Between hope and despair

Argentinian-Israeli surgeon devoted to helping Syrian refugees

05 March 2018

Alejandro Rosentul and Syrian refugee kid
Dr Alejandro Roisentul entertaining his young patients

It was the extent of their injuries—compounded by their youth—that most struck Dr Alejandro Roisentul when the first group of Syrian refugees showed up at Ziv Medical Center in February 2013. The arrival of those first seven patients—existing between hope and despair and ravaged by gunshots and blasts from explosives—marked the beginning of a steady stream of Syrian refugees in dire need of medical care. 

Since then, he has treated more than 200 of the 1,500 Syrian refugees treated in the hospital with multiple trauma injuries (most of them orthopedics), says Roisentul, Head of the Oral and Maxillofacial Surgery Unit at Ziv Medical Center, a medium-sized hospital located in Safed, just 40 kilometers from the border between Israel and war-torn Syria.

“Ours was the first hospital to receive Syrian refugees. In February 2013, we suddenly received seven patients, all at the same time, brought to us by military ambulance,” says Roisentul, an Argentinian-Israeli specialist in oral and maxillofacial surgery. “At that time, we didn’t know who these patients were. We didn’t know the nature of their injuries and we were surprised by their severity. It was the first time I had seen injuries of this kind. These patients were all male, all very young—teenagers.

A short time later, children—some as young as six—and women began coming, he says.

"Bombs have no respect for age"

Dr Alejandro Roisentul

“We have seen a lot of children. Bombs have no respect for age. Six or seven babies of refugee women have been born in our hospital because no facilities exist on other parts of the border,” he explains.

The way it works, Roisentul says, is that the refugees make their way to Syria’s border with Israel, and the Israeli Defense Force (IDF) transports them to Ziv Medical Center.

“The care we provide really is a humanitarian act towards these people. On their side of the border, people are dying,” he says, clearly moved by those patients’ plight. “From the beginning in February 2013, there was no discussion of whether we would treat these patients. As human beings, you don’t think about things like religion or nationality. Any human being deserves the best treatment. As maxillofacial surgeons, our mission in this life is to treat patients.

In fact, Roisentul believes he has reached this point in his career in order to help those most in need. It’s a demanding mission for both his team of senior oral and maxillofacial surgery (OMFS) specialists, Daniel Lesmes, DMD, and Keren Yudovich, MD, DMD, and Ziv Medical Center, which serves a population of 250,000 people in the Golan Heights and Galilee areas.

Ziv Medical Center Ziv Medical Center
“Maxillofacial has emerged as a specialty for this hospital since I opened the maxillofacial unit here 20 years ago with the help of my mentor, Dr. Daniel Temkin,” Roisentul says. “At one time, they thought we would be doing fillings and extracting teeth. We proved to the hospital that maxillofacial specialization is very important for treating complicated injuries and multiple trauma injuries.”

The cost of caring for the Syrian refugees is underwritten by the Israeli government, he explains.

“A non-refugee patient might arrive for a mandible fracture and stay one to three days, but these patients come here and cannot go home after their treatment because they have no place to go,” says Roisentul. “Sometimes in orthopedics cases, a patient may stay here for three to six months. This is necessary; otherwise, these patients will die.”

Because these patients are no full refugees—they have no visas, official documents, or families to sponsor them—they exist in a kind of limbo. Ziv Medical Center’s staff tries to shift the balance in their lives toward hope.

“We open a file and start treating them—not only physically but psychologically, as well,” he says. “We want to give them some good feelings about us, to demonstrate that we are all human beings. We love these patients as they are, even if our countries are enemies.”

"We love these patients as they are, even if our countries are enemies."

Dr Alejandro Roisentul

A complicated case

Roisentul recalls one particular case where he and his team at Ziv Medical Center made a real difference in a patient’s life.

“This male patient in his 20s had been injured three years previously by a gunshot,” he says, adding the bullet entered the patient’s upper left orbit, passed through his face and smashed his mandible before exiting. “The patient developed a mass of scar bone tissue and could not open his mouth to eat so he could consume only liquids. He also was unable to brush his teeth. We managed this complicated operation to open his mouth.”

Alejandro Roisentul OR AOCMF Giving a second chance at life for refugees
To ensure the best possible outcome for the patient and to address the patient’s rare condition, an ankylosis, Roisentul and his team performed an transmasseteric antero-parotid facelift. “The antero-parotid transmasseteric facelift approach permitted direct exposure and safe osteotomy,” Roisentul explains.
Rather than dissecting the parotid gland, the parotid gland was retracted posteriorly to expose the masseter muscle, and the muscle fibers were incised and retracted obliquely to directly expose the coronoid process area. This allowed Roisentul to gain access inferiorly and medially to the zygomatic arch.

“That provided direct access for excellent exposure and ability to perform the osteotomy of the mass of scar tissue that was limiting the patient’s ability to open his mouth,” he says.

Able to eat solid food again within a few days of the surgery, the patient was eager to express his thanks. “He told me, ‘I knew you could do this,’” says Roisentul. “This patient will be one of those people who remembers that he was helped. Who knows? Maybe he will be an ambassador of peace in the future.”

"My hands have touched the enemy's blood, not to tear his flesh, but to cure his wounds."


Dr Alejandro Roisentul

Objectives shared with the AO

In addition to demonstrating the compassionate care provided by Ziv Medical Center, that young man’s treatment illustrates what Roisentul—and many others active in the AO Foundation community—commonly refer to as “the AO spirit.” That spirit reflects the foundation’s vision of excellence in the surgical management of trauma and disorders of the musculoskeletal system, he says.

“My first encounter with the AO was an AOCMF course I took years ago in Slovenia. It was the first time I really had good, formal training in trauma care,” Roisentul says. “After that, I followed the AO’s activities by the Internet, AO publications and AOCMF, and took part in AOCMF temporal mandibular joint (TMJ) courses in Germany. As an organization, the AO for me represents opportunities to communicate with other surgeons and get advice from others in the community. It’s a big family of people who care about the profession, improving patient care, and teaching the next generation of surgeons. Our objectives are the same: we are all working together to improve patients’ quality of life.”
Dr Alejandro Roisentul AOCMF Dr Alejandro Roisentul
Dr Alejandro Roisentul graduated as a dental surgeon from Universidad de Buenos Aires in Argentina and completed his residency program in oral and maxillofacial surgery in Poryia Hospital in Tiberias, Israel and The Queen Victoria Hospital in East Grinstead, Great Britain. Certified as a specialist in oral and maxillofacial surgery, he currently is Head of the Oral and Maxillofacial Surgery Unit as Ziv Medical Center in Safed, Israel. Additionally, Roisentul is a clinical instructor with the Bar-Ilan University Faculty of Medicine in Safed, Israel. He is immediate past president of the Israeli Association of Oral and Maxillofacial Surgeons and has earned a variety of awards internationally in recognition of his human rights work and humanitarian service.