“Fractured Bones, Mangled Limbs, Blast Wounds”: An American Surgeon’s Experience in Ukraine

The war in Ukraine is dragging on. And I’ve been wanting to understand the toll of Russia’s bombardment from someone who has witnessed the brutality up close. So, late last week, I called up Dr. Samer Attar. Attar is an orthopedic surgeon. Most of the time, he practices in Chicago. But earlier this year, he traveled to Ukraine as the Russian invasion began. “I was in Kyiv right at the start around March, and we were probably doing around 10 operations a day on war wounded,” Attar said. “A lot of fractured bones, mangled limbs, blast wounds—a lot of what you do as a war surgeon is just cleaning up wounds and trying to get broken bones to heal and trying to get areas of muscle that are exposed covered.”

These wounds were very familiar to Attar. That’s because in 2013 he began traveling to Syria to treat people injured in that country’s civil war.

It’s worth remembering, Russia has been deeply involved in the Syrian civil war. Since the beginning of the conflict, Vladimir Putin has backed Syrian President Bashar al-Assad. In 2015, Putin’s support turned into military intervention, with Russian forces dropping bombs on hospitals, schools, and residential neighborhoods.

Now, Attar is seeing some of the same tactics he witnessed in Syria play out in Ukraine, where just a few months ago, he saw the human cost.  “There was one little girl, about 14 or 15, but she lost her right leg and had a fracture in her left leg. She just spent the day watching episodes of Bridgerton because her right leg was amputated and it was infected. And she was requiring multiple trips to the operating room to get cleaned up and washed out,” Attar described.

On a recent episode of What Next, I spoke with Attar about his efforts to repair the wounds inflicted by war—and what he’s noticed in two different countries scarred by Russian bombs. Our conversation, which contains some graphic descriptions, has been condensed and edited for clarity.

Mary C. Curtis: How did you get involved with the Syrian American Medical Society and their work in Syria?

Samer Attar: Syria, that was my heritage. I grew up going to Syria. My parents are from Syria. And when I learned that doctors were being targeted and assassinated, and hospitals and ambulances were being targeted and destroyed, and that they were running out of medical staff, I felt obligated to give back. They said they needed a surgeon in Aleppo, and if I wanted to go all the way in, they could get me in just as long as I understood the risks.

I find myself being smuggled across the border into Syria. The war had been ongoing for about two years at that point. The first time I went in, I wondered what I was doing and why I was there. And I was scared to death. But once I got to the hospital and I met the chief surgeon, the first thing he did was give me a big hug, and he said, “Thank you for coming to Syria to help.” And I changed into scrubs and immediately got to work.

You were only supposed to stay for a couple of weeks. Was there a particular moment that made you decide to stay longer?

I was there my third day and there were a lot of attacks and there were a lot of patients coming through the doors. A school was bombed. It was Ramadan at the time, and at one point the emergency room was overrun. There were so many people trying to get through the front door that there was no place to step. We were placing patients on the floor because we just we didn’t have enough beds.

And there was a kid who had the bone fragments of other people that had embedded into him, which was not uncommon to see in these explosions. And that was horrifying to see. I remember the boy’s father asked the nurse who I was. And he said, “Yeah, this is Dr. Sam. He’s an American.” And the dad said he’d never met an American and he never thought he would. That for me was very meaningful.

I stayed for two weeks, and I tried to make it a habit to go for a week or two a year after that.

Did the child with the bone fragments from the blast from other people make it?

He made it.

How did you feel? 

That feels good. You see a lot of people die. You bear witness to the worst of humanity. And then one night, I remember strangers brought in a kid who was found after an airstrike. He was found alive but unconscious in the rubble. Everyone was working together. They were doing CPR on him. And one surgeon was holding this boy’s femoral artery with his fingers because the child had a huge wound with a broken femur and an obliterated artery. And they actually revived him. And we fixed his fracture, and he woke up and told us what his name was. He told us who his dad was. And his dad came to the hospital and found his son. And that was a win because a lot of times children or people would be caught in these attacks and would be dismembered or disfigured or burned beyond recognition and never identified, taken to be buried. And family members would never know what happened. So this dad got to come to a hospital and find his son and never left this side. It’s those memories that I try to keep with me to balance out all the other horrors that you witness.

When did you begin preparing for a possible trip to Ukraine?

I had a feeling I’d be volunteering even before the war started. We all heard about the Russians mobilizing. And we all had a sense that Ukraine was going to be at war at some point, at least reading the news. After what I had seen and done in Syria, and having been under Russian bombs before and having dealt with those war injuries and those war wounds for years, I just felt obligated to go help out.

