Makeshift Captagon Labs Emerge in Syria from Rubble of Assad’s Narcotics Trade

Asharq Al-Awsat examines the impact the drug has and continues to have on the country.

Syria's new authorities burn hundreds of tons of Captagon pills and bags of hashish at the headquarters of the Fourth Division in Damascus. (EPA)
Syria's new authorities burn hundreds of tons of Captagon pills and bags of hashish at the headquarters of the Fourth Division in Damascus. (EPA)
TT

Makeshift Captagon Labs Emerge in Syria from Rubble of Assad’s Narcotics Trade

Syria's new authorities burn hundreds of tons of Captagon pills and bags of hashish at the headquarters of the Fourth Division in Damascus. (EPA)
Syria's new authorities burn hundreds of tons of Captagon pills and bags of hashish at the headquarters of the Fourth Division in Damascus. (EPA)

Ahmed el-Jouri

 

Syria has not only endured a war that shattered its cities, but also a quieter conflict—one that devours lives long before bodies fall. Amid the charred ruins of burned-out neighborhoods, an entire generation has grown up under the grip of a cheap pill originally intended for export but now flooding the local market.

The story began when the former Syrian regime transformed Captagon—a synthetic stimulant made from amphetamine and theophylline—into a lucrative war currency.

Once a controlled substance, it soon became a torrent surging through the country's alleys and streets, robbing youths of their futures and turning dreams into nightmares.

By 2020, the crisis had deepened. The price of a single Captagon pill plummeted from $1.50 to just five cents—cheaper than a cup of tea.

The drop reflected a cascade of events: the enforcement of the Caesar Act sanctions, sweeping sanctions targeting the Assad government, Lebanon's economic and banking collapse in late 2019, restrictions on dollar transactions and withdrawals from Lebanon, and tighter control over land borders that slightly curbed smuggling.

This Asharq Al-Awsat investigation, drawing on field visits to areas of post-Assad Syria and interviews with pharmacists and doctors in Amman and Erbil, retraces the production pipeline of Captagon.

It also features testimonies from addicts and their families, painting a stark portrait of a drug that fuels despair in a nation already exhausted by war.

A member of the Syrian security forces at a Captagon factory in Douma near Damascus on December 13. (AP)

In the shadows: Captagon addiction grips Syria's youth

In the crumbling streets of Damascus, where tangled electric wires dangle like specters above weary passersby, a toxic trade thrives under innocent names—“energy pills”, “happiness tablets” and others depending on the dealer. But behind the playful labels lies a systematic crisis. Syria's youth are not falling to addiction by chance—they are being consumed by design.

According to the International Labor Organization, 39.2% of working-age Syrians (15 and older) were unemployed in 2023. But statistics say little about how people like Ahmed, 19, spend their days.

Slumped on a crumbling curb in Damascus' Rukn al-Din district, Ahmed stares at his tattered shoes as a nearby dealer leans in: “This pill will make you a man... you'll work like a horse without feeling tired.”

Ahmed didn't know that the “man” he was promised would become enslaved to a handful of blue pills. The long hours at a bombed-out workshop turned into a nightmare only numbed by more doses.

His story is far from unique. It echoes across Syria like a shared curse in a land battered by war and poverty. In this darkness, Captagon glimmers like a false shooting star. Sources recount how the pill knocks down young people one after another, like dominoes—girls included.

Even the dream of escape has become part of the tragedy. Some sell family land to fund a risky boat journey out of the country. One man made it only as far as a Turkish prison—addicted, penniless, landless, and with no future.

This investigation collected over a dozen testimonies from across Syria—either directly from addicts or their families—offering a window into a drug crisis that has taken a darker turn since the fall of Assad's regime.

What was once a tightly controlled trade, reliant on pharmaceutical infrastructure and exports while feeding a growing domestic market, has devolved into a chaotic, deadly business claiming more lives through overdoses and despair.

