At one point, 51 people lay on the bloodstained floor of the emergency room as doctors rushed from patient to patient, crunching discarded syringes underfoot. New casualties had to be turned away. As Dr. Amal Shamma, chief of pediatrics and emergency services, puts it, "We would just run out into the street, patients in our arms, and flag down passing cars to take them to another hospital."
The war that is ravaging Lebanon has turned the 38-year-old Shamma into the choreographer of a danse macabre. Trained at Beirut's American University, Johns Hopkins and Duke, she chose to return to her native Lebanon in 1974, shortly before the outbreak of civil war. Through successive waves of violence, she has risen gradually to the self-appointed position of hospital overseer. "Someone has to put the pieces together," she says, describing the anarchy of the emergency room. "You will have a person with a minor cut and blood all over him with five people working on him. Then you'll have another person with one small shrapnel hole whose abdomen is filling with blood, and he's on the floor, dying unattended."
Shamma, an American citizen, has been more steadfast in her dedication to duty than most of the physicians on the Berbir staff. Since Israel invaded two months ago, 77 of the 92 doctors at the hospital have left. Only two other major hospitals in Beirut remain open.
"There is much greater fear during this conflict than during the civil war," says Shamma. "The enemy is different, the weaponry is different, and the amount of death and maiming is much higher. Doctors who have taken incredible risks in the past have left during this war. If we lose one more, we will just not be able to go on."
Without her extraordinary determination, this 5', 100-pound physician would not be able to continue herself. She is fatalistic about personal risk. "I have a very dangerous trait," she observes. "I don't feel fear. If you're going to be hit, no matter what you do you're going to be hit. If you're not, you can walk through shellfire and not get a scratch. Because I'm such a firm believer in that, I don't react to this nightmare around me."
Yet Shamma harbors a great deal of anger toward those previously responsible for the Berbir Hospital. Although years of bloodshed should have prepared it for dealing with another war, the hospital is still woefully under-equipped. Only four stretchers are on hand to cope with the victims. "The best you can do is dump bodies around," says Shamma, with disgust. "This man is dead—throw him in this pile. This man is alive—throw him in that pile. And then you work on patients on the floor."
Even amid the routinized horror, some particularly gruesome scenes stand out. For Shamma, trained as a pediatrician, her worst memories tend to involve children. "I watched a boy running into the hospital carrying his wounded brother, and the boy's brains fell out on the floor of the hospital garage," she remembers. "How is that child going to live with that vision the rest of his life?"
Even when she can leave the hospital late in the evening, she finds an escape from violence elusive. One quiet night, the first in a week of fighting, she went to enjoy the view from the roof of her apartment building. Her appreciation of the panorama lasted just a few moments. For there, not far from where she stood, was the severed head of a man resting on the rooftop.
Amal Shamma's family wonders why she chooses to remain in Lebanon. Both her divorced mother, Nouhad, and brother Ramsey, 35, an engineer, live in Durham, N.C. Amal was born in Lebanon, but as the daughter of a diplomat, she grew up in the U.S., Canada and Egypt. Despite her family's concern, she is glad she returned to Beirut, although she notes, "I thought I was coming to do great things in pediatric medicine. Instead I've become a self-taught expert on war medicine." The bloodshed has radically altered her outlook. "I remember when I bought my first car in the United States," she says with a laugh. "It took me three months to decide what the best car would be for me. When I went to buy a car here, my only conditions were that it be old, ugly and full of shrapnel holes, so no one would steal it."
Even before the Israeli invasion, Shamma had grown inured to the threat of violence. She recalls treating many victims of fighting between armed street gangs. "They would bring a victim into the emergency room, decide what treatment he should get, and if you didn't do what they said, they would pull a grenade or shoot," she says. There have been dozens of shootings in the emergency room. Normally she earns her salary from private practice (she receives no pay for her emergency room duty). The war has changed that. "I haven't seen a private patient for six weeks," she says. "People are too afraid to come here."
Her ambition is to enter politics, but Shamma quickly acknowledges the difficulty. "You just can't do it in this part of the world if you're wearing a skirt," she says. However, the hardships and prejudices she endures do not dim her satisfaction in knowing that in Beirut she makes a difference, a feeling she didn't have when she lived in the U.S. "There is something about being one person out of 200 million compared to being one person out of 2.5 million," she explains. "Whatever you do has 100 times the impact. So I prefer to serve here."
In its precarious position near the Green Line that separates Christian East Beirut from the predominantly Muslim West, the 180-bed Berbir Hospital resembles a charnel house more than a place of healing. One recent evening, when the hospital was subjected to nearly four hours of continuous bombardment from Israeli artillery, patients from all four floors were evacuated to the reception area to shelter them from shrapnel flying through the windows. Five of the six operating rooms were too exposed to be used.