A photo of a young girl with brown hair whose face has been disfigured in a chemical attack sits on a bed and looks at the photographer. She wears a blue knit jacket, blue knit skirt, and a white dress shirt. The walls in the room are white, the blankets and sheets on the bed are white, and there is a red Teddy bear on the bed.A photo of a young girl with brown hair whose face has been disfigured in a chemical attack sits on a bed and looks at the photographer. She wears a blue knit jacket, blue knit skirt, and a white dress shirt. The walls in the room are white, the blankets and sheets on the bed are white, and there is a red Teddy bear on the bed.

American Doctors Are Reconstructing the Youngest Faces of a Brutal War

These Syrian children survived attacks that left them burned beyond belief. One program thousands of miles from home is offering them life-changing treatment.

American Doctors Are Reconstructing the Youngest Faces of a Brutal War

Winter was on its way in northwestern Syria when Hana Al Saloom awoke around 6 a.m., preparing to make morning tea. There was a chill in the air. Her 5-year-old daughter, Aysha, was asleep near a gas heater, as her brothers and sisters slept in other rooms. Hana’s husband stirred nearby.

Hana blinked. The blast knocked her down. Silence. Then screams. She swiveled on her knees. She looked around. Everything was on fire. It was as if her house had exploded. She didn’t realize it right away, but a missile had blown off the side of the concrete-and-steel home. The impact must have caused the gas heater to blow up too. The flames spread fast.

Hana raced outside with her older children. That’s when she saw her husband carrying Aysha’s listless body. He had reached into the flames to pull her out. His legs and hands were seared. But Aysha was injured the worst. Neighbors rushed to put out the fire on her body — and all around them. By the time they blotted out the flames, Aysha’s flesh had turned a chalky whitish-gray. Her skin was smoldering.

“First, I was screaming,” Hana remembers. “And then I was crying.”

A neighbor rushed Aysha and her dad to a hospital. But since Aysha’s wounds were so severe, she was transferred to another hospital across the border in Turkey.

Hana would not see her daughter again for seven months.

* * *

Three years later, sitting next to Aysha’s bedside at Shriners for Children Medical Center in Pasadena, California, Hana pulls out her phone and scrolls to a photo of her daughter before the bombing, a smooth-skinned girl with pink lips and reddish-blonde eyebrows. Her wavy hair dances around her bright eyes. There she is in a white blouse. There she is in a purple plaid dress. There she is with pigtails, sitting on a swing, wearing a white, blue and red polka-dotted tutu.

Aysha Al Saloom, 8, at the apartment in Irvine, California, where she lives with her mother. Aysha will spend several years here while she undergoes surgeries for her burn wounds.
Aysha Al Saloom, 8, at the apartment in Irvine, California, where she lives with her mother. Aysha will spend several years here while she undergoes surgeries for her burn wounds.

Hana shows a photo taken on the day of the bombing, moments after Aysha’s father pulled her from the flames. Her mouth hung open, her eyes slightly cracked, her neck as reddish-pink as a bloody raw steak. Her face looked as if someone had slathered it with a mud mask. Pasty in some places, blackened in others. But her skin, Hana says, was still there, even if it had turned a different shade. Badly hurt and on the brink of death, that is how Hana remembered her daughter on the day she was burned.

After Aysha was whisked away to Turkey for medical care on the day of the accident, an uncle who accompanied her sent a photo of her face wrapped in white bandages. But not many more photos arrived in Hana’s phone over the next few months. Instead, the uncle would call regularly with updates from Turkey. Aysha’s burns would heal, he told Hana. She was going to be OK. Doctors focused on her lungs especially, which were damaged from the smoke.

Hana prayed and cried, waiting for Aysha to be well enough to come home. Finally, that day came. Hana waited, and when she saw the car coming down the road, she ran out of her house in time to see her little girl step out.

She remembers that Aysha wore jeans and a red and white striped dress. Her hair had been shaved off. But it was her face that shocked Hana the most. She did not know that the burned layer of skin had fallen away in sheaths, and that the new skin that replaced it was a combination of grafts, recent growth and irregular-shaped scars. Aysha’s lips had been whittled away too. It looked as if someone else’s flesh had been stretched too thin across her facial bones.