Yasser, 17, from Aleppo, was kicked out of his family home and now lives in a basement room owned by his uncle-in-law.

“My friends used to laugh when they took the pills,” Yasser told Asharq Al-Awsat.

“They told me it felt like being the hero in a video game. I tried them to prove I was brave like them. Now, I wander the streets like a ghost. I hear my mother's voice haunting me. On cold nights, I sneak back to our house, touch the locked door and imagine a shell falling on me... maybe death would offer me a forgiveness I don't deserve,” he added.

In the northeastern city of Hasaka, Ali, 22, from Deir Ezzor, spoke after a grueling day of physical labor. “One day, I carried sacks of flour on my back for 10 straight hours,” he recalled.

“My boss was watching, then tossed me a pill and said, 'Take this—it'll make your back like iron.' Now, my back carries more than weight... the heaviest burden is what I see in my children's eyes. When I get home, I pretend to sleep so they won't come near me. I hear them whisper, 'Papa sleeps like he's dead.'”

Mohammad Abu Youssef, 45, rubs his cracked hands and gazes at a photo of his eldest son.

“I sold my health, worked myself to the bone just to pay his school fees. But Captagon stole him from me,” he said.

“When I found him trembling like a leaf in the corner, I screamed, 'Why didn't you die in the bombing?!' I tried sending him to Europe with smugglers, but he fled the truck halfway and returned months later—his eyes are just two black voids. Now, I've locked him in the house. I buy the pills for him myself and pray every night that God takes him.”

Captagon pills concealed in fake fruit found inside a factory in Douma east of Damascus. (EPA)

No rehab, no way out: Syria's addicts face slow death

In a country ravaged by war and addiction, the absence of rehabilitation centers is proving fatal for many. Without treatment options, a growing number of Syrians are left to spiral deeper into dependency—with no support, no shelter, and no escape.

Dr. Rawan al-Hussein, who requested using an alias for safety reasons, works with a branch of the health directorate and also consults for a non-governmental organization focused on addiction cases. Each day, she sifts through piles of case files, trying to salvage what's left of shattered lives.

“Just last week, a frail young man came to me carrying his infant daughter,” she recalled.

“He said, 'Take her before I sell her for pills. I don't even have a bed to put her in.'”

With rehab facilities scarce or nonexistent in many areas, stories like his are becoming tragically common—leaving medical workers overwhelmed and addicts trapped in a slow-motion collapse.

Al-Hussein exhaled deeply as she gathers water-damaged papers from her desk.

“International organizations send us boxes of medicine without assessing our needs,” she said. “Our youth are dying because the toxins are already in their blood. What are we supposed to do with bandages for wounds no one can see?”

The real tragedy, she explained, lies not just in the spread of addiction, but in the absence of mental health and rehabilitation services.

Staff working in Syria with the UNHCR and the World Health Organization told Asharq Al-Awsat that as of February 2025, there were no more than 10 specialized rehabilitation centers across the country, while the need is estimated at over 150.

With more than 70% of health facilities damaged or destroyed by war, accessing emergency care or psychiatric treatment has become nearly impossible.

“Even the programs that do exist are struggling,” al-Hussein added. “They rely heavily on volunteers and lack basic psychiatric medications.”

But the crisis runs deeper than infrastructure. Stigma, too, is a powerful barrier. “In Daraa, for example, residents rejected plans to open a rehab center out of fear it would tarnish the area's reputation,” a local organization told Asharq Al-Awsat.

Caught between a crumbling healthcare system and a society that shuns them, Syria's addicts are left to fight a silent war with little hope of rescue.

Captagon after Assad: Makeshift labs and a generation being wiped out by doses

The fall of the Assad regime did not mark the end of Syria's suffering—instead, it ignited a new phase of chaos, more fragmented and deadly.

As state institutions collapsed during years of war, young people became easy prey to a cheap addiction. Now, the regime's toxic legacy is playing out in the shadows through a deadlier, more decentralized Captagon industry.

