Written by: Anna Davies and Rêvan Kobanê
Anna Davies is working in Rojava on different medical and psychological projects in collaboration with the Kurdish Institute.
We are writing this article as two Europeans who are living and working in Rojava. One of us has spent six months working in the physiotherapy department at the military hospital in Kobanê, and both of us have made some visits to the Mala Birîndara (MB) for YPJ/YPG in Qamişlo.
This article is aimed at giving our impressions of the two MBs that we have visited, and providing information about these centres, the services they provide, the people working there, and the hevals (friends/comrades) who spend time there after being injured. We conducted some short interviews with staff and those who are injured, and will include the voices of these people in this article to give a real impression of this part of Rojava’s health infrastructure.
Interviews were conducted with help from an interpreter when needed. Some of the names in this article have been changed to protect the identity of those involved.
What are the Mala Birîndara?
Mala Birîndara means ‘house of the injured’ in Kurmancî. There are houses for injured YPJ (Women’s Protection Units) and YPG (People’s Protection Units) in all three cantons of Rojava.
In Qamişlo injured fighters usually only stay at the MB for a short time. It is located in a big, well-organised complex of buildings. The MB is well connected with the central hospital and provides physiotherapy, education, a prosthetics service, and also a pharmacy where basic medication is available.
When we visited we were impressed right away with the atmosphere of this place; it had a real sense of being a therapeutic environment, both in terms of its physical appearance, with gardens all around it and shaded seating, and also the social atmosphere – a real sense of camaraderie and mutual aid between everyone who lives and works there.
In the evening of one of our visits, we were invited to join in a game of volleyball. A volleyball court is set up on the grounds of the MB; this is a sport which is much loved in Rojava. We were also told that volleyball is useful for rehabilitating injuries. People with various levels of skills, fitness and ability all played together including many with significant disabilities (needless to say we were the least able!). We were impressed with how everyone (including us) was supported to participate and everyone seemed to be really aware of their hevals needs.
We were invited to stay for dinner, and again the sharing of food highlighted the care that everyone gave each other – for example helping one another to mobilise or to remember words for objects. This was all done whilst joking, laughing, and without patronising or infantilising injured or disabled comrades.
There are two people responsible for the day to day running of the Mala Birîndara, one person from the YPG and one from the YPJ. They are also people who have been injured in the past. Hevals help each other with everyday living, such as with eating, showering and going to the toilet. In Qamişlo they also have support from assistants and there are people who assist with cooking food and help with physiotherapy. Every day a health professional from the hospital comes to help with medical care such as changing bandages.
In Kobanê there are four houses which make up the MB; this centre operates slightly differently than its equivalent in Qamişlo and the injured fighters stay for a longer period of time. Some of the houses have help from assistants, but mostly the people living there help one another. The MB is connected to the military hospital and the injured go there for physiotherapy treatment twice a day. The military hospital, the physiotherapy, and the pharmacy are all located within the same area.
There is also a MB in Derik, where there are more patients than in the other cities. A bigger premises is currently being built, this will be a central rehabilitation centre where 150 injured fighters can receive support with their rehabilitation every day. If medical equipment can be brought in from Başur (South Kurdistan, located in the northern part of Iraq) or Bakur (North Kurdistan, located in the south part of Turkey), something which currently is not possible, this will be the biggest rehabilitation centre in Rojava.
The physiotherapy service in Qamişlo is quite limited; there is only one small room and there is not the specialist equipment that would be required to help those who are injured in a professional way. Two people from the city come every day to help with the provision of physiotherapy. The staff here have never studied physiotherapy but try to help with what they have learned themselves. The injured hevals have physiotherapy treatment two times a day if appropriate, but because of the lack of equipment the focus is on manual exercises.
The physiotherapy service in Kobanê is based in a separate building next to the hospital. There are four treatments rooms containing specialist equipment. The patients start with treatment in the these rooms to get help with reducing pain and to prepare for manual physiotherapy and individual training programmes. There are bicycles, rowing machines, arm wheels, leg press, a balance mat, and a walking aid.