Tell me more about what it was like when you first arrived in Ukraine.

I remember it being very quiet. I first went to Lviv, and then I took a train into Kyiv. And I remember the curfews and the streets being empty. And then the environment would be punctuated by air raid sirens.

Russia, of course, is a common denominator in both of these conflicts, and they’ve been criticized for intentionally targeting civilians. How have the injuries you’ve seen in Ukraine compared with what you saw in Syria?

They’re high-energy blast injuries. They’re the same. The injuries I saw in Syria are exactly like the injuries I saw in Ukraine.

A lot of those injuries come from what are called “cluster bombs”—munitions that get dropped from the air and break into pieces, hitting multiple targets in one shot. Cluster bombs are technically banned from being used on civilians. But Russia has used the weapons in both Syria and Ukraine. And the damage they leave behind can take a long time to diagnose.

It’s a lot of little bits and pieces of metal and shrapnel. The other thing to keep in mind is that the wounds are constantly evolving. Most of the time, you have to leave the wounds open because muscle that looks alive on Day One might die on Day Five.

For example, if somebody came in with an amputated leg, you don’t close the wound; you leave it open and let the muscle declare itself. Because over time, due to the high-energy blast of the injury, the muscle can necrose. And so that’s why you’re oftentimes going back to the operating room to cut more tissue before you can make the decision to close a wound.

But despite these similar injuries, you’ve also noted there was some big differences between the two conflicts, particularly the status of the health care infrastructure in Syria compared with  Ukraine. Can you describe that difference?

In Syria, wearing a red cross or red crescent or scrubs made you a target. So symbols of medical neutrality became targets. And that’s why health care was driven underground. That’s why you’d find hospitals made out of caves and farms and apartment buildings. The hospital I worked out of in Syria was out of a basement, and sterility wasn’t great. You didn’t have access to a lot of equipment. You were just doing the best you could. I learned a lot from Syrian surgeons because they taught me how to do so much more when you’re given very little.

The good thing about Ukraine is that at least the hospitals are still functioning, and hospitals aren’t being built out of caves. But in Ukraine, we all slept in the hospitals because it was too dangerous to go home—and everyone wanted to be ready in case they got flooded with patients. But at nighttime, we couldn’t leave the lights on because they were worried we might get targeted.

In Kyiv, one hospital I worked at, when the Russians were close, they were shooting into the hospitals, so they had to cover all the windows with blankets. The major issue was if—like right now, there’s been an onslaught of recent attacks in Ukraine. And the big issue is if the hospital’s been hit or the water supply has been hit, they worry about whether the electricity is going to work, whether the water is going to work, because you need water to scrub into surgery and electricity to run anesthesia machines. That was the bigger threat.

Subscribe to What Next on Apple Podcasts

Get more news from Mary Harris every weekday.

You’ve mentioned that when you left Ukraine in the spring, people were hoping that the war would be over by the summer. Well, months have passed, and there are a no signs of the war coming to an end. There’s escalation. Do you feel a sense of déjà vu with what happened in Syria?

Yeah, I talk to my friends that are there, and many of them haven’t seen their wives or their families in several months. And one of the surgeons I worked with hasn’t seen his family since February. He’s just been moving from hospital to hospital.

I told him I’d like to come back in the winter and help out. And he said, “Well, we’re hoping that the war will be over by then.” And I hope so, too.

You’ve talked about the romanticized image that many have of the wartime surgeon, saving lives in dangerous times in dangerous places. What’s the reality?

If it’s work that you want to do, you have to be careful because it can take a toll, bearing witness to all that suffering. I know one surgeon in Syria who lost count of all the amputations he was doing. And it can really burn you out. It’s very easy to get overwhelmed with feelings of helplessness and powerlessness and meaninglessness. But you have to find ways also to balance that with the courage and compassion and resilience from the people around you. That’s where I tried to get strength from when I was there. When I was in Ukraine, in spite of all the bombs, you’d see people on the streets that were still cleaning the streets and running public transport. People that worked on the trains just saw it as their duty. And it means a lot just being there and looking them in the eye and shaking their hand. It’s a form of solidarity.

The last thing is you get to be an advocate. You get to be a voice for them. You get to bear witness and come back and let people know what you saw. Because there are a lot of narratives in war and you get to speak on their behalf and amplify their voices in areas that otherwise wouldn’t be heard.