While the new authorities dismantled public-facing drug labs in the wake of Assad's downfall, they failed to anticipate what would come next: the splintering of production into informal workshops run by former smugglers and recovering addicts navigating a shattered economy.

The once-affordable pill that had flooded the streets is now scarcer—and more expensive—driving many addicts to work inside the very workshops that sustain their addiction.

These makeshift labs operate with no safety standards, mixing dangerous chemicals by hand, without protective gear, and relying on improvised recipes that often push the drug's potency to lethal extremes.

In this post-Assad vacuum, Syria's Captagon trade has not disappeared—it has mutated, dragging a generation deeper into a cycle of desperation, exploitation, and overdose.

In the immediate aftermath of Assad's fall, Syria's new leadership launched a sweeping military and security campaign aimed at dismantling the country's Captagon empire—a key source of funding for the ousted regime.

The crackdown succeeded in destroying dozens of large-scale production facilities in the rural outskirts of Homs and Damascus. But what seemed like a victory soon spiraled into a deeper crisis.

With the collapse of organized production, the price of a single Captagon pill soared—from just five cents to more than $1.50, according to pharmacists and users interviewed by Asharq Al-Awsat.

Primitive material used to manufacture Captagon in the village of Hawik. (Asharq Al-Awsat)

The price surge has pushed many addicts into a state of desperation, willing to pay or do anything for a fix. It's a Russian doll of catastrophe: inside every crisis, a smaller one waits. The fall of Assad did not dismantle the machinery of death—it merely scattered it into thousands of dangerous fragments.

The addicts once hooked on the “cheap high” of mass-produced Captagon are now trapped in a darker spiral: counterfeit pills from unregulated workshops, mixed with unknown chemicals, sold on the black market.

To stave off withdrawal, users are turning to theft or joining smuggling rings. Families who once believed that regime change would bring their sons and daughters back from the brink have instead watched as they became statistics—new entries in the growing toll of addiction and overdose.

What began as a crackdown has, for many Syrians, morphed into a new chapter of the same tragedy—only now, it's less visible and harder to stop.

Captagon under Assad: A state-engineered drug empire disguised as pharma

Under the Assad regime, Captagon production was far from a rogue operation. It was a state-run enterprise cloaked in the legitimacy of Syria's once-thriving pharmaceutical sector.

Before the war, Syria boasted one of the most advanced pharmaceutical industries in the Middle East. The regime exploited that infrastructure to manufacture synthetic drugs on a large scale.

Licensed factories in Aleppo and Damascus—equipped with modern technology—became the backbone of a sophisticated narcotics operation. Inside, chemists and pharmacists engineered carefully calibrated formulas designed to hook users without causing immediate deaths.

Three former pharmacists who worked in separate Syrian pharmaceutical firms told Asharq Al-Awsat that official state laboratories were covertly used to develop these drug blends.

At times, authorities would shut down or confiscate equipment from legitimate factories under false pretenses—creating space for Captagon experts to refine new chemical compositions.

A chemical engineer who worked in a factory in Al-Kiswah, south of Damascus, said the effort was supported by foreign expertise.

“Iranian and Indian specialists were brought in to help perfect the formula,” the source revealed.

“There were strict protocols in place. The regime wanted addictive pills without scandals. That's why Syrian Captagon became the most sought-after on the market.”

Lighter versions of the drug were even rebranded and sold as “party pills”, offering users a temporary high and masking the addiction beneath.

Assad's narcotics machine wasn't just a revenue stream. It was a calculated instrument of control, designed to addict both domestic users and foreign buyers while preserving plausible deniability.



Israel Follows Iran Negotiations amid its Broadest Escalation in Eastern Lebanon

A bulldozer clears debris near heavily damaged buildings in the village of Bednayel in the eastern Bekaa plain of Lebanon (AFP).
A bulldozer clears debris near heavily damaged buildings in the village of Bednayel in the eastern Bekaa plain of Lebanon (AFP).
TT

Israel Follows Iran Negotiations amid its Broadest Escalation in Eastern Lebanon

A bulldozer clears debris near heavily damaged buildings in the village of Bednayel in the eastern Bekaa plain of Lebanon (AFP).
A bulldozer clears debris near heavily damaged buildings in the village of Bednayel in the eastern Bekaa plain of Lebanon (AFP).