We spoke to Dorpêç, a physiolog (advanced physiotherapy specialist) originally from Kurdistan who has lived in Sweden for most of his life. He says that one of the problems in Kobanê at present is that there is no specialist doctor to assess injuries when new patients come to the physiotherapy service. Heval Dorpêç recently educated eight physiotherapy assistants in Kobanê over a 7 to 8 month period. They know the basics and are familiar with the equipment and manual exercises but they cannot give diagnoses to new patients. Heval Dorpêç also spent two months teaching two assistants in anatomy, physiology, and practical skills and they are now working in Derik. The Kobanê physiotherapy service is better resourced than that in Qamişlo because heval Dorpêç brought all things he needed when he built the physiotherapy centre over a year ago. Unfortunately eighty per cent of the electronic equipment is now broken because nothing new has been brought to the centre since it opened due to the current embargoes.
In Kobanê the physiotherapy service provided about 27,000 treatment sessions (many patients have multiple sessions) over the last year. As well as YPG and YPJ civilians were also treated, for examples those who had been injured by rocket attacks or mines.
“I treated civilians at home or they could come to me – adults and children. Sixty five civilians have been killed by mines only in Kobanê”, heval Dorpêç said, and continued:
“Because of the war right now in Manbij, we will get a lot of patients, warriors, from there. For example in my time in Kobanê I had 28 men and women fighters who had a bullet in their head, sometimes two bullets in their head. We have tetraplegics, paralysed from the neck down, paraplegics who are paralysed from the waist down, and also hemiplegics, for whom one side of their body is affected.”
“When they are on the front, often the enemy only sees one side of the body so they are often shot in the right shoulder and this can cause nerve damage. We also have many problems from mines – amputated legs, feet, or arms. We also have problems with material for orthopaedic techniques – like you saw, our technicians are trying to make prosthetic arms and legs. They are good, but they are not enough, and they are not fully qualified.”
For some time now there has been no reliable way to get material into Rojava because the borders with Turkey and Iraqi Kurdistan have been closed. Supporters in Europe have raised funds and collected large amounts of material to support medical work, but they have been unable to get it into Rojava. For example heval Dorpêç told us, “A community of doctors and teachers in Holland collected money and sent physiotherapy and medical materials and equipment worth $200,000 directly to Kobanê but the Turkish military confiscated them and took them to their own medical centre. There is also a need for specialists to make prosthetics, brain surgeons, neurosurgeons, orthopaedic specialists, hand surgeons and also trauma specialists….we work with nurses who get only a few months of education. They do a good job but they are not fully educated.”
Heval Dorpêç told us that although this need exists, the border situation means that it is very hard for health professionals to travel to Rojava. He told us that anyone thinking about coming should not do so without first making contact with people in Rojava and finding out if it is possible. They should also be aware that the situation here can be dangerous. We would also like to add that it can be quite difficult for health professionals to organise work to do here, even those with high levels of relevant skills. This is particularly the case at times of military operations, and for non-Kurdish speakers and those who come for brief periods of time.
There is a prosthetics service based in the Qamişlo MB, which provides prosthetic limbs for people across the whole of Rojava. We met prosthetic technician Serbest, along with his colleague heval Ahmed, in their busy workshop in the MB.
Heval Serbest has been working at the MB for a year. He himself is an amputee with a prosthetic leg. It usually takes two years to train to be a prosthetist. Serbest’s colleague, qualified prosthetist Ahmed, travels to and from his home in Bakur so he only works at the MB for a week or so at a time. He couldn’t manage the work on his own, so heval Serbest trained in 20 days to be able to make prostheses.
Heval Serbest told us, “In 15 days we make prosthetic limbs for 20 people. Then after that we start making a new batch of prosthetics. There are now 650 people with prosthetics in Rojava. I have made 100 prosthetics in the year I have been working here and everyone is happy with them.” When we asked him what it is like to work here he replied that, “the work is good but hevals want it to happen faster than it does!”
We were shown several prosthetic limbs, including an arm which was fitted with sensors that allow the owner to use their arm muscles to clench and unclench the fist. Prosthetic legs work on a motor system. Heval Serbest told us that it takes about a month to get used to an arm with sensors.
They need more materials to be able to continue to do their work, but because of the current situation it is very difficult. “We have been waiting for 5 months for more materials to be sent from Germany, but they aren’t able to get here because the border is closed. Some material is getting here from other places, but it is not as good quality” he said.
There is currently no specialist mental healthcare provided at the MBs, or as far as we are aware in any of the military healthcare provisions in Rojava. We got the impression that this is partly because of a lack of available specialists, but also because it is not something that the organisations are able to prioritise at the moment.
