May 18, 2012
Pacifists in the Cross-Fire
By LUKE MOGELSON
Gulali’s mother ran to her and began to stanch the hemorrhaging stump with a head scarf. Two of Gulali’s uncles, Pasha and Sartor, were working a field about a mile away when they heard the explosion and saw the brown plume drift and dissipate. It took Sartor, the younger one, more than 30 minutes to reach the scene, and when he arrived, he found Gulali cradled in her mother’s arms. Sartor put his niece over his shoulder and ran back to where Pasha and a group of nomadic herdsmen were waiting. An old shepherd offered his winter shawl, which Pasha and Sartor used as a makeshift litter to carry Gulali another 20 minutes to the nearest Afghan Police post. Gulali, who remained conscious the entire time, never made a sound. When she was 6, she fell down a 30-foot well that was dry at the bottom. Her father found her hours later, both of her legs broken. He had to climb down a ladder and lash her to his back with a rope to get her out. During that ordeal as well, her father told me, Gulali remained spookily calm.
Now her mother was screaming for help as they approached a metal shipping container with a machine-gunner’s nest on its roof. The police officer in charge of the post flagged down a car, put them in the back seat and instructed the driver to take them to the
• 'We Cannot be on One Side of the War'
• Triage After the Bomb
• What Do We Owe the Civilians Injured in a War We Started?
• 'If They Wanted to Treat Them, They Could'
• The Pacifists vs. the Military
• 'A Patient is a Patient. This is Our Rule'
• A Policeman's Last Delusions
• One Remedy Among the Tragedies
• 'They're Not Like Our Children'
When they arrived at Emergency — a former kindergarten built by the Soviets — Tijana Maricic, the head nurse, rushed Gulali from the car into the operating theater, her nearly severed right leg bundled in her mother’s scarf and a huge open wound on the left. Mine injuries, especially traumatic amputations, are uniquely vulnerable to infection — the blast often forces dirt, shrapnel and other contaminants deep into the stump — and a priority for the Afghan surgeons working on Gulali was to excise foreign bodies and damaged tissue. In the end, they also had to complete the amputation of the leg, removing it just below the knee.
“She was very brave,” Maricic said of Gulali’s stoic reaction to her pain. “Here, even most of the very young children with severe injuries never cry.” Maricic, a Serb, worked as a pediatric nurse in
Despite Emergency’s central location, Maricic and her colleagues see little of the city outside the hospital grounds and almost nothing of the country. Inside the hospital, however, they see everything — the worst of what war can do.
“I prefer it here,” Maricic told me recently. “
Emergency is an Italian-based nonprofit that opened its first surgical center in
Eventually, Mullah Omar, the leader of the Taliban, agreed to let Emergency open its hospital in the former kindergarten. Because of the ever-shifting front, Strada said, “we had Taliban fighters who were taken to Panjshir, and Northern Alliance fighters who were taken to
A vast majority of Emergency’s patients, however, are civilians. In 2011, the war in
Until she came to Emergency, Gulali grew up somewhat insulated from the conflict. For years, her father fought the Soviets in Qala-e Naw; the rusted carcass of a Russian tank, which one of his compatriots set alight with a rocket-propelled grenade, still sits on the bank of the stream near their house. But since 2001, Qala-e Naw has been relatively peaceful, and Gulali’s childhood was uncorrupted by violence. The Shiite holy day of Ashura, commemorating the martyrdom of the Prophet Muhammad’s grandson Imam Hussein, arrived during Gulali’s first week at Emergency, however, and that afternoon visited on the hospital some of the grisliest brutality that 11 years of fighting has managed to produce.
Shiites represent a small minority in
Sometime shortly after noon, a suicide bomber infiltrated the ceremony and detonated himself. The explosion ripped through the heart of the crowd. It cleared a wide swath and at the periphery of its force created a semicircle of wrecked bodies piled along a strangely geometric arc. More than 200 people were injured or dead: crumpled improbably, heaped among odd scraps of clothes and limbs as if they had plummeted from a great height. In the carnage and confusion, the dying were hard to distinguish from the dead. Bodies in all manner of distress were taken to Emergency in taxis and cars and in the backs of pickup trucks. When Luca Radaelli, the hospital’s 35-year-old medical coordinator, opened the first ambulance’s doors, he found several dead infants stacked atop a mass of bloodied but breathing women and men. “I also found the head of what was probably the suicide bomber,” Radaelli later told me. “As I took out the first patient, the head fell down at my feet.”