The intense Israeli airstrikes that targeted the Bekaa in eastern Lebanon on Thursday evening marked the broadest aerial escalation against the Bekaa since the ceasefire agreement entered into force. This came a week after the killing of eight members of Hezbollah, including a commander, whom Israel said were responsible for launching rockets.

The pace of events does not reflect a clear upward military trajectory, but is instead linked to domestic and regional political calculations, at a moment coinciding with US-Iranian negotiations and the possibility of changes to the rules of engagement, according to experts following the developments.

Fire map... intensity and rapid succession

On Thursday evening, Israeli aircraft carried out eight strikes on the outskirts of Shmustar in the Western Mountain Range. The raids also hit the outskirts of Budai and Harbata. Less than half an hour later, shelling resumed heavily on the outskirts of Budai and the surroundings of Baalbek, amid low-altitude drone activity. The strikes extended to the outskirts of the city of Hermel, while the vicinity of the town of Taminine was also targeted, in addition to another strike on the outskirts of Budai, before new raids were launched on the outskirts of Nabi Sheet.

What stood out was not only the number of strikes, but the speed of their succession and the breadth of the geographic area, suggesting the management of concentrated fire rather than isolated attacks.

Local sources described the raids as “highly explosive,” telling Asharq Al-Awsat that “the tremors were heard in towns far from the strike locations, which caused panic and led some residents to believe that war had effectively begun, especially amid the charged regional atmosphere.”

The Ministry of Public Health announced that the strikes resulted in two deaths, including a Syrian child and a woman, and left 29 people wounded.

A political message

In an analytical reading linking the battlefield to politics, retired Brig. Gen. Naji Malaeb said that targeting the Bekaa in the recent phase was not a tactical detail, but carried clear political indications. He told Asharq Al-Awsat that “the Israeli escalation in Lebanon has two main objectives.

The first is to send a message to those betting on the Lebanese Army’s ability to carry out the task of disarming Hezbollah, as Israel is trying to say it will intervene if it sees that the army has not done what it wants. The second is linked to expanding the margin of military action in areas it considers less costly in terms of official Lebanese reactions.”

Malaeb pointed to the development in the use of concussion bombs, considering that “Israel is seeking through this to show that the targeted sites are weapons or ammunition storage areas.” He noted, however, that “the Radwan Force that Israel claimed to have targeted in Thursday’s raids is an elite unit that relies on rapid movement and guerrilla warfare, and uses medium weapons that can be carried, not a traditional artillery or missile force that requires large depots or fixed infrastructure.”

Malaeb said that “Israel’s focus on naming the Radwan Force in its statements serves an internal objective, namely reassuring settlers in the Upper Galilee that the threat is under control,” adding: “Israelis talk about the redeployment of the Radwan Force and the possibility of it storming areas inside Israel; therefore, the focus is on targeting it to give residents there a sense of security.”

In a broader context, Malaeb said that “the three-hour meeting between Israeli Prime Minister Benjamin Netanyahu and US President Donald Trump constituted a pivotal moment, as European information indicates that Israel was given a free hand in Lebanon in particular, within a wider margin of maneuver in the Middle East.”

He added: “The decision in the region is US by nature, of course, but in Lebanon it appears to be Israeli, and this is what we have observed on the ground, whether through the performance of envoys who come to Beirut, or through what was called the mechanism, whose role has effectively been canceled.”

He said that “the role that was supposed to be headed by an American party has turned into a tool of nullification rather than activation, as we have not seen a single objection to any of the Israeli attacks, which means that Israel is the one deciding how escalation unfolds in Lebanon.”

