Frontline medics: The men and women fighting to save soldiers and civilians in Afghanistan

It has been a bloody summer in Afghanistan. But for the young medics on the front line, confronting tragedy is just part of the job
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The Independent Online

A neat queue of khaki ambulances, their lights flashing, is primed by the side of the landing site as two American Pave Hawk helicopters appear over the desert horizon and sweep down. The rotor blades are still thudding as the first ambulances rush forward to meet them. Bent double by the down-draft, their crews carry four laden stretchers from the belly of the aircraft.

Seconds later, the Pave Hawks lift off just in time for a giant RAF Chinook to make its thunderous descent. With a precision choreographed over a thousand rehearsals, more khaki vehicles, each of them emblazoned with a giant red cross, arrive in swift sequence. Their blue lights are still blinking as they cover the few hundred metres to where the doctors and surgeons are waiting expectantly on the steps of the field hospital. It is a good sign – an indication to the medics that these patients can still be saved.

As each ambulance backs up to the door, a team springs forward before disappearing with the patient through the double doors. One vehicle is swiftly replaced by another as 13 more casualties are off-loaded in rapid succession. The loudspeaker echoes across the British military base of Camp Bastion: "All trauma teams to the hospital".

Inside the emergency ward, a young British soldier clutches a cloth to his bloody face, another lies back on a stretcher, his features pale with shock, while a third stares down numbly at a bandaged leg stained red with his own blood. An American marine manages a weak thumbs up, while an Afghan in a wheelchair glares around himself in confused terror.

Within seconds, however, this relative serenity is shattered as every bay in the ward fills up, doctors and nurses buzzing around each newly arrived casualty. Some of the injured are wheeled quickly away to the operating theatre; the hospital prides itself that from landing site to surgical table takes just four minutes.

Welcome to just another day in the relentless, exhausting and frequently heart-breaking life of the military field hospital in Helmand, Afghanistan.

during the bloodiest summer since the US-led mission began in 2001, the public has watched with horror as the death toll in Afghanistan has mounted. But what quickly becomes clear on a visit to Camp Bastion is how many young men are snatched away from that list of fatalities on a daily, even hourly, basis. Nobody is considered beyond hope in this hospital.

As Colonel Tim Hodgetts, medical director at the hospital, tells me: "There have been times when we have had three critical injuries on the operating tables, then another three, then another three going into theatre. Everyone keeps going until it is finished. You can't afford to stop. If you don't clear what you have got, you are not ready for the next lot." A veteran of seven tours of Iraq and Afghanistan, Colonel Hodgetts admits that his team has never been busier.

At one point this summer, 50 per cent of all UK blood supplies were needed in Bastion. Double and triple amputations – the kind of thing a doctor in Britain might not see even in a lengthy career – are commonplace. As one surgeon put it, the high explosives being used by the Taliban are not designed to maim – but to cut you in half.

During a nine-week tour, Surgeon Commander Sarah Stapley amputated 62 limbs from NATO and Afghan soldiers as well as locals – including eight limbs in one shift during the five-week British operation, Panther's Claw, to recapture Taliban territory this summer. But she saved far more than she was forced to sever – 98 per cent of those casualties who come in, clinging on to life, survive to be flown home.

The staff here have the advantage that many of their patients are extremely fit, as Colonel Hodgetts explains: "You pour blood and plasma back into them and they bounce back quite quickly, if we can get to them before the critical moment. It is amazing when you see somebody who has had limbs blown off – staring into the jaws of death – and the following day they are sitting up in intensive care."

Amid the sprawling, sandy metropolis of tents, razor wire and military machines at Camp Bastion, the double doors of the hospital transport the patient into another world – a world of spotless white corridors. Only the sign above the door gives any indication that you are in the middle of a war zone. "No weapons beyond this point," it reads.

