Another day in Baghdad A&E

What happens to the victims of Baghdad's countless bombings? Ghaith Abdul-Ahad meets the doctors who battle to save them

Ghaith Abdul-Ahad Tuesday November 22, 2005

Guardian

Inside the compound of Yarmouk hospital, the mud-coloured buildings are filthy and falling apart. Smashed windows provide the only lighting along the corridors. Children touting sweets or cigarettes thread their way through piles of rubbish. Hundreds of people, some pushing wheelchairs, others supporting crouched figures - all clutching files of papers and x-rays - squeeze through narrow metal gates between the different sections of the compound.

There are the usual sort of hospital patients here: those with intestinal pains or broken limbs. But there are also Baghdad specialities: patients with car-bomb damage or mortar-shrapnel injuries or gunshot wounds.

Yarmouk, one of Baghdad's biggest hospitals, was built in the late 1970s when the oil-rich Iraqi government launched a five-year school, factory and hospital-building programme. That ambitious undertaking left Iraq with a modern and respected health-care system. But three wars and two decades later, it is in a shambles.

All the urgent cases end up in Yarmouk's emergency room - and there are plenty of urgent cases. The hospital receives most of the casualties from the west of Baghdad, the area of the city with the highest level of insurgent attacks; an area that has no-go zones for the Iraqi army and police personnel.

The ER is a big room with male and female sections divided by a curtain. Adjacent is a small operating theatre, a pharmacy and a large hall where waiting family members chain-smoke, sob and blame the Americans, the Zionists and the insurgents for the injuries to their loved ones.

In the main room, the floors and walls are tiled; the walls are filthy and covered with stains. In one corner sits a bulky, obsolete piece of equipment that is now used as a telephone table. In another corner there's a small, broken basin that the doctors use to wash their hands and cleaners use to fill buckets of water. Along one wall, there's a surface where doctors can fill in the three forms necessary for each patient, and then copy the forms into a big book. In the midst of all this, there are 12 metal hospital beds. Each is covered with green plastic sheets.

Over the past few months, I've spent what amounts to about two weeks in the ER. Each time I come, there are police cars and army pick-up trucks parked outside where you might expect to see ambulances. These are the vehicles that bring the victims from the latest scene of violence.

Early-morning casualties

Dr Omar Ta'ie is 26 and has only recently qualified; he speaks flawless English and says he listens to western pop music. As part of his ongoing medical training he is spending a year here in the ER. He does 12-hour shifts for four consecutive days, then gets three days off. He talks me through an average day.

"Our day starts busy," he says. "The first attacks happen in the morning, and patients start arriving by 7.15am. By 8am all these beds are full."

The first victims tend to be from insurgent attacks. The insurgents like to let off their car bombs and small explosives, and to carry out their assassinations, while it's still early. The idea is to catch officials and policemen either as they change shifts or while they are driving to work. Many of the victims, however, tend to be passers-by on their way to work in the early-morning rush hour.

"Around 10am, things calm down and we have a break until one in the afternoon when the biggest wave of car bombs and explosions often happens," says Ta'ie. "By that time most of the patients have to lie on the floor. And then nothing until 9pm, when sectarian assassinations flare up, mixed with a couple of drunken fights."

There are usually four to five doctors and a couple of medics assigned to each shift. After each wave of patients, two workers, dressed in blue factory overalls, come in and start collecting the plastic sheets from the beds. One of them brings a bucket of water and the other a grey rope mop, and with the sheets done, they start cleaning the floor. Sometimes they have to use a piece of cloth to remove a difficult bloodstain.

I was in ER one morning in September when we heard ambulance sirens. The doctors came from behind their counter into the middle of the room as a medic entered. He was pushing a gurney on which a girl lay unconscious. "Shrapnel wounds in her arm and chest from a mortar that fell on their house," he said.

Two of the doctors took her to the female section and pulled the curtain closed. The girl's mother, a huge woman dressed in a black abaya, her headscarf in disarray and her hair falling over her face, stood in the middle of the room wailing as a young female doctor - given the job of filling in the usual forms - tried to question her.

A few minutes later a big man ran into the room. "Where is Saneya?" He was looking for his sister. One of the doctors assured him that she was fine, but that she had needed to go to another hospital where they had specialist brain surgery equipment - "just for a routine check".

"Our biggest fear is when someone dies because then the family and relatives will start beating us," one doctor told me quietly.

What's even more frightening for these doctors is that they get casualties in from "commando" units, part of a feared paramilitary group with links to a Shia militia, which has a base a few hundred metres from the Yarmouk hospital.

