One of the most outstanding documentaries of the year was Feras Fayyad’s The Cave, premiering at the 2019 Toronto Film Festival, where it received the People’s Choice award in the documentary category.

Fayyad returned to his native Syria to capture on film a remarkable feat of heroism and courage. In the city of Ghouta, near Damascus, where the buildings lay in ruins and the streets are regularly attacked by fighter jets and missiles, a group of women doctors set up a hospital underground, in the relatively bomb-proof basements of the destroyed buildings, labouriously connected by a series of tunnels. They endure the same difficulties as the remaining population—avoiding death in the unsafe streets; finding food and supplies in a place where markets are regularly attacked—along with maintaining the equipment necessary to keep a hospital functioning, and coping with the periodic waves of severely injured patients, many of them children. The female doctors also must, on occasion, endure disapproval from conservative residents who feel women should be limited to domestic concerns rather than practice medicine. There is also, it goes without saying, the question of sustaining morale under these harsh, often frightening conditions. 

Fayyad does magnificent work, his finished product, not the rough, choppy footage expected of a war zone documentary, but polished and well organised, depicting the chaos the medical staff cope with, without losing clarity. The central focus is Dr Amani, a young paediatrician who sets the tone of the makeshift hospital with her calm, humour, kindness, and dedication. The film crew follow Dr Amani and the rest of the dedicated “cave” staff over many months, offering a detailed, intimate depiction of their lives and work, most of the time seemingly without the subjects’ awareness of the cameras. It is a touching and perceptive account of quietly heroic work.

In a film whose settings consist of a claustrophobic series of tunnels, and streets destroyed by explosions, the sound becomes important to telling the story, and it is used carefully and to wonderful effect in The Cave. Far Out was fortunate enough to be granted an interview with Peter Albrechtsen, supervising sound editor and sound designer on the production and a man with decades of sound crew experience, and gain some insight into the making of the film.

Albrechtsen speaks positively about his work with director Feras Fayyad on The Cave: “Feras Fayyad and I met at the beginning of 2018 to talk about the project and already at that point – just when he started picture editing and a year and a half before we mixed the film—Feras had a very clear vision of how he wanted the sound design to be. It should be immersive, very emotional and almost a physical experience.” The two men were of one mind on the approach to the film’s sound; Albrechtsten notes that Fayyad “ knew that sound would be a very integral part of the storytelling—so much of the film is about things we don’t see but only hear—so it was also very important that we developed the sound for the film alongside the picture editing. During the process, we kept on developing new ideas, of course, but it’s quite amazing how many of those initial thoughts which are now reflected in the final film. Feras is very visionary in that regard.”

The subtle changes in voices and interior sounds in the underground hospital creates a distinctive atmosphere, something Albrechtsen says was part of the filmmakers’ plan, noting that Fayyad “wanted the audience to feel what it was like to be in the cave. And sound can be incredibly emotional. It touches you in a way that goes beyond words and logic, it touches you deep inside and can be both beautiful and brutal, poetic and visceral—Feras wanted all of those qualities in the film.”

(Credit: TIFF)

Part of what makes the film’s sound unique and haunting is the choice of technology, something the director and sound editor worked on together. “At this first meeting,” Albrechtsen recalls, “Feras said that he wanted to do the movie to be mixed in the modern three-dimensional sound system Dolby Atmos. The audience should be immersed in sound. One of the unique things about Dolby Atmos is the speakers placed in the ceiling and these were perfect for The Cave as the war is happening on top of the characters and we could have the sounds of war coming from above the audience. It really means that the audience is in the middle of the cave, in the middle of the chaos.”

Complex plans for the use of sound technology began early in the process/ “Because I talked with Feras very early about the film, there was a lot of time to research for sounds. That was incredibly helpful. I always spend a lot of time on getting hold of the right sounds for a film and in this movie I got recordings from people all around the world.” Albrechtsen allowed that choices of technology extended what was possible in the making of the film. “The Cave is one of the rare documentaries mixed in the modern sound format Dolby Atmos. There is this misconception of Atmos as if it’s only designed for big bombastic modern blockbusters but actually it works just as well or perhaps even better for movies with a more dynamic and subtle soundscape. For The Cave, it meant that we could create a truly enveloping sound of war. But the amazing clarity of the Atmos speaker system also meant that we could have so much more subtlety in the soundscape and you can really feel all the details of the hospital noises and the sonic environment overall. There are some enormous dynamics in the film going from a quiet breath to full-on intense assault and that’s something that really gets enormous extra impact in Dolby Atmos.”