In Ward 2, young British soldiers, covered in bandages, doze quietly beside their American and Afghan counterparts. The ripped, filthy uniforms they wore on the frontline have been replaced by pristine white T-shirts. A rare treat of chocolate sits on their bedside table. Everywhere are touches of humour. One hardened veteran of the conflict dozes beneath a bright pink Barbie-doll duvet. In their midst, 10-year-old Sakhi spins around the ward in a specially adapted wheelchair, grinning at everyone, apparently oblivious to the fact that he now only has one leg after being hit by a roadside bomb.

Speaking from his bed, Guardsman Gareth "Gaz" Scaife, a 22-year-old from Wolverhampton, is uncomplaining about the shrapnel wounds that have peppered his body. Just hours ago he was in a patrol base in Babaji when a suicide bomber ran into the compound. "If he had got a few more metres inside the camp, I could have been really messed up," recalls the soldier from the 1st Battalion, Welsh Guards. "At first I didn't know what had happened. I was more worried about the lad on the front vehicle who he had thrown a grenade at, but he was OK. Within 10 minutes a chopper got me out." A few hours later, the soldier who had provided the initial medical treatment for Guardsman Scaife at the frontline base was himself brought in with a gunshot wound.

Resting in another bay with his left leg in traction is Rifleman Robert Welsh, of 2nd Battalion, the Rifles. His unit were jumping off a helicopter, heavily laden for an operation, when he collapsed in pain and was unable to get up. He had broken his femur. "At times it is shit but I pull myself together," explains the 21-year-old from Hereford, who has had two friends killed during the tour. "The worst thing is not being on the ground with the lads. I am absolutely gutted not to be going. They are flying back through here from the op, though – so hopefully they might pop in if they are not too busy."

"The only thing they ever want to know is how their buddy is, how they are doing," says American nurse Lieutenant Junior Grade Jill Mott, who is 24. "You try and keep them together as they heal better together. The thing that is amazing with your soldiers is they come in with broken bones, blown up, and they are making jokes. They are very cheeky."

According to Captain Joseph Rappold, the senior American surgeon, the book has not yet been written on the techniques developed at Bastion. The College of Emergency Medicine in the UK has even dedicated its national conference next year to the advances that have been learnt in the field hospital. "If there is a success story over here, it is this hospital," says Captain Rappold. "What we have learnt in Afghanistan is now implemented in UK and US hospitals. You just would not see these types of injuries, these triple amputations, anywhere else other than in this war zone, this horrible place.

"We have no special gizmos or gadgets," he continues. "Only when you see it and have to deal with it, do you appreciate the devastating nature of the wounds and develop the ability we have to save these young men's lives. It is just an experimental process of learning. It is a great privilege to save the lives of these kids."

Lieutenant Colonel Simon Orr, commanding officer of the newest regiment in the British army, 2 Medical Regiment – founded just over a year ago – says that on a tough day the emergency department could receive more than 30 patients. There is always an "inner groan" among his staff when the uniform is British – and he has seen many a senior NHS clinician on attachment reel with physical shock at the severity of the wounds.

As well as the "golden hour" to get a casualty to hospital, the doctors now also talk of the "platinum 10 minutes" in which a critically injured man can be saved. The fact that so many are saved has much to do with Lieutenant Colonel Orr's combat medics on the ground, as well as the speed with which casualties are treated at the hospital. "If you were back in the UK and you came in with a serious trauma in the middle of the night," he explains, "it might take 40 minutes to get a surgeon or an anaesthetist. Our soldiers take a right turn and have a team of surgeons working on them straight away."

Two-thirds of the servicemen and women who come through the hospital do not need to be sent back home. Many suffer back, neck or other injuries from being caught up in explosions, or simply through the daily toll of patrolling. Scribbled in marker pen on the board in the physiotherapy department are the words: "Body armour, helmet, weapon and webbing = 27kg" – and that is without ammunition, radios, water and other equipment.

