0513 GMT June 26, 2022
As soon as I introduced myself to her as a journalist who was there to collect her story, she focused her motherly yet intense gaze upon me.
“Hello, my son,” she said.
And then, she kept looking at me. In a matter of seconds, her face turned red, which foreshadowed – as I was to learn soon enough – letting out a stream of grievances she could not suppress anymore.
In the outburst of emotions that followed, her Kurdish accent couldn’t fail our communication as a host of nonverbal cues were at play.
The wrinkles on her face became more pronounced. Her voice started to tremble. Her moist eyes delivered much – or, perhaps, too much. And the many blisters and bruises on her body, which she showed us without hesitation, served as a constant reminder that the agonizing experience she had gone through during Iraqi-imposed war more than 30 years ago led to a pain that was meant to keep her company for the rest of her days.
“We couldn’t escape. We had kids. We had a home, a flock of sheep,” lamented the 61-year-old Maryam Haqmoradi. “It was 10 in the morning. A few fighter jets came and dropped chemical bomb.”
They lived in the mountainous Bazideraz area in Kermanshah Province, western Iran, when Iraq began a notorious post-ceasefire operation in July, 1988.
A wild mixture of mustard and blistering agents combined with tear gas, dropped mercilessly by Iraqi warplanes on civilians, branded Maryam, her husband and their nine children forever.
We met Maryam on the day of our visit to Sasan Hospital in downtown Tehran to meet some of the people who still need medical attention due to conditions they developed during the war (1980-1988).
Originally built in 1975, the hospital was turned into a specialized referral center for treating those who were injured in the war zones. As they usually needed subsequent visits and treatments, the hospital became a cornerstone of the medical infrastructure established to deal with their medical affairs.
“We primarily serve the those who were injured during the war and their immediate family members as well as the families of the martyrs of the war, but the hospital’s doors are open to the wider public to take advantage of its unutilized capacities,” said Dr. Alireza Tavakoli Mehrjerdi, a general practitioner who has been the CEO of the hospital since eight years ago.
Speaking to him, the very first question that came to my mind was about the bills.
“Our primary clients don’t need to pay a penny here,” Dr. Tavakoli explained. “As law determines that they have to have access to free medical treatment, their expenses are covered through insurance policies purchased from insurance companies.”
There, however, might be additional costs not covered by those policies. For instance, the costs associated with hosting a companion for the patients, certain ambulance services, some tests, or purchasing medicines from certain foreign manufacturers are sometimes not covered by insurance. But the Hospital “is committed to its goal that no primary client will pay anything for their treatment there”, Dr. Tavakoli maintained.
I asked about the legal status of the hospital.
Dr. Tavakoli said, “It is run as a private entity but it officially belongs to the Foundation of Martyrs and Veterans Affairs.”
‘Veteran’ is a poor translation for the emotionally charged term we use in Farsi to refer to Maryam as well as tens of thousands of other Iranians who are still dealing with various forms of war-induced disability.
In the vernacular use, those who lost some part of their being, bodily or otherwise, during the war are referred to as janbaz (singular) or janbazan (plural), which means that they’ve risked their lives. Taken more literally, the term falls in the category of the words ending in –baz, a suffix which means either ‘playing’ or ‘losing’, and implies some sort of spiritually or romantically motivated gamble on a valuable object that comes before baz – in this case, jan, meaning life.
They had gone all in for the love of God or Motherland, even though in most cases the two had been, and still are, intricately linked for them.
Part of the legacy of the war is the various forms of disabilities people suffer, each of which requires its own version of medical attention.
According to Dr. Tavakoli, janbazan have typically been divided into five categories based on the types of their injuries.
The first group suffers from spinal cord injuries. Approximately two thousand Iranians fall into this category, 10 percent of whom have sustained a severe neck (cervical) injury, which creates more complicated, serious problems.
The second group was once in contact with chemical gases, regardless of what other injuries they carry. The severity of their complications can itself be divided into three categories, namely, mild, moderate, and severe. There are around 60 thousand victims of chemical warfare in the country, 10 percent of whom are again suffering from severe cases. They typically have developed serious conditions relating to lungs, eyes, and skin.
The third group, which is quite large, includes amputee disabled persons.
The fourth group have neuropsychological conditions, most prominently due to shell shock. Their dysfunction can be either chronic or acute, controlled or active.
Finally, the last group of the disabled have internal problems in organs such as their abdomen.
In more recent times, the third and fifth groups are merged for official and administrative purposes to refer to those with “special disability.”
