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Hospitals in Helmand hot zone treat more 'collateral' patients

Mohamed doesn't know who fired the bullets that hit him

By Karlos Zurutuza

A visit to the two hospitals in the war-torn Helmand region of Afghanistan exposes the horrors that innocent civilians, so-called collateral damage caught in the crossfire, experience in modern wartime.

"No weapons allowed beyond this point," reads a sign at the entrance of Boost Hospital in Lashkar Gah, Afghanistan. Such advice may be redundant elsewhere, but here at Boost it is as much a declaration of principle as a regulation.

Lashkar Gah is the capital of Helmand province - one of Afghanistan's biggest battlefields. The region may look like a wasteland but it is still able to produce more heroin than anywhere else in the rest of the world. In a place like this, travelling often means taking roads that may be laid with explosives, or shelled by helicopters. It's little wonder, then, that common health problems often become real emergencies.

No questions asked

"We do not ask anyone which side they belong to, or who injured them. Our work is limited to offering free medical care to anyone who comes to the hospital," says Stefano Argenziano. He is the project coordinator for Doctors Without Borders - known by its French acronym MSF - in Helmand province. Accordingly, nobody at Boost speaks of "Taliban terrorists;" they use the term "government opposition" instead.

There are more than 2,000 NGOs registered in Kabul, but just a handful of these have a field presence. MSF is one of those rare groups. It relies solely on private funds and, unlike many other groups, does not have paid soldiers protecting the safety of its staff. Even the usual barbed wire and sandbags aren't to be found at the camp where MSF staff lodges.

"We try not to be in the same place as foreign troops. Nonetheless, our best calling card is our work," Argenziano said. "We have earned the respect of local people because everybody knows what we are all about."

MSF resumed its work in Afghanistan after an absence of five years, following the murder of five of its staff in Badghis province in 2004. Their humanitarian mission in Lashkar Gah, supporting Boost hospital, was launched in November, 2009. Boost is one of the two reference hospitals in the war-torn south of the country, alongside the one in Kandahar.

A reference hospital is the term used by the World Health Organization for hospitals that accept complex cases for cutting-edge diagnosis and treatment.

Ilona is a nurse who arrived in Afghanistan from Germany two years ago. Today, she moves gently but swiftly through the sea of blue burkhas in the female section of Boost hospital.

Patients from all over

"Many of the cases we handle deal with malnutrition in infants after drinking cow or goat milk. Their mothers are anemic and can't breast-feed, so the children suffer from chronic gastroenteritis because they are unable to process the animal milk," she said.

There are also Afghan nurses at Boost, and Assadullah - a native of the relatively peaceful northern region Mazar, is one of them.

"We also treat those hospitalized for an overdose of heroin or simply the most direct victims of this war," she said.

Boy in hospital bed Helmand

Civilian casualties and deaths continue to increase in Afghanistan, despite a commitment by NATO troops to avoid them. UN figures suggest ISAF troops are causing less "collateral damage" - army-speak for injured civilians - but insurgents continue to target civilians, so casualties are rising.

A UN report on civilian casualties in Afghanistan, released in the summer of 2010, showed civilian deaths and injuries in the country had increased by 31 percent from a year earlier, to 3,268.

The UN attributed 76 per cent of these incidents to insurgents – up from 53 per cent in 2009.

Mistaken for Taliban?

At Boost, MSF is primarily responsible for pediatrics and maternity. But its not hard to find direct victims of the war as well.

Take Sharifullah, for instance. A 16-year-old boy, he was shot in the stomach during the celebrations of the end of Ramadan. His older brother, Abdullhaq, says he believes the wound came from British troops.

"It came from a British convoy. The kids began to run alongside the road. The soldiers probably took them for a gang of Talibs and shot," Abdullhaq said. He added that four months ago, four children in his village were killed the same way.

Assadullah, who was briefing Sharifullah on how to walk with crutches, said such cases of injury via coalition fire were "unfortunately very common" at Boost.

Ihmatullah, a 16-year-old shepherd from Musa Qala, was also possibly injured by coalition fire. He was hit by rocket shrapnel one night while he was sleeping outdoors. According to his father, Abdulwazid, it was the British who wounded his son - then stabilized him and brought him to Boost.

Child with a stump instead of a leg. Six-year-old Daudchan lost a leg; his brother lost two

Laura Mendikoa is an experienced nurse from Mexico who has worked around the world, doing stints in Liberia, Somalia, Kenya and Mexico - and now Helmland.

"Back home life is doubtless more comfortable but it's much more rewarding here," she said.

Mendikoa's job one recent day was treating Abdulraziq, a 13-year old from neighboring Farah province who was admitted three weeks earlier after he had a life-changing encounter with an IED, or Improvised Explosive Device. He lost an eye and his right hand in the blast.

IEDs and other tragedies

Sudden tragedy also changed the lives of six-year-old Daudchan and his four-year-old brother, Mahmadullah. Daudchan lost his leg, and his brother lost both legs.

"They were travelling with their father on a motorcycle when they had the misfortune of running over an IED," the children's grandfather said, holding Daudchan's bandaged stump. "My son was luckier: he has only lost the toes of his right foot," he added in a resigned voice.

