Studying medicine in a war zone

This article was originally published in Student BMJ, a magazine produced by the British Medical Journal for medical students. An online version can be found here.

“When the crisis started, I was in high school. The situation was catastrophic. I was preparing for exams under daily bombardment and killing”.

Yusuf now studies medicine at Damascus University, Syria’s oldest medical school, but his studies remain compromised by the conflict. There are regular power blackouts and the internet connection is sporadic.

The quality of teaching he receives has also been affected. He describes that “some of the good professors have left the country” and he has far fewer opportunities to practise clinical techniques. He “wastes hours on the streets” travelling to classes, slowed down by military checkpoints and crowded traffic jams.

Omar, a student at another Syrian medical school, says on one occasion, he was one of over 60 students attempting to examine a patient admitted with a traumatic chest injury.

“I felt sorry for the patient, but had no other option. It is a regular occurrence; we often do not have the opportunity to examine patients during our clinical sessions” he explains.

Omar worries that he won’t be prepared to graduate as a doctor. “If I am stuck in this system, I will not become a good physician”.

The conflict has also disrupted everyday life. Omar has been forced to move home eight times, and his mother, who has cancer, struggles to get her medicine. “We used to get the drug for free from the hospital, but the war has made this nearly impossible. Now we have to buy it from specific pharmacies, and it is ten times more expensive”.

Fearing for safety

Both Yusuf and Omar want their stories to be heard, but remain guarded, particularly when talking about politics or family life. They worry that being interviewed for Student BMJ could put them in danger and insist on using pseudonyms. “The repercussions might be that I’m arrested or killed, perhaps the government will accuse me of being a terrorist” Yusuf explains.

This is not without good reason. In 2013 one of Yusuf’s friends, a dentistry student, was arrested by government forces. There was no public trial or media coverage of his arrest and, according to Yusuf, nobody knows why he was arrested. Yusuf does not know where he is, or if he is alive.

According to the organisation Physicians for Human Rights, of the 826 medical personnel who have been killed by shelling, torture and execution since 2011, nine percent have been students. In May 2016, the UN Security Council condemned all attacks on healthcare workers after reports that Syrian doctors had been executed for treating patients injured in anti-government protests. The government has now passed a law criminalising the provision of medical care for anyone injured in these protests, in an attempt to justify these arrests and executions.

Amira, another student, recalls living in Damascus when the conflict broke out. “There were bombs and shootings all over the neighbourhood,” she says. “I was forced to evacuate my school and we were stranded in the street with nowhere to go. Human carnage, blood and smoke; it was a matter of survival.”

One morning, she mistakenly crossed a police perimeter on her way to classes. Before she realised, a group of four armed men grabbed her backpack, opened it and stepped on her books. “They hit me with rifles, slapped me and pushed me against a wall, before throwing me on the ground. They were kicking me, all four of them. I couldn’t look up, they were all over me.” After the assault, she was left “humiliated in public, bleeding on the ground”.

Today, Amira lives and studies in New Jersey. Despite the distance from her hometown, the effects of the conflict have not faded. A year after moving to the United States, she was diagnosed with post-traumatic stress disorder. Soon after she arrived in the US, she developed anxiety attacks when she saw men in uniforms, such as security guards at shopping malls or at university. “I started to hallucinate about rifles and being assaulted. I’d wake up at night screaming that I was being beaten” she says. Eventually she learnt that her symptoms had psychological triggers, but it took her months to seek treatment. “I couldn’t accept the fact I was sick, and couldn’t relate my condition to the conflict. It destroyed my life, I fell behind with my studies, lost friends and now have to take regular pills”.

Continuing studies

It is unclear how many Syrian students have sought asylum in order to continue their studies abroad. Before the conflict, thousands of young people were studying in the nation’s higher education sector, although recent statistics are unreliable. Of the 6.5 million people displaced within Syria and the 5.1 million refugees who have fled the country, estimates suggest approximately 220,000 are university students yet to complete their degree. The country’s medical education infrastructure has been particularly badly affected. As early as 2015, 36% of the nation’s hospitals had been destroyed and more than half of the country’s doctors had fled the country.

Western nations have offered variable support to help Syrian students. The Institute of International Education (IIE), a non-profit organisation based in the United States, has declared an “academic emergency” in Syria and now organises scholarships for Syrian students across a network of 60 international universities, some of which host medical students. According to an IIE representative, of the 2,400 Syrian applications the organisation receives each year, a disproportionately high number come from students with a background or interest in medicine.

Global Platform, a Portuguese non-profit organisation, runs a similar scheme allowing Syrian medical students to transfer to the country’s universities. When Global Platform first advertised the programme, they received over 1,700 applications for only 45 places. Opportunities to transfer to the UK are scarcer. The Home Office does not routinely collect data on the number of Syrians enrolled at UK universities, but no UK medical school currently advertises support for Syrian refugees.

Global Platform has recently submitted a funding application to the European Commission for a large-scale project to support student refugees. The application proposes to work with the World Bank, the World Health Organisation and the League of Arab States to offer Syrian students the opportunity to continue studying at international institutions, while also providing remote learning resources for those residing in areas of conflict. The application, seen exclusively by Student BMJ, draws comparisons to the exodus of European intellectuals to New York during the Nazi regime and outlines plans to support hundreds of Syrian medical students. The European Commission is yet to reach a decision on the application.

Currently, opportunities to transfer to foreign medical schools are so scant that many students in Syria intend to pursue clinical work abroad after graduating. Yet this is also fraught with difficulty. A group of medical students at Damascus University have blogged about how the high cost of foreign examinations, such as the United States Medical Licensing Examination, prevent them from working abroad. The withdrawal of foreign embassies based in Syria causes further problems, particularly when trying to obtain visas.

Life as an asylum seeker

However, international asylum is not a panacea for all of the tragedies of war. “My life in Syria is the only life I loved,” Amira says. She recalls the moment her US visa was granted as “one of the saddest days of my life. Nothing will ever make up for what I felt there.”

Studying in the United States has also brought challenges, particularly for a Syrian Muslim woman. “My religion, nationality, appearance and gender are under attack,” she describes, while the media portray Syrians “as needy, poor and ignorant”.

Speaking to the German broadcaster Deutsche Welle Alan Jarwich, a Syrian medical student at the University of Cologne, describes the “psychological strain” of living away from his family and friends. “What happens in Syria always pains us. The videos we find on the internet are horrible. For the past two semesters, I was practically unable to study anything” he recalls.

However these stories are not without hope. Amira explains that “the war initially hurt [our community], made us weak, broken and polarised,” but with time, “it has strengthened the bond between many Syrians”.

When asked how she copes with the emotional turmoil of the last few years, her response reveals a touching but harrowing philosophy. “We feed on unity now, because everything else is worthless. As the world turns its back, it’s what Syrians will always hold onto”.

The writer’s fee for this article was donated to Médecins Sans Frontières, a charity operating six medical facilities in northern Syria and supporting over 150 facilities countrywide. You can donate at: www.msf.org.uk

 

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