The painstaking management of sound on the film included augmenting the sounds of the actual environment, through the joint efforts of the sound department. Albrechtsen refers to one contribution in particular: “The German dialogue editor and mixer Lars Ginzel was part of the project from very early on and he scanned through the raw location material to pick up any interesting ambient sounds he could find. I got hold of recordings of lo-fi hospital machinery like what was used in the cave. I got in touch with some Russian sound recordists who had recorded the Russian military jets which play such an important role in the film. I also knew that the vibrations and rattles of the walls in the cave would be a big element and I got hold of some wonderful metallic rattles that I could use for this. I recorded sounds of these stretchers rolling through underground hallways at a hospital in Copenhagen where I live. I even got some recordings from the streets in Syria while the war was going on.” He adds, “Listening to those authentic recordings felt really scary.” The sounds of warfare which periodically disturb the hospital inmates are, indeed, frighteningly effective, creating an ominous reminder of the constant threat that exists above the hospital’s underground shelter.

Asked about the director’s ultimate vision for the documentary, Albrechtsen recalled, “Feras talked very much about the physical and mental aspects of sound in the war. He called it traumatising sounds: when sound is not just a sound, but a visceral experience, something that connects with you on a deeper, scary, instinctive, subconscious level. For example, the jets are one of the signature sounds which Feras talked most about from the very beginning of the process. For him, that was a traumatising sound. The jets weren’t just jets but monsters. So the sound of the jets in the film is a mixture of the original recordings and different beastly noises to create the feeling that Feras was looking for. It took a lot of experimentation and trials and errors. Pretty much every sound in the film should have its own unique character so I spent a lot of time on gathering sounds.”

It was also important that the sounds of the real environment be enhanced or replicated exactly, not replaced by artificial sound effects. “It was very important that everything felt real and realistic, even though there were a lot of layers and sonic elements. The explosions couldn’t sound like big Hollywood sound effects but they still had to feel very impactful. So instead of just having a giant booming sound, you’re hearing a lot of what happens when a bomb goes off—stuff rattling, the ground shaking, dust and dirt flying around, sirens going off. All these textures make the explosions seem very scary and physical. Feras told me that the local church often start ringing their bells when the bombings are happening so that sound is also used a few places in the film. It’s extremely evocative. A glimpse of beauty in the middle of hell.” He also notes the value of contrast, of alternating scenes of danger and disruption with episodes of peace and camaraderie among the hospital staff: “Quiet, poetic moments between the bursts of noise of terror and war. So it’s also a very dynamic track. It would be impossible to stomach a movie like this if it was just full on assault all the way. It’s a film about war and terror but also about the beauty of humanity.”  This contrast is most striking in the film’s opening scene, which moves quickly from explosions to a quiet interior shot at the hospital, a scene which Albrechtsen feels “really encapsulates the whole film—at the very beginning you hear urban city sounds, even with a bit of music in the distance, and then the bombs explode, vicious, violent, brutal, and then from there we move from horrendous, loud war to fragile quiet breathing in just a minute or so. It’s very dynamic and unpredictable. It makes the audience know that they’re entering a world where everything can happen. Actually, the opening also has some more abstract sonic elements. When the camera travels down underground from the bombings on the ground, I also use some stethoscope recordings from the inside of the human body, the sound of blood rushing, of a heartbeat. It’s a way of showing the audience that this will also be a very subjective sonic experience. You’re hearing the world from the inside out.” 

