In one of the quieter moments of "The Cave," just after warplanes are heard dropping bombs overhead, Ballour -- or "Dr. Amani" as she's known -- comes across a young girl sniffling into her shirt sleeves. As she wipes the tears from the girl's eyes, Ballour, the de facto pediatrician in an underground hospital in Al Ghouta, a region adjacent to the Syrian capital of Damascus, confides that she also cries easily and that she covers her ears whenever she feels frightened by the planes. She brushes the hair out of the young girl's eyes, and braids it, insisting she never take it out. The girl's eyes brighten and her face breaks into a smile. With some prodding from Ballour, the young girl shares that her father was killed by a car bomb a few years earlier. The girl fumbles with a balloon someone has given her with a face drawn on it as she tries to maintain her smile. After he died, she and her family moved into the tunnels inhabited by many other fearful Syrians -- the same network of basement rooms and underground paths to which the Cave belongs. Her father is in a better place now, Ballour tells the girl, and then asks her the same question that adults so often ask of children: "What do you want to be when you grow up?" Smiling so hard she is squinting up at Ballour, the girl, who could be 7 or 8 years old, shakes her head. "Shouldn't you know what you would like to be?" Ballour presses her. "Why are we alive then? For what?" The girl doesn't know, she says. "You don't know? We live so we can be something important," Ballour responds, tapping the girl's nose with her finger. "We don't want to be just ordinary. We have to be something important." The Syrian-Danish documentary, "The Cave," from National Geographic Documentary Films, is set in a subterranean hospital in Al Ghouta. For a time, a network of underground rooms and tunnels connected eastern Ghouta to the opposition-held areas of Qaboun and Barzeh. The tunnels allowed residents to cope with the severe restrictions on food, electricity, potable water, and telecommunications imposed on the area by the Syrian government, and they provided access to the underground hospital. (L to R) Christopher Albert, vice president of communications at the National Geographic Society, Amani Ballour, MD, and Mufaddal Hamadeh, MD, president of the Syrian American Medical Society, at the Washington screening of "The Cave." The film was directed by Syrian-born Feras Fayyad, and nominated for an Academy Award this year. Ballour, the film's central character, is a pediatrician and hospital administrator. Through her eyes, the director invites the world to see the struggles of the people of Al Ghouta and the clinicians and staff who try to care for them. In 2017, after some 5 years of siege and bombardment, there were 107 doctors left in eastern Ghouta to care for more than 400,000 people, according to a report from the Syrian American Medical Society Foundation. Playful moments appear throughout the film, but so do conflicts, internal and external. Ballour feels guilty that she has food to eat when others are dying of malnutrition. At one point she collapses into tears in a back room, after watching a mother wail over her son's dead body. In one of these darker moments, she says, "I don't know what makes people have children in these circumstances." "God forgive you for what you said," a man responds off screen. When she isn't covering her ears to blot out the roar of warplanes, or comforting children, or defending her authority against male patients and family members, she is just a woman, a remarkably young woman given her position. She celebrates her birthday with friends and popcorn in a windowless basement room. During her down time, she admires a friend's eyelashes and contemplates whether, when the siege is over, she will wear mascara. The hospital shut down in 2018 when the siege in Al Ghouta was lifted. But the Syrian war isn't over, she told MedPage Today. The film is "very easy" to watch, but the scenes that aren't shown, what she herself saw, can't be forgotten, and "it's still happening." "This film is not something from the past. It's happening now. People still need help now," Ballour stressed. When she was young, no one told Ballour she could be someone "important." Ballour does not cut an imposing figure. She's petite with big brown eyes, pale skin, and a quiet smile. But there's a confidence in her demeanor and her gait, as she walks to the back of a large auditorium at the National Geographic Museum in Washington, D.C., and finds a seat. She speaks quickly, almost nervously at first. Girls in her community were told that they must get married and have children, she said. When a girl turns 20 and isn't married, she will be told, "You can't get married, you are -- " Ballour stopped, looking over to her translator. "Basically, spinster," the translator suggested. The women laugh. Ballour said she hopes this has changed, at least in Damascus, but she's not sure. "There are a lot of smart girls. They want to study and they want someone to tell them, to encourage them, that you can be a good thing," she said. Early on, Ballour wanted to be an engineer because there were no women engineers in her village, but because of her high grades she was encouraged to pursue medicine instead. "This is the culture in Syria," she said, explaining that anyone who does well in school is expected to go into medicine. Even when she was in high school and first in her class, her father would tell her, "Maybe you will get a degree, but you will put it in the kitchen." It was only after she earned a high score in her baccalaureate, that her father acknowledged, "Yes, you can be a doctor, because all the people respect doctors," Ballour recalled. In time, Ballour came to really like medicine and because she also likes children, she decided to be a pediatrician. Ballour was studying in Damascus, Syria, traveling back and forth to her village in Al Ghouta, when it came under siege in 2013. "The Syrian army started to shoot people, then they started to bomb and besiege them," she said. In August 2013, a chemical attack killed more than 1,200 people there and the government began implementing its "starve or surrender" tactics, according to SAMS. Even though she had not completed her course work in pediatrics, her community was small enough that everyone knew what she was studying. "So, they think that I'm a pediatrician, and they bring me, all the time, their children to help," she said, laughing. Her first patient was a 12-year-old boy. When she first saw the boy, she was shocked. She'd never had to face a case alone. "I tried to do something, but he was dead," she said. She was angry and frustrated by how little she could do. "They shoot him in his head. They kill him just because he was walking next to the