“It wasn’t unusual for shells and missiles to smash through the upper floors, leaving sizeable holes. Every time we were hit, we’d wonder if we should close the hospital.”

​That is how Dr. Amani Ballour, a Syrian paediatrician and the first female director of a hospital in a Syrian war zone, recalls working in an underground medical facility during the Syrian civil war. Yet despite repeated attacks, “the people kept coming, and we kept working. We never did close the cave.”

​Speaking on the Global Health Matters “Dialogues” podcast, Ballour described six years spent treating civilians under siege in Eastern Ghouta, where hospitals became targets and medical workers struggled to provide care with dwindling resources. The underground facility known as “The Cave” cared not only for war injuries but also for children suffering from hunger, disease and a lack of basic medicines.

​Among the most traumatic moments was the August 2013 chemical attack on Ghouta. Arriving at the hospital in the middle of the night, Ballour found hundreds of victims struggling to breathe.

​”The hardest thing was to choose how to begin,” she recalled. “The people whom we will start helping will live, but other people will die. So we have to choose who’s going to live and who’s going to die.”

​The siege also created a public health catastrophe. Food, medicines and infant formula were scarce. Ballour remembered treating children whose primary complaint was hunger.

​”The first question I asked them was, ‘What are they suffering from? What they have, they said, ‘I’m hungry, I need to eat.'”

​Today, Ballour serves as Programme Advocacy Officer at the Syrian American Medical Society and continues to advocate for accountability for attacks on healthcare.

​”International humanitarian law is already protecting the health workers and the medical facilities,” she said. “There must be stronger enforcement mechanisms, like independent investigations, and real consequences for those who target healthcare.”

​For Ballour, preserving the stories of those lost remains essential.

​”Silence allows injustice to be normal,” she said. “Keeping their stories alive is a way of honoring their lives.”

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Image Credits: Global Health Matters Podcast.