The attack last month by a group of Israel's Druze minority on wounded Syrians traveling in an Israel Defense Forces (IDF) ambulance to a hospital in the Golan Heights has drawn attention to Israel's practice of offering medical care to Syrian militants. But it's not just rebels who are being treated.
In nearly two and a half years, around 2,000 Syrians have been admitted to Israeli hospitals. While the vast majority are male — up to 90 percent at Ziv, the hospital closest to the border — there are women, too, and 17 percent of all patients are children.
There are the very old, and the very new: At least 10 Syrian babies have been born at Ziv alone since Syrians began arriving in February 2013.
Word has spread that Syrians can access medical help over the border from people they've long believed are the enemy. Medics say more patients, and less urgent cases, are filling the beds of publicly-funded Israeli hospitals. As these patients flow in, questions are being raised about the ethics of filling a hospital's limited beds with Syrians — and how comfortable Israelis are helping their old enemy so close to home.
Ziv Medical Center in the mountain city of Safed, just west of the Golan Heights, is the first port of call for most patients who come through the border fence near the devastated Syrian city of Quneitra. With 331 beds and seven operating theatres, Ziv is modern, well-equipped, and only 40 minutes from the border in a fast-moving IDF ambulance.
Ziv has been treating Syrians since the night of February 16, 2013, when a convoy of IDF ambulances unloaded seven wounded Syrians in the emergency room. Trauma nurse David Fuchs said he and his colleagues were shocked but quickly adjusted.
"Syria, it's the head of the devil! Suddenly to get people from over the border and to be saving lives, you need to change a disk in your head," Fuchs told VICE News. "We had to say, listen, what happened, happened. From this moment we need to put this aside and act with a Christian attitude. I think we did it very nicely."
Fuchs and his trauma room team were unprepared for the severity and complexity of the injuries. "In Syria there's no CT scan, no X-ray, just 'Allahu akbar,'" Fuchs says. "They do some heroic things, the doctors in Syria. I think that if I had a hat…" he said, reaching up to doff an invisible cap.
Ziv's Syrian patients come with an added challenge for Fuchs and his team: trying to figure out what happened. Two unconscious patients have come in with blood-stained notes pinned to their blankets, but most have entailed pure guesswork.
A bloodstained note pinned to an unconscious patient. (Photo via Ziv Medical Center)
To date, more than 500 Syrians have been treated at Ziv. Some days there are just a handful, and during one busy stretch there were 22.
"We thought it was a one-time event, you know? Fix them up, go home, job done," said Linda Futterman, Ziv's director of international relations. "It varies, but since we started receiving them, at no time have there been none."
As the number of cases has risen, the nature has changed.
"None of these patients are life or death. It's not immediate. They come after a day, two days, sometimes five days," said Dr. Tal Solomon, head of Ziv's vascular surgery unit. "A few are even elective procedures — for example, a guy with an infected hand."
"At least 70 percent to 80 percent of our Syrian patients are combatants, but we don't know what happened, when or how. We don't know who they are, either," said Solomon, who is kept busy with lengthy reconstructive surgeries on damaged and nearly-severed legs.
"I've only lost two limbs where I treated the patient and tried to salvage the limb but had to amputate," the doctor told VICE News, pulling out an array of 'before' photos of mangled, nearly-severed legs and corresponding, almost impossible 'after' shots of grinning patients on crutches.
Solomon's record — a handful of amputations in a sea of unlikely reattachments — stands in stark contrast to the trend in Jordan, another place wounded Syrian refugees are washing up, and in far greater numbers.
Amputations are so common in Jordan's overworked, underfunded health sector that they are seen as the likely, if not necessary, outcome of a serious limb injury. Salvaging a damaged limb takes tremendous medical expertise and many expensive hours of complicated, staff-heavy surgery. With fewer patients and more money, Israel is managing the task better.
