First installment of a three-part series published in the Milwaukee Journal-Sentinel by Pulitzer Center grantees Mark Johnson and Mark Hoffman.
Two refugee girls enter the doctor's bare examination room, walking slowly, their upper bodies arched grotesquely to one side, like hooks. Tarif Bakdash, a pediatric neurologist, guesses they are 8 and 11 years old.
The doctor examines their backs and right away he knows. The warped spines bulging under the skin, the protruding ribs. Severe scoliosis.
In the United States, where Bakdash lives, the girls would receive surgery to save their lives. But they are Syrians, living in a refugee camp in Jordan. The camp has no facilities for the surgery, the family no money to pay an outside hospital.
The doctor visualizes what lies in store for the girls. Without surgery, their spines will keep twisting. They may suffer paralysis, loss of bladder and bowel control. Eventually, their spines will press against the lungs, making it harder and harder for the girls to breathe.
He does not tell the mother her girls will die. "I couldn't say it in front of the kids," he says.
Instead, he tells her that the girls need surgery. The mother asks if he can take them with him to America, but the doctor knows it will be extremely difficult to get visas and a hospital to foot the bill—probably impossible.
"I'm so sorry," he says.
As the mother gathers her girls to leave, the doctor is left trying to smile at her in a gesture of comfort. And he is conscious of how difficult it is to force that smile, how awful it feels.
Although he helps dozens of children with seizure disorders and other conditions during his visit to the camp, it is that forced smile—and the girls he could not help—that remain a vivid memory.
He'd do anything to change that.
Almost a year later, on an evening in late March, he is on a 787, bound once again for Jordan, for the same refugee camp, the same cramped examination room.
A restless man of 51, Bakdash has lived in a Milwaukee suburb since 2014, when he joined Children's Hospital and the Medical College of Wisconsin. A few weeks ago, he resigned; the next step in his nomadic career yet to be determined.
He is certain of one thing. Healing, his life's work, is calling him to the camp known as Zaatari, where 80,000 refugees from the Syrian civil war are living in limbo. They wait in a vast dirt field of prefab dwellings, hoping to return home if it is ever safe, but knowing their future may lie elsewhere. It is a tug-of-war the doctor has felt in his own heart.
A dual citizen, Bakdash is American by residence, Syrian by birth.
The 11-hour flight on Royal Jordanian Airlines offers time to reflect on all he misses: the sight of falafel cooking in the shops of Damascus; the scent of fresh-from-the-oven bread; the smoke from the ever-present hookahs; and the reverberating notes of the call to prayer floating through the old city.
Now, the doctor lives in Brookfield, in a kind of exile, unable to forget his troubled homeland, but unable to return. Once Syria's national secretary for the disabled, Bakdash left to take a job in America in 2010. When the civil war began the following year, he had the audacity to email first lady Asma al-Assad, whom he knew personally, asking her to plead with her husband, President Bashar al-Assad, an old classmate of his from medical school.
"Your Excellency," he wrote, "I plead to your kindness and compassion to ask his Excellency to use mercy with the rebellions, and not to allow the security forces to use live ammunition.
"The people are so frustrated and tired after so many years of hardship. Most of the youngsters are not malicious. They are just looking for their rights to live a better life."
He received no response.
In the five years since, as evidence mounted that Assad was attacking his own people with barrel bombs and even chemical weapons, Bakdash emailed President Barack Obama and Vice President Joe Biden. He gave talks and published a memoir—all critical of the Syrian government.
"If I return, they will kill me," he says, "after they torture me, for sure."
So he is flying back to Jordan to care for refugees who've fled Syria. This time, he is leading a small mission: two other doctors, two nurses, a social worker and a young man hoping to become a pastor.
Although they won't be setting foot inside Syria, Bakdash worries about their safety. Two weeks earlier, seven men with ties to the Islamic State were gunned down by security forces in the Jordanian city of Irbid — the same city his mission had originally planned to visit.
Bakdash worries too about how much they can accomplish in less than one week.
To distract himself, the doctor scrolls through the list of movies available to passengers and chooses "Brooklyn," the story of a woman torn between two homes.
Arab Spring, which began in Tunisia more than five years ago with a small but powerful act of protest, the self-immolation of a roadside fruit-seller, has evolved into an endless winter in Syria.
