The grim struggle to save lives inside a ragged Baghdad ER

By Hal Bernton
Seattle Times staff reporter

	THOMAS JAMES HURST / THE SEATTLE TIMES An Iraqi man shot while trying to foil a kidnapping grasps the leg of another wounded man as doctors in the Al Kindi Hospital in Baghdad work to stabilize him. The hospital tries to make do as it treats waves of patients, many of them victims of war-related violence.
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The doctors wanted to transport him by ambulance to a specialty hospital. But two of the Al Kindi ambulances were broken down; a third was in use. So they gathered around to try to save a life.

"We don't have enough equipment here. We need more of everything," says Dr. Ayad Taha, huddled over the patient. "But the most important thing we need here is humanity."

For the emergency-room doctors of Al Kindi, the first nine months of the U.S. occupation have been a dispiriting time. They thought the American rule would bring them more medicines, new equipment and a shot of hope to one of Baghdad's busiest hospitals.

Instead they try to make do as wave after wave of patients — men, women and children swept up in the violence and mayhem — are delivered to their front door.

They treat the victims of bombings. They tend to children struck by the stray bullets from firefights. They try to save the lives of policemen gunned down on the job and administer to the casualties from robberies, kidnappings and other violence.

How to help Giving money is the best way to give aid: Relief agencies can use it for exactly what they need, it's easy to distribute and supports economies in disaster regions. Donating medical supplies or drugs requires extra care because of specialized needs or because medications can expire before they reach their destinations. Contact the relief organization before collecting donations. InterAction (www.interaction.org) has a list of humanitarian organizations involved in Iraq relief efforts. The following aid groups focus on medical and health-care needs: MAP International P.O. Box 215000 Brunswick, GA 31521-5000 912-265-6010 or 800-225-8550 www.map.org Northwest Medical Teams P.O. Box 10 Portland, OR 97207-0010 503-624-1000 www.nwmedicalteams.org Doctors Without Borders P.O. Box 1856 Merrifield, VA 22116-8056 888-392-0392 www.doctorswithoutborders.org International Medical Corps 11500 W. Olympic Blvd., Suite 506 Los Angeles, CA 90064 800-481-4462 www.imcworldwide.org

The bloodiest months immediately followed the political toppling of Saddam Hussein. Then, as many as 70 to 80 injured people arrived at the hospital a day, says Dr. Mustafa Al Jedda, another young and harried emergency-room doctor. Now, on a bad day, 20 or more patients are brought in, still substantially above the numbers under Saddam's rule, Al Jedda says.

The doctors acknowledge that they did not see much of the carnage under the old regime. Back then, the blood so often was spilled out of sight, in the prisons and torture chambers of the former leader. But in the first winter of American governance, they are frayed and increasingly bitter.

"Before the war, things were better than now," Al Jedda says. "Americans made many promise, but these promises do not come through."

The 300-bed hospital is one of more than 15 hospitals scattered about this sprawling capital city.

It draws from a wide area, including several poor districts.

During the day, its long grimy hallways are jammed with hundreds of people seeking outpatient treatment. At night, the hallways are empty, but the courtyard and street outside often become a gathering place for a smaller but more unruly crowd, including gangsters whose cohorts have been taken in for treatment.

American soldiers used to guard the entryway to the hospital. Now, Iraqi police have taken over.

The doctors didn't much care for the soldiers but they don't trust the police, either. And the hospital can be a rough place. When a doctor can't save a life, he may be targeted with threats — or even assaulted — by friends and relatives of the patient.

One emergency-room doctor last month was kicked in the face by the relative of a traffic-accident victim. Bloodied and discouraged, the doctor declared, "I will never work in this hospital again," says Al Jedda.

The doctor later changed his mind and returned to the hospital.

Many of Al Kindi's doctors are in their 20s and 30s, struggling to raise young families on a salary as low as $120 a month. That's a lot higher than the prewar salary of less than $5 a month. But they say spiraling inflation has eroded most of those gains. They are organizing protests in hopes of improving their pay.

