In the opening moments of the new documentary The Cave, set in the bombed-out Syrian war zone of Eastern Ghouta, a missile lands. Then another. And another. Each detonates a cloud of rubble, dust, and, though the frame is thankfully not zoomed in enough to confirm, inevitably human life. The cumulus of debris eventually envelops the once-visible trajectory path of the rocket, the lingering smoke memory of eventual, catastrophic destruction.
The shots are beautiful, in their own macabre way, in the film from director Feras Fayyad, the man behind 2018 Academy Award nominee Last Men in Aleppo. It’s a sequence as cinematic as they come, made more horrific by the knowledge that it is not special effects, but actual war we are witnessing. Yet, because of the motif of war in film, we are conditioned for something visual or artistic to happen next, perhaps a tracking shot as the camera trains in closer to tell the story of what is happening in this city, to these people under such violent siege.
But the camera doesn’t zoom in. Instead, it pans down. And then down further. It keeps going and going. Eventually, we arrive at the Cave.
The journey downward feels unsettling, and it should. There’s little sense of comfort for the people we encounter there, ingenious and almost singular a refuge as it is. Nor is there comfort for those watching, over the next hour and 45 minutes, what is taking place there under the streets of the Syrian city under siege.
Officially released Friday by National Geographic Documentary Films, The Cave is one of the toughest, most necessary films of the year. As events unfold in the news, it is also perhaps the most timely.
Since the Syrian regime and its Russian allies first waged chemical warfare against civilians in 2013, hundreds of thousands have died, millions have been displaced, and the streets have been transformed into battlefields. While fleeing has been the only means of survival, the 400,000 people who remained in Eastern Ghouta found themselves trapped, under siege by the surrounding regime with no way out.
The UN Commission of Inquiry has classified the situation in Ghouta as a war crime against humanity. Lasting over five years, it is considered the longest continuous siege in recent history.
As war spread, medical facilities became a strategic target for the regime, a vengeful intimidation tactic to leave citizens no option but to flee and forcing hospitals to move underground. A complex network of tunnels and basement shelters underneath Eastern Ghouta lead to the Cave, the name for an underground hospital and refuge where a handful of doctors, many of them students, stayed behind to care for the wounded left in the region.
“The idea of moving underground was simple,” says Dr. Amani Ballour, the woman who, after leaving her postgraduate studies in Damascus to care for the people in her home of Ghouta, was elected manager of the Cave. “As simple as the death lurking on the surface. The cause of that death is clear and simple too. As simple as the urge to survive. As a doctor, I’ve witnessed so many tragedies. So much suffering. So many lies. It made us search for a way to survive.”
Dr. Amani first garnered the attention of Fayyad in the aftermath of the August 2013 chemical attack on Ghouta ordered by President Bashar al-Assad. The warheads had dropped at 2:30 a.m., choking citizens in their sleep. A filmmaker who is friends with Fayyad spent the next days documenting the rescue effort, and Fayyad was particularly struck by the footage of two female doctors working fastidiously to save whatever lives they could. One of those women was Dr. Amani.
He learned that Dr. Amani worked in the Cave, which had been erected in 2012 in the subterranean floors of a six-story hospital construction that was left unfinished when the Syrian rebellion began. After completing work on Last Men in Aleppo, he began talking to Dr. Amani about the possibility of filming in the Cave. During that time, she was elected manager of the operation, and it became clear that the documentary would not just be about the hospital, but about her and her female colleagues as well.
Not only does The Cave lend a human face and visceral reality to the destruction, devastation, and violence in Syria, it is a case study and exposé of the misogynistic culture that devalues and debases women. In this patriarchal society, these underground hospitals, in conditions of grave danger, are among the only places where women can find work.
The Cave not only shows these women proving their value, treating patients or cooking meals for staff while simultaneously ducking for cover or singing the constant fearful refrain of, “Is that another war plane?” It also shows the frequency with which they must defend themselves against sexist attacks and prejudices.
In one scene, a man berates Dr. Amani because there is not enough medicine for his wife. Because of the siege, it is nearly impossible to keep the hospital stocked. But he blames it on the fact that it is a woman who is running the hospital instead of a man.
Fayyad won the trust of Dr. Amani after the two connected and he spoke of the time he spent imprisoned by the Syrian regime, locked up and tortured for 15 months. He had been arrested in 2011 after making a short film about an exiled Syrian poet and the struggle for freedom of expression. While held captive, he witnessed enraging abuse and cruelty against women, many of whom were tortured simply because of their gender.
He has said that The Cave is inspired by and rooted in his relationships growing up in Syria with the strong women in his life, including his mother, seven sisters, and 12 aunts. One of his most vivid childhood memories is when his Kurdish mother reacted to Iraqi dictator Saddam Hussein’s 1990 threat of widespread attacks on the Kurdish people, whom he had already used chemical weapons against, by teaching her young son how to wrap a piece of cloth around his face and breathe through it.
“As the saying goes, she didn’t give me a fish, she taught me how to fish,” he wrote in a letter to critics that accompanied a screener of the film. “The image of her face, so near to my eyes, is still embedded in my mind.”
It’s an eerie memory to consider when watching one of the most powerful sequences in The Cave. By the film’s final act, you’ve grown accustomed to the waves of bloodied, dismembered victims flooding into the hospital, ravaged by the bombings. But this rush of patients isn’t suffering from discernible physical wounds. As everyone scrambles to understand what is happening, reaching for surgical masks and clean clothes to cover their faces, they realize there has been a chemical attack.
The Cave, especially when viewed as a companion piece to Fayyad’s last work, Last Men in Aleppo, which followed members of the White Helmets on dangerous search and rescue missions through the rubble, is crucial in understanding the stakes at play as the conflict in Syria and the involvement of the Russian allies escalate into further chaos.
In the aftermath of his abrupt withdrawal of American troops from northeastern Syria, Donald Trump dismissed Turkey’s invasion of Syria, saying on Wednesday, “It’s not our border.” Critics of Trump’s decision to withdraw from Syria argue that Kurdish troops, who had until recently fought alongside the United States, have been left abandoned and unable to defend against invading Turkish forces. The resulting power vacuum has left them vulnerable to Russia’s expanding influence.
"If Russia wants to get involved with Syria, that's really up to them," Trump said. "They have a problem with Turkey, they have a problem at a border. It's not our border. We shouldn't be losing lives over it."
That The Cave and Last Men in Aleppo were directed by a Syrian Kurd is noteworthy. Watching his films, The Cave especially, should give much-needed—and perhaps angering—context to Trump’s decision.
The entire film is shot cinema verité-style, sans narration. The only storytelling device used is introductory text and some title cards at the end offering an update on the Cave and the people who worked there: who has since fled Syria, who has stayed behind to continue to save lives, and who has died in the midst of it all.