Aysha did not look like the little girl her mother remembered, but Hana had no doubt she was her daughter. She grabbed Aysha and carried her inside of the house. She sat down, weeping. “I would not let anybody touch her, or talk to her,” Hana remembers. “I just took her to the room, and we continued hugging each other, hugging for hours.”

Hana recalls how Aysha was welcomed back to parts of the community, but the children who used to play with her refused. “In Syria, all the kids, when they saw her, they were scared of her,” Hana says. “People who used to know her, who she used to play with, nobody came close to her.”

When Hana heard from a doctor in Syria that there was a program in America with premier doctors treating Syrian children with burns, she put Aysha’s name on the list. In May 2018, they boarded a plane and arrived in California.

For the last 10 months, Aysha has lived in Southern California, traveling with a chaperone several days a week — an hour each way from an apartment in Irvine — to the hospital in Pasadena for checkups and surgeries, all to treat the burns and scars that run across her arms, chest, neck and face. She is one of six Syrian children who have come to the U.S. with the help of the Burnt Children Relief Foundation, which launched in 2014. Given the immigration hurdles and expenses for travel, living and medical care, it would be almost impossible for most Syrian families to travel to the U.S. and access these world-class surgeons without the help of this rare kind of program.

“These kids don’t have passports or IDs,” says Susan Baaj, chairwoman of the Burnt Children Relief Foundation, which works on their behalf to obtain these documents. Baaj, a Syrian-American who lives in Orange County, is a founding member of the Syrian American Council, Los Angeles chapter. She has been active in humanitarian projects since the war in Syria began. “It’s very challenging to get them through all these borders to come to the United States.” Yet in the wake of travel bans and curbs on refugees, the U.S. State Department has remained supportive of temporary visas to bring burned Syrian children and their families to the U.S. for treatment through the foundation, requiring that they return promptly to their home country after the surgeries are complete.

“If you can bring your child to the hospital, we will treat you,” says William Norbury, a surgeon specializing in plastic and reconstructive surgery at Shriners Hospitals for Children in Galveston, Texas, which has treated four of the Syrian burn victims. “If you do have insurance, we will try and claim on your insurance,” but if not, he adds, “we offer the same treatment.”

Three Syrian boys—Anwar Almaddad, 7, Yazen Al Khalid, 8, and Abdullah Al Ahmad, 9—play on their tablets and phones at their apartment in Galveston, Texas. The boys are all being treated for their burns at the nearby Shriners Hospitals for Children.
Three Syrian boys—Anwar Almaddad, 7, Yazen Al Khalid, 8, and Abdullah Al Ahmad, 9—play on their tablets and phones at their apartment in Galveston, Texas. The boys are all being treated for their burns at the nearby Shriners Hospitals for Children.
(L-R) Yazen, Anwar, Abdullah, and Manal Al Hindawi, 13. All four children and their families live together in one apartment in Galveston.
(L-R) Yazen, Anwar, Abdullah, and Manal Al Hindawi, 13. All four children and their families live together in one apartment in Galveston.

Twenty-five more burned Syrian children are currently on waiting lists to come to the U.S. for medical care at Shriners with the help of the Burnt Children Relief Foundation, which relies on donations to secure funding to pay for travel, housing and living expenses. Currently they do not have enough funding to bring all of the children who need help.

There have been half a million deaths and at least two million injuries since the start of the Syrian Civil War in 2011, and the young Syrian patients who show up at Shriners come with gnarled hands, missing eyes and knotty scars, as well as obstructed breathing, hearing and vision. Some can barely swallow. Their injuries are the direct result of air strikes and, in some cases, chemical weapons attacks.

“The intensity of the burns inflicted on these kids are beyond belief,” says Saed Moujtahed, founder of the Burnt Children Relief Foundation and president of the Syrian Institute for Progress, which focuses on supporting Syrian refugees. A longtime Syrian-American activist within the Arab-American community, Moujtahed worked on developing the partnership with Shriners as well as getting support from politicians. “Many victims die. Those who survive their burns have a really tough, heavy pain, not only from their burns, but also psychologically.”