Hevals suffering from serious mental health problems, who might pose risks to themselves or others, are taken back to their base. Those responsible for them take away their weapons, try to give them medication, and if possible send them to a safe place.
Physiolog Dorpêç told us, “when you are in a group of people, they have been like a family, many years they have been in war, they helped each other, they have drunk tea together, they danced together, sang together, and suddenly only 3 of them are left… of course they have mental health problems. I have a patient, a real warrior. She said: please doctor help me I can’t sleep. Every night when I lay my head down on my pillow to sleep I hear my friends’ voices.”
He told us that he thinks that psychological problems are less visible now, whilst the war is still ongoing, but that the problems will become more apparent in the future, saying that, “at the moment because of being in a war situation, these problems are under the surface, but I think that when it calms down, these problems will explode”
Who stays at the MB?
When hevals from the YPG/YPJ defence forces are are injured whilst on duty they are given immediate treatment at the front if possible and appropriate, and then taken to a military hospital for further urgent or intensive treatment. Following this they go to live at one of the MBs, where they are provided with ongoing medical treatment as well as supported in their daily lives.
Injured hevals stay in the MB for as long as they need to – until they have recovered and are no longer in pain. We were told that even then they are never sent back directly to the front line. If they are heavily injured and/or have had amputations they will not be sent to the front line at all. Instead they may go to the ‘veteran’s house’ to work there and to help others. They will be offered alternative work, for example in an office, a MB, or a YPG/YPJ centre or they will start an education program.
Heval Dorpêç told us, “Most hevals have a lot of pain and cannot sleep. They never complain, even if they don’t sleep til six in the morning. When I ask them how they are feeling, they always say it’s OK, even though I know they are in a lot of pain. Every time you talk to them they are laughing, they are smiling, they are singing with you. We give them medication but it doesn’t always help, when the nerve system is cut off or they are deeply injured it can cause a lot of burning symptoms. Because of the medication they get problems with their kidneys so we can’t give them the medication all the time. Every time you talk to them it is like nothing happened – they have no legs, no arms, but they are happy. They are also still asking, saying I want to go the front, to my friends.”
We met with some of the injured hevals at the Qamişlo MB and asked them about their experiences. Heval Berivan was injured whilst fighting with the YPJ. Before joining the YPJ she was organised in Ciwanen Şoreşger, the Revolutionary Youth, in Kobanê. Everyone in her youth group was prepared for war and ready should they need to go to fight.
Heval Berivan was injured at Freedom Square in Kobanê, whilst fighting to liberate the city. just under two years ago. She told us that “it was a tough time. I was hit in the head by a sniper” The injury affected her speech and ability to walk. At first heval Berivan was treated in Bakur, and then she continued the physiotherapy in Kobanê where she felt that she got the best help. “Before I had a lot of pain, I cried. My language disappeared, which made me afraid. Before I was injured I used to talk a lot, but that all changed. I couldn’t walk, I couldn’t eat. I wanted to die”
At the MB heval Berivan has education every day where they take a lot of time to discuss various issues. She also does physiotherapy exercises every day. With a lot of time and hard work, heval Berivan’s mobility and language has gradually improved and she is now walking unaided and speaking well. Whilst it is clear that things are still hard for her, and she is at times self-conscious about her speech, she comes across as a very strong, smiley and independent woman.
Heval Welat was injured in the recent battle for Manbij, whilst with his YPG unit in a village just outside the city of Manbij. He was shot through his right arm. He told us that the injury has caused problems with the veins in his arm. This is his third injury – once he was injured in his legs and once in his left arm. “After a month the doctor will make an assessment of my arm and I might be able to start physiotherapy, and I will also find out whether I will need an operation.” Heval Welat told us that he suffers with a ‘pulsating pain’ and that the medication he takes does not really manage the pain effectively, meaning that he only gets an hour or two of sleep at night.
We asked how he feels about being injured: “Your know what your goal is, you know what your desire is. It is war so there is killing and there are massacres, people are injured and people are martyred. And when it happens you don’t ask why it happened, why my life is like this. You don’t think about these things.” We asked what he will do when he has recovered – “I will go back to fight of course”
Note: We have used gender binary pronouns and assumed binary gender identity in this article. This does not reflect our beliefs about gender identity but comes from a need to balance our own opinions with those of the dominant culture here, and also the need to ensure that women and their struggles are visible and identified.