A psychiatric hospital on the front line in Syria’s war-ravaged second city of Aleppo, home to some 60 patients, has suffered from chronic shortages since fighting first broke out in July.
“They’ve had no medication for months, and it gets worse each day. There’s no light, no heating, not even running water — and the patients have hardly anything to eat,” said nurse Abu Abdo, who helps to run Dar al-Ajaza hospital.
“If residents of the area hadn’t given them food they would have died of starvation ages ago,” he added.
During the summer, Aleppo became the focus of the battle between the army and rebels opposing President Bashar al-Assad, in a conflict that the Syrian Observatory for Human Rights says has killed more than 44,000 people.
“Most staff stopped coming to work when the battle for Aleppo began, abandoning their patients. I’ve been working here for five years: this is my family, and I couldn’t leave them and let them die of cold and hunger,” Abu Abdo said.
“I fight for them each day.”
He offered a cigarette to Omar Sattut, an elderly patient dressed in military fatigues, who believed himself to be an army officer and said he wanted to go and fight against Israel.
Abu Abdo then introduced the youngest patient, Mohammed Matar, bare-footed and wearing a polo shirt, teeth chattering from the cold.
“Eight patients have died in the last few months,” Abu Abdo said. “We try to look after them as best we can. It’s a wonder they’re still alive.”
He and two other staff still come to the asylum every day, despite no longer receiving their salaries.
The imposing hospital, built in Aleppo’s once bustling historic old town, contains around 30 rooms overlooking the splendid mediaeval city centre.
It has been hit by artillery fire from Assad’s army since the uprising to bring down the regime, initially a peaceful protest movement in March 2011, descended rapidly into civil war.
“When the bombs hit, we put all the patients in the same room to try and calm them down,” said Abu Abdo, pointing to a massive shell hole in the wall.
He said that medical staff are now too afraid to come because of the bombardments. Even the hospital’s director only passes by at most two or three times a week.
Patient Walid Assiad ambled in the courtyard, walking without shoes in puddles of ice-cold water. In one bedroom, Matar huddled up under a thin blanket, shivering against the biting cold.
“The worst of winter is yet to come,” said Abu Abdo. “When there’s snow and ice it’ll be terrible. I’m scared that many of them won’t survive. Without heating they’ll die of cold.”
Dar al-Ajaza does not exclusively house mentally disabled patients — there are also elderly people who have lost all their family, and people suffering from physical disabilities.
The worst part of the hospital is the second building, where those not allowed to be left alone are housed.
A room bolted with a padlock, measuring about 10 square metres (110 square feet), contained the 12 most mentally disturbed patients, all prone to violent behaviour.
The patients shared three yellowed mattresses, and the stench of urine, vomit and faeces was nauseating.
One patient, able only to move his head and arms, lay under a soiled blanket, covered in cuts and bruises.
“We wash them every day, since most of them aren’t able to go to the toilet by themselves,” said Abu Abdo.
Without any medication, “there’s nothing we can do for them when they have violent outbursts, apart from locking them in a room until they stop lashing out,” he said, bolting the door again behind him.