Norbury recalls the injuries of one Syrian boy he treated recently. “He couldn’t see with his right eye. His nostrils were almost completely destructed,” Norbury says. “His hands had some of the worst scarring I’ve ever seen. It looked like he was balancing a baseball on the back of his hand.” When Norbury removed the scars, the entire mass was four centimeters thick — from the outside to the deepest part of the scar.

So far, doctors have taken skin from Aysha’s legs and grafted it onto her arms, and from her stomach to her cheeks. They’ve smoothed the surface of her skin with lasers. But she still has more surgeries to go.

When Aysha is not in the hospital, she plays alone, or studies with a 17-year-old Syrian girl, Hamama, who is also receiving treatment at Shriners and lives with Aysha and her mom in the Irvine apartment. Hamama lost her parents, along with key parts of her memory, when her village was attacked. She cannot recall her past, the accident, or even her family members who died. Sometimes Aysha and her mother wonder if Hamama’s memory loss is a blessing.

Hamama Almansoor, 17, in the Irvine, California, apartment where she lives while being treated at Shriners Hospital for Children.
Hamama Almansoor, 17, in the Irvine, California, apartment where she lives while being treated at Shriners Hospital for Children.

They occasionally go to the shopping mall, or out to eat. Aysha collects dolls, watches Disney cartoons, and loves Skittles. But mostly she longs to attend school in a building outside with other children, even if they stare or laugh at her. “Can I go to school only for one day, one day?” she begs. It is too risky. Doctors have prohibited her from attending school outside because they worry the sun and environment could harm her already fragile skin and nervous system.

Hana homeschools Aysha, who tries to stay in good spirits, even though she wishes she had other kids her age to play with. Sometimes she tells her mom, “I’m so bored, I don’t want to live.”

When she does go outside for brief periods, she worries about what people think of her. Once, Aysha spotted a woman pushing a stroller. She noticed a toy fall from the stroller to the ground. Aysha thought of picking up the toy to give to the baby. Then she hesitated and told her mom, “Go pick up the toy and give it to that child.” Her mom asked why couldn’t she pick it up herself. Aysha answered, “The baby will be scared of me.” Every night, the magnitude of all that has happened in the last two years sets in, as Aysha cries herself to sleep in her mother’s arms.

Aysha shows a photo of herself from before she was injured in a missile attack.
Aysha shows a photo of herself from before she was injured in a missile attack.

At Shriners, Hana helps Aysha change into a tiger-printed hospital gown, and rubs the patchy scars on her daughter’s legs, areas where doctors have removed swaths of flesh for skin grafts to treat the burned and disfigured spots on her face. Hana tucks the a blanket around Aysha’s thin body, and brushes her clove-colored hair out of her eyes, kissing her marbled, ruddy forehead.

A nurse in a blue cap and gown takes Aysha’s blood pressure. On the television, a shark tries to catch a dolphin. “Baby shark do-do-do-do-do-do,” Aysha sings, clapping her hands together like jaws. “Daddy shark do-do-do-do-do.”

Hana wears a gray head scarf and a red trench coat, which she has buttoned. She gives Aysha rosewater. She is often so focused on her daughter, she forgets about herself. Hana left five other children behind in Syria. Though Hana and Aysha video chat with their family members back in Turkey and Syria regularly, they know that they will likely not see them again for at least another two years. That is how long the doctors expect it to take to complete the needed surgeries. Hana’s eyes well with tears when she mentions she has not yet met her grandchild, born since they came to the U.S.

Abdullah and Anwar on the merry-go-round at the local theme park in Galveston.
Abdullah and Anwar on the merry-go-round at the local theme park in Galveston.
A doctor examines Abdullah, while his mother looks on, at the Shriners Hospitals for Children.
A doctor examines Abdullah, while his mother looks on, at the Shriners Hospitals for Children.
* * *

When Aysha was a baby, her family resided in the close-knit village of Heesh, where she and her husband lived off the land, raising animals and growing their own food. They made cheese and traded it for other products. Their agrarian life was peaceful, Hana says, until the military came in 2012 and ordered everyone in the village to leave. Heesh would become a bloody battleground as opposition fighters and Assad-regime forces clashed — artillery, rockets and mortars dropping over the hamlet, driving out residents and killing those left behind.

