Like other visitors, Yousef is forced to pass through the inspection point at the entrance to the mall in Istanbul’s Fatih district in Turkey. This process does not usually go smoothly, however, He is forced to undergo additional inspections several times, as the device always sounds off indicating his possession of metal objects.

“The security guard allows me to pass after physically examining me and failing to find anything on me,” said Yousef Hommos, 24, to Enab Baladi. The metal objects the device detects are the remains of shrapnel that have been lodged in his body for nearly six years.

“I was injured twice in 2013 and 2014, and the second time the shrapnel remained in my body,” Yousef, a native of Hamouriyah in Eastern Ghouta, described the day he was injured during his coverage of a battle between the regime and the rebels. “A bomb went off next to me and shrapnel hit my left hand, my head and my neck. I was taken to the nearest medical center and then to a hospital in Douma.”

Yousef’s injury was diagnosed as very serious, as a piece of shrapnel had embedded near his spinal cord. The neurologist and vascular surgeon taking care of him thus decided to leave the shrapnel in place.

Having left Eastern Ghouta in 2017, and later settled in Istanbul, Yousef currently suffers the consequences of his injury, often in the form of debilitating pain that prevents him from getting a stable employment.

Yousef’s case is one of the thousands among young Syrians who carry in their bodies pieces shrapnel that were intended to end their lives, but who have instead joined the lists of those with war injuries.

By the end of 2017, the World Health Organization (WHO) and Handicap International had documented three million war casualties in Syria, 1.5 million persons with permanent disabilities, and 86,000 persons whose injuries led to amputation of limbs.

20 Pieces of Shrapnel in a Single Body

Along with his wife and two children, Shaker Bashkawi lives in the village of Ma’aret Hurmah in the southern countryside of Idlib. Currently unemployed, he has spent a year and eight months frequenting doctors and undergoing surgical operations to reduce the burden of his shrapnel injury.

Shaker, 23, was wounded by a mortar shell that exploded in his vicinity, and shrapnel penetrated all parts of his body, leaving 20 pieces embedded within, according to what he told Enab Baladi.

“11 of the shrapnel pieces have settled in my right knee, and the rest are in my right shoulder,” Shaker continued. “There is some shrapnel that is still unstable. My foot is completely disabled, I cannot flex it and it would need a joint to become functional again. I cannot work with my right arm either.”

Despite Shaker’s challenging medical condition, he is considered medically “fortunate.” Although he has more than 20 shrapnels , he is still alive and can move independently.

Dr. Mazen al-Saud, a specialist in orthopedic surgery, noted that the location of the injury determines its seriousness and its burden on a person’s life. He explained that if a shrapnel settled in part of the nervous system, such as the spinal cord, it would mean the end of the person’s life, rendering them completely dependent on their family’s assistance for their living.

“We have about 50 to 60 people in Maarat al-Nu’man who have lost the ability to move due to spinal cord injuries,” said the resident physician in Idlib countryside.

Shrapnel can be directly fatal if they hit major vessels, the heart, or the arteries, or if they caused an intracranial or abdominal haemorrhage.

 

Why Is Some Shrapnel Not Removed?

If the shrapnel stabilizes in non-vital areas, i.e. areas that would not cause disability or death, doctors leave it inside the body, so as to not put the patient at risk after surgery.

“Some shrapnel settle in the body for long periods of time without affecting it, and the body forms a fibrotic capsule to surround and isolate it, so long as it is in a critical location,” Dr. said Akram Khulani, a Family Medicine specialist, in a conversation with Enab Baladi. “If it were in the thigh, for example, it could cause discomfort when sitting, and if it were close to nerves or tendons, after it undergoes fibrosis it could limit the movement of tendons or the function of nerves causing adverse effects.”

“Some shrapnel that settles in muscle tissue, whether metallic or glass, may remain in the body for long periods of time without any implications,” the doctor added.

In contrast, “some shrapnel may not be directly fatal, but if they remained in the body they would induce a reaction by the body forming abscesses and purulence,” according to Dr. Khulani.

Dr. Mazen al-Saud agreed with Khulani’s statement, adding that “there is a rule among doctors that shrapnel should not be removed. We treat the shrapnel’s implications on the body, but we do not treat the shrapnel itself.”

“Sometimes, the removal of the shrapnel may cause problems, while in others it may be necessary. For example, if the knee joint were injured, it would limit the person’s movement and hinder their lives, it would also cause severe pain. In such cases, the shrapnel is to be surgically removed.”

Conversely, “if the shrapnel settled in the brain and damaged 2cm of it affecting the centres where it settled, it would be useless for the surgeon to intervene in order to remove it. This could both cause damage as well as exacerbate damage that has already been done to the brain, especially that the areas damaged in the brain cannot be restored.”

Subsequent Pain and a Future of Caution

While young Shaker’s injury rendered him unable to work, Ahmed al-Suwas managed to overcome the impact of shrapnel in his head and continue his career as a gymnastics player and trainer.

“I was injured in 2017 by an explosive barrel in Aleppo, and shrapnel settled in my head,” said Ahmed. “Doctors decided not to remove it because it was very close to the spinal cord.”

He emphasised that the location of the shrapnel puts him in constant fears, especially when performing certain movements in gymnastics, despite having undergone surgery to stabilise the shrapnel.

Ahmed, who won the 2012 Asian Olympics in Russia, said that he would feel excruciating pain if he fell on his head during a game.

The pain that Yousef, who has shrapnel near his neck, suffered from in his left arm eventually subsided, according to what he told Enab Baladi, but he is still unable to put too much effort on his arm.

This prevented Yousef from working after he had sought to earn a living in more than one place. He lost his job in a fabric-dyeing factory as a result of the extreme exhaustion he suffered from under the pressure of work and the consequent loss of productivity.

Yousef, Ahmed and Shaker require constant medical follow-up of the shrapnel in their bodies, according to Dr. al-Saud, who confirmed to Enab Baladi that shrapnel can have negative implications on a person’s health depending on their location.

According to the physician, if the shrapnel settled in the brain it could cause epilepsy, and if in the chest or abdomen it could cause infections due to the presence of a foreign body inside the body. In bones and soft tissue, it is very likely to cause infections on the long-term.