As editorials of journals are usually written by medical authorities and senior physicians, I had to think twice after I was kindly invited to write this editorial. I had to process lots of contradictory motives and ideas. After all, I am only a junior neurosurgeon who was fortunate to be born in Syria, the country that belongs to the league, they call “Developing world.” Let alone that I do have neither a vast expertise in peer-reviewed medical journalism or in the latest technology and updates of neurosurgery.

After the eventful decades of the 20^th century and coming to the end of the year 2010, young generations in countries such as Egypt and Tunisia started defying their governments to establish what approaches democratic political systems after centuries of colonialism and dictatorship.[ 1 ] Due to the linguistic and cultural links with my country Syria, these calls for freedom reached the oppressed and deprived in the Syrian towns. Calls to gather and chant against the regime started to be heard. In March 2011, a group of children were detained in the Southern city Dara’a after they wrote anti-government slogans. Demonstrations followed and nothing remained the same after that.

In the same year, I finished training, and I was granted my specialty certificate after 7 years of working in different Syrian hospitals. My rotation as a resident trainee involved working in departments such as general surgery, intensive care, emergency, and even orthopedics before spending the last 5 years to practice neurosurgery and undergoing my exit examination. The examination consisted of three parts: Written, practical, and oral. The success threshold was more than 60% of the total marks aggregated. I passed with 76%, and I ranked second of 14 applicants. In that year and right after passing my examinations, my dream of being a successful neurosurgeon ceased to exist.[ 2 ]

Because it is one of few countries that still accepts Syrians without entry visa, I escaped to Sudan after few months to avoid detention, or even worse, after refusing to join military service. I was not the only one to leave. Scores of professionals, skilled laborers, and businessmen started to run away. The country was slowly but surely collapsing.

In the summer of the year 2012, the regime lost a substantial part of the country to the armed opposition groups. Many of these local groups started protecting their towns against the regime troops and by that time ISIS was not a part of the equation in Syria yet.[ 3 ] At that point, I made up my mind to come back and help on the ground as a neurosurgeon who might help the wounded and sick in whichever way he could. To my dismay, I found out that chaos and destruction were bigger than I feared. Hospitals were bombed, and medical equipment were ransacked. The regime targeted everything, even trees. What was worse that many of the trained medical and nursing staff had to leave. It was so difficult to perform basic procedures let alone complex neurosurgery.[ 4 ]

Despite these unimaginable challenges, I joined the forces of one of the societies of the “Red crescent” in cooperation with other nongovernmental organizations on the ground. Our main project was a network of basic makeshift hospitals which were built near the Turkish border that aimed to stabilize the wounded before transferring them to the better-equipped centers inside Turkey. However, this was not a walk in the park as we were faced with a high mortality rate en-route which was not a surprise given that 4–5 medical members of staff can hardly cope with 40–50 surgical emergency cases a day. There was no proper transfer network or pathways and, logistically, we had to be innovative to overcome long distances on roads that were subject to random shelling. Surgical complication rate was expectedly high. Sterility was not strict at the best for obvious reasons. In the rare moments of rest, we used to look at each other and laugh in a desperate effort to be louder than the flying jets that patrolled over our heads shortly before laughter became weeping over a country we could see dying in front of our eyes.

During those harrowing moments, my fear was complex as it was caused by the death surrounding me and it was aggravated by my worries over my 4 year old daughter. Moreover, I was terrified for my mother, the woman who did not have a chance to enjoy her son after his graduation as life deprived her of that joy with no promises that they are to be reunited. I always wonder about motherly love and how it defies logic. A mother would not feel happy if only one of her many offsprings is not nearby. Could that be a late side effect of the Oxytocin that her body secreted?

Complex fear requires complex and rapidly responding thinking especially in times of war. Without being able to mull over my decision I arranged for my daughter to leave to Egypt by the end of 2014. My mother and her other four sons stayed back in Aleppo, which was possibly the most dangerous city in the world.