Albrechtsen offered some insight into the balance between presenting objective facts, and inserting the filmmaker’s view into the finished production. He allows that a great deal can be done to manipulate the material and present a finished product that includes the director’s viewpoint without actually distorting the facts. The director, he says, “wanted the film to feel subjective. The audience should not just see how it is to be in the cave, but feel how it feels to be in the cave. There is a big, big difference. So the mood of the sound is really all about the mood of the characters. During the plane attacks and war scenes, the sounds are gritty, evil, violent. During the birthday scene and the scenes with Amani taking care of the small baby it is much more light, poetic and hopeful. The film isn’t really shot subjectively—there’s no point-of-view photography or anything like that—so the subjective feeling often comes from the sound by selecting which sounds to hear when, sometimes making a noisy moment quiet or the other way around. For a lot of moments we’re very selective about which sounds we hear, which creates a special focus. It’s not something you really notice consciously as a viewer, but subconsciously the sound guides the eye and fuels the emotions.”

(Credit: TIFF)

How is sound used to enhance a documentary, and to what extent the original footage should be manipulated? Albrechtsen gave his take on the matter: “There’s certainly a lot of different views on how much manipulation you’re allowed to do with sound on documentary. In my opinion, the director has chosen to point the camera in a specific direction and prioritise the material and edit the story in a certain way and this means that reality has already been severely manipulated. This doesn’t mean that I’m going to do a big action slam bang soundtrack for a small quiet documentary. Of course, I spent a lot of time on creating a sonic world that feels right for the film and true to the story, the environment and the characters. I always do a lot of extensive sonic research for every film I work on and this means that I pretty much know how the actual locations sound and I always utilise local recordings as much as possible. But at the same time, I often have several subjective sound moments in the documentaries I do—we all listen to the world in a subjective way and why should we try to be objective when telling stories? What is objectivity? No film is objective. It’s always a filmmaker’s personal vision.”  

He went on to describe some of the particular challenges of managing the soundtrack for this film: “On The Cave it really took a lot of work to clean up the dialogue. Many weeks. The original sound was recorded with small camera microphones and it sounded awful. Some of the footage sounded so bad that we needed to clean up the dialogue before the translators could even hear what was being said! But nowadays there’s all this amazing noise reduction software that makes it possible to make even very bad recordings work in a cinematic sound mix. We did a lot of foley sounds for footsteps and movements and that also helped make you feel close to the characters. I’m working with an amazing Finnish foley artist called Heikki Kossi who this year also worked on Ad Astra and Sofia Coppola’s new movie. He and I have developed this style for foley for documentaries where things are recorded a bit bad to make it sound more real and fit with the gritty documentary sound recordings.”

Far Out asked about the rather stark surroundings, in contrast with the variety of sound: children’s voices, music, the war outside, and how much of this was a deliberate choice. Albrechtsen replied, “It’s a very detailed soundscape, for sure, and it was very important to have a lot of contrast, a lot of variety. The sound should also show you the size of the place as The Cave is a giant underground system of corridors and hallways. So the backgrounds are constantly changing to give the audience the feeling of size and how different locations have their own unique sounds. Sometimes you hear other people, sometimes you hear hospital machinery, sometimes you hear construction work of more hallways being built, sometimes you hear the bombings above. For every room we found the sounds that fit the place, the geography, the tone and then I orchestrated the sounds so that they fit with the scene—sometimes starting out loud and becoming quieter throughout a scene and sometimes cut rhythmically so they fit with a specific dialogue exchange in a scene. There is a lot of work put into these details.” 

(Credit: TIFF)

Similarly, the interior of the underground hospital has a hollow, echoing sound. Is this heightened purposely, to increase the sense of being underground? Albrechtsen explained, “Because of the whole structure of the hospital with the many hallways and corridors there is a lot of sound travelling through the air, echoing through the construction. So the sounds have a lot of reverb naturally. At the same time, there are several scenes where the main characters talk about listening. There is even a scene where our main character Amani Ballour talks with a friend about being hypersensitive to sound. All of this means that the audience are listening even more intensely and it makes you very aware of all the sounds around you. I’m not sure we’re heightening the echoes, but you’re more aware of the sound than you might normally be because you sympathise with the main characters and your ears are alert just like their ears are. We’re hearing things all the time—even when we sleep—but we’re not really used to listening. We’re not used to focusing so much on sound. And when we do, it makes the whole sensory experience stronger. Sound is incredibly psychological like that.”