U.S. Agency for International Development officials say a broad health initiative is helping to renovate more than 60 Iraqi health clinics and secure new equipment for more than 600 others. And the U.S. money is helping the Ministry of Health battle malnutrition and disease in a variety of efforts, including vaccinations of 3 million young children and supplemental food rations for more than 100,000 pregnant mothers.

	THOMAS JAMES HURST / THE SEATTLE TIMES Dr. Ayad Taha pauses to decide what to do next as he fights to save the life of the man who was wounded trying to thwart a kidnapping.

At the Al Kindi emergency center, the biggest change under way is the renovation of a new and larger receiving area for victims of bombings or other mass-casualty events. The ER director, Bashir Mohammed, proudly shows off the room as it receives a new coat of paint; he downplays the problems the hospital faces.

The frontline doctors share a bleaker view.

They lack basics, such as a working phone to communicate with other hospitals, and ambulances that work on a steady basis. The hospital has a functioning generator to operate during frequent power outages. But the doctor's quarters, used for sleeping, eating and relaxing during down time, does not have a working generator. So the building is frequently plunged into darkness.

Her name is Halla Ramdhan. She is one of about a half-dozen children being treated at the hospital who were accidentally injured in clashes between the U.S. military and insurgents since this summer.

	THOMAS JAMES HURST / THE SEATTLE TIMES With her mother by her side, 12-year-old Halla Ramdhan tells how she lost her right leg when she was shot by U.S. troops while she was playing on a rooftop. She thinks they mistook her for a sniper. "I think it was all a mistake," Halla says.

She has always liked American soldiers. When she would see them as she was coming home from school, Halla would wave and say hello.

But in early December, playing on her rooftop, she had no time to wave. A wedding was under way next door, and the celebratory shots brought an American patrol into the streets below. She thinks they mistook her for a rooftop sniper. She says she ran to try to get out of the way, but a bullet from an armored vehicle tore off her right leg and struck her left leg.

"I think it was all a mistake," Halla says.

Today, the 12-year-old is an amputee patient in a ward at the Al Kindi. Her mother, 40-year-old Ascha Karim, sleeps in a nearby bed and helps tend to the bandages swathed around Halla's left thigh and around the stump of her right leg.

Since arriving at the hospital, Halla has had several operations and is still confined to bed. She has huge almond eyes and an easy smile that has yet to dim.

She dreams of the time when she can return home. If she sees American soldiers, she says, she will still say hello.

Her doctor, Al Jedda, cannot forgive so easily.

For a woman without a leg, life in Iraq can be cruel, he says.

"When she will become an adult woman, she will understand more. I think she will never say hello to any American man."

	THOMAS JAMES HURST / THE SEATTLE TIMES The only ambulance in working condition at the time delivers a patient to the Al Kindi Hospital.

No one has a precise count of how many men, women and children are the accidental victims of the warfare that continues in Iraq. They may be struck by the stray bullets of insurgents, or victims of American firepower.

The seriously wounded are supposed to be able to get treatment at U.S. Army hospitals. In Baghdad, that is the 28th Combat Support Hospital, located on former palace grounds in the Green Zone, a verdant, heavily guarded area along the banks of the Tigris River.

Many casualties gathered up by U.S. medics do make it to the military hospitals. They include severely injured enemy combatants who often require extensive and prolonged medical treatment that saps limited U.S. medical resources.

Others do not.

Instead, they trickle into hospitals such as Al Kindi.

The hospital reports combat injuries to the Iraq Ministry of Health, says Al Jedda. But he says he lacks a way to phone U.S. military officials to inform them of the war-wounded patients.

	THOMAS JAMES HURST / THE SEATTLE TIMES A doctor at Al Kindi Hospital reviews the X-ray of a little girl's arm that was broken at the elbow. On a bad day, 20 or more new patients arrive at the hospital.

This fall, Al Jedda says, U.S. officials did visit one boy who claimed to have been shot in the leg after he made a thumbs-down sign to a soldier. The U.S. military launched an investigation and offered the child's family compensation, Al Jedda says.

But the hospital receives no routine visits from U.S. military officials, he says.