A mob of distraught relatives and survivors began to form outside. Radaelli shut the hospital’s gate, allowing only patients to enter. Some of the bereaved tried to break down the gate, others to scale the walls. More victims continued to arrive. Soon gore and body parts littered the sidewalk. When I arrived at the main entrance, about an hour after the bombing, a brain lay on the street. It was perfectly intact and surprisingly white. An Afghan employee of the hospital, wearing heavy rubber gloves and equipped with a wheelbarrow and a hose, was hurrying to clean up the mess.
A mass-casualty triage tent was hastily erected on the lawn where the local staff members sometimes play volleyball. In Gulali’s ward, injured children came and went. She sat in her wheelchair, watching. It’s difficult to imagine what it all must have looked like through her eyes or how she understood it. At the time, no one understood it. Never before during the decade-old war had there been an attack targeting Shiites on such a scale. Within the maelstrom of ethnic, tribal, economic and political enmities churning the violence in
Late in the afternoon, the orderlies began collecting the bloody mattresses and backboards and stretchers that littered the lawn, scrubbing them clean with antiseptic. The nurses hurried from ward to ward, attending the dozens of moaning wounded in line for surgery. I went out to talk with some of the relatives crowded around the gate, where a list of names was posted on the wall. The sun was starting to go down, but dozens of Hazaras still anxiously awaited news.
When I asked whom they blamed, everyone said
Back inside, two teams of surgeons — five Afghans and one Italian — performed operations until 4 in the morning. For many of the Afghan employees, the day had been all too familiar. One senior surgeon, Dr. Hamed Nazir, was reminded of being a young physician in the northern city Mazar-e Sharif during the war between the Taliban and the
The gulf between how this war impacts the people living in its midst and how it is represented back in
Last year, Emergency’s three hospitals and 34 clinics across
According to NATO, even civilians who are injured during operations by
In April, I traveled to Sayad, a town in
Both of his legs were gone, and wounds covered his hands, arms and back. He was nauseated and fevered; every movement elicited a grimace. “Most of the pain is in my stomach,” Zobair told me as soon as we met. His eyes were half-shut, heavy with fatigue, and he spoke so softly that I had to lean close to catch his words. Without a wheelchair, Zobair had no way to reach the landing where we had set up the meal. When Nasir climbed into the back of the
Zobair and Nasir were from Tagab District, where French troops have struggled for years to dislodge a deeply entrenched insurgency, without much success. In February, a French airstrike, mistaking them for insurgents, killed seven boys while they were herding sheep not far from Tagab. A few weeks later, according to Zobair and his family, Zobair was sitting outside his house with four cousins, watching the sun go down, when two low-flying helicopters approached from the distance. Helicopters have long been a daily occurrence in Tagab, but something about the way this pair hovered near the house made Zobair nervous. He said as much to his cousins, who mocked him for being overanxious.
Zobair stood up and began to walk away. He does not know what kind of ordnance or ammunition the helicopter fired. Given the damage, it was likely a Hellfire missile. Two cousins — ages 14 and 18 — were killed immediately. Zobair, who had taken about four steps before the explosion, was thrown into an irrigation ditch. Villagers rushed the survivors to the French military base in Tagab, where another of Zobair’s cousins soon died. In response to my questions about the helicopter strike, a representative for the French military told me that they had conducted an investigation, the conclusions of which were “full positive”: “On that day, after having checked there were no civilians in the area, one helicopter fired at a group of five insurgents with hostile intentions.”
The last thing Zobair remembers before losing consciousness was a foreigner sticking him with a needle. He woke up “in a white room with white walls,” he told me. “They wouldn’t tell us where we were.” Back in Tagab, no one from the base would inform Nasir where Zobair had been taken; it was generally known, however, that casualties from Kapisa were often airlifted to Bagram. “We came to Bagram several times to write our names and give them to the interpreter at the gate,” Nasir said. “Sometimes the interpreter told us, ‘Yes, he is here.’ Sometimes he told us, ‘No, he is not here.’ Zobair called us one time. He told us: ‘I am in a hospital, but I don’t know where. I’m not allowed to tell.’ ” When I asked NATO why Zobair was not allowed to speak with his family, a representative replied, “We know there is a policy on this and are seeking more information at this time.” I was later told that he should have been allowed to call home.