All these changes in my family life happened while the health infrastructure in Syria was collapsing. An endemic of polio in summer 2013 was declared which instated an international intervention led by World Health Organization. I happened to become a coordinator of some of the vaccination campaigns among Syrians within Syria and abroad.[ 5 ] These efforts and campaigns required constant meetings between health staff inside Syria on one hand and the international organizations such as WHO and UNICEF on the other. I was heavily involved in those efforts until I heard that one of the governmental security apparatus branches detained my brother from the house of our mother. That was followed the next day by detaining 3 of my friends in Aleppo. The charge they used was the same in all cases. These people had links to me, and I was accused of “financing terrorism.” This accusation was cynically based on me transferring 300 American dollars to my family in Aleppo, so they can buy water in a city that was and still is one of the most hydro-poor cities in the world. However, and with benefit of reflection, I do believe that this absurd allegation was merely a pretext to blackmail my family on one hand and to send me a message that regardless of the nature of my humanitarian activities I am not allowed to work in Syrian territories that is outside the government control.

After that shock, I resigned my post due to my concern about further harassment or incarceration that could affect the rest of my family, and while I was trying to recalibrate my exhausted self, I was horrified with news that one of my detained friends was killed under torture. That friend was the one who walked with me on every path I walked in my childhood, adolescence and adulthood. That friend was the one who would deliver my kisses to my mother when I left my country. I was devastated, and I stopped being able to think straight.[ 6 ] I wondered, as I still do, about the reason of his early and tragic departure. Was it just because he was my friend and because I was a doctor who tried to fulfill his professional duty and lend a healing hand to his people? Should I have turned down sick women and children because they were guilty of living outside the rule of government? I still struggle to understand!

Sometimes, I want to ask people in another country to try to imagine a similar situation in their country where people rise against a dictator and due to a certain political process the dictator loses control over half the country. Could they imagine that a neurosurgeon who chooses to help people in that half would have to go through the ordeal of seeing his brother detained, his best friend killed, his family scattered, and most of all his dreams shattered. Maybe, if you can imagine that neurosurgeon being yourself, you could start to understand how my colleagues and I felt and lived during those years. Those years that taught me to appreciate peace more than I ever did and to sincerely wish it for all humans on our earth.

In summer 2014, I lost the ability to cope; I could not live under the constant strain of bloodshed and suffering. My wife and I decided to take one more risk and cross the sea to Europe in one of those small boats displayed in the media, seeking a land where we could live like other people do; a home where we could sleep with no fear and eat without being surrounded by the blood of the victims. We wanted to work, to study, and to chase a career waiting for a day when we might be able to go back to Syria and rebuild it. We reached the Netherlands in September, and a journey of soul search began. In your country, I recaptured my old dream of becoming a neurosurgery professor, and I do hope whole heartedly that the day will come where I will return to one of the Syrian universities and teach this noble art to the younger doctors of my country.[ 7 ]

References

1. Last accessed on 2015 Dec 09. https://en.wikipedia.org/wiki/Arab_Spring.

2. Last accessed on 2015 Dec 09. http://arab-board.org/node/43202.

3. Last accessed on 2015 Dec 09. http://www.polgeonow.com/2012/12/syria-uprising-map-december-2012.html.

4. Last accessed on 2015 Dec 09. http://www.reuters.com/article/syria-crisis-healthcare-idUSL6N0M60M2201 40309.

5. Last accessed on 2015 Dec 09. http://www.who.int/csr/don/2014_3_21polio/en/.

6. Last accessed on 2015 Dec 09. http://www.dailymail.co.uk/news/article-3257299/New-book-reveals-grotesque-torture-murder-meted-Syrian-dictator-Assad-man-Russia-s-Putin-helping-power.html.

7. Last accessed on 2015 Dec 09. http://data.unhcr.org/syrianrefugees/regional.php.