Since the offensive to retake the city of Mosul from the so-called Islamic State started last October, hundreds of thousands of people have been displaced and those who remain face extreme difficulty reaching healthcare. Many have been wounded or killed, often as the frontline moves through their neighbourhood. Dr Kevin Baker, an anaesthetist from Sydney, was working in Médecins Sans Frontières’ trauma hospital to the south of Mosul in March this year.
“We were almost overrun by the numbers initially. After an initial triage process we received the code-red patients, such as those with gunshot wounds to the chest or abdomen. People who had typically lost a lot of blood. Near-death experiences basically. One day we received 100 patients, but 40 to 60 patients was a fairly typical day. Because of the sheer numbers and the time constraints, we were only able to do damage control surgery. If the surgery was expected to take more than 1.5 hours then the next person waiting wouldn’t make it, so we were working on the principle of ‘doing the best for the most’. We aimed to stabilise patients before transferring them to another Médecins Sans Frontières facility in safer grounds where they could have more surgery.
The facilities are remarkable, with all the required surgical and anaesthetic equipment. There’s one operating theatre in a shipping container on the back of a truck, which is claustrophobic at first, but just brilliant once you get used to it. Then there’s a second operating theatre in a tent and a recovery room with an intensive care unit, where we would maintain patients before transferring them. The injuries we were seeing were predominantly gunshot wounds. There was a remarkable number of children under 15. Many of these kids weren’t hit by a stray piece of shrapnel – but appeared to suffer sniper wounds. It seemed they had been intentionally hit. That was the most dramatic thing about this field placement: kids being shot, even toddlers being shot. That was an emotional experience for the team, and there were plenty of tears shed, including my own.
"There was a remarkable number of children under 15. Many of these kids weren’t hit by a stray piece of shrapnel – but appeared to suffer sniper wounds. It seemed they had been intentionally hit"
There was one little boy who had a gunshot wound in the neck and had apparently laid in a gutter for several days. It initially appeared that the bullet hadn’t gone too deep, but we soon realised that it was no wonder he hadn’t moved, because the bullet had transected his spine at about the T2 [upper chest] level. He was still breathing, but is paralysed below chest level. It was remarkable that he had survived; hard to believe. We sent him to Erbil to see what surgery they could do, and there can be some healing with the spinal cord. But it’s hard not to think about what’s ahead for a little boy like him, how difficult his life is going to be. Some of the things I saw were like a scene out of World War Two. Two of our patients were husband and wife who had been separated as they fled. And there they were, reunited in our medical tent, clutching each other, just weeping and laughing, with their baby suspended between them. It was incredible to witness.
It was a difficult mission, and everyone worked incredibly hard. Most of our staff were local Iraqis, who were brilliant. The whole experience for people working there is exhausting, overwhelming, but humbling somehow… an experience that probably all of us will be a bit damaged by initially. I think it’s the sheer numbers of patients – and particularly the number of children.”