For Major Phyllida Simmons, the officer in charge of the Defence Medical Rehabilitation Team, it is the added task of screening the soldiers for mental-health problems that is new this tour. The most serious cases will be passed on to the psychiatric team but many just need a kind word. "They are young lads who just don't want to go back out," she explains. "They have seen their mates blown up and they are so young. Our job is to get them physically fit and give them confidence to go out again."

The hospital is a cooperation between British, American and Danish medical staff. But it is not just International Security Assistance Force (ISAF) soldiers that receive this specialist care – Afghan forces and locals are treated too. As Captain Rappold says: "Blood is all red. It doesn't matter whether you are British, American, Danish or Afghan. This joint venture works amazingly well. We should have been doing this years ago."

Since UK forces went into Helmand in 2006, the hospital, which can extend from 28 to 50 beds, has treated almost 3,000 British patients, 850 of whom were wounded in action. In the first eight months of this year, 784 British casualties, 296 with battle injuries, passed through its doors – but far more Afghans were also admitted. In the 12 months until the end of July, the hospital treated a total of 4,234 patients, peaking during Panther's Claw in July when 656 were admitted – an average of more than 21 a day.

Back in intensive care, where two injured Afghan soldiers lie hooked up to drips, they are preparing for a new influx from the morning. The dramatic events of the day mean that the 10-bed unit may have to overflow into the adjoining Ward 1 – a set of beds that are often used for groups of soldiers who are brought in together. "If one of their friends is in intensive care, we will try and keep them nearby," explains Danish senior nursing officer Captain Sean Norregaard.

But this morning Ward 1 contains just two little boys bundled up in baby pyjamas, lost amid the sheets of an adult bed. One stares solemnly from under a bandaged head while the other has yet to wake.

Leaning protectively over his sleeping son Bashir, farmer Abdul Malik explains that the toddler was kicked by a cow: "I was very worried about my son. I couldn't reach the local hospital but there was an American base nearby. Now I am happy, he has been treated so well."

One unexpected aspect of this military hospital is the amount of care given to women and children – Afghans caught up in the conflict. There can be few army units that have had to request breast pumps, toys and nappies from their Royal Army Medical Corps chain of command.

Dealing with the children, brought in with everything from blast amputations to terrible burns, often falls to Captain Gail Whittle, a leading paediatric nurse. Many of them stick in her mind – like Mohammed, an eight-year-old who had been blinded in a bomb which killed most of his family, or Amina, a little girl with such severe leg injuries that the staff had to make her a wheelchair out of a discarded baby buggy. Many of these children are utterly terrified by this alien world and stare with bemusement at the toys the staff offer them.

"The thing about Afghan children is they are very different from the children we have in the UK," says Captain Whittle. "They are very quiet, they very rarely cry. They could have massive injuries and they just tolerate it. If there is anything that gets the people out here, it is the sight of kids coming in."

Recalling the moment a father sat sobbing amid the bustle of the hospital after losing a child, Captain Catriona Kemeny, 2 Medical Regiment adjutant, says: "He just sat there, one man isolated in the middle of this mayhem, completely unable to communicate, and his whole world had just turned upside down. It is at moments like that when you think: this sucks."

For their own survival, the medics try to distance themselves from the heart-wrenching casualties they see. But it is hard not to be affected. On the day of my visit, news that the medical helicopter-rescue team had tried in vain to reach a terribly injured soldier in time sent a wave of sombre reflection through the hospital – as did the announcement that one of the youngsters they had sent home had succumbed to his injuries back in Selly Oak hospital, Birmingham.

Yet, as Colonel Hodgetts explains, it is the success stories that keep his young medics going. For some, faced with an incomprehensible volume of tragedy on their first tour of duty, it is a lifeline. "You just need to focus on the people leaving the hospital, the people who came in on the ragged edge of their physiology," he explains. "People who were so close to death ... indeed their heart has stopped ... can still be resuscitated and leave. We hear later that they are doing well, they are up and walking and out of hospital. It brings a lump to your throat to get letters from their relatives ..."

He pauses, before adding: "And it does a great deal for morale."