Israel’s conditions

The escalation in the Bekaa coincided with political and security rhetoric raising the level of possibilities in the region. The Israeli daily Yedioth Ahronoth reported that “the possibility of Hezbollah entering the fighting against Israel if Iran is attacked is worrying and is being dealt with.”

Malaeb said that “giving Israel a free hand in Lebanon is linked to what will take place between the United States and Iran,” adding: “The decision between Washington and Tehran is American in essence, and could lead to understandings if interests converge, but Israel’s interest is different, as it views long-range missiles and Iran’s nuclear program as an existential threat.”

He noted that “if the elements of Iran’s nuclear capability remain in place, and a final halt to enrichment is not achieved as Israel demands, then the likelihood of war remains. Israel may be the one to initiate it, while the US side may intervene later to rein in its pace, because any Iranian response would be wide-ranging, and it cannot be ruled out that Hezbollah would become involved in the confrontation within this context.”


What Is Israel’s Multi-Layered Defense Against Iranian Missiles? 

A fragment falls through the sky after Israel's Iron Dome intercepted a missile launched from Iran towards Israel, amid the Iran-Israel conflict, as seen from Ashkelon, Israel June 20, 2025. (Reuters)
A fragment falls through the sky after Israel's Iron Dome intercepted a missile launched from Iran towards Israel, amid the Iran-Israel conflict, as seen from Ashkelon, Israel June 20, 2025. (Reuters)
TT

What Is Israel’s Multi-Layered Defense Against Iranian Missiles? 

A fragment falls through the sky after Israel's Iron Dome intercepted a missile launched from Iran towards Israel, amid the Iran-Israel conflict, as seen from Ashkelon, Israel June 20, 2025. (Reuters)
A fragment falls through the sky after Israel's Iron Dome intercepted a missile launched from Iran towards Israel, amid the Iran-Israel conflict, as seen from Ashkelon, Israel June 20, 2025. (Reuters)

Israel has multi-layered air defenses against attacks by Iranian ballistic missiles, an umbrella it may need to lean on as the United States and Iran teeter toward potential military conflict that could draw Iranian attacks on Israeli territory. Here are details of Israel's defenses against drones and missiles:

ARROW

The long-range Arrow-2 and Arrow-3 interceptors, developed by Israel with an Iranian missile threat in mind, are designed to engage incoming targets both in and outside the atmosphere respectively. They operate at an altitude that allows for safe dispersal of any non-conventional warheads.

State-owned Israel Aerospace Industries is the project's main contractor while Boeing is involved in producing the interceptors.

DAVID'S SLING

The mid-range David's Sling system is designed to ‌shoot down ballistic ‌missiles fired from 100 km to 200 km (62-124 miles) away.

Developed ‌and ⁠manufactured jointly by Israel's ⁠state-owned Rafael Advanced Defense Systems and RTX Corp, a US company previously known as Raytheon, David's Sling is also designed to intercept aircraft, drones and cruise missiles.

IRON DOME

The short-range Iron Dome air defense system was built to intercept the kind of rockets fired by Palestinian group Hamas in Gaza.

Developed with US backing, it became operational in 2011. Each truck-towed unit fires radar-guided missiles to blow up short-range threats such as rockets, ⁠mortars and drones in mid-air.

A naval version of the Iron Dome, ‌to protect ships and sea-based assets, was deployed ‌in 2017.

The system determines whether a rocket is on course to hit a populated area. If ‌not, the rocket is ignored and allowed to land harmlessly.

Iron Dome was originally ‌billed as providing city coverage against rockets with ranges of between 4 km and 70 km (2.5-43 miles), but experts say this has since been expanded.

IRON BEAM

Developed by Israel for more than a decade and declared fully operational in late 2025, the ground-based, high-power Iron Beam laser system ‌is designed to intercept smaller aerial threats, such as UAVs and mortars.