The required medical attention varies with person. The disabled with spinal cord injuries typically get admitted to the hospital for gastrointestinal disorders, bedsores, urinary tract issues, etc. Predictably, chemical warfare victims are still dealing with lung involvement, shortness of breath, and pulmonary fibrosis. The amputees, however, encounter prosthesis-related issues and secondary conditions.
In the ward, we met Teymour Sohrabian, a veteran of war with a neatly trimmed mustache, a smile etched on his face, and a fine sense of humor, who tried to entertain us with funny stories about the war to make us feel a bit more cheerful in a place where so much pain was accumulated.
He lets us know that he has four children, three sons and a 17-year-old daughter who was born with severe disability due to birth complications.
Shell shock and several ricochets, including those in his legs, were his primarily causes of disability in the war. After the war, his condition was exacerbated due to diabetes, leading to cutting off his legs. He was satisfied with the services he has so far received in the hospital.
“In terms of medical attention, the food, the cleanness, the way the personnel treat us, it’s very good if not excellent,” he said.
He stayed in the army for some 15 years until he had to retire due to neuropsychological after-effects of the war.
I asked him about the wartime.
“One time, we captured a hilltop front from Iraqi forces,” he told us.
“It was just past midnight, and it was really cold. Our commanders told us to rest in their captured shelters. I chose one with a small wood burning stove where several others were sleeping. The space was so cramped that I couldn’t lie down easily. Many times I asked them to move around a bit, but they didn’t pay any attention. I was irritated.
“It was only in the morning that I found out they were our fallen soldiers who were put there by our forces.”
I noted that he, therefore, had a sort of dialogue with martyrs.
“That was not the only time,” he said.
There are currently 200 beds in the hospital, including beds for CCU, ICU, dialysis, and surgery. Roughly 300 physicians of varying specialties work with the hospital and triple that number serve the clients as medical, administrative, and support personnel. The center serves approximately 1000–1200 outpatients and 40 inpatients every day.
According to Dr. Tavakoli, Sasan Hospital provides every paraclinical service available in the country, except for nuclear medicine, and its lab similarly covers every aspect of healthcare.
In several respects, it is one of the advanced medical centers in Iran. For example, the hospital is equipped with one of the few EBUS machines available in Iran that can be utilized for endobronchial ultrasound and allows for intervention. It’s also been equipped with a 64-Slice CT scanner since 10 years ago, when only three other medical centers had the same device.
It also provides multi-specialty diagnosis panel service, where several specialists sit in the same room to assess the interrelated conditions of patients and collectively plan and make decisions for them, for example in the cases which suffer from bone infections.
“In short, we strived to prepare necessary facilities and equipment for the hospital. Our goal was to build a strong foundation and maintain it for years to come,” stated Dr. Tavakoli.
The challenges the medical staff face in the hospital are abounding.
“There was a time when the challenge facing veterans was suffering from wounds and short-term medical conditions,” reminisced Dr. Tavakoli. Now that years have passed, veterans are also dealing with problems that arise from aging such as obesity and diabetes. New wounds are likely to develop due to diabetes and nerve injuries. Not to mention the development of osteoporosis and the resulting bone fractures, which are caused or accelerated by lack of exercise in veterans.
Procuring necessary equipment is yet another challenge. “It should also be mentioned that a major portion of medical equipment is high-tech, whether in technology or materials,” Dr. Tavakoli said. “Hence, much of this equipment is exclusively manufactured in foreign countries. They can be manufactured in Iran, of course, but it can’t be done overnight. Therefore, we need to import them.”
I asked him about the genders of those who sustained injuries in the war.
He explained that during the Iran-Iraq war of 1980 to 1988, Iranian women primarily played their role in supporting the soldiers behind the fronts. However, they would still get injured or killed in bombings or rocket attacks, especially during the early years of war in the province of Khuzestan. As a result, he estimated that less than 10 percent of Iranian veterans are female.
The number of their clients, however, keeps rising. Besides the fact that the immediate families of those who participated in the war are eligible to receive their services, others keep being added to the list because, in addition to war, there are other ways of sustaining injury or losing your life while serving your country. These include assassination targets, victims of bombings and bombardments, casualties of uncleared mines in the border regions, and armed forces who were involved in accidents on duty.
Therefore, Dr. Tavakoli insists that the numbers don’t match as the current capacities sometimes fail to meet the demands of their clients. The hospital needs government assistance to further develop its facilities and services.
“It already has the basic infrastructure and the land, but it currently lacks the budget to stay an updated, well-equipped center for veterans and the public alike,” he said. “As you know, such needs cannot possibly be satisfied through self-governance.”
