As Syrian war planes bomb towns and villages held by anti-government rebels, a group of Syrian-American doctors is quietly providing medical aid inside Syria.
The Syrian American Medical Society, or SAMS, has a long track record of supporting health care in Syria.
But as Syria's 18-month revolt has grown more lethal, these Syrian-American doctors have sided with the revolution and undertaken risky work delivering medicines and volunteering in field hospitals.
Dr. Zaher Sahloul, a pulmonary specialist from Chicago, is on his fifth medical mission to Syria — a mission that requires skills he didn't learn in medical school, like the heart-pounding dash across the Turkish border into Syria and back.
"Never in my dreams I expected to sneak to the border three times and have the border guards shouting at me," he says.
Medical school didn't prepare him for creeping through holes in barbed-wire fence, smugglers urging him on, or for sneaking into the mountains at night and walking for three hours.
He's done all of these things to get to Syrian field hospitals and clinics.
"I think this is part of the reality now in Syria for physicians trying to help, especially if they are from the outside," he says.
But Sahloul is hardly an outsider: He graduated first in his class from medical school in Damascus. He was also a classmate of Syria's president, Bashar Assad, who worked as an army doctor and studied ophthalmology in London before he became Syria's leader.
Does Sahloul think his famous classmate knows what the doctors are doing?
"Probably he knows that the Syrian American Medical Society is doing a lot of medical relief work among the people he is trying to hurt," Sahloul says.
A Field Hospital Under Stress
When he arrives in the northern Syrian town of Aldana, close to the Turkish border, and pulls up to the hospital, the staff is lined up to welcome Sahloul.
Everyone looks tired. Medical supplies are scarce, and the casualties are rising. The wounded come by taxi, in cars and on foot.
Surrounding towns and villages are within range of the Syrian military's long-distance artillery and airstrikes, the head surgeon tells Sahloul.
During the last battle, Sahloul says, 110 wounded came to the hospital — which has only 10 beds. The rest went to Turkey.
Patients are dying as a result, because Turkish hospitals are too far away. The doctors urge Sahloul to help expand this hospital to save more lives.
Dr. Iyad — he gives his first name only — another Syrian-American working at the Aldana field hospital, is on break from his work at a hospital in Tennessee.
"We see a lot of shrapnel, really bad shrapnel injuries," he says. "You see these small metallic shrapnel, like little flying knives, literally. We've certainly seen a few deaths out of these."
He volunteered to work in Aldana after rebels took control of the town. Iyad thinks the town, for the moment at least, is relatively safe.
"I mean if you spend the night here, you can hear the bombing all the time, some of them are near, some a bit further, but relatively safe," he says.
Dr. Sahloul agrees.
"This is the safest area I've seen south of the Turkish border," he says.
A Place To Rebuild?
The Syrian army is too stretched fighting rebels elsewhere to try to retake Aldana. On the drive out of town, the doctor's car passes open barbershops and restaurants, children playing in the streets.
Sahloul sees a place to rebuild, here in these "relatively safe" Syrian towns that hug the frontier where the Turkish military provides unofficial cover. Syrian doctors who fled the country could come back to work here.
"Many of them already want to come back to Syria and want to volunteer ... in Syria. Some of them may serve in the emergency room, especially if it is relatively safe," he says.
Doctors have a special place in Syrian society — they're the top graduates, the cream of the crop, natural leaders — so it's natural they were an early target of the regime when the revolution began, Sahloul says. At least 60 physicians have been killed, and more than 200 arrested, he says. And Syrian's health care system, one of the best in the Middle East, is near collapse.
"Hospitals are being targeted, patients are pulled from the operating room, patients are being tortured inside the hospitals," Sahloul says.
Many doctors fled to Turkey and are caring for a refugee population that has overwhelmed the Turkish health care system.
A Country In Critical Condition
At a rehabilitation center in southern Turkey, a patient bears his pain in silence as a doctor bandages the stump of his leg, recently amputated below the knee. Syrian doctors run the facility, which is funded by a Syrian businessman in the Gulf.
The medical staff all fled Syria under threat, says Dr. Ammar Martini, who heads the center. When protests broke out in his hometown, Idlib, security police ordered doctors to withhold treatment from anyone shot on the streets.
"Three or four times, they told me, it is not allowed for you to treat any wounded person," Martini recalls. He says he left when he began to feel he would be killed for doing his work.
Now, he can offer long-term care for patients from protest towns under fierce army shelling across Syria: Idlib, Hama, Homs.
Dr. Sahloul is visiting the new center. He stops by the bed of a young woman from Homs. She tells him she waited days for treatment, smuggled out of the besieged city through a sewage pipe, her wounds badly infected during the long ordeal. His physician's composure slips for a moment as he surveys her damaged body.
"She was shelled by a missile, to her left arm and her left side, as you see, she has several surgeries on her belly and her left leg, and her left arm was amputated," Sahloul says of the 24-year-old woman.
Rebuilding Syria's shattered health care system is one of the biggest challenges ahead. Treating the wounded inside Syria is his immediate concern.
"We learn in medical school and training how to deal with crisis, how to deal with patients who are in the intensive care unit," he says. "Right now, Syria is in crisis, is in critical condition."
It's a critical condition caused by his old medical school classmate, Assad, he says. But Sahloul is convinced this is a turning point in the revolution, as rebels take more territory across the country. It is time now for the doctors to go back.
Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.