Hektoen International

A Journal of Medical Humanities

In the heart of Damascus

Kera Panni
Seaside, California, United States

Propaganda in support of President Bashar al-Assad between the Citadel of Damascus and the entrance to the suq (May 2007). Personal archives, photo by author.

Even as a child in the American suburbs, I knew my blood flowed from Syria. Relatives said my Jiddoo’s parents were farmers near Homs, and my Sittoo’s family was from the town of Mashta al-Helu in the coastal An-Nusayriyah Mountains. Still, I had only been able to create a fuzzy mental picture of my great-grandparents’ lives in the old country.

We do not know why they joined the first wave of Syrian immigrants to America. We do know that around 1918, they boarded a boat, crossed the Atlantic Ocean, and made their way to western Pennsylvania, where the men found work in the steel mills. My Jiddoo was born a few years later in a blue-collar neighborhood known as Syrian Hollow; my Sittoo, in a little town just north.

In their earnestness to assimilate, many of the families in this diasporic community shed their Arabic language and adopted Anglicized names. (My father and his brothers are Bob, Tom, and Jim.) But they kept their religious and culinary traditions—thanks in large part to the women at the heart of the Syrian Orthodox Church, who made sure the congregation received their sacramental wine with spongy squares of home-baked Syrian bread.

I grew up in the Pittsburgh suburb of Mount Lebanon, almost 10,000 kilometers from the Anti-Lebanon Mountains of Syria, but I had always wanted to make my ancestors’ journey in reverse. In spring 2007, when a friend was studying Arabic in Damascus, I could not pass up the opportunity to visit.1 Stepping out of the plane and into the desert heat,2 I felt a little light-headed. Maybe it was mild oxygen deprivation from the flight.

Archaeologists debate whether Damascus is the oldest, or just one of the oldest, continuously inhabited cities in the world.3 Evidence of human settlement in the area dates to 9,000 B.C.,4 but most experts agree that the oasis—strategically positioned at the intersection of trade routes between Africa, Europe, and Asia—became an important city around the third millennium B.C.5 The  Barada River runs through the arid plateau like an artery, carrying dissolved oxygen from the Anti-Lebanon Mountains to depleted tissues of the desert.

In the Middle Ages (476-1453), Damascus rose to prominence as the heart of Levantine industry. Syrian craftspeople had invented the art of blown glass;6 Damascene smiths were reputed to forge swords7 sharp enough to cut a single strand of hair falling across the blade.8 Merchants in the city’s suq peddled intricate lamps and metal beads,9 hand-painted ceramics and woven silks.10

It was in the waxing centuries of the medieval era, in 1213, that Ibn al-Nafis was born. From age sixteen through his mid-twenties, al-Nafis studied medicine at the prestigious al-Nuri Hospital in Damascus.11 His teacher was the revered Al-Dakhwar, who had served as the Egyptian sultan’s personal physician.12

Al-Nafis is credited with many discoveries during his lifetime, but he is most renowned for a passage in his medical encyclopedia, Al-Shamil fi al-Tibb (The Comprehensive Book on Medicine), that describes how the body exchanges oxygen between the lungs and the heart.13

The pulmonary artery carries deoxygenated blood from the heart’s right ventricle to the lungs, al-Nafis explained; and the pulmonary vein delivers the newly oxygen-rich blood from the lungs back to the left side of the heart.14

He was the first medical scholar to accurately describe pulmonary circulation.15

A Damascus marketplace displays modern-day wares under ancient arches (May 2007). Personal archives, photo by author.

Walking through the colorful alleys and under the crumbling arches of old Damascus felt like traveling through time. The Ancient City, one of six UNESCO World Heritage sites in Syria, is home to 125 monuments spanning a 5,000-year history—through Hellenistic, Roman, Byzantine, and Islamic rule.16

My friend and I visited the Umayyad Mosque, built in the eighth century A.D.17 and famous for its Byzantine mosaics—colorful landscapes of lush gardens and flowing rivers that decorate the mosque’s walls, prayer hall, and court facades.18 In the marketplace, I ran my fingers over beautiful chess sets inlaid with fractals of wood and mother-of-pearl. I held hand-blown drinking glasses up to the sun, watching the light bend, and admired intricate sterling silver jewelry priced much too low. It occurred to me that these arts had been practiced in these same streets for millennia, almost longer than my American mind could fathom.