After 23 days, Nasir received a call from an interpreter at Bagram, who told him to come pick up his nephew. At the airfield, Zobair was carried out from the hospital and put into the ambulance, accompanied by an Afghan interpreter. The interpreter told Nasir that they should go to the Red Cross in
If Nasir had been able to read the papers, he would have learned that American surgeons at
The ambulance took them to a Red Cross orthopedic center in
When the ambulance left with Nasir and Zobair, the staff at the Red Cross assumed they were returning to Bagram. Instead they were taken to Kapisa’s provincial hospital, Mahmud-i-Raqi, where doctors informed Nasir that few if any public hospitals in Afghanistan possessed the special tool required to remove the metal staples that were used on Zobair. “They said they were not able to fix this problem,” Nasir told me, “and they sent us away.”
I visited Mahmud-i-Raqi twice. Part of the hospital is made of free-standing plywood and sheet-metal rooms with corrugated tin roofs, while the main building suffers from severe disrepair. Paint peels from walls; water creeps from ceilings; and the floors are covered in dirt. The first time I went there, I arrived at around 3 in the afternoon, but I was told that all the nurses and doctors had gone home early. The second time I visited Mahmud-i-Raqi, it was overrun with people jostling to be seen. Faiz, the director, gestured at the melee and asked, “Why would a hospital like the one at Bagram want to send a patient here?” He explained that Mahmud-i-Raqi could never accept a patient like Zobair for the simple reason that it had no surgeons. He then asked me if I could procure his staff some medical textbooks the next time I went to Bagram.
Nasir says that when Mahmud-i-Raqi refused to admit Zobair, the Afghan escort from the ambulance called Bagram and asked what to do. When he got off the phone, the escort told Nasir: “Zobair didn’t have much problems. He only needed his dressings changed. He said we could take him home.” The ambulance returned to Bagram, and Nasir hired a taxi to drive him and Zobair back to Tagab. The following afternoon, an elder from the village visited Zobair to help with his dressings. When he saw the incision, the elder told Nasir that he needed to get Zobair to a hospital immediately. They went to Emergency’s medical center in
The only patients Emergency does not accept, however, are those who have already been operated on at NATO facilities. They adhere to this policy very strictly — some might say brutally. In the past, Emergency used to treat patients like Zobair, “but we stopped,” Emanuele Nannini, the program director for
One nurse at Emergency who helped make the decision to turn Zobair away later told me: “It was a disaster. The incision was not clean. It was infected.” When I asked Radaelli, the medical coordinator, whether Zobair was in danger of dying from the infection, he said, “If someone doesn’t take him, for sure.” He added, “We see this all the time.” Nannini, the program director, is strident on the subject of NATO’s discharge policies, going so far as to characterize them as criminal. “They did nothing for this patient,” he said of Zobair. “It’s better to let him die than to suffer while going from one hospital to another.”
I met Nasir and Zobair in Sayad the day after they were refused by the Panjshir facility. I had to sit facing backward in the front seat of the
Zobair complained that it was hot in the
It’s easy enough to dismiss pacifism as quixotic or naïve. But nowhere does it appeal more strongly to reason than among the wounded and the maimed. At Emergency’s hospital in
Emergency has always promoted a pacifist agenda. In 1994, the year it was founded, Emergency initiated a campaign against the manufacture of antipersonnel mines, leading to their prohibition in
That same year, President Obama deployed an additional 30,000 American troops to
“During the first period of the operation, we didn’t receive many patients,” Dell’Aira told me. “Or sometimes we saw patients who had been injured seven days earlier. The coalition, together with the national military and police, blocked the roads around Marja and prevented the injured civilians from reaching the hospital. This for us was absolutely a crime against humanity.”
During several interviews with Western journalists, Dell’Aira and Gino Strada condemned the military cordon. Theirs was a counternarrative that contrasted starkly with the assessments of military commanders who lauded the operation as a triumph. The reality seen at Emergency continues to contradict the military’s message. “In
On April 10, 2010, an Afghan employee of Emergency in Lashkar Gah told the international staff that he had been warned of a possible attack against the hospital. Following protocol, the Italians vacated the premises for their living quarters elsewhere in the city. An hour later, an Afghan doctor called to say that armed men had entered the hospital. Weapons are banned, without exception, from all Emergency facilities, and Dell’Aira, along with Marco Garatti, a surgeon, and Matteo Pagani, an administrator, decided to go back and find out what was happening. They were stopped by several Afghan Army soldiers outside the entrance to Emergency. The three Italians eventually were handcuffed, blindfolded and taken to a prison run by the National Directorate of Security,
Later that afternoon, the governor of Helmand called a press conference, during which he claimed that the weapons and munitions were taken to Emergency by one of its Italian staff members, who had been paid half a million dollars to assassinate him. He also later charged that the hospital was purposefully amputating the hands of Afghan soldiers.