Using lasers to super-heat and disable aerial threats, Iron ⁠Beam's operation is ⁠expected to be substantially cheaper than some of the other aerial defense systems that use intercepting missiles to shoot down incoming threats.

US THAAD SYSTEM

The US military said in October 2024 that it had sent the advanced anti-missile system THAAD - Terminal High Altitude Area Defense - to Israel.

THAAD is a critical part of the US military's air defenses and is designed to intercept and destroy short, medium and intermediate-range ballistic missile threats in their terminal phase of flight.

The US military helped to shoot down Iranian missiles fired at Israel, using ground-based systems, one US official said in June 2025, after Israel attacked Iranian nuclear facilities. A US Navy destroyer in the Eastern Mediterranean also helped to shoot down incoming ballistic missiles, Israeli media has reported.

AIR-TO-AIR DEFENSE

Israeli combat helicopters and fighter jets have fired air-to-air missiles to destroy drones that were heading to Israel, military officials have said.


Iranian Agents Obstructed Care at Hospitals Packed with Wounded Protesters 

This image from video taken between Jan. 9 and Jan. 11, 2026, and verified by AP, shows bodies and mourners outside a morgue in Iran, following a crackdown on protests in Kahrizak, Tehran province. (UGC via AP, File)
This image from video taken between Jan. 9 and Jan. 11, 2026, and verified by AP, shows bodies and mourners outside a morgue in Iran, following a crackdown on protests in Kahrizak, Tehran province. (UGC via AP, File)
TT

Iranian Agents Obstructed Care at Hospitals Packed with Wounded Protesters 

This image from video taken between Jan. 9 and Jan. 11, 2026, and verified by AP, shows bodies and mourners outside a morgue in Iran, following a crackdown on protests in Kahrizak, Tehran province. (UGC via AP, File)
This image from video taken between Jan. 9 and Jan. 11, 2026, and verified by AP, shows bodies and mourners outside a morgue in Iran, following a crackdown on protests in Kahrizak, Tehran province. (UGC via AP, File)

As wounded anti-government protesters poured into an Iranian hospital during last month’s crackdown, a young doctor hurried to the emergency room to help treat a man in his 40s who had been shot in the head at close range.

When the doctor and others tried to resuscitate the man, a group of armed, plainclothes security agents blocked their way, pushing some back with their rifles, the doctor told The Associated Press.

“They surrounded him and didn’t allow us to move further,” the doctor in the northern city of Rasht said.

Minutes later, the man was dead. The agents put his body in a black body bag. Later, they piled it and other bodies into the back of a van and drove away.

This wasn’t an isolated incident.

Over the course of a few days in early January, plainclothes agents swarmed hospitals in multiple cities treating the thousands wounded by Iranian security forces who fired on crowds to quash massive protests against the regime. These agents monitored and sometimes obstructed care to protesters, intimidated staff, seized protesters and took away the dead in body bags. Dozens of doctors were arrested.

This story is based on AP interviews with three doctors in Iran and six Iranian medical professionals living abroad who are in contact with colleagues on the ground; reports from human rights groups; and AP’s verification of more than a dozen videos posted on social media. All of the doctors inside Iran spoke on condition of anonymity for fear of retaliation.

The AP worked with Mnemonic, a Berlin-based organization, to identify online videos, posts and other material relating to violence in hospitals.

The doctors in Iran and abroad said the level of brutality and militarization of health facilities was unprecedented in a country that for decades has experienced crackdowns on dissent and surveillance of public institutions.

The Iran Human Rights Center, based in Oslo, has documented multiple accounts from inside hospitals of security agents preventing medical care, removing patients from ventilators, harassing doctors and detaining protesters.

The government has blamed the protests and ensuing violence on armed foreign-backed “terrorists.”

Health Ministry spokesman Hossein Kermanpour denied reports of treatment being prevented or protesters being taken from hospitals, calling them “untrue, but also fundamentally impossible.” He was quoted in state media as saying all injured were treated “without any discrimination or interference over political opinions.” The Iranian mission at the United Nations did not immediately reply to a request for comment on the doctors’ accounts.