This was four years before the country plunged into the civil war that continues to smolder today. But at the time, I was struck by how stable the country seemed. My visit coincided with Syrian President Bashar al-Assad’s “re-election” campaign, though he did not have any opponents. We passed fawning posters of the dictator on concrete walls, shop doors, and telephone poles. My friend translated for me:

“Dear leader, we love you!”

“From the heart, yes!”

When we arrived in Mashta al-Helu, my great-grandmother’s town, we were not able to track down anyone who recognized her name. But we did find an old Christian chapel at the top of a hill. I touched my forehead to a statue of the Virgin Mary, wondering if my great-grandmother had ever done the same.

That evening, soldiers patrolled an election rally in the town square, blasting songs of loyalty for the president over loudspeakers. A few days later, officials would announce that Assad had garnered ninety-eight percent of the vote, a sweep into his second seven-year term.19

That kind of iron-fisted consensus, I thought, must be what gives this country its staying power.

In 1924, Egyptian physician Muhyo Al-Deen Altawi came upon Ibn al-Nafis’s manuscript, “Commentary on Anatomy in Avicenna’s Canon,” and recognized it as the earliest known description of pulmonary circulation.20

In the manuscript, a twenty-nine-year-old al-Nafis challenged an accepted anatomical theory of the time.21 Galen of Pergamon, a Greek physician, had postulated that the blood in the right side of the heart travels through invisible pores in the cardiac septum. Emerging on the heart’s left side, Galen theorized, the blood mixes with air to create spirit, which is then distributed throughout the body.22

Al-Nafis had dissected enough cadavers, animal and human, to be skeptical. The tissue separating the heart’s right and left chambers, he argued, is too thick for blood to pass through. Instead, he reasoned, the pulmonary artery circulates blood from the heart’s right side to the lungs, where it is enriched with oxygen; and the pulmonary veins carry this blood from the lungs to the left side of the heart.23 From there, the systemic circulatory system takes over, shuttling oxygen-rich blood from the heart’s left ventricle to the rest of the body’s tissues. This network, like streams in a watershed, cycles oxygen-depleted blood from our tissues back to the right atrium—where the pulmonary arteries circulate to the lungs for another refill of oxygen.24

Historians estimate al-Nafis wrote around 110 volumes of medical literature; eighty of those comprised Al-Shamil fi al-Tibb, his unfinished medical encyclopedia.25 At the time, it represented the most robust summary of medical knowledge in the Islamic world.26

But al-Nafis did not stay holed up writing textbooks. After a move to Cairo in 1236, he served as chief physician at the Almansouri Hospital and, like his mentor Al-Dakhwar, was the personal physician to the sultan of Egypt. Somehow he also found time to study law, literature, and theology.27

Al-Nafis grew up during the Islamic Golden Age, marked by leaps forward in humanity’s understanding of the sciences, mathematics, and engineering.28 By the time of his death in 1288, however, cracks were beginning to form in the era’s hand-painted facade. The Ottoman Empire, establishing its first tiny foothold in the early fourteenth century, would grow to subsume most of the Middle East.29 And in the early twentieth century, when the empire finally released its grip on Syria, my great-grandparents let go, too.

A family poses for a photo as merchants sell textiles, jewelry and metal dishware in the Ancient City of Damascus (May 2007). Personal archives, photo by author.

Maybe they were tired of living under Turkish rule, of being the religious minority, of poverty. Maybe they followed the promise of a country where opportunities branch out like pulmonary arteries. I imagine that as the boat set out to sea, they prayed they would be delivered to a place where they could breathe easier.

In March 2020, Syria marks its ninth year of civil war. The Syrian Observatory for Human Rights estimates that 400,000 to 600,000 people have been killed in the conflict to date.30 The International Committee of the Red Cross and the Syrian Arab Red Crescent are working to distribute food, restore water supplies, and support medical services for regions in crisis.31

Among the war’s casualties are several UNESCO World Heritage sites.32 In 2013, air strikes reportedly hit a tower of Krak de Chevaliers, a Crusader castle built several centuries before Ibn al-Nafis’s lifetime.33 In 2015 a bomb exploded on a bus near Damascus’ historic citadel, killing at least four people and injuring dozens.34

Dark red, oxygen-poor blood flows from the heart’s right ventricle to the lungs.

