Coping with loss of limb and life in the shadow of Syria's war

GAZIANTEP, Turkey - Anas Jibran looks protectively over at his daughter learning how to walk again. He remembers the exact date the five-year-old lost her limb. Reem Anas walks assisted by crutches and a nurse to get used to her new left leg.

Reem Anas and her father are from Termanin, in the Idlib province of Syria.

"On January 25, 2016, there was a Russian airstrike on my village. It was four o'clock in the evening, I had stepped out for 15 minutes," Jibran says. "When I came back I found the roof caved in on my home. I tried lifting up the roof to save my wife and one-year-old baby, but it was too heavy."

Jibran fainted out of shock. Once awake, he was told that his wife and baby had been buried alive. His five-year-old daughter was the only survivor and was in a critical condition.

Jibran trusted in the kindness of a stranger, who pretended to be Reem's father in order to get her across the border to Gaziantep, Turkey. The stranger gave Reem a fake name and dropped her off at the Will Steps Rehabilitation Center (WSC).

There, Doctor Hamza Diab, a specialist in two-legged amputation surgery - the amputation of both legs at once - and manager of the centre, amputated her left leg.

While there are no exact statistics of how many Syrians have lost limbs, Diab says between 16,000 and 20,000 people have lost their arms or legs in bombings during the war, now stretching into its sixth year.

"Before the war, I would see one amputation case a year or less," said Diab, in an interview at his office. "Now I see roughly 60 amputation cases a month. There was one day when I amputated five injuries, three of them were children."

Within the past week, the siege on Aleppo by Syrian regime forces has closed the city off to humanitarian aid. The regime onslaught has also left injured civilians trapped in a war zone.

For amputees across the border in Gaziantep, however, physical therapy at the Will Stepps Centre goes on.

At least 1.9 million Syrians have been injured in the years-long conflict. However, to Syria's foreign minister, Walid al-Moallem, the injured people, including Reem, are part of an elaborate media campaign meant to smear the Assad regime.

Speaking to CNN's Christiane Amanpour in November, Moallem said the reports of bombings and air raids by the regime are merely media manipulations.

"You are from TV, you know how to make them up," Moallem chuckled, pointing to the CNN reporter. When the reporter asked the minister to clarify his opinion about the bombings on men, women, children, and schools, Moallem said, "Yes because we never shelled civilians. We are aiming only at the [terrorist] groups."

Jibran offers a simple reply to the minister: "Let him come to Idlib for a month and see what happens."

With a new leg, Reem and Jibran have new hope, but also challenges. Jibran says if he is able to find work in Turkey, he will stay and Reem can go to school, but if they have to go back to Syria, Jibran has no intention of sending Reem to school.

"I am scared that another bomb might come," Jibran said, mentioning that his sister and brother-in-law were also killed in an airstrike.

In October, the United States said either the Damascus regime or their military backers in Moscow were directly responsible for abombing that destroyed a school complex in Idlib.

"People in Idlib live in fear of death. Honestly, people say they wish a rocket would just hit them and get it over with."

Even now Reem is terrified of the sounds of airplanes overhead. "She keeps saying, ‘I'm going to die! I'm going to die!'" Jibran says. "And that is not just my daughter's case, it is all children."

Reem has no recollection of what happened the night of the bombing. Jibran says that when he brought Reem to her mother and sister's burial sites and explained what really happened to them she responded with: "I want to go there [to heaven] with them."

Reem, at only five-years-old, does not understand the injuries she sustained on her head and legs. Jibran says, "I tell Reem that her leg is getting repaired and they will bring it back to you."

Diab says that loss of limb for children is different from adults.

"They lose their whole life, they will never be able to do things other kids can do," Diab said.

Leyla Akca, director of therapy at Project Lift, an Istanbul-based NGO focusing on treatment of psychological issues facing Syrian refugees, says the mental health of refugees often goes unchecked for any number of reasons.

She points to the lack of awareness of resources, limited funds, and the struggle to find mental health professionals are just some of the reasons that the mental health of refugees has gone unchecked.

"Some of [the children] come really traumatised where they can't sit still, they can't focus. They are either completely isolated, withdrawn, disassociated, really aggressive, or just can't tolerate anything because they think that everything is a threat to their safety," Akca told TRT World. "They are very much in their fight or flight state and they are still not back to normal."

On the whole, almost half of the Syrian refugee children surveyed by theMigration Policy Institute display symptoms of PTSD – ten times more prevalent than among children around the world, according to a reported released by the institute in October 2015. In Turkey, authorities report that 55 percent of Syrian refugees are in need of psychological services, but only five percent have their needs for this kind of healthcare actually met, according to theBrookings Institute.

In 2014, the Turkish government reported having provided $3.5 billion of aid to Syrians with $100 million in healthcare, according toThe Daily Hurriyet.

Diab also says that teams of therapists specialising in childhood trauma are needed to rehabilitate, give the children a new life, and help them overcome airstrike trauma and their injuries.

"Unfortunately, there are no such teams like this and we are really suffering from the lack of specialists that have dealt with such specialised cases," Diab said.

On WSC's website in the past two months, 190 people registered for limbs. That is a sharp increase from the usual 60 registered per month. While Diab is concerned the that the centre will not be able to keep up with the increasing need, its contract with Relief International only provides 33 limbs a month.

"A person who registered today could wait for four to five months for their turn, but if we had more funding we would provide the limb in less than a month," said Diab over the phone to a translator.

Custom-made limbs made in Germany cost 2000 euros a month, while knees and other specialised prosthetics cost 1500 euros. The organisation will have to work for five to ten years to get through all the specialised cases, according to Diab.

Having seen the direct results of the bombings on civilians, Diab said he cannot understand why the war has continued: "If the war ended today, 50 lives could be saved and 200 people could remain uninjured."

One month after visiting the centre, Jibran and Reem are still in Turkey. Reem has to go back to the centre in four to five months for more physical therapy. Meanwhile, Jibran has struggled to find work that can afford Reem and him a life in Turkey. Jibran is seriously considering moving back to Syria, even with the ongoing siege of Aleppo and relentless bombings.

"I'm waiting for death, that'd be better" Jibran said.

When asked what help others can provide, Jibran said, "All we ask for now is God's help."

AUTHOR: Dominique Bonessi

Muhammad Abunnassr contributed reporting.