Doctors tried to protect the wounded

The crackdown, which reached its height on Jan. 8 and 9, was the deadliest since the regime took power in 1979. Details have been slow to emerge because of internet restrictions imposed by authorities.

The Human Rights Activists News Agency says it confirmed more than 7,000 deaths and that it is investigating thousands more. The government has acknowledged more than 3,000 killed, though it has undercounted or not reported fatalities from past unrest.

Once the crackdown began, the doctor in Rasht said he worked through 66 hours of hell, moving each day to a different facility to help with the wounded — first a trauma center, then a hospital and finally a private clinic.

Armed agents brought in wounded protesters and stood watch over them as staff worked, the doctor said. When it came time to discharge a patient, he said, “they would take anyone who was confirmed to be a protester.”

The doctor said he and other staff tried to hide wounded protesters by recording false diagnoses in hospital records.

“We knew that no matter what we did for the patients, they wouldn’t be safe once they stepped out of the hospital,” he said.

The AP could not independently confirm the doctor’s account of events at the hospital in Rasht. But it conformed with AP’s other reporting.

AP’s reporting focused on what happened at four hospitals, a snapshot of the Iranian security forces’ activity. Mnemonic gathered dozens of videos, posts and other accounts it says showed forces were present in and around nine hospitals, in some cases firing guns and tear gas. Mnemonic has been preserving digital evidence of human rights violations in Iran since 2022, creating with partners an archive of more than 2 million documents.

One video verified by AP shows security agents breaking through glass entrance doors into Imam Khomeini Hospital in the western city of Ilam. They then barged through the halls with their guns, yelling at people.

The Health Ministry told state media it was investigating the incident, saying it was committed to protecting medical centers, staff and patients.

Treating the wounded in hiding

On the night of Jan. 8, a 37-year-old general surgeon was out for dinner in Tehran when he received a call from a professional friend, an ophthalmologist. The fear in her voice made clear she needed his help urgently. She gave him an address.

Just before midnight, he drove to the address, a clinic for cosmetic procedures. Inside, he found the lobby transformed into a trauma ward, with more than 30 wounded men, women, children and elderly on the couches and blood-covered floor, shouting and crying,

The surgeon spent nearly four days there, treating more than 90 people, he estimates. At first, it was just him, the ophthalmologist, a dentist and two nurses. Eventually, the surgeon summoned three other doctors to help.

He used cardboard boxes and pieces of soft metal as splints for broken bones. With no anesthesia or strong painkillers, he used weaker suppository analgesics. The clinic had no blood supplies or transfusion capabilities.

They couldn’t send patients to hospitals for fear they’d be arrested.

A young man in his 20s had been shot with live ammunition in his elbow, shattering it. The surgeon sutured the wounds but knew the arm would have to be amputated.

A family of four — a mother, father and their 8- and 10-year-old children — were all riddled with pellets, the surgeon said.

On the morning of Jan. 9, the surgeon reached out to doctors he trusted to refer patients to them. First he had to make sure to remove all bullets and pellets from their bodies so they wouldn’t be detained at the hospital. He wrote referral letters saying the patients had been in car accidents.

None of the wounded died at the clinic, he said. The AP could not independently confirm the surgeon’s account of events at the clinic.

Doctors targeted for arrest

Since Jan. 9, at least 79 health care professionals have been detained, including a dozen medical students, according to Homa Fathi, an Iranian dentist pursuing a Ph.D. in Canada and member of IIPHA who has been monitoring Iranian government action against health professionals since 2022.

Around 30 have been released, most on bail, but many of them still face charges, including one accused of “waging war against God,” a charge that carries a death penalty, Fathi said.

The surgeon who treated protesters at the secret clinic said he was surprised security forces never stormed that location to make arrests.

But arrests have come since. Two health care workers who volunteered at the clinic were seized from their homes, the surgeon said.

“I am waiting, too.”