It was around 4 pm on an otherwise quiet afternoon in the Syrian rebel-held city of Douma when the bombs began raining down. Mustafa got to work in the basement of a crumbling building.
He was one of three medical students and eight nurses accompanying a lone doctor in what passed for an emergency room. They worked for 30 straight hours, treating the wounded staggering or being carried by others into the makeshift hospital.
Those 30 hours were just the prelude.
Before the end of Mustafa’s second chaotic day in the repurposed basement, Douma was known across the globe as the site of an apparent nerve gas attack on civilians. Horrific videos of the aftermath, showing the bodies of victims with white foam seeping from their mouths and nostrils and frightened children with inhalers pressed to their faces, went viral online.
"I will never forget the screaming of the children, how afraid they were. It was a terrifying moment to see all these people suffering so much," said Mustafa, who is going by a pseudonym in this report. McClatchy agreed to conceal his identity to protect him and his family in Syria.
After the attack became known, President Donald Trump promptly blamed Syrian strongman Bashar al-Assad, as well as Russia for supporting his regime. For several days threats between the world’s two largest nuclear powers bounced back and forth. On Friday evening — shortly before dawn Saturday in Damascus — the U.S., France and Britain launched coordinated missile strikes into Syria, hitting a chemical weapons research facility and two storage sites, according to Gen. Joseph F. Dunford Jr., chairman of the Joint Chiefs of Staff.
On Saturday, U.S. Ambassador to the United Nations Nikki Haley warned, at a meeting of the U.N. Security Council that was called by Russia, that the United States military was “locked and loaded” to strike again if there’s a repeat of the chemical attack.
Meanwhile, first-person stories of the gas attack on Syrian civilians that prompted the week of nervous waiting for a U.S. response have begun to emerge. Mustafa talked to McClatchy via a cellphone call and texts to a Syrian-American doctor who taught medical students, including Mustafa. The doctor asked not to be identified because he feared for his family back in Syria.
“We were able to gather that it was a chemical attack from the descriptions we received from the injured. They saw yellow smoke, they suffocated, and they’ve described an overly pungent smell of chlorine,” he said. “We have witnessed this before ourselves and remember the strong smell of chlorine. This attack was so strong that the smell of chlorine coming from the patients has made it hard for us to breathe.”
The communication with Mustafa came as he was evacuated to points north, along with hundreds of other Syrians. They left, he said, on buses belonging to the Syrian government along routes protected partly by Russian air power and military advisers. He and friends provided cellphone photos to McClatchy they said were taken inside the buses.
Mustafa’s account fills in some of the blanks on an incident that the Syrian regime claims is fake news and Russia insists was concocted by non-governmental organizations seeking to create sympathy for opponents of the Assad government. On Friday, Russia changed its account, saying Western governments staged the attack to embarrass Assad and his ally Vladimir Putin.
After 30 hours of bombing that started April 6, driving families into basements and other underground protective spaces, the first chemical weapons began falling around 7 p.m. local time on April 7, he said.
“Hours after the attack people were able to enter the town after the smell of chlorine has faded, unfortunately, most apartments still had the fumes as some of them had closed windows and poor ventilation,” recalled Mustafa. “This is how people hide and stay safe when shelling occurs and unfortunately, these hiding places have became their own graves.”
Victims started coming into the basement clinic, in operation for about a year after the previous one was destroyed. They said they saw a yellowish gas in the air and complained of difficulty breathing. The initial victims had mild symptoms. But soon many civilians began streaming into the facility.
By Mustafa’s count, he and the other medical personnel were able to help about 70 people. He believes the death toll in his immediate surroundings was 43, mostly women and children.
Four hours into the chemical attack, he saw two young children who were brought in dead, having choked on secretions. Rigor mortis was setting in.
For five hours, Mustafa and his fellow med students, the lone doctor and the nurses frantically attended to the victims, separated into triage areas by sex. A large number had problems breathing and smelling of chlorine.
There wasn’t much on hand to work with, only four tanks of oxygen to use on patients. The medical crew alternated the masks between people with mild symptoms and those in worse shape.
The treatment protocol involved a series of steps. First victims were treated with a bronchial dilator, essentially an asthma inhaler that opens up the lungs. This account corresponds with videos circulating on social media showing stunned children in Douma being forced to breathe in the mist from inhalers and being doused with water.
When symptoms persisted, Mustafa said, the next step was to give the victims dexamethasone, a corticosteroid often used for severe cases of asthma. For the most severe symptoms, the team turned to Atropine, a drug used to counter the effects of a wide range of poisons.
“The situation was very, very bad, the symptoms also included coughing blood, slow heart rate, dilated pupils, and it was very hard for us to rescue them with the limited supplies we had,” said Mustafa, adding that some victims suffered seizures, while others vomited blood.
Having treated patients suffering from chlorine gas attacks in Syria before, Mustafa said this time was different. The cases were more severe, making him question if another chemical was added to the chlorine bombs. On Friday night, Dunford said the allies were not yet certain if chlorine was used alone or if another chemical was also involved in the attack.
Some reports said victims suffered burns of their corneas. Mustafa said he did not notice this amid the onslaught of patients seeking urgent care.
Mustafa believes Russian air raids that brought the first bombs drove civilians into basements, paving the way for Syrian nerve agents to be dropped with even more deadly effect than usual, as people would be trapped inside and not realize until it was too late that they had to get out. Those who survived the chemical round were evacuated from Douma, leaving portions of enclave uninhabitable for residents and government opponents alike.
When asked about the emotional toll on medical students learning under the most unimaginable circumstances, Mustafa was philosophical.
"You’re not thinking about what is happening around you, you are not thinking about being killed, you have to believe this is your fate by God," Mustafa said. "If you get killed, at least you can say I died trying to do something."
He then offered a plea: “My message to the world is that since the first chemical attack in 2013, we were promised intervention from the rest of the world, now with what happened ...Help us for the rest of Syria.”
Hany Attia contributed to this report.
Kevin G. Hall: 202-383-6038, @KevinGHall