demonstration," she said. "I saw that he is a child and I saw the innocent people. They need help. So I stopped my studying, and stay in Al Ghouta." At that time, there were only a few pediatricians and about 100,000 children under age 12, she said. And because of the siege and the bombing there was limited access to good healthcare and little medicine. Food was also scarce, she said. Practicing medicine was also dangerous. Doctors were arrested for helping the injured and the Syrian forces began bombing hospitals. "That's why we started working underground," Ballour explained. The Cave, as it's known in the film, was set up underground to protect the medical staff, the hospital equipment, and the injured. Ballour graduated from medical school in 2012 and began working there about 7 months later. At some point, the hospital staff voted and put her in charge of the hospital. So she became not only the hospital's de facto pediatrician but its administrator as well. And while she's not a surgeon, Ballour, along with other hospital staff including psychologists and university student volunteers, were called to help in the emergency room. Ballour said she didn't have a clue as to how to work certain cases, and sometimes found it difficult. "But the surgeon(s) ... in Al Ghouta, they teach us," she said, and sometimes, she would help in the bigger operations. She recalled a child who had suffocated under the rubble and appeared to be dead. "And when we do some emergency procedures ... he come back to life," Ballour said. Ballour is Muslim. She prays and regularly reads the Koran and she credits her faith with helping her survive the most difficult times in Al Ghouta. "I believe that God is watching everything, and justice will be done one day." She also found support from her colleagues. For her 30th birthday, they arranged a surprise party for her, with popcorn and balloons made out of hospital gloves. They pretend, of course, that instead of popcorn it's a feast of pizza and ice cream -- foods that would be impossible to find during the siege. In another scene, Ballour sits atop a hospital gurney, while a colleague winds her through the tunnels. "We are not machines just working ... we try to create ... happy moments to stay alive," she said. While most of her memories of the Cave are sad, Ballour said at times she misses the hospital. She and her colleagues were happy to be helping those they could. But there were also times when she felt helpless. She remembered a 5-year-old patient with nasopharyngeal cancer who needed chemotherapy. They didn't have any treatment to give her. "We try to talk to the U.N. ... to evacuate her or to send us the [chemotherapy] and they didn't," she said. "We watched her just, we do nothing for her for about 3 or 4 years, when we finish and we leave," Ballour said. In 2018, the hospital had a list of about 40 to 50 names long of the most serious patients "and we try to evacuate them but no, Assad regime refused," Ballour recalled, referring to the Syrian government led by Bashir al-Assad. Every few days another one would die, she said. The darkest time for her was after the chemical attacks of 2013 that killed more than 1,000 people in one night, she said. "I saw thousands of victims. Just in the Cave hospital there were hundreds of dead bodies," she said. The chemical attack happened at midnight and the next morning "they bombed us again." "I thought after that, that all the people they will help us," Ballour said. She felt certain that after news of the protests and the videos and the images of the dead and dying reached the international community, people would respond. "But nothing happened after that. Nothing," she said, with a wry laugh. "Too many times we feel that all the people let us down," she said of the international community. "They do nothing for us. But we try to stay strong. We feel that maybe something will happen. The siege will end. They can't bomb us forever." In March 2018, rebels struck a deal with the government to allow residents of eastern Ghouta to leave, and most did so according to SAMS. Ballour shut down the hospital and left for Idlib in northwestern Syria. A few months later she moved to Turkey. In the U.S. and in Europe, Ballour said she feels useful because she's able to reach people that other Syrians can't. "This is my responsibility, to talk about Syria, to tell" the stories of the Syrian people, "because they still need help." While she misses her hospital and her colleagues, Ballour no longer wants to be a pediatrician. "To see sick children again is very painful" for me. "I don't want to see the sick children, children who are suffering, because they remind me of 'my' children," she said. "I can't forget them." At a SAMS conference in early February, she met an 11-year-old girl named Nour who lost her mother in a kerosene fire that severely burned her own body. SAMS evacuated Nour first to Lebanon then to Italy and eventually to the U.S. to live with an aunt. When she first saw Nour, Ballour said she cried a lot, remembering another young teenager in Al Ghouta who had similar burns and eventually died. Ballour's team could do little for her. While she was working in the Cave she had no time to think, but after leaving Al Ghouta, once she was alone with her thoughts, the bad memories and nightmares crept in. At night she'd imagine she heard bombing. It didn't help that when she was in Turkey, she lived near an airport for a time. But there has been one bright spot in her life. While she was still in Syria, a man called her and asked her to marry him. He had seen her media interviews, when she was in Al Ghouta. Incredulous, she told him, "I don't know you." Still he repeated, "I want to marry you. I love you." They spoke on the phone and seemed to share many of the same interests. "We always think about the revolution, about Syria," she said. Both were extremely passionate about human rights. "I meet him when I enter Turkey and after about 20 days maybe, or a month, we get married," she said laughing. "It's very fast," she said, and while she doesn't recommend such a quick engagement, she said she's happy. But the situation in Syria is worsening, she said. In the northwestern part of the country where rebels still hold territory, people are fleeing as the Assad regime and its Russian allies close in. One million people have been newly displaced and have nowhere to go, she said. "They need anything. They need shelters, food, something for heating," she said. She recently collaborated with the King Baudouin Foundation to create the Al-Amal Fund to help girls and women access schooling, healthcare, to find jobs, and to teach them about their rights. "It means hope," she said of the name. "We can't be [too] hopeful, but I'm a little hopeful that I can help. That's why I'm okay now." Source