So far, according to reports, the Ancient City’s oldest and most revered sites have been spared. The Umayyad Mosque is still standing. And somehow, more than two million people in Damascus are carrying on with their lives.35

For several years in the decimated suburb of Darayya, in the basement of a bombed building, residents created a “secret library,”36 stocking it with books they rescued from the rubble. Inside the library, students kept studying. Kids read books with their parents. Medical volunteers referenced medical literature. Perhaps one of them came upon al-Nafis’ encyclopedia and found the passage that would become his legacy.

Bright red, oxygen-rich blood rushes out of the lungs and re-enters the heart.

The heart keeps pumping.


  1. “Learning to love America while traveling in Syria. | Features ….” 7 Jun. 2007, https://www.montereycountyweekly.com/features/learning-to-love-america-while-traveling-in-syria/article_b70b323b-dcc3-53b6-8f70-7376304fb66f.html. Accessed 14 Jan. 2020.
  2. “Damascus – Wikipedia.” https://en.wikipedia.org/wiki/Damascus. Accessed 14 Jan. 2020.
  3. “List of oldest continuously inhabited cities – Wikipedia.” https://en.wikipedia.org/wiki/List_of_oldest_continuously_inhabited_cities. Accessed 15 Jan. 2020.
  4. “What is the oldest city in the world? | Cities | The Guardian.” 16 Feb. 2015, https://www.theguardian.com/cities/2015/feb/16/whats-the-oldest-city-in-the-world. Accessed 12 Jan. 2020.
  5. “Ancient City of Damascus – UNESCO World Heritage Centre.” https://whc.unesco.org/en/list/20/. Accessed 12 Jan. 2020.
  6. “Glass Blowing History – GlassBlowing Art – The History of Glass.” http://www.historyofglass.com/glass-history/glass-blowing-history/. Accessed 12 Jan. 2020.
  7. “Damascus steel – Wikipedia.” https://en.wikipedia.org/wiki/Damascus_steel. Accessed 12 Jan. 2020.
  8. Sharada Srinivasan; Srinivasa Ranganathan (2004). India’s Legendary Wootz Steel: An Advanced Material of the Ancient World. National Institute of Advanced Studies. OCLC 82439861. Archived from the original on 2019-02-11. Retrieved 2014-08-12.
  9. “Handicrafts in Damascus from ancient history to war victims.” https://npasyria.com/en/blog.php?id_blog=764&sub_blog=11&name_blog=Handicrafts%20in%20Damascus%20from%20ancient%20history%20to%20war%20victims. Accessed 12 Jan. 2020.
  10. “Ancient City of Damascus – UNESCO World Heritage Centre.” https://whc.unesco.org/en/list/20/. Accessed 12 Jan. 2020.
  11. “Islamic hospitals – Wikipedia.” https://en.wikipedia.org/wiki/Islamic_hospitals. Accessed 15 Jan. 2020.
  12. “Al-Dakhwar – Wikipedia.” https://en.wikipedia.org/wiki/Al-Dakhwar. Accessed 12 Jan. 2020.
  13. Majeed, Azeem (2005). “How Islam changed medicine”. BMJ. 331 (7531): 1486–1487. doi:10.1136/bmj.331.7531.1486. PMC 1322233. PMID 16373721. Retrieved 28 May 2019.
  14. “Systemic circulation | physiology | Britannica.” https://www.britannica.com/science/systemic-circulation. Accessed 12 Jan. 2020.
  15. “Ibn al-Nafis – Wikipedia.” https://en.wikipedia.org/wiki/Ibn_al-Nafis. Accessed 12 Jan. 2020.
  16. “Ancient City of Damascus – UNESCO World Heritage Centre.” https://whc.unesco.org/en/list/20/. Accessed 14 Jan. 2020.
  17. “Umayyad Mosque | Islamic Landmarks.” https://www.islamiclandmarks.com/syria/umayyad-mosque. Accessed 14 Jan. 2020.