The catalyzing event was the arrest and beating of more than a dozen boys in the southern city of Daraa. They were accused of spray-painting anti-government slogans on the walls of a school. Protests followed, but unlike those in Tunisia, which toppled the president, the Syrian demonstrations triggered a government crackdown. Thousands were arrested in Damascus, Aleppo, Daraa and Hama. By the end of July 2011, Syrian army tanks were rolling into cities.
What began as a conflict between the Assad government and the rebel Syrian Free Army festered unresolved. It eventually mutated, drawing terrorist fighters from the Islamic State and al-Nusra Front, as well as Russian bombers. To those who accused him of bombing his own people, the Syrian leader insisted his forces were fighting terrorists.
Apart from criticizing Assad and participating in airstrikes against the Islamic State, the U.S. stayed on the sidelines.
Now dragging into its sixth year, the civil war has spawned its own grim novelties, including the use of YouTube and social media to broadcast torture and executions. But the war's most distinctive feature is one that is deeply personal to Bakdash: the systematic targeting of hospitals and clinics.
Physicians for Human Rights, an international group that investigates mass atrocities, has documented 365 attacks on hospitals and clinics in Syria and the deaths of more than 700 medical personnel. Such attacks violate rules of warfare that date back to the first Geneva Convention in 1864.
"What we're seeing in Syria really is unprecedented," said Widney Brown, the group's director of programs.
In eastern Aleppo city, held by the opposition but under regular attack, 95% of the doctors have fled, been killed or been imprisoned. Some areas of the country have been hit so hard that the hospitals left standing lack water, electricity and supplies. In cities besieged by government forces, medical supplies have been stripped out of the convoys trying to get through.
All of these actions imperil not only civilians caught in the war's crossfire, but also those with routine conditions: heart attacks, strokes, cancer, diabetes.
The idea behind the assault on medicine, Brown believes, is to erase any distinction between military and civilian, and to cause a sickening ripple.
"When you kill a doctor, you don't just kill one doctor," Brown said. "There's a loss of life beyond that. There were people that doctor would have treated and saved."
Toward the back of the plane sits one of Bakdash's recruits, Thomas Chelimsky, a kindly 59-year-old neurologist from Froedtert Hospital who is busying himself writing a grant proposal and a scientific paper.
From time to time, he pauses. He wonders what he will see in Jordan.
The French-born Chelimsky has never been to the Middle East. He has never gone on a medical mission, though he has wanted to for some time. This mission, he believes, carries "a more than minimal risk," which is why he and his wife, Gisela, also a doctor, decided that only one of them would go. They have two children.
Chelimsky reminds himself of his wife's injunction: He must not go anywhere in Jordan by himself, especially on his morning jog.
To prepare for the trip, he has been listening to a teach-yourself-Arabic CD and reading the Qur'an. A deeply spiritual man, Chelimsky has arrived at a feeling of peace about the trip.
"I had gotten clear in my mind that the Lord was sending me, sending us all, on this trip, both for the Syrians and for our own growth," he says.
He imagines himself greeting refugees, taking medical histories and arriving at diagnoses—all in the few minutes he will have with each patient.
And occasionally, he scolds himself for the one thing he forgot.
Sitting in his car at home is his tan leather physician's bag containing his stethoscope, reflex hammers and all of his other equipment.
Unlike the others on this journey, Bakdash is a child of the Middle East, his life shaped from birth by the certainty of a mortal enemy: the Jews.
Bakdash was 2 years old when the 1967 War broke out and the Israelis wrested the Golan Heights away from Syria. Six years later, he jumped up and down with excitement at the outbreak of the Yom Kippur War, full of hope that his country would recapture the lost Golan. Instead he would find himself full of shame — the Golan offensive beaten back, the Israelis inside Syria, 40 kilometers from Damascus.
By then, violence had already touched his family. In 1972, while working as a secretary for an import-export company, his mother opened a letter bomb. The explosion blinded her right eye, severed a finger and disfigured her face, leading to 40 surgeries.
Bakdash would learn that the businessman to whom the letter was addressed worked for the Palestine Liberation Organization. The explosion occurred less than two months after the Munich Olympics. His relatives suspected it was intended as payback for the murder of Israeli athletes.
At first Bakdash did not know what had happened, only that his mother hadn't come home for several weeks. His father said she was visiting aunts in Jordan, where she grew up.
When the children finally saw their mother, her face was so smothered in bandages that Bakdash's brother cried, "That's not my mother."