Doctors and staff members at the Combat Support Hospital say that U.S. personnel do circulate among some hospitals and bring some wounded patients into the U.S. military health-care system. But they do not have scheduled visits with all the hospitals or reliable telephone communications.

The Combat Support Hospital is in the marble-floored building Saddam once used as a kind of private treatment center. The hospital has a heavy — and acute — patient load. In the United States, only about 5 percent to 15 percent of the patients entering an average hospital have what are considered acute injuries. At the Combat Support Hospital, that figure is almost 40 percent. The patient load sometimes strains the hospital's supply of blood and some types of drugs.

Al Jedda acknowledges the limitations of the U.S. military health-care system. But he would like to see more U.S. dollars invested in his hospital to help compensate it for treating war victims and to improve its staffing and service.

	THOMAS JAMES HURST / THE SEATTLE TIMES Ahmed Aziz's legs were shattered in a weapons-cache explosion that killed his brother. The 9-year-old boy, who had been in the hospital since August, was allowed to temporarily leave but expects to return soon for another operation.

Ahmed Aziz is a frail farm boy from outside of Baghdad. Wounded in an explosion, he has undergone numerous operations and bone grafts on his damaged legs and feet. but his recovery is still a long way off.

At 9, he has lost his smile.

He has been in the hospital since August.

His father, Hussain Aziz, says a U.S. helicopter fired and detonated a weapons cache that was stored in the fields. The explosion killed Ahmed's 10-year-old brother and severely damaged both of Ahmed's legs, the father says. Ahmed was allowed to temporarily leave the hospital, but he expects to return soon for another operation.

His prolonged recovery is an emotional and financial burden on his father, who has spent months at the hospital, praying his son will heal.

Back home on the farm, his wife cares for their third son, who is just 5.

To survive, Aziz says, he has had to borrow money from friends. There is no time to leave his son's side to seek help from the U.S. military, he says.

	THOMAS JAMES HURST / THE SEATTLE TIMES A limited supply of medicine is on hand at the hospital pharmacy. Doctors had hoped the U.S. would alleviate that problem.

Moreover, he says, he does not even know how to reach the Americans.

When the sun sets, the emergency-room doctors brace for a surge of gunshot victims. On a recent Saturday, the rush begins early. In midafternoon, three gunshot victims are brought to the hospital.

They are dead on arrival.

The pace in the emergency room slows until about 9 p.m., when a police siren marks the arrival of the shooting victims from the kidnap plot.

According to police, kidnappers tried to hold a young boy for ransom. The police and the boy's relatives set out to ambush the kidnappers. The scene ended in a gunfight.

One policeman was shot in the head. A relative of the boy's was shot in the chest.

Taha performs a quick triage on both men. The policeman is gravely wounded, so he dispatches the operating ambulance to take the officer to a neurological hospital.

Ideally, Taha says, he would like to send the man with the chest wound to another hospital that specializes in thoracic surgery. But he is still hopeful that the man can be saved at Al Kindi. He brings the patient into a small operating room meant for one or two people. On this night, it is holding four, including a teenage boy shot in the arm who unleashes a piercing wail.

	THOMAS JAMES HURST / THE SEATTLE TIMES Doctors could not save the life of the young man who was shot as he tried to foil a kidnapping. He lies alone in Al Kindi Hospital, waiting to be taken to the morgue.

Taha inserts a tube down the man's throat to help him breathe and inserts another tube into the chest to drain blood. But after the man is shifted over into a holding room, he goes into cardiac arrest. A crowd gathers around, a mix of medical personnel and relatives of other patients.

Taha administers drugs. He leans into the man's chest, pumping down with clasped hands to perform cardiac massage. He puts on cups to administer electrocardiac shock. But the patient fades fast.

Afterward, Taha is agitated.

He smokes a cigarette and ponders what else he could have done.

"This is a small story," he says. "There is a huge number of these stories here. Poetry stories, no. When I saw this patient, he was alive.

"We did the best we could."

Hal Bernton: 206-464-2581 or hbernton@seattletimes.com

Thomas James Hurst: thurst@seattletimes.com

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