  18. “Great Mosque of Damascus | The Metropolitan Museum of Art.” 9 May. 2012, https://www.metmuseum.org/exhibitions/listings/2012/byzantium-and-islam/blog/where-in-the-world/posts/damascus. Accessed 14 Jan. 2020.
  19. “Syrians Vote For Assad in Uncontested Referendum”. The Washington Post. Associated Press. 28 May 2007. Retrieved 13 January 2020.
  20. “Ibn al-Nafis – Wikipedia.” https://en.wikipedia.org/wiki/Ibn_al-Nafis. Accessed 12 Jan. 2020.
  21. Haddad, Sami; Amin A. Khairallah (1936). “A Forgotten Chapter in the History of the Circulation of Blood”. Annals of Surgery. 104 (1): 1–8. doi:10.1097/00000658-193607000-00001. PMC 1390327. PMID 17856795.
  22. “Galen – Wikipedia.” https://en.wikipedia.org/wiki/Galen. Accessed 12 Jan. 2020.
  23. “Knowledge of the circulation of the blood from Antiquity down to Ibn al-Nafis”. Hamdard Medicus. 37 (1): 24–26. 1994.
  24. “Pulmonary circulation – Wikipedia.” https://en.wikipedia.org/wiki/Pulmonary_circulation. Accessed 12 Jan. 2020.
  25. “Ibn al-Nafis – Wikipedia.” https://en.wikipedia.org/wiki/Ibn_al-Nafis. Accessed 15 Jan. 2020.
  26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964710/
  27. “Ibn al-Nafis – Wikipedia.” https://en.wikipedia.org/wiki/Ibn_al-Nafis. Accessed 12 Jan. 2020.
  28. “Islamic Golden Age – Wikipedia.” https://en.wikipedia.org/wiki/Islamic_Golden_Age. Accessed 15 Jan. 2020.
  29. “Ottoman Empire – WWI, Decline & Definition – HISTORY.” 3 Nov. 2017, https://www.history.com/topics/middle-east/ottoman-empire. Accessed 15 Jan. 2020.
  30. “Casualties of the Syrian Civil War – Wikipedia.” https://en.wikipedia.org/wiki/Casualties_of_the_Syrian_Civil_War. Accessed 15 Jan. 2020.
  31. “Syria crisis: Humanitarian situation in Syria now | ICRC.” https://www.icrc.org/en/where-we-work/middle-east/syria. Accessed 14 Jan. 2020.
  32. “List of heritage sites damaged during the Syrian Civil War ….” https://en.wikipedia.org/wiki/List_of_heritage_sites_damaged_during_the_Syrian_Civil_War. Accessed 12 Jan. 2020.
  33. “Latest victim of Syria air strikes: Famed Krak des Chevaliers ….” 13 Jul. 2013, https://middle-east-online.com/en/latest-victim-syria-air-strikes-famed-krak-des-chevaliers-castle. Accessed 12 Jan. 2020.
  34. “Damascus medieval citadel bus bomb blast kills four – BBC.com.” 1 Feb. 2015, https://www.bbc.com/news/world-middle-east-31083565. Accessed 14 Jan. 2020.
  35. “Damascus, Syria Population 1950-2020 | MacroTrends.” https://www.macrotrends.net/cities/22610/damascus/population. Accessed 15 Jan. 2020.
  36. “Syria’s secret library – BBC News – BBC.com.” 28 Jul. 2016, https://www.bbc.com/news/magazine-36893303. Accessed 15 Jan. 2020.

KERA ABRAHAM PANNI, B.A., Environmental Sciences; M.A., Magazine Journalism, is a communications professional based on California’s Central Coast. Before her current position with an ocean conservation nonprofit, she worked as a print journalist on the environment beat. In 2003, as a graduate student at the University of Oregon, she was honored with the Jack G. Shaheen Mass Communications Scholarship. Her master’s thesis on Arab-American identity after 9/11 was published in the book “Seeing Color: Indigenous Peoples and Racialized Ethnic Minorities in Oregon.” Although she considers herself relatively brave, she cannot look when the phlebotomist punctures her vein.

Highlighted in Frontispiece Volume 12, Issue 2 – Spring 2020

Winter 2020



Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.