Dell’Aira and his colleagues spent four days in the custody of Helmand’s National Directorate of Security before being transferred to its central prison in
For Gino Strada, the meaning behind the whole ordeal was obvious: “It was an operation aimed at pushing us out of
One afternoon in March, after visiting Gulali, I met a 22-year-old paraplegic named Safiullah who had recently been shot in the back by an Afghan Police officer. The shooting took place in the Ghorband Valley of Parwan Province, during a protest of the burning of Korans at an American-run detention center on Bagram Air Base, which is also located in Parwan. A few days earlier, Afghan employees at Bagram witnessed American soldiers discarding Korans into a garbage incinerator, and since then violent demonstrations had spread throughout the country.
A few days after speaking with
Back at Emergency,
It was more a statement of fact than an accusation. The nurse didn’t care. Maybe they were Taliban, maybe they weren’t. Maybe the Local Police were thugs who fired on them for no reason, and maybe it was much more complicated than that. My interest in these things arose from a mentality that was alien to the hospital. Who
A couple days after
Nafeh was originally from Zhari District, the scene of intense fighting every summer and close to where Staff Sgt. Robert Bales is accused of murdering 17 villagers this March. (I once met a Talib from Zhari who lost his leg to an I.E.D. placed by one of his compatriots; not even the local insurgents can keep track of all the bombs.) Nafeh was 12 when his father died of a stroke, prompting him, his mother and his two younger brothers to move to the provincial capital, where he went to work painting houses. Even during the best of times, the wages Nafeh earned were barely enough to support the family, and about four months ago, when his cousin became the deputy commander of a Local Police unit back in Zhari, Nafeh asked to join.
Nafeh told me that he loved being in the Local Police; he felt for the first time that he possessed a sense of purpose about which he could be proud. During our last conversation, a couple days before he died of sepsis, Nafeh said: “I lost one leg. But if I lose the other and both of my hands, I will still be a policeman.”
By this time he was already half-lost to the delirium of his final hours. It was a taxing effort for him to speak at all. A nurse had wheeled his stretcher and IV stand into the breezeway, where he shut his eyes against a warm sun and told fantastical stories. My questions about his life seemed to afford him an opportunity to imagine one that was much grander than reality — or maybe, alternately, Nafeh was lucid to the end and, knowing that his words were limited, used those remaining to embellish what was finally a short and unexceptional past. He told me he had served for years as the trusted assistant to
A couple of weeks after Nafeh died, I went down to
Nafeh’s cousin Dad Gul told me that doctors at Mirwais recommended he take Nafeh to
“He arrived in very bad condition,” Radaelli, the medical coordinator at Emergency, told me. He said the doctors in
A few days later, Nafeh came down with a fever. Maricic removed the dressings on Nafeh’s leg and discovered that it was completely black. The hospital called Dad Gul and persuaded him to allow them to amputate. Nafeh was rushed into the operating theater. After the surgery, he never fully emerged from the anesthesia. The infection had become systemic, and a couple of hours later, Nafeh went into cardiac arrest.
In retrospect, the saddest of Nafeh’s delusions was his belief that important people cared about what happened to him. As we talked outside in the sun the week before he died, Nafeh repeatedly boasted of the powerful men who exercised their influence on his behalf. He seemed unaware that both his stump and remaining leg were infected because of the sloppy treatment he received in
Of course, then again, Nafeh might have understood everything perfectly. One of the last things he said to me was: “I don’t want my brothers to join the police. It’s no good. I would like to see them become doctors or engineers.”
About a week after I met Zobair, the 14-year-old boy from Tagab injured in the helicopter attack, a colleague of mine found a hospital willing to accept him. The French Medical Institute for Children, based in
I was unsure which would be the better course: to take Zobair to the institute or to try to get him back into
Following a rutted road along stacked Hesco barriers topped with razor wire, we arrived at a dirt lot crowded with groups of ailing Afghans, maybe a hundred or more in all. A rifleman in a tall guard tower looked down on them. One elderly, feeble-looking man lay on the ground, next to a plastic bin that held a bag of urine connected to his catheter. He had been taken there by his nephew, who told us that in another hour, at 9 o’clock, someone from Bagram would come out, review everyone’s paperwork and determine who could be admitted into the hospital. The old man proudly showed us a handwritten note from an Afghan clinic.
Nasir and I were debating whether to wait or to continue on to the French Medical Institute for Children, where its chief of pediatric surgery awaited, when Zobair asked us to please not send him back into Bagram. He was worried, he said, that he would again be forbidden from speaking to his family. That decided the matter, and Nasir agreed to follow us to the institute.