Stacey Volkman looks up from her seat and sees Bakdash pacing the aisles of the jet, stretching his legs.
Back in December, the 36-year-old Froedtert Hospital social worker heard Bakdash give a talk about the Syrian civil war and his mission, and he was so passionate that right there, in that dark auditorium, she made up her mind. She was going.
Her sons, 8 and 10 years old, worried about her flying all that way. She listened and explained this was something she had to do.
Now she carries an extra suitcase filled with deflated soccer balls and puzzles for the children in the camp.
Volkman has no expectations about what will happen, and she finds that liberating. She hasn't worried about the plane, or Customs, or terrorism.
What she thinks about are the refugees. She is no doctor. Her job will be to connect with the parents and children, to talk with them, provide comfort, make them smile, if she can.
It's what she does.
Bakdash closes his eyes. Chelimsky and Volkman have been sleeping for hours. The plane's cabin is dark and quiet, except for the exhausted crying of an infant. Four hours to go.
A memory: He is 11. All the children are taken to march in the streets of Damascus. No school. It is March 8, anniversary of the 1963 coup that brought the Ba'ath Party to power. The children march and cheer for President Hafez al-Assad. Some have been given banners to carry. Bored with chanting, Bakdash and his friends follow the crowd until they find a quiet side street to duck down. Then they run home.
The march comes every year followed by another on April 7 to celebrate the establishment of the Ba'ath Party, and yet another on Nov. 16, the day Hafez al-Assad took over the government.
"Those days, man, they are carved into your head," Bakdash says.
A second memory: He is 17, preparing to enter medical school. Hafez al-Assad has just quelled an uprising in Hama, laying siege to the city for almost a month and killing as many as 40,000 citizens. In the privacy of his home, Bakdash criticizes the Syrian government. His father, a banker, an easygoing man most of the time, raises his voice: Don't say anything bad about the government. Don't even think it in your head.
That year two students from his class disappear. They simply never show up to school again, and when a friend goes to check on one of them, intelligence officials beat him and threaten to kill his family.
Bakdash never jokes about the government, or about Assad. He never complains about high prices in the stores or corruption in the legal system. Even so, he worries often that something will slip out, that he will say the wrong thing, dooming his entire family.
What Bakdash cannot control no matter how hard he tries are his thoughts. He hates the fear in his homeland, and for that, he hates the government.
"We had no freedom, no rights," he recalls. "We were just living in a cage called Syria."
A third memory: It is 1988. He is 23. He sits aboard another plane, the one that will take him to the U.S. to continue his medical career. Medicine is not yet a calling. He thinks of it mostly as a ticket to a more affluent life. Still, he has watched and admired the doctors who've helped his mother heal since the letter bomb.
As he feels the plane lift off, Bakdash stares down at the city where he grew up.
He swears he will never come back.
And yet, he does.
Fourteen years had passed since he left Damascus. His parents had paid the $10,000 Syria charges to exempt a young man from military service. Bakdash had decided to move home.
On the flight back to Syria, he felt nervous: What if something goes wrong?
If anything bad did happen, he had a trump card: an invitation to meet the new president, the son of Hafez al-Assad, Bashar, his old classmate from medical school.
Much had changed since their school days. Bakdash was not the person he'd been 14 years ago; maybe he'd find Syria was not the same country.
After arriving in the U.S., Bakdash spent two years studying to pass the American medical exams. Then he began a residency at the Henry Ford Hospital in Detroit, working for a supervisor named Jeffrey Devries, a Jew.
"Oh my God," Bakdash remembers thinking. "I'm meeting a Jew." They shook hands, and it was the first time he'd ever done so with someone of the Jewish faith.
The wars with Israel had shaped Bakdash. He believed Jews would see him as he'd always seen them: The enemy.
Not Devries. He knew Bakdash was Muslim, but it didn't matter. Devries had already trained more than a dozen other Syrians. Bakdash found him professional, kind and fair; Devries would remember the young resident as "very caring and interested in ethics."
When Bakdash moved to Houston to begin a residency at the Baylor College of Medicine, his new supervisor was Marvin Fishman, another Jew. Fishman became a great friend. Another doctor at Baylor, also Jewish, invited Bakdash into her home for Thanksgiving.
Again and again, the Jews he met treated him with kindness.
"Over the years," he says, "I changed the way I saw Jews."
