Hospital Another Victim of Beirut’s Long Civil War

An old woman, shrouded in black, stands frozen in a painfully familiar tableau outside the emergency room at the American University of Beirut’s medical center.

Her arms raised to the sky imploringly, the woman utters a low moan as militiamen carry a young man, presumably a relative, out of a makeshift ambulance. A crimson blossom of blood has sprouted on the boy’s dirty green shirt and, fully armed, the fighters barge inside seeking a doctor.

The American University Hospital has seen more than its share of tragedy in the 11 years of Lebanon’s civil war. Once the foremost teaching hospital in the Mideast, the facility has become a victim of the conflict, buffeted by militia battles and hobbled by staff departures.

Of the many thousands of people who have been killed and wounded in Lebanon since 1975, a significant percentage have been carried to the grimy beige complex in Beirut’s predominantly Muslim west side for treatment after shellings, sniper attacks, car bomb blasts and a variety of other forms of violence. Since no one pays any heed to sirens in Beirut, agitated militiamen traditionally clear traffic from their path by firing wildly into the air.

“The worst is the young kids who have lost arms or legs,” said Dr. Munir Shamaa, a faculty member at American University Hospital. “We doctors are not supposed to get emotionally involved, but seeing this every day just makes me cry.”

In the last two years, the hospital itself has been increasingly caught up in the anarchy of West Beirut and its myriad rivalries and gang wars.

The hospital’s American director, David P. Jacobsen of Huntington Beach, Calif., was kidnaped in May and is now among the Americans being held by the terrorist group Islamic Jihad (Islamic Holy War). The kidnapers demand the release of 17 Shia Muslims imprisoned in Kuwait after having been convicted for bombing the U.S. and French embassies there in December, 1983.

Shamaa, a Christian, and a colleague were kidnaped by Muslim gunmen in early December. University hospital doctors and nurses staged a white-coated protest march--the first by medical personnel in West Beirut--to the offices of Premier Rashid Karami and threatened to go on strike unless the two men were released.

After the abduction and rally, the leftist daily As Safir was moved to remark that the university hospital’s doctors are “the bright light in the Lebanese darkness.” The two men were freed after a week in captivity.

Supported by U.S. Aid

The hospital is officially the medical center of the American University--the medical school was established in 1873--and is supported in part by grants from the U.S. Agency for International Development. The doctors are licensed in the United States, but their accreditations for medical specialties are no longer accepted because of the disruptions caused by the war.

“Some people misunderstand the role of the hospital and think we are an American institution,” Ahmed Nasrallah, the acting director of American University Hospital, said. “But now we’re just a humanitarian institution. People know that West Beirut wouldn’t survive without this hospital.”

On occasion, the mayhem has spilled into the corridors of the hospital itself, with gunmen blazing away in room-to-room battles as wounded people lay trapped in their beds. In 1980, a bomb exploded in the hospital’s emergency room but, miraculously, no one was killed.

Doctors at American University Hospital, who did not want to be identified, said many of the most frightening incidents occur when a militiaman dies of wounds, evoking an emotional response from comrades who are often heavily armed.

Pursued by Militiamen

One doctor recalled being pursued through the corridors of American University Hospital while pushing a wounded militiamen on a gurney. As he frantically pushed the bleeding patient through the halls, members of a rival militia chased him with drawn pistols until the doctor finally hid in the hospital’s morgue.

But even the morgue isn’t always safe. At times, agitated militiamen have gone on frenzied rampages there, disfiguring the dead bodies of their opponents.

During the so-called Camps War last June, when Palestinian refugee camps just south of Beirut were attacked and overrun by Shia Muslim militiamen, doctors said that at least two wounded men were taken from their beds in the emergency room, dragged outside and shot to death.

“Most of the doctors became very upset,” a young resident physician said. “It wasn’t that we sympathized with the Palestinians but you cannot treat a human being like this, not even your worst enemy.”

‘The Will of Allah’

One surgeon recalled, “Once I came out to tell a guy’s family that he had died and found about 40 militiamen, all armed to the teeth, waiting for me. In this job, you quickly learn to begin such announcements with a short speech on ‘the will of Allah.’ ”

Army troops are stationed just inside the front doors of the hospital, ostensibly to collect weapons. But militiamen still roam the building with their pistols tucked in their waistbands.

A surgeon said emergency-room doctors, fearful of crazed gunmen seeking revenge, frequently flee their posts and barricade themselves in basement offices when large groups of armed militiamen enter the building. Once, he said, a gunman chased him up and down the stairs for nearly half an hour.

“These guys want immediate attention, even when you have critically wounded lying around everywhere,” the surgeon said. “They are armed and many of them are stoned on drugs. The doctors take one look at what’s coming and run away.”

Corpses Stacked Outside

During the worst fighting, wounded are left in the corridors because of bed shortages and the dead are stacked like cordwood outside the morgue. During the Camps War, the hospital borrowed two refrigerator trucks because there were so many unclaimed corpses.

By a remarkable stroke of luck, the architect who designed the hospital placed the operating room in a sub-basement. As a result, operations are rarely disturbed by even the heaviest shelling.

Although the hospital was once renowned for its many areas of medical specialty, it has increasingly become a trauma center: basically a big emergency room. The more well-to-do private patients in need of elective surgery often are afraid to stay at American University Hospital and go elsewhere.

Hospital in the Red

According to Nasrallah, the acting director, the hospital is running a $6-million annual deficit, largely because the Lebanese Ministry of Health, which pays the medical bills of all war casualties, owes the hospital 110 million Lebanese pounds, around $7 million.

“We all hope the American government continues to help this hospital, whatever political differences might exist with Lebanon,” said Dr. Khaled Jeraky, head of the Residents Assn. at American University Hospital. “Most of these casualties are innocent civilians, not militiamen.”

According to officials at the hospital, the largest problem is the continuing departure of trained doctors--many of them department heads--and the lack of qualified replacements.

“This used to be one of the most sought-after ivory towers in the world,” Shamaa lamented. “Now each area of specialty has suffered a 50% loss. And the 50% staying is young and inexperienced.”

Nasrallah noted that the staff shortages also affect the corps of nurses and medical technicians. When equipment breaks down now, he said, it cannot be repaired.

Doctors’ annual salaries at American University Hospital average $7,200. Nurses earn $2,400.

“A lot of doctors are taking a sabbatical year off,” Nasrallah said. “I don’t think many will come back.”