Two and a half years into the program, the number of Syrian patients is rising. It's not yet unmanageable, but throw in an emergency situation and that could change quickly: As several medics pointed out, every bed given to a Syrian patient is one that can't be given to an Israeli patient.
'They think we can do miracles so they bring lost cases.'
Doctors at Ziv shrugged off the idea Israel might become some sort of wartime medical tourism destination, but a growing number of Ziv's Syrian patients say they already knew people who had been treated in Israel — the word is out. And in Jordan, while Syrians tend to be cagey on the subject of Israel, the half-dozen approached by VICE News agreed that their old enemy's medical care was "the best in the world." Should the word continue to spread, and should Israeli hospitals continue to offer this care, it's not far-fetched that those injured Syrians who can travel might choose Israel versus Jordan for their medical care.
Already, word of Israeli medical expertise has attracted cases no doctor can cure. Ziv's doctors have long lists of patients who arrived in Israel with the misplaced belief that doctors here can rehabilitate anyone. Terminal cancer, genetic diseases, and intellectual disabilities are just a few examples.
"There are many diseases. They think we can do miracles so they bring lost cases," said one staffer. "It's sometimes very sad. We say, 'We can't help you, we are sorry but we are not able to help.'"
For those the Israelis can help, there's another challenge to patients' long-term prognosis: None of the Syrian patients stick around after discharge.
"Here at Ziv, we have to start rehab in the hospital and cram it all in. We release these patients way before we can fully rehabilitate them," said Solomon.
According to senior administrators, patients are most commonly discharged when doctors say they are ready to go, though some have discharged themselves earlier than doctors would have liked. There's no out-patient therapy for Ziv's Syrians, who head back to the border by IDF ambulance, shuffling along on crutches, often with shiny metal fixators holding tender limbs in place.
A prosthetic limb and an external fixator on a Syrian patient. (Photo via Ziv Medical Center)
Ziv hasn't seen its own head-count rise since it started treating Syrians, so it has had to stretch budget and shuffle staffing to cover the care. An Israeli-Arab social worker, Faris Issa, has been assigned to oversee the Syrian caseload.
"These people have suffered three traumas. First there was the war, and then they've been injured, and now they're in an enemy place," Issa told VICE News.
"They're hearing Arabic, English, Hebrew and Russian, they're seeing lots of faces and hands. I start at the trauma room and I give patients control of their body again. I tell them, 'Don't worry, I am here for you.' I sit at their head and I tell them what's happening," he said.
In those first months, Ziv's Syrian patients were a secret, not just from the local community, but from the family and friends their patients were going home to.
"We were about to discharge those first patients, and we realized, we can't send them home in Ziv pajamas," said Futterman, pointing at the hospital's standard Hebrew-printed hospital gowns. She and Issa started collecting clothing, joking that they're now co-owners of the Faris Boutique, a hospital closet filled with donated clothing, new shoes and toiletries.
Futterman speaks of "huge generosity" in the community, and donations have funded prosthetic limbs and expensive dental surgery. But there has long been tension between Israeli Druze and Arab Muslims. Ziv serves a mixed community: Jews, Muslims, Christians, Druze, Circassians and Bedouins, and on the day VICE News visited Ziv, there were plenty of Druze, Jewish and Syrian patients in the hospital's crowded wards. It's a combustible mix.
When patients check out, these politics come back into play. Hebrew lettering is carefully sanded off prosthetic limbs. Pills are popped out of Hebrew blister packs and placed in unmarked jars. Gifts, too, must be checked: one small boy almost gave the game away when he left the hospital on new legs, kicking an Israeli flag-printed football. Only on his way out the door did staff realise their oversight and swap the ball for another model.
"We try to take away every sign that they were in Israel, because we're afraid for them," explains Issa.
Yet over the past year, that fear has started to fade.
Doctors perform surgery at the Ziv Medical Center. (Photo via Ziv Medical Center)
When VICE News visited Ziv, the patient roster included at least two young opposition fighters. Eighteen-year-old Omar had belonged to the Free Syrian Army's Yarmouk Division for four months before opting to train on his own. He was injured when an RPG struck his car.