The change came gradually and in tandem with a deepening commitment to his own faith and profession. As he moved from residencies to practice, Bakdash grew closer to the families he cared for, dining in their homes, receiving their cards of gratitude, realizing the bond between doctor and patient transcends race and religion.
One night, while reading sayings of the Prophet Mohammed, he came upon a simple declaration: "All creatures are the children of God." In those words, Bakdash found no distinction between Muslim and non-Muslim.
Much as he grew to love America, where he was now a citizen, Bakdash still missed his homeland. He longed to visit his parents and walk through the old neighborhoods in Damascus.
On June 10, 2000, Syrian President Hafez al-Assad died; a month later his son, Bashar, succeeded him.
Bakdash remembered their medical school days together, how he'd started out fearing Bashar, only to find him friendly and easygoing, a man who wore jeans, drove a dented Peugeot and walked the streets without bodyguards.
As he considered the change in his homeland, Bakdash felt a sense of hope and purpose. In America, he'd trained with some of the finest teachers and the best technology. In Syria, that training would make him a rare commodity.
Enlisting the help of a Syrian woman with political connections, Bakdash wrote to the new president, describing his studies in the U.S. and his hopes for Syrian health care. He praised the new leader.
Weeks later, the phone rang at Bakdash's apartment in Cleveland, where he was an assistant professor at Case Western Reserve University. The caller asked him to hold for the chief of staff from the Syrian presidential palace.
Bakdash could hardly believe it. The president remembered him. His chief of staff gave Bakdash a phone number to call the next time he was in Syria.
The doctor was carrying the number with him when his plane landed in Damascus in October 2002.
A few days after his arrival in Syria, Bakdash received a kiss on the cheek from the president.
Over coffee, Bakdash and Assad reminisced about their school days. Bakdash spoke of his intention to teach Syrian medical students. The president spoke of improving health care and making the nation more democratic.
Then their chat was cut short by a call from the prime minister of Canada.
Home at last, the doctor was happy. For the next seven years, he taught ethics to medical students at Damascus University, encouraging them to think and to question, and not to be timid. He ran a two-room clinic in the city, taking patients from as far off as Baghdad, almost 500 miles away. Many were poor. When they couldn't afford treatment, he waived the fee. He refused no one.
During these years, neighboring Iraq was embroiled in war and insurgency and its refugees poured into Syria, establishing their own neighborhoods in Damascus. The doctor saw the conflict through his patients. Many were suffering from seizures and post-traumatic stress disorder.
One 5-year-old girl with seizures was brought to see Bakdash by her mother. After treatment, the girl and her family tried to return to Iraq. Six months later the girl reappeared at Bakdash's office, this time accompanied by an uncle. Her mother had been killed by a bomb.
Bakdash came to the attention of the Syrian first lady, who tapped him to work on her pet project, the nation's largest nonprofit organization for the disabled. He started in 2007 and two years later received a promotion to a new governmental post created by the president: secretary general for the disabled.
As he rose, however, he grew increasingly aware of the old barriers that had always held Syria back—corruption, bureaucracy and the favoritism shown members of the Ba'ath Party. At 13, he had joined the Ba'ath Party, though he tired of it quickly and left after two months.
Three decades later, despite his clinic, his work at Damascus University and his broad training, he couldn't get approval to treat patients at Damascus Children's Hospital. Despite his new post, he had no power. Important disability programs went nowhere, blocked by ministers.
Frustrated, he looked back to America. A hospital in Billings, Mont., had offered him a job. On April 21, 2010, he typed a letter to the first lady, starting with effusive praise for her "amazing support," and "the great trust" she had placed in him.
"Your Excellency," he wrote, " I need your kind permission to leave my post... My parents are getting old and in need of better medical care."
In truth, his parents' health was an excuse; neither one wanted to move to America. It was Bakdash who wanted to leave, disappointed with the lack of change in his homeland.
When he boarded the plane back to America in May 2010, his parents stayed behind in Syria.
By December that year, the Arab Spring protests began in Tunisia. Within a month they would spread to Syria. And in 2012, with the protests now a war, his parents joined him in the U.S.
Back in the U.S., Bakdash worked at the hospital in Billings for two years, then at a hospital in Springfield, Mo., for about the same length. In 2014, he moved to Wisconsin for a better job at Children's Hospital and the Medical College.
He watched on television as his homeland erupted in civil war, and he remembered that conversation at the palace with his old classmate, the man who'd spoken of making Syria more democratic, the man now cracking down on protesters and bombing his own people. Bakdash felt betrayed.