Hana remembers gripping Aysha in her arms, carrying a bag of just a few clothing items, and making the two-week trek from Heesh to the border of Turkey on foot, with her husband and six kids. Aysha would sleep against her mother’s chest even as bombs fell around them. Each time, they would duck for cover as Hana told her older kids, “Do not get up. If we make it out alive, we are alive. If we don’t make it, God will have mercy on our souls.”

They spent four years in the camps. Aysha learned to crawl, and walk, between the tents. Since their entire village and extended family members had relocated there too, Aysha knew many people. She would spend her days going from canopy to canopy, hiding and hunting for food. The neighbors would bring Aysha back to her mom and say, “Here, take your daughter!” To which Hana would reply jokingly: “Why are you giving her back? You keep her!”

The family eventually learned that the fighting had subsided and they could return to Heesh, but when they made the long journey back to the village, they found a heap of rubble, broken glass, burned toys, cracked concrete, dust, dirt and crumbled storefronts. The ceiling had collapsed. The living room was a hill of rocks. Like the rest of the village, they rebuilt their home, one concrete slab after another. Less than a year later, it was not fully intact, but they had repaired it enough to live within its walls again.

Then, the missile hit.

Manal’s mother (center) fixes her wig, with a little help from Yazen's mom.
Manal’s mother (center) fixes her wig, with a little help from Yazen’s mom.
Abdullah’s mother holds his hand as he is wheeled into the operating room for a follow-up procedure.
Abdullah’s mother holds his hand as he is wheeled into the operating room for a follow-up procedure.
* * *

“How are we doing here?” the Shriners doctor asks, pushing back a curtain as he enters the hospital room. “Is she sleeping?”

Aysha’s eyes are slightly open, but she is snoring. Her nostrils are narrow pricks that don’t take in enough air. She has no eyelashes, no eyebrows, and her lids don’t fully close when she sleeps.

The doctor begins to make marks on her ears with a marker. “What we want to do is, maybe improve the nostrils a little bit for her, so she can open it up,” he says. “Then the ribs, we’re going to go down here. There’s going to be a little incision like that on the ribs. We’re going to take a little piece of that rib out, and then we’re going to shape it into this part of the ear.”

“We know you’re going to do your best,” a translator for Hana says, looking at Aysha curled up with a stuffed animal. “She’s calm as an angel.”

After today’s surgery, Aysha’s head, arm, stomach and nose will be wrapped in bandages for weeks. Once she’s healed enough, she will have another surgery.

Doctors know the patients may never look the same as before, but they hope to help them live a more normal life by improving their burn injuries and deformities step by step, until they look and feel closer to the kids they are inside. The ones who skip down halls, sing YouTube songs, and grab for toys like other kids their age — without fear of frightening others.

Anwar plays, with the help of Abdullah's mom, Kawthar, at a local park in Galveston.
Anwar plays, with the help of Abdullah’s mom, Kawthar, at a local park in Galveston.

At 10 a.m., the doctors prepare to operate. Hama tells Aysha to open her mouth. It’s time to take her anesthesia. The syringe is filled to the tip with the bright pink liquid. “Cherry taste,” a nurse says. Aysha breathes deeply, gathering the courage to drink it down. Hama squeezes the medicine into Aysha’s mouth. She drinks it down with a grimace and wipes her lips.

Minutes later, Aysha is groggy. She can’t lift her arm on her own. Her mom leans in close. “What does my love want?” Hana says. Aysha says nothing, her eyes droop. “What does my love want?” Hana strokes her hair.

A few minutes later, the nurses wheel Aysha out of the room, down the hall, as Hana watches from behind. “My baby.” Suddenly, the nurses stop midway between the automatic doors. Aysha is trying to call out. Her voice is so faint. Mama! Hana hears her. Mama! Hana rushes to her side once more.

(L-R) Hamama, Hana, and Aysha in Irvine, California.
(L-R) Hamama, Hana, and Aysha in Irvine, California.