It was early on a summer's morning in Nad-e-Ali, and Amina and Guldasta had run outside to play. They were not to know that the Taliban had laid an explosive device at their favourite spot, a field nestling beside a meadow.
The explosion tore into the two sisters, inflicting dreadful injuries. Eight-year-old Amina's leg was almost severed; Guldasta, a year older, received serious injuries from spraying shrapnel.
The girls' family lived just outside Nad-e-Ali, a part of Afghanistan's Helmand province which had seen ferocious fighting for a prolonged period and a place where medical facilities were, at best, rudimentary.
The sisters were saved from having their legs amputated – and probable death – by a remarkable combination of crushed prawn shells and the ingenuity of British Army medics. The technique is just one of a range of innovations that the doctors there have come to rely on. Faced with a weekly influx of horrific casualties, their improvised and revolutionary procedures are now being adopted internationally for civilian trauma treatment.
"The circumstances in Helmand mean that we are seeing many more severe trauma patients than in most UK hospitals," says Lieutenant General Louis Lillywhite, the Surgeon General of the UK armed forces. "And we have had to learn fast. What we have learned has been useful to the NHS."
When the blast went off, the girls' parents were frantic. But then their father, Faizullah Khan, spotted a passing British patrol. Amina and Guldasta were rushed to the nearby headquarters of the Welsh Guards battlegroup.
The sisters arrived at the base mute with shock. Their father, a village teacher, desperately told everyone around him that with every passing moment his daughters' lives were ebbing away.
Amina was in a particularly serious condition; her leg was almost hanging off. Both of Guldasta's legs, meanwhile, were embedded with razor sharp metal shards. "We did the best we could," said Major Colin Wall, the Army doctor in charge of the medical unit at the base.
"They had a hell of an experience, but they were pretty brave. We have to deal with a lot of casualties from IEDs (improvised explosive devices) – British and Afghan soldiers, but also a lot of civilians. We do what we can, but there are obviously limits at a place like this in the front line."
But they made the best of it – and it worked. The first stage of the treatment in Nad-e-Ali had involved special bandages made with crushed shellfish. On being placed on wounds, "chitosan", an ingredient derived from prawns, rapidly stops severe bleeding and accelerates clot forming.
The girls were flown to Camp Bastion, the massive British base in Helmand with a hospital that has become one of the major Nato medical centres in Afghanistan. Conditions there are rather different to those in Nad-e-Ali. Equipment is better than most general hospitals in the NHS, or indeed, Europe and North America.
Here they were given an "intra-oseres" treatment, which meant that, rather than spend time searching for veins, drugs were pumped straight into bones. Blood was then pumped in using "massive transfusion protocol", a method of countering blood loss born of the need for emergency surgery on battlefield injuries.
As the Surgeon General, Lt-Gen Lillywhite regularly undertakes the task of relating the advances made in the field of defence medicine to conferences across the world. One of his tasks in the coming months will be to work with Professor Keith Willets, the newly appointed national trauma director for the NHS who is carrying out a nationwide review of trauma care.
Lt-Gen Lillywhite said: "Some of these developments are simple but effective. The crushed shells react with blood to form a clot, while ordinary bandages just act on pressure."
He went on: "We fit in as many Afghan patients as we can, it is the right thing to do and it also good for hearts and minds. However, we do need to keep our beds free for service personnel, and one of the things I would like to do is help Afghan hospitals provide better treatment." Until that happens, the British Army doctors will continue to work under even greater pressure than they would otherwise. Their peers are mindful of their achievement.
Colonel Tim Hodgetts, head of the British team at Camp Bastion, and his team were recently named hospital doctor and training team of the year by Hospital Doctor magazine. The colonel, 47, has been on four tours of Iraq and is now in the middle of his third in Afghanistan. The injuries he and his staff have to cope with are often horrific – double, sometimes triple, amputations, shattering chest and head injuries and massive blood loss.
"But, if they get here on time, we do manage to save many of them," said Col Hodgetts. "These are the 'unexpected survivors'. Of course, a lot of them will have to learn to live with quite serious handicap. But at least they are alive. With these two little girls the procedure worked, we have done all we can for the time being, their condition can be monitored locally, and if necessary we will have them back."
Amina and Guldasta were flown back by helicopters to the Helmand provincial capital, Lashkar Gar, and from there taken back to Nad-e-Ali by road. Their farewell at Camp Bastion – the main British military base in Afghanistan – was attended by many of the medical staff who had treated them and become fond of them. The girls were at first solemn and silent. But then, as they said their final goodbyes, there were sudden dazzling smiles and hugs.
Mr Khan, 55, who had stayed at Camp Bastion during his daughters' treatment, said: "We are all very thankful for the really good help we have received here. I do not want other children to have to go through what happened to my girls. But it will happen, I fear. This is a terrible war and there are innocent people getting hurt, killed every day."
Watching the two girls leave, Captain Cat Kemeny, the hospital adjutant, wiped her eyes. "They were really lovely, those two. You do worry what will happen when they go back. But, for now, it's good to think they have survived, you hope they stay safe, that's all you can do."Reuse content