When we reached
“Where are you taking us?” he demanded.
“To the hospital,” we said.
“No, you’re not. You’re lying. There is no hospital. You’re taking us to Pul-e-Charkhi.”
We argued for a while, and eventually, reluctantly, Nasir agreed to keep going. A few minutes later, however, their car stopped again, and again I had to get out and assure Nasir that the hospital was real. This happened three times. Finally we found ourselves standing in a busy rotary with traffic rushing past us, my interpreter yelling that we were trying to help them and Nasir repeating that he was taking Zobair back to Tagab. An Afghan soldier appeared and told us to move out of the street. Nasir asked him whether the hospital existed. The soldier said it did.
In the end we made it to the institute, and surgeons there removed the internal sutures and the metal staples in Zobair’s abdomen. They sutured and dressed his open wounds and gave him antibiotics. After a few days, he was able to sit up comfortably.
“There is no doubt that they did a very good and big operation,” Dr. Abdul Jalil Wardak, the chief of pediatric surgery, said of the doctors at Bagram. “The result is that the child survived. But of course the way they discharged him is not fair.” I asked what might explain it. “It’s difficult to understand,” Wardak said. “You have to ask them.”
In a written response to my queries, a representative for
Nasir gave me the same number that he said he gave Bagram. It worked every time I called.
A few months after the Ashura bombing, a new girl was admitted to the hospital and given the bed next to Gulali’s. She was roughly the same age, and they quickly became friends, staying up to talk at night after the nurses turned off the lights. Abeda was from
About a year ago, a convoy of Afghan government vehicles was passing by Abeda’s house when it came under attack. Afghan security contractors were escorting the convoy, Abeda told me, and when she stepped outside to see what was happening, one of the contractors shot her three times in the gut with a Kalashnikov. “When he shot me, everything came out of my stomach,” Abeda said. She remembers lying in her doorway, her brother yelling for their father. Then she was at Emergency.
Abeda remained in the hospital for a couple months before going home; in April she returned to Emergency to have her stoma closed and her intestine reconnected. While recovering, Abeda and Gulali spent their days wandering the hospital grounds: Gulali in a wheelchair, and Abeda pushing an aluminum stand with an IV bag. One day when I came to visit, Abeda was gone, and Gulali seemed depressed. Though they live maybe 30 minutes apart, it’s very unlikely the two girls will ever meet again. Gulali’s village straddles the border of
Eventually Gulali went home as well. When her parents and uncles came to Emergency, they brought some of her old clothes with them. For the first time in months, she changed out of her hospital gown. It was the happiest I’d seen her.
I followed Gulali and her family back to their village. We stopped at the police post where Gulali was taken after her injury. The shallow stream ran nearby; Gulali’s mother pointed beyond it to the hill where Gulali had stepped on the mine. It seemed a very long way to be carried with a half-severed leg, and I was reminded of something Tijana Maricic, the head nurse at Emergency, said to me shortly after Gulali’s surgery: “They are different. They are really strong. They’re not like our children.”
A few weeks later, across the street from Emergency, a group of insurgents barricaded themselves in the upper floors of a half-constructed building and began firing into nearby foreign embassies. Afghan Special Forces quickly took up positions surrounding the building, including on a rooftop situated directly between Emergency and the gunmen. During the ensuing 18-hour battle numerous rounds impacted inside the hospital grounds. A physiotherapist was taking a shower when the shooting started, and before he could get out, a bullet pierced the bathroom door and slammed into the wall beside him. Luca Radaelli immediately began setting up a mass-casualty triage tent, just as he had done for the Ashura bombing, but abandoned the plan when bullets began loudly whizzing by his head. Another round hit the wall of the children’s ward, a few inches from a high glass window. Later, when the rocket-blasts and automatic salvos were in a frantic crescendo, a young boy stood on his bed and peered out of the window. He stood there craning his neck until someone yelled at him to get down. He wanted to see what was happening outside.
Four dead civilians and several wounded Afghan Special Forces soldiers were rushed into the hospital late in the afternoon. With nightfall, the fighting died down, only to start again with even greater intensity around 1 a.m. By dawn, when the last of the insurgents was killed, 27 wounded Afghans, mostly soldiers, were being treated at Emergency. Every one of them survived.
No one from the hospital slept that night, but the next day, new gunshot, shell and mine victims arrived from northern
Editor: Joel Lovell
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"The master class has always declared the wars; the subject class has always fought the battles. The master class has had all to gain and nothing to lose, while the subject class has had nothing to gain and everything to lose--especially their lives." Eugene Victor Debs