Professor Paul McMaster:

Nearly 80% of the wounded with whom the surgical teams are dealing are civilians. However, we see young fighters with gunshot wounds. The injuries of civilians are largely inflicted in bomb and rocket attacks. The system in the area I was in is that helicopters drop what are called barrel bombs loaded with explosives and fine shrapnel. They explode over a wide area and women and children are being caught in the midst of them. We have been presented with babies with shrapnel wounds which are not medically life threatening but deeply distressing and disturbing for the family. The team I was supporting was working in a cave, which became untenable because of the bombing. We then moved to a chicken farm - that is progress - which we were converting rapidly to an emergency field hospital. There we started to see many more members of the general population who had run out of medication to treat blood pressure, diabetes and asthma and were struggling to gain access to basic health care. I performed Caesarian sections and other emergency obstetrics procedures. I took out a tooth for a person with an abscess as there was no dental service available to the community. Although many had fled, I was truthfully surprised by how many were still there. It tends to be the old who cannot or will not leaves their homes, the women and the children who stay. We were seeing fighters and predominantly treating their gunshot wounds. Although it was very rudimentary, we were using an inflatable operating theatre inside the cave. Some of the other teams have more sophisticated facilities. We were able to perform basic war surgery and treated many hundreds of patients. In general, we cannot evacuate our patients; we must care for them where they are, although I hear some are able to cross the border. It is a challenging environment, medically and surgically. For me, as a grandparent, I find it most difficult to see the wounded children and babies. Médecins Sans Frontières is not a political but a medical organisation. We want to access any area in which people are struggling. It is hard to treat children and babies who have been injured in these circumstances.