Fighting for life on the frontline
Last updated at 17:48pm on 31st August 2007
CommentsIn a field hospital in Afghanistan, British Army medics tend to the wounded and dying victims of the war in Helmand Province. The ethical dilemma? Among their patients are Taliban rebels who have been shot by our own troops
A Chinook skims over the desert, blowing up a sandstorm as it lands beside what looks like a huge marquee in the most unlikely of settings.
With the blades still turning, the back drops open and a soldier is stretchered out to a waiting Land Rover, then driven the few hundred yards to the entrance of the marquee. When the soldier is not sobbing he is screaming.
The trauma team hurry him into the tent. They tell him time and again he will be fine; but I can see in their eyes the words of comfort are simply to keep him calm.
They don't know if he will still be alive by the end of the day.
Outside in the desert the temperature is 45_C; a wall of heat that saps you relentlessly.
It invades the tent, too - even though vast air conditioning units pump away, it is still hot and humid inside.
Consequently the odours are more piquant; as soon as the stretcher is enveloped by the marquee flap dropping, you can smell the blood mixed with the body sweat of the soldier who hasn't been able to wash for days.
The colours seem more vivid here, too: the red of the blood staining his khaki uniform, the green of the hospital staff vests, the blue of the surgeons' gowns all shine out against the tent's white fabric walls.
Now the soldier looks pained but resigned.
I can see his face and torso are covered in blood and he has numbers written in marker pen on his forehead - his blood pressure and pulse readings, written there by the British Army Medical Emergency Response team that had flown out to pick him up from the front line.
After the trauma team have stabilised him he is wheeled through to the operating theatre.
It is alive with the tools of salvation; highly sterilised steel instruments, scrubbed surgeons with microsurgery sight aids, attending retinues of secondary doctors, nurses, orderlies and anaesthetists, tubes, screens, power units and yards of hanging canvas.
All the workers have a rank.
Many sport a Union flag on their uniforms. Now they descend on their patient and begin the surgery to extract the shrapnel from his body.
This is not a single tent; the extraordinary tableau of war is played out in a temporary hospital in the middle of a desert, right on the edge of Camp Bastion, a 2,500-man Nato outpost in Helmand Province in southern Afghanistan.
This is a hospital like no other. There's only ever one sort of car in the car park - Land Rover.
And the first thing you do when coming into the hospital as a patient, visitor or member of staff is unload and hand in your weapon at the reception counter.
No visitor can be unimpressed by the commitment of the British military medical personnel who man this base.
It is not just the work they do in such conditions, although these are gruelling enough - the volume of patients admitted and life-saving surgical procedures is relentless; shifts are often 24 hours; sometimes they work ceaselessly for 48 hours without giving in.
More than this, it is the effortless disregard for the ethics of the situation that is moving.
Inside, the staff treat Brits, Danes, Estonians, Czechs and the occasional American and Dutch troops that make up the predominantly British Task Force Helmand, as well as Afghan Government troops, national police, and civilians.
But here the British medical teams are also saving the lives of their enemy - Taliban fighters.
They treat them all the same, even if the patients bear the wounds of the surgeons' own fighting colleagues, and then, having recovered, go back into battle and claim the lives of some of their own.
Indeed, in a way, they treat the Afghans better because while most serious British casualties are flown back to the UK within 24 hours, Afghans stay for up to a month.
The British are extremely respectful towards civilian casualties.
Of course there are many different levels of Taliban, from hardcore Islamic fundamentalists to the so-called "$10 Taliban" - not real fighters, but maybe farmers or growers of opium, who have perhaps shot off a couple of rounds with a Kalashnikov.
The British don't actually hold anybody captive - the hardcore Taliban fighters they treat and hand over to the Afghan authorities, while the lesser ones they tend to release.
The field hospital is a sprawling complex of tents with a concrete floor running the length of its 150m spine.
It has its own power, laundry, sewerage, plumbing and infection-control systems, and contains equipment that would leave most NHS hospital administrators green with envy.
Its five-bed accident and emergency department has two portable digital X-ray machines, a CT scanner and an operating theatre, where two patients can undergo surgery simultaneously.
There's ward space for 25 casualties, including up to eight patients in intensive therapy beds, although the number has surged to 50 patients at one time.