Albrechtsen was asked to discuss the contrast between the isolated, rather claustrophobic Cave, and the open but dangerous outdoors. “These are other big contrasts of the film,” he observed, “the empty exterior and the tight interiors. For the exteriors I used sounds of wind, metal creaking, echoes of things in the distance, these things all helped to create the feeling of being outside in a city that is now a ruin. The sounds of shootings in the streets are actual recordings from Syria. It was very harrowing. Hearing gunshots echo through the streets felt very scary and deeply unsettling. I’m so impressed by the doctors and nurses in the film who dare to drive around these streets. They are heroes.”

The action in the film often follows a pattern: periods of comparative peace broken by episodes of bombing, and the resulting rush of injured patients into the hospital. The sounds of war planes overhead typically signals a coming crisis. Far Out asked how sound is managed to reinforce this effect. “It is true that the planes are indeed used in the film as a character in itself. We worked a lot on all these sequences really making sure that the plane sounds fit with the scenes and the people’s reactions. The original recordings were very bad, as I’ve mentioned, so you could hardly hear the planes and it took a lot of layering of sounds to make these scenes feel realistic. Feras has lived in Syria during the war and experienced how these plane sounds and he knew exactly what he was looking for. After having seen the film, one of the main characters, Samaher, actually said that this was exactly how it sounded in the cave. That was the greatest compliment we could get. We worked so hard to make The Cave feel real.”

Asked how the film managed to make dialogue so clear despite constant background noise—something which is often a problem in war zone documentaries—Albrechtsen replied, “I try to approach the whole soundscape as a piece of music. You don’t want to have every instrument playing on top of each other. That would just be meaningless noise. All instruments should work together and you want certain instruments to come in now and then and really shine. So the sounds of the hospital change all the time and constantly support the scenes, going in and out of focus. It’s a symphony of sounds. Sometimes loud, sometimes quiet, but hopefully always musical and well-orchestrated so it fits with what’s going on during the scenes.” In fact, classical music, which hospital staff sometimes play during surgery, is used as background in certain key scenes; he remarks on this choice. “There is actually only one scene in the film where the classical music goes from being background music to being upfront—that’s the scene with Mozart’s Requiem which I find quite impactful because it is the only place we do something like that. Otherwise, the music from the medical treatments is actually only playing as background music. These classical pieces have a very special effect, it actually calms the soul. ‘Music is an anaesthetic,’ Dr. Salim says. I love that line. Again, it highlights how the characters in this film are really listening all the time.”

The film takes a darker turn toward the end, following an unexpected chemical weapons attack. At this point, and while the staff cope with severely injured patients, the soundtrack changes, introducing a low, sombre background sound. Albrechtsen commented on the choices made, and their intended effect. “The final chemical attack is so scary and horrible. This is one of the places in the film where my sound design really melts very closely together with the score by Matthew Herbert,” referring to the composer responsible for the minimal music used in The Cave. “[Herbert] used different musical drones and I created different loops of respirator sounds and these played together very well. The soundscape is deliberately very dirty and rough but the drones and loops also create a hypnotic feel throughout the whole sequence. If it was just wounded people screaming all the time it would have been impossible to go through and it would have alienated everyone. But by slowly making the sequence sound more and more abstract I think the audience understand the horrors and at the same time there is space for reflection—the reflective soundscape makes the whole thing more emotional and enveloping. I’ve seen the movie many, many times and I still cry every time I see this part of the film.” 

The effect in the more intense moments of the film is subtle, barely noticed but extremely effective in setting a mood and making the more painful scenes bearable. “Regarding the music, I always find it important that this builds on an emotion that’s already established in the scene and is not forcing itself on the audience. I hate when the score tells me what to feel. Way too much film music does that. On the other hand, it can be incredibly powerful when I already feel something and the music then comes in and expands on and deepens that feeling. As John Cage once said: “I don’t mind being moved, but I don’t like to be pushed”. That’s the balance we wanted to achieve in The Cave and I think Matthew did an amazing job.”  Indeed, the entire crew seem to have done an amazing job. The Cave is a disturbing, inspiring work of documentary filmmaking. Far Out is grateful to sound editor/designer Peter Albrechtsen for providing this behind the scenes insight into the artistic choices that go into making such a film. 

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