It’s hard to imagine surviving in a world where nearly everything is working against you. Bombs rain down from above. Hateful words emanate from the man standing next to you. In front of you, a grandparent is dying.
In situations like these, where does your strength come from—if not from inside?
That is the moving message from director Feras Fayyad’s documentaryThe Cave, an unflinching look at the courage, resilience and solidarity that exists between female physicians working in war-ravaged Syria. For that lead physician, Dr. Amani Ballour, hope is found underground in a subterranean hospital in Syria known as The Cave.
Over the past eight years as the war in Syria has expanded—displacing millions and killing hundreds of thousands of Syrians—the work of physicians like Dr. Amani goes on underground.
While filming the 2017 film Last Men in Aleppo, Fayyad focused on the systematic impact of bombing hospitals by the Syrian government as a means of intimidation and revenge. “It became impossible for the health sector to exist on the surface, so hospitals were built underground,” he said. “I was able to visit a number of them, and it was astonishing to witness the human ingenuity at work. These hospitals became the only hope for people to survive and receive treatment. And they provided a place where men and women could work together.”
In fact, Fayyad said, these small underground spaces were some of the only places where women can work.
Of all the interviews and footage he collected, the individual that stood out at once was Dr. Amani.
“When I found about her I realized there was something special about Dr. Amani,” Fayyad said in an interview with Amanpour and Company on PBS. “I found out she has a very special way of leading the hospital and found out she was first woman to ever lead a hospital in Syria.”
Most importantly, he said, she managed to build a road of equality for other female physicians. “She built a space for these people to find their identity,” he said, even in the face of massive recrimination and sexism by male patients who arrive at the hospital for help — only to question why a man is not in charge.
“I wanted to focus on the work of the female in Syria; I want to make a case study of women—not as a victim but as a heroine subject,” he said.
There’s a reason that the film has been named as one of the best movies of the year by The New York Times, Los Angeles Times, NPR and The Washington Post and was nominated for a 2020 Academy Award.
“[Fayyad] films The Cave with a grace and compositional sensitivity all the more impressive for being achieved under the most difficult circumstances. While conveying the cramped, claustrophobic desperation of his subjects, he also makes space for technical beauty, especially in long tracking shots and moments of discretion with his observant but never obtrusive camera,” wrote Washington Post film critic Ann Hornaday.
That immersion in the life of these doctors and patients ended up being a struggle for Fayyad, even among his own production team. When he viewed raw production clips, many times the camera was trained back on the male characters in the room. “The camera was all the time moving from the female to the male,” Fayyad recalls. But he insisted to shoot footage another way. “Just train the camera on her and let the camera observe her. Then the cinematographer started to recognize, ‘She is powerful.’”
Another remarkable side effect: the fact that because the camera was trained on Dr. Amani—and not a male doctor — others around her began to realize that she was in fact a powerful woman. “It built around Dr. Amani,” Fayyad said. “They started to see her as something important. That is the power of the change that cinema can do in the right moment.”
The physical environment that Dr. Amani and her colleagues work within in shocking. In Eastern Al Ghouta, where the film makes place, incessant bombardment of Syrian villages turned the landscape into an wasteland dominated by rubble and bomb-pocked buildings. The underground hospital staff faces bombardments, chemical attacks, and a dwindling supply of medicine and supplies.
That would be enough of a story in and of itself. But there is a deeper story to tell, Fayyad said. “It’s about a change in political and social levels that the society needs to see—as a mirror in front of them,” he said.
Society has showed up in support. A petition to address the human rights atrocities in Syria has been led by National Geographic, which also embarked on an educational screening tour to show the film across the world.
For the film’s women-backed production company, Danish Documentary Films, documentaries like these need to be made because war time atrocities across Syria remain rampant. “What is going on right now gets very little attention, and it’s a strategy from the Russian regime, to target any hospital,” producer Kirstine Barfod told Stefan Papen. “It’s coming through a little bit, but not enough.”
It was a challenge as a filmmaker to know the rules when it came to intervening in some of the more frightening situations, Fayyad said. Especially when a life and death situation arose; after all, the women at this hospital had become like family, he said.
“There were rules from Dr. Amani to not touch the victims because they don’t know what kind of weapon was used in the attack,” he said. “The camera just had to observe, and not interrupt the team from what they were doing, so any movement from the team couldn’t interrupt them.”
“It was hard, these were my fellow citizens and their death in front of me was like my death. It was terrible,” he said. “To film what it happening to our country and I couldn’t do anything for them, all I could do was put my camera there and try to save their memories and their history and the crimes that have been done against them, and respect them and show the there is someone trying to do something through their stories and bring them to another level and hope people engage and feel involved in their story.”
The director was himself in danger by being in Syria at all. Fayyad had been arrested and tortured twice by Syrian troops in 2011, he said in an interview with The Hollywood Reporter. Fayyad had no desire to return to a jail cell.
“But even though my picture was well known and I knew it was going to be dangerous for me, I still felt that if I didn’t use this position—the success, the knowledge and everything I had gained from this movie—then I’m not really a documentary filmmaker,” he said. “Because this is where the power of cinema can really make change. It can provide a lot of emotion, empathy and knowledge for people. And if I close my eyes to that, or I feel scared, then I’m not going to make anything.”
All in all, Fayyad and his team shot more than 400 hours of material, much of it distressing and very graphic. His goal was to seek a balance between showing the reality of war and omitting scenes that were extremely violent. “We actually tried not to use extremely violent images. We had so much hard footage — tough in a way I don’t think any human can handle,” he told The Hollywood Reporter. “My editor and I had to go to therapy every day and every week.”
The team, too, suffered mightily for this production. According to an interview with the Observer, four of Fayyad’s crew members did it not make it out of Syria alive. In order to shoot The Cave and take the documentary out of the country, Fayyad and his crew would smuggle the filmed material out. It was then uploaded to the cloud and re-downloaded for production in Denmark. In 2018, a chemical weapon attack destroyed a satellite, a move that delayed the process of Fayyad’s file transfers.
But the story was one that needed to be told. Just before the Oscars this year, Dr. Amani told Good Morning America: “I want this story to … tell the truth about what happened in Syria. And what is still happening now.”