In addition to accident and emergency, surgical and ward care, the hospital also has physiotherapy, pathology, dental and welfare departments.
The medical staff include RAF and Royal Naval medical personnel but the main body consists of regular soldiers from 4 GS (General Support) Medical Regiment based in Aldershot and Territorial Army soldiers from 212 Field Hospital on a three-month tour, recruited primarily from Yorkshire and the Midlands.
The work is unremitting. Back home, Lieutenant- Colonel Andy Bruce of the Territorial Army, wearing a Union flag bandana, is a consultant orthopaedic surgeon at Doncaster Royal Infirmary.
He has been at Camp Bastion for seven weeks and has performed about 130 surgeries. "We are on call 24 hours a day. If being on call is working, consultants are working 100-day shifts."
The hospital has three surgeons - an orthopaedic, a general and a neurosurgeon, but Andy Bruce is inevitably the busiest since most of the casualties have injuries to their limbs.
Soldiers wear bulletproof jackets that protect their upper bodies but leave limbs vulnerable.
Many of the injuries suffered by both civilians and military are caused by shrapnel from roadside bombs, land mines and rocket-propelled-grenade attacks.
Patients are picked up from the battlefield by a helicopter team made up of air paramedics, a trauma nurse, a doctor and a consultant, as well as a squad of infantrymen to provide protection on the ground.
"We're all experienced in trauma," says Surgeon-Commander Adrian Mellor, a Royal Naval consultant anaesthetist.
"But we are witnessing things not seen since Korea. Not only do you have to cope with the stress of dealing with a new scenario every time you go out, but there is the added stress of going into a battle environment to do it."
Being in a combat zone, the hospital is mainly designed for treating trauma cases.
"I've seen more trauma cases here in five weeks than in four years back home," says Lieutenant Phil Bond, whose civilian job is an A&E nurse in Nottingham.
Once stabilised by the trauma team and after undergoing surgery in the operating theatre, British forces are then flown back to a hospital in the UK.
Those receiving longer-term treatment are therefore Afghans.
Malalia, a five-year-old Afghan girl, was run over by an Afghan National Army vehicle.
Her right arm was crushed against a wall. Initially, doctors at the field hospital thought amputation was the only possible solution.
But in rural Afghan society this would have led to her being ostracised, so Andy Bruce promised her father that he would do everything possible to save her arm.
The dead and damaged muscle was cut out and the bone repaired with makeshift external scaffolds of wire, plastic tubing, aluminium bars and plastic ties because of the lack of specialist paediatric equipment.
She needed further surgery every two days for 16 days, and then skin grafting. Five weeks later, against all odds, the arm had healed and Malalia was able to move all her fingers.
Then there's the story of Hassan, the hospital's miracle boy.
He was brought in after being caught by a mine with a shrapnel wound that had pierced his heart.
He technically died on the operating table and would not have pulled through were it not for the efforts of Colonels Bruce and Andrew Hall.
The shrapnel had penetrated deep into his chest, causing massive injuries.
The wound in the heart bled, eventually forcing the heart to give up.
The surgeons opened up his chest, drained it, stitched the wounded heart, sealed the child back up and left his fate to the gods.
Had he been an adult he would have had a two to 16 per cent chance of recovery.
There is no documented occurrence of the operation being carried out on a child. Within five days Hassan was up and walking. Two weeks later he was playing football.
It's not just military personnel that work in the hospital.
Michelle McLaughlin is a UK civilian working for the Defence Medical Welfare Service.
The DMWS provides emotional and practical welfare care for military patients, working in MoD hospitals in the UK and UK medical facilities in Germany and Cyprus, as well as the operational theatres of Iraq and Afghanistan.
She relishes the chance of being out there not just to help hospital cases but also any soldiers who need to talk to someone.
"There's not much to laugh about here," she says.
"But if I can help make just one person smile I feel I've done some good during the day."
Next door to the massive tent a large new concrete hospital is being built, set to open in October.
When I first saw it, I was gladdened.
I saw it instinctively as part of a legacy that the British will bequeath to the Afghan people. I was wrong. It means no such thing. I came to understand it for what it really is: a sign that this war is going to go on for a long, long time.
