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Iraq: “No training module could prepare me for the flood of human debris”

Responding to a mass casualty event late last year near Tal Maraq, Iraq, Dr Georgie Woolveridge, from Tasmania, was confronted with a severely injured toddler.

I’ve never wanted to forget something so desperately as the first time I saw you. As I finished treating the sixth patient in an hour, I watched as you were wheeled into the only empty space in a rapidly shrinking emergency room. Yours was one of two tiny bodies laid out on a steel bed meant for broken adults, bodies destroyed as tokens of war. Your baby brother was next to you.

I choked back tears and the acrid taste of vomit as my world hurtled from one where babies cried when they were immunised, hungry only in the minutes it took to prepare a bottle, hurt only in learning to walk – to one where children are brought to hospitals bloodied and seemingly lifeless. 

"A call came through that a suicide vest had been detonated at a checkpoint and ‘a few ambulances were on the way"

An hour before, a call came through that a suicide vest had been detonated at a checkpoint and ‘a few ambulances were on the way’. Mechanisms were in place to accommodate the arrivals, but no training module could prepare me for the flood of human debris that was to ensue. Chaos descended and by the time your stretcher was wheeled in we were engaged in a morbid game of Tetris with all the extra beds. We bunkered in for the worst. 

 

“I was dubious about you, little one”

In a hospital of finitely limited resources – with the majority of our medical staff living over two hours away, as they had fled during occupation by the Islamic State group – treatment goals have to focus on the essentials. I was dubious about you, little one. Limp, verging on lifeless and with injuries that could potentially prove fatal, the message was clear – we work as hard and fast as possible to stabilise you and your brother while our colleagues vehemently petition authorities to grant us passage through checkpoints to definitive care. But if the patient load and acuity increased, your treatment would have to be modified to a comfort-based approach. 

Medicine can make us hard, detached, emotionally disengaged, but in a moment of uncharacteristic calm between waves of arrivals I stood by your bedside, hand on the side of your head, and lost it just a little.

Implying you were lucky that day is blasé and borderline offensive. Being involved in a blast that killed your mother and sibling, leaving you and your brother severely injured, conjures no imagery of luck. However it was fortunate that permission from the authorities was granted to send a single ambulance. We stabilised you the best we could, squeezed three tiny, war ravaged bodies – you, your brother and an 11-year-old boy – into the back of the ambulance and sent you off with nervous anticipation.

"And then on waking, seeing you vital, playing, cuddling for hours is the most precious memory I could take from an experience that overwhelmed every sense"

Mustering hope

Vague reports filtered through about you. ‘Alive’, ‘severe brain injuries’, ‘no family’. Two weeks later, I was the fortunate one. Tracking you down to a hospital two hours away, I walked with quiet apprehension into your room to find you sprawled in childish sleep – one hand instinctively flung over your younger sibling, your ally. And then on waking, seeing you vital, playing, cuddling for hours is the most precious memory I could take from an experience that overwhelmed every sense.

The day we met, I struggled to dream of a future for you. Now, I can muster hope. Hope that one day, against all odds, your biggest concern will be which grassy knoll to roll down, how to kick a ball past your brother, how to negotiate a later bedtime. A life where ‘suicide bomber’, ‘internal displacement’, ‘refugee’ are buzzwords semi-retired. My wishes for you may be overzealous, naïve, but already you’ve survived. For you to thrive, in the future, I have hope.