Two visceral accounts of the Syrian civil war have been nominated in the documentary category at the Oscars this year. One is For Sama, Waad Al-Kateab’s personal visual diary of the conflict that has ravaged Syria since 2011. The other is Feras Fayyad’s The Cave, which follows the staffers at an underground hospital in the Al Ghouta locality on the outskirts of Damascus. The Cave has been produced by National Geographic and will be premiered on the television channel on February 8 at 10pm. The Oscars will be held on February 10.

Running as long as a feature film – 95 minutes – and with scenes and sounds that outstrip the average war drama, The Cave is both challenging and essential viewing.

The hospital operates in territory held by rebels opposed to Syrian President Bashar Al-Assad’s regime. The opening scene provides a view of the skyline. The calm is shattered by air strikes, and from there on, the film dives into the subterranean facility, emerging only occasionally to survey the mayhem on the ground above.

The Cave (2019).

There is chaos below too as the staff struggles to treat an almost unending flow of injured men, women and children. The hospital administrator, the sensitive and quietly fiery Amani Ballour, serves as the film’s protagonist and conscience. “Let’s keep smiling for the children,” she advises her colleagues. But the relentless pressures of the job, the tragedy of the victims (many of them children) and the challenges of keeping things running in unimaginable circumstances cause Amani to break out into tears every so often.

There is anger too as Amani ponders over the future of Syria and the endurance levels of her people. “Is there a God?” she asks. “Why do people have children in these circumstances?” And yet, she is fighting another battle too. As a woman in a position that might traditionally have been held by a man, Amani is reminded ever so often of that other war as old as humanity itself, the one against patriarchy.

The Cave (2019). Courtesy National Geographic Documentary Films.

There’s only so much that Amani, who is a vivid, talismanic presence, can do to soothe frayed nerves. The precariousness of life in a conflict zone – Al Ghouta was under continuous siege for five punishing years – plays out in the tunnels and corridors of the hospital in several ways. Medical procedures come to a halt with every shuddering aerial bombardment, and the fear of the hospital itself being hit is very real. The electricity goes off at times and medical supplies are in short supply, as is food. A simple demand for salt and margarine is similar to asking for the moon.

The range and extent of injuries is staggering, and the doctors and nurses can barely catch their breath. The hospital’s founder, Salim Namour, tries to relieve the tension by playing Western classic music on his mobile phone as he operates. After a particularly heavy bombardment notches up casualties, the situation gets to him too. “There is nothing we can do for them,” he says.

Fleeting moments of levity – the nurse Samaher’s infectious buoyancy despite the unremitting gloom, a birthday party celebration – are reminders of the resilience that keeps the establishment running. When the film occasionally travels upwards and into the destroyed streets, it becomes clear that the hospital is an unlikely refuge with great regard for life and limb than elsewhere in Al Ghouta.

The Cave (2019). Courtesy National Geographic Documentary Films.

The Cave was filmed between 2016 and 2018. Remarkably, its director, whose credits include the Oscar-nominated Last Men in Aleppo (2017), was not present at the location. Unable to enter Al Ghouta because of the siege, Fayyad recruited the cinematographers Muhammed Khair Al Shami, Ammar Sulaiman and Mohammed Eyad to execute what he called in his director’s note “an observational, character-driven cinema verite documentary, without voice-over or direct-to-camera interviews”.

The ever-present cameras produce a disturbingly intimate and immersive experience of the horrors of war. The visuals gain a grim beauty as the siege drags on, and the skillful stitching together of scenes of bedlam with moments of calm produce an experience as moving as it is harrowing.

The Cave (2019). Courtesy National Geographic Documentary Films.