Our talk about the challenges they have in delivering medical services to those in need inevitably led to a discussion about economic sanctions imposed on Iran.
“To make the matters worse, Iran was suddenly hit by sanctions,” Dr. Tavakoli said. In effect, these sanctions prevented hospitals such as Sasan from importing some items that were disposable or higher in price, or at least, skyrocketed the cost of delivery. He notes that the domestic companies which procure such items are in the private sector and will predictably stop importing if it’s not turning a profit for them.
“It was not like the companies that manufacture medical items rejected our purchase offers outright for being under sanctions,” he said. “Rather, since the transfer of equipment and specialized drugs to Iran was a multi-step process, each step is now much more complicated, to the point that many give up on the effort altogether.”
As far as we could see, the hospital staff have also developed certain personally motivated emotional bonds with their primary clients.
Fatemeh Abolhasani is a 35-years-old PhD candidate in human resources management who works in the training department of the hospital. Her father was martyred in the war before she was born.
“When I’m in the wards, my reactions to events therein are a bit different from those of others.”
I had already witnessed an instance of what she referred to. She was with us when one of the patients told us, “We are still in much pain, and I sometimes find myself waiting for it to end for good.” Fatemeh immediately left the room with moist eyes.
“I graduated with a bachelor degree in midwifery but I didn’t pursue that line of work. Seeing people in pain overwhelms me to the point that I can’t handle myself. And to be honest, I don’t want to get emotionally detached,” Fatemeh told us.
We also met Zahra Esmaeil Talaei, the 45-year-old manager of nursing care, who believes that a memory from her teenage years has set her devotion in motion.
“I was 15. Our school took us on a field trip to an institution whose inpatients were like ours now. We were at an age that we sort of understood the war. We started visiting the patients, giving them flowers. And there was this one patient, whose body was amputated from waist down, with a sheet covering that part. His face affected me so much,” Zahra recounted with a hint of trembling in her voice.
The man’s luminous, humble countenance troubled her emotionally, making her leave the room in tears.
“My religion teacher asked why I was crying. I told her how deeply moved I was, seeing all those people. She then put forth the idea that I would later lead a life in which my debt to these patients is repaid. It then occurred to me that I could be a caretaker or a nurse for them,” she said.
When the news of the COVID-19 outbreak first emerged, no one knew anything about it. There was just a general panic, and everybody was trying to avoid contact with the coronavirus patients. Dr. Tavakoli remembers that medical centers were similarly frozen by fear.
“Private sector hospitals immediately went into defensive mode and stopped admitting patients. Here in Sasan Hospital, we knew we had to think of something, even though we were not mandated to. Just like in times of crises and natural disasters, it took 10 minutes of speaking, and then all of our colleagues were mentally ready, even one head nurse who used to even complain about the weather under normal circumstances. Their only initial worry was if and how the hospital would support them and their families if they got in trouble.”
That was only the beginning of the troubles of the staff at Sasan Hospital who set to work with empty hands. They managed to get their hands on some medicines with the help of passengers that were coming from abroad, including Germany. A workshop was set up to manufacture gloves, protective face shields, and face masks. They worked night and day.
It reached a point where Sasan Hospital was providing its services to about 170 COVID patients at any moment. For a time, 30 percent of their inpatient beds were occupied by non-veteran patients. They even admitted critically ill patients from cities where there were no ICU beds in their hospitals.
Still, the mortality rate of staff in Sasan Hospital was very low during the pandemic as it took good care of its personnel. It provided twice the number of personal protection items compared to public hospitals. The staff at Sasan Hospital would also take regular tests, and as soon as one individual was tested positive for COVID-19, they were removed from the list of serving personnel and immediately replaced temporarily. Only one physician working in the emergency room was lost during the pandemic, according to Dr. Tavakoli.
In another room of the ward, we met Hamid Vahedi in the company of his wife. The 56-year-old veteran was severely injured on the battlefront in 1986.
“It was a mountainous area. I was lying in a hole for some 2-3 days, almost invisible to our forces,” he recounted.
I asked him how he was finally saved.
“You know, in those areas we used mules for transportation. I used to be very kind to them, tending to their needs, making life as comfortable as possible for them.”
Finally, one of those mules came to his rescue.
“It stood there above the hole, making noises, until it caught the attention of our forces,” Hamid said.
“I believe it always pays off to care for those in need.”
*Zahra Mahdvar, public relations officer at Sasan Hospital, was of much help in arranging the visit. Amir Mollaee Mozaffari and Ali Amiri, staff writers at Iran Daily, contributed to writing the report.