.

The staff smokes freely in the corridors, watching TV during breaks in treating the waves of wounded. Dr. Osman al-Haj Osman even has moved his wife and two small children into the facility in order to be close to them.

Hospital officials say they see about 100 to 120 cases a day, of which 10 or 15 are children. Eighty per cent of the cases are of civilians; the rest are mostly rebel fighters. In the 24-hour period the AP was there on Wednesday and Thursday, the hospital's records showed nine dead and 107 wounded.

Because the hospital has no morgue, the dead are left on the sidewalk outside, where it is cooler. If the bodies are not identified and claimed within 12 hours, they are photographed and then buried. Residents who come to the hospital looking for missing relatives are shown the photos and -- if they recognize a loved one -- are given the choice of exhuming the remains for reburial elsewhere.

Osman, 30, spoke of the snap life-and-death decisions that he and others have to make when the hospital is flooded by casualties two or three times a day.

"I have to make a choice between a child with a 10 per cent chance of survival and one with a 25 per cent chance," he said.

"Our cruellest moments are when we get a child whose foot or part of his leg is only held by skin and we have to amputate," according to Osman, who said he was jailed and tortured by the Syrian regime twice since the start of the uprising in March 2011. "In the early days, we used to cry when we had a child with a severe injury, then recharge our psychological energy before we return to work.

"Now, there is just no time for that."

When AP journalists first arrived Wednesday afternoon, there were only a handful of patients being treated. Dr. Abu Rayan, who studied medicine in Moscow, stood in one corner chatting with two members of the hospital's pharmaceutical team. The doctor asked to be identified by his nickname for fear of retribution.

A man approached him, complaining of pain from shrapnel lodged in his right leg."Forget it, it will never come out," the 35-year-old doctor told him with a smile.

Nearby, Zakariya Khojah lay on a gurney, a tube draining a wound in his side. He had a lifeless stare fixed on the ceiling. Standing at his side was his 13-year-old son, Bashar.

"Papa, is there anything hurting you beside your chest?" the boy asked. The father replied with a slow shake of his head.

"I was walking just ahead of him when a bomb fell close to us," Bashar said. "He's all I got. My mother died three years ago."

Around 3:10 p.m., shortly after artillery blasts were heard nearby, a wave of wounded arrived. Frantic men screamed, "Emergency! Emergency!" as they carried the casualties inside.

In minutes, the small, three-bed intensive care unit was filled, and the overflow of patients had to be treated on the floor of the lobby.

"Where are you guys? Hurry up, please, guys!" yelled one of the escorts. Others shouted, "God is great!"

Word quickly spread that the wounded, about 15 in all, had been standing in a bread line when a shell fell nearby.

Thursday morning was ushered in with an airstrike and intense shelling that sounded much closer than the previous day's attack.

The overwhelmed staff asked those with superficial wounds to go home and come back later. "My brother is dying!" cried a young man as he stood next to his wounded sibling. "For God's sake, people, come and help him!"

Dr. Abu Rayan was preparing to meet his wife and two children across town in a government-controlled area of Aleppo, using a fake ID to get him through checkpoints. But he delayed his departure to help out.

Then the power went off, and an overworked generator kicked in as the sound of shelling got louder.

"I don't know whether we will ever be able to lead normal lives again," Osman said.

"Will we have dreams and ambitions like regular people, or have we been scarred forever?"

-- The Associated Press

Republished from the Winnipeg Free Press print edition October 13, 2012 A27