In the spring of 2015, he made his first trip to Zaatari to work in the clinic. That's when he met the two girls with the badly misshapen spines, the ones he could save in America but not in the refugee camp.
For months after returning to Brookfield, he thought of the mother dressing her doomed girls each morning, and he wondered how wealthy nations can send rockets and bombs, but turn down visas for dying children. He saw the results of those weapons, mostly when he turned on Arabic television stations: Dead children who'd lost arms and legs, others burned black.
He saw the survivors too, each Wednesday at 6 in the morning, when he called a mental health clinic in Syria via Skype.
For an hour or so, he helped the clinic's lone doctor treat a grim procession: a 3-year-old girl from a heavily bombed village who endures two dozen seizures a day; a 10-year-old boy who saw his father murdered and suffers from post-traumatic stress disorder; a 12-year-old boy with PTSD whose sister was killed by a Russian bomb.
And week after week, Bakdash finished his Skype session feeling he was doing so little. Too little.
In mid-February, at the annual meeting of the nonprofit Syrian American Medical Society in Orlando, Fla., he listened as colleagues described sneaking into Syria to work in cave hospitals built 20 meters underground. Given his obligation to care for his parents, he could not take the risk of attempting to enter Syria.
"You feel, 'I'm so limited, so handicapped,'" he says. "I can't go there. I can't be there."
Days after the conference, he gave his notice at Children's Hospital and the Medical College of Wisconsin. He was leaving, in part, because he wanted more time to travel on missions. If he could not help his countrymen in Syria, at least he could help the refugees who'd escaped to the camp in Jordan.
"If I was there now," he wondered aloud, "how many could I see?"
The doctor glances toward the sunlight streaming through the cabin windows. The 787 passes over the Mediterranean Sea, heading south toward the Israeli coast.
Thirty minutes to Jordan.
"I hope one day these countries are going to find peace," Bakdash says. "You have to be genuine about seeing the other side as a human being..."
Below passes Netanya, Israel.
"A child doesn't know Christianity or Judaism or Islam. But if everybody teaches something negative about the other side, the child will grow up hating..."
Mount Gerizim, 20 miles from Jordan.
"Human suffering is global. It doesn't know land. It doesn't know religion..."
He stops talking and fastens his seat belt. The plane is in full descent. The runway in Amman comes into view.
Early the next morning they set out from Amman, their van passing through a flat, sand-colored landscape with few trees. Along the highway, men tend herds of goats and sheep.
"You see those hills," Bakdash says, pointing to the north. "Those are Syria."
Along the way, there are few breaks in the landscape — an abandoned house, stone ruins, the odd factory. In the distance, nothing suggests a place where 80,000 people live. The reason becomes clear at the entrance to Zaatari. Virtually all of the structures are the same: single-story tin huts. No tall buildings or landmarks of any kind.
Barbed wire surrounds the camp, which opened in July 2012. Beside a steel gate, armed guards check the government permits for the Wisconsin team.
Staring out from the van, nurse Jennifer Nitschke-Thomas is struck by how much Zaatari has the look and feel of a prison.
After two checkpoints, the visitors report to the Syrian Refugee Affairs Directorate, an administrative office for the camp. At each stage, Bakdash greets officials warmly, shaking hands and hugging, chatting and complimenting them in Arabic.
Finally, they set out for the clinic following a road nicknamed the Champs-Elysee; it is lined with shoe and T-shirt huts, places selling ice cream and popcorn, and small shawarma stands, where chicken cooks beside an open flame.
The shops have few customers. The United Nations gives each resident 20 Jordanian dinar per month for food (about $28 American). A sandwich at one of the shawarma stands costs about 1 dinar.
Finally, Bakdash and his group arrive at a large open-air waiting area, swarming with families. Harried mothers cling to fussing children; other mothers watch their kids dart in and out of the rows of benches.
This is the clinic entrance. Inside are the two busiest rooms: "Emergency Department Men" and "Emergency Department Women."
Beyond, a tiny passageway leads into a warren of prefab huts, each one with a label such as "Pharmacy Department," "Vaccine Department," "Prosthetics Department."
Outside each door stands a crowd of parents and children waiting to be seen.
First installment of a three-part series published in the Milwaukee Journal-Sentinel by Pulitzer Center grantees Mark Johnson and Mark Hoffman.