One night when I was about to leave the ER there was a burst of gunfire - heavy machine guns roared at the entrance of the hospital. The doctors started running around urging patients, if they were well enough, to clear out. Moments later, a group of masked young men in army fatigues and black T-shirts burst into the ward. Two went to where people had gathered in the hallway, pointing guns at them and telling them to look away. Three others carried between them a piece of cloth in which one of their comrades, badly injured, was lying. They placed him on one of the plastic-covered beds.

"Save him," said one of the men in black T-shirts. One of the commandos took off his mask and began weeping. The others laid their machine guns against the walls and lit cigarettes, trying to stay calm.

A doctor asked me to go. "If they find you are here, they will kill you," he said. Outside, some commandos were holding up the traffic with bursts of gunfire. I crouched between cars until it was safe to go. The doctors were lucky that day; the injured commando didn't die. But twice in the past few months the doctors have gone on strike, protesting against commandos and army soldiers beating them up and kicking patients out of their beds to make space for their casualties. After each strike they get assurances from the ministry of interior that no armed men will be allowed into the ER. But it keeps on happening.

No pain relief

The doctors here work hard, and are dedicated, but resources are scarce, and things frequently feel chaotic. One afternoon when I was in the ER a man with a partially severed hand was brought in, another victim of a mortar attack. He was holding his dangling hand with his other hand; a friend in a blood-splattered white robe came in with him. Three doctors laid the injured man out on a bed, then stretched his injured arm out over a plastic garbage bin.

"Get me some anaesthetics," a doctor shouted at one of the cleaning boys. The boy dashed out of the room.

A doctor wearing blue medical scrubs, helped by another doctor, started to clean the wound. The injured man had been calm with shock, but now began to scream.

The cleaning boy came back saying there was no anaesthetic in the hospital. The injured man's friend ran outside in his blood-soaked dishdashas to find out for himself, but the doctors decided to stitch the hand back on without waiting any longer. The injured man started to wail: "Oh, imam, come and help me. Oh God."

The doctor in blue started to sweat as he tried to find the bleeding artery. The man's screams grew louder.

"I can't find the damn thing," said the doctor.

Patients, relatives and passers-by formed a circle around the doctors as they carried out the operation. A cleaner swept beneath the bed.

After some 10 agonising minutes, a more senior doctor managed to complete the operation. By the time they had finished the man lay unconscious. The anaesthetic still hadn't arrived.

Once Ta'ie took me to the living quarters where the emergency doctors spend their time between shifts. The doctors' residence is a big three-storey building on one side of a courtyard. Inside is a long dark corridor with rooms off to either side. Each room is small, 3m by 2m, with two camp beds, a small table and a chair. The walls are painted in green and are as dirty as everything else at Yarmouk. Luckier, more senior doctors, have a functioning toilet in their rooms, but the others have to share.

Ta'ie walked me to his room, which he shares with six others, on the upper floor. The corridor there was lit by holes in the wall. Broken doors lay gaping open and the floor was thick with dust and mud. The toilets stank.

The doctors' communal dining room was furnished with four plastic tables and a few plastic chairs. Three cats wandered around. "It's not all bad like this," said Ta'ie. "We have a TV and satellite dish in the reading room, [although] all the sofas are broken."

"I feel I am alone here," he said later. "If we ask the administration of the hospital why the situation is like this, they say, 'Because the minister of health is from a different sect to the hospital manager.'"

Too late to save a leg

Not all the casualties are victims of mortar attacks and car bombs. On my last day in the hospital a few weeks ago, a whole football team showed up. They wore cheap football T-shirts and shorts. They were all young men; one of them, a young man called Hassan, was lying on a stretcher with his leg wrapped in plaster. His leg was broken in two places and needed an operation, the doctor told me. "He should have had an operation by now; instead, a medic just twisted back his leg and fixed him with the plaster."

When I asked why they couldn't do the operation, the doctor told me that the specialist comes only once a week. "He has to wait for another two days before we can do the operation. I think by then it will be too late for his leg to be back to normal."

By that time Hassan was crying and screaming, holding his head with his hands and shouting at his friends, who stood around him not knowing what to do. "Tell me what is happening?" he shouted.

As the football team gathered around the doctor, trying to find out if there were any other hospitals that might do the operation, a crowd of people rushed into the room, pushing a gurney. An old man, blood soaking his shirt, lay motionless on top of it. His son stood by, holding his father's head and shouting at the doctors to save his life.

"Please doctor - try, I beg you, maybe you can save him." The doctors, knowing the man was already dead, patted the son's shoulder, telling him it was too late. "They killed him just because he is a Shia, because he loves imam Ali," wept the son.

The man was a Shia shopkeeper who lived in Jihad, a Sunni area west of Baghdad. The football team silently pushed their injured mate away. It was already past nine o'clock and the first of the sectarian violence had begun.