In the building adjacent to Boost hospital, an Italian NGO callled Emergency runs a hospital that specializes in treating the war-wounded, specializing in victims of land mines.

At the entrance one Friday, a smiling child gave his three-fingered hand to a visitor to shake. But the child was no longer a patient - he was there to see his brother. Friday is not only a day of prayer, it's a day to visit wounded relatives in the hospital.

The Emergency hospital in Lashkar Gah has been in operation since 2004, and it is the third one the Milan-based NGO runs in Afghanistan. The other two are in the northern districts of Panjshir and Kabul, open since 1999 and 2001 respectively.

Not surprisingly, the one in Lashkar Gah is the busiest of the three. Around 90 percent of the patients admitted are civilians - and 40 percent of those are children, according to Matteo Dell'Aira, the local medical coordinator.

Doctors arrested, charged with plot

"The hospital where we are now is witnessing the war from the other side," he said.

Dell'Aira and eight other colleagues, both Italian and Afghan, were arrested in April by a mixed group of Afghan police and British troops. The nine doctors were accused of participating in a plot to assassinate Helmand's governor, Gulab Mangal.

Mohamed doesn't know who fired the bullets that hit him

"The police claimed that we were handing information to the Taliban and that they had even found weapons and explosives in one of our warehouses at the hospital," the Italian doctor said with a rueful smile. "It's a real shame what is happening here."

The arrest came under the aegis of Operation Moshtarak ("together" in the Afghan Dari language) which was one of innumerable ISAF military offensives in the region. Emergency complained that they were denied the establishment of a humanitarian corridor to evacuate the wounded from Marjah, a nearby village which was heavily shelled for months.

Finally, the detainees were released after nine days in jail without charges. Immediately afterward, Gino Strada, who founded Emergency, said that the attempt to discredit his organization had failed. He said Emergency in Afghanistan, especially in Helmand province, was "an uncomfortable witness to what the Coalition forces are doing here."

Yet more innocent victims

The number of patients treated daily in the Emergency hospital depends on how busy it is from day to day, said Luca Radaelli, one of Emergency's nurses.

"We have treated 400 patients in the past two months, but numbers can vary greatly depending on the day. We can get 20 in one day, or just three," he said.

After spending a day at Emergency's admission desk, the testimonies of the patients start to sound painfully familiar. The location of the accident, and the means - gunshot, IED, mortar attack, - may change, but the victims' profile is often recurrent: civilian, under 14 years old, with amputated limbs.

Vague details, serious consequences

Like many others here, 15-year old shepherd Ziacho still doesn't know who shot off the rounds of ammunition that tore off his two legs.

"I was walking my flock in Greshek (Helmand). I remember I sat down to rest when I spotted a mine nearby. I also saw a helicopter over me so I'm not sure what caused the explosion," he said.

Next to him, 12-year-old Mohamed listened to Ziacho´s testimony with a blank stare. In a low and breathy voice, he explained that he was on the roof of his house when he noticed an impact on his body.

"When they brought him here his liver was stuck onto his lungs. It's really a miracle that he's still alive," said Radaelli. Bullet wounds are the most common cause of admission in this hospital, he added.

Abdulwahid lost his leg in the middle of the crossfire. "I was working in my farm when the battle began," recalled the villager from Musa Qala. "The fighting lasted between one and two hours. In the end I felt a sharp pain in my chest and leg. I couldn't tell where the shot came from."

Abdulraziq in hospital bed. Abdulraziq's meeting with an IED changed his life - and took his limb

Indeed it is often difficult to know just who is behind each attack in Helmand province. In addition to American and British soldiers, there are also Estonians, Canadians, Danish, Georgians and Arabs from Bahrain fighting in Helmand. And of course there are the Taliban, or drug smugglers or, simply, road bandits.

Mahmud Khan, a patient at Emergency, is a Pashtun who had just had his right kidney removed.

"I was shot when I was driving across Delaram (Nimroz). They were simply thieves who wanted my motorbike. I wish I had given it to them from the very beginning," he lamented.

And 12-year-old Quadratullah, lying in the bed near Khan, explained how he ended up in the hospital.

Unfortunate house search

"Back in my village we spotted some people getting into an empty house. We were most curious so we decided to see what was inside," said Quadratullah. "I went first but I had to push the door hard because it was blocked. Then something exploded...When I woke up here, my father told me it happened to be a warehouse where the Taliban stored their weapons and explosives."

Quadratullah tells the story with the composure and the distance of somebody who has not yet had time to reflect on what has happened. His apparent state of shock seems like a mechanism to prevent him from thinking about what kind of life awaits a kid from Afghanistan who's lost his right eye and arm, and both his legs, in a seemingly endless war.

"One has to get used to this suffering in order to survive here, but it is not easy," said Radaelli said, visibly moved. His six-months rotation is almost over and the NGO requires its workers to rest for at least a few weeks before resuming their jobs - a well deserved oxygen break before diving again into the horror of the Afghan war.

Author: Karlos Zurutuza

Editor: Jennifer Abramsohn