He'd been at Ziv for 20 days and was feeling well enough to flex a bit of attitude. Being treated in Israel? "Aadi," responded the scrawny teenager — "whatever."
"I know lots of FSA who have been to hospital in Israel," he told VICE News, admitting he was lucky to be here. "There's a high quality of treatment here. High, high, high. There's no air-conditioning in Syria, there's not even any power!"
The 20-something Syrian patient in the bed next to him agreed the care here was good, but would not talk about who he was or who he fought for. Staff said this silence was common amongst male patients suspected of being militants.
Down the hallway, a middle-aged Syrian woman named Souad was in her fourth month of recovery and joking with social worker Issa about when he's going to deliver her a falafel sandwich. She misses Syria but it's evident she's comfortable at Ziv.
"When I woke up, I asked the nurse, where am I? Another Syrian arrived and I realized: I am in Israel. I looked out the window and saw the flag, but I wasn't afraid. They are not devils," she said.
Like Omar, Souad knows of other Syrians who've been treated in Israel, and she doesn't feel compelled to keep her stay here a secret. "My family and my village know I'm here, and if someone asks and I trust them, I'll tell them."
IDF deliver a patient to Ziv. (Photo via Ziv Medical Center)
While the frontline health workers who tend to Israel's Syrian patients speak of their work in humanitarian terms, at a policy level, there's more to it.
The project is in part a public relations strategy toward everyday Syrians, and it's working: The quality of care and the bonds formed between healthcare workers and their patients are slowing chipping away that old enmity, albeit in tiny measures.
But the costs and risks of bringing Syrians to Israel and treating them for months on end are significant, and politically are only worthwhile if they deliver intelligence or geostrategic gains. By providing medical care to the so-called moderate rebels, like 18-year-old Omar fighting with the FSA, Israel is bolstering defenses against its biggest enemies — Hezbollah and the so-called Islamic State — by helping the rebels who fight against them.
No one at Ziv was able to confirm or deny that members of Jabhat al-Nusra, al Qaeda's Syrian syndicate, are being treated in Israeli hospitals. They insist they don't know who they're treating — and it doesn't matter. Insiders speak of seeing all extremists as "shades of black."
'It doesn't matter to us if it's Hezbollah or Nusra or ISIS, for us it's the same.'
"It doesn't matter to us if it's Hezbollah or Nusra or ISIS, for us it's the same," one said, using a common acronym for the Islamic State.
Ziv's admissions slowed in the month after the attack on the Golan Heights, as Israeli police were reported to have suggested Syrians be treated in hospitals in the center of the country, away from large Druze and Arab communities. But the flow of patients didn't stop. It's a clear indication that the program is still useful — useful enough to outweigh rising medical costs, enormous amounts of manpower, and spiking tensions with Israel's own Druze community.
The attack continues to create fallout, and this week, Israel's Haaretz newspaper quoted a senior IDF source as saying medical treatment had been halted for Nusra members. The directive may calm some uneasy Israelis, but it's not clear how this policy shift will be implemented: How do you check the military credentials of an unconscious, unaccompanied, malnourished teenage boy in plastic sandals and blood-soaked trousers as he bleeds out on a dusty hill?
More tellingly, among the doctors stitching such boys together again, it's not clear whether that even matters.
"We don't know who our patients are — Jabhat al-Nusra, the FSA, the Syrian Army. We can't tell, and it wouldn't make a difference," said Solomon, Ziv's vascular surgeon.
"When you are a doctor, you don't get to know who is good and who is bad. You treat everyone," explained another Israeli doctor, a 45-year-old father who declined to give his name.
"It's very hard for an Israeli to say, but it's a Holocaust what happens in Syria now. And the world doesn't take a side. And as a doctor, you can't take a side," he told VICE News. "This is a humanitarian mission and I am very proud to do it."
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