War scenes in Lashkar-gah

It’s 8:30 AM. Luca, a nurse from Milan, and I are talking in front of EMERGENCY’s hospital.

While enjoying the smell of the roses in the garden, on this beautiful spring morning, we are discussing some of our patients: the kid with head trauma is still not walking--we need to try harder with the physiotherapy; the boy with chest drains is still bleeding, we must ask the surgeon to check him again; Bib Aisha, the woman who had surgery three days ago, is getting better and can be moved from the intensive care unit to the ward.

Terrorist attack readiness in the city.
The whole hospital is alerted

All of a sudden, the radio announces: "Mass casualties. Mass casualties starting now. All staff must take their positions".

A suicide bomber has exploded his loaded belt in the middle of a group of policemen who were waiting for their paychecks at the central police station of Lashkar-gah.

In a few minutes the hospital will be full of victims. Silently but quickly we run towards our positions.

In every hospital managed by EMERGENCY there is a Mass Casualty Plan, a predefined set of procedures in case of a massive influx of patients due to a war event or a serious terrorist attack.

The Mass Casualty Plan establishes a clear role for every staff member to follow in order to respond efficiently to the emergency situation.

The whole hospital’s organization changes radically: the nurses are removed from their specific areas and are dispatched to the key locations of the hospital; tents are set up in the front yard in preparation to handle the emergency situation.

Patients arrive transported by ambulances, cars, any other possible means of transportation; some of them are even carried all the way.

Manuele, the logistics manager, has prepared a line of guards at the main gate: with the exception of the injured, everybody must be searched, because of the high the risk of more terrorist attacks.

Fifty injured at the hospital
Operating rooms at full capacity

Next to the main gate, all of the injured are loaded onto stretchers and Matteo, a nurse, performs the triage to evaluate and prioritize care for the various patients.

All of the wounded bear multiple lesions caused by shrapnel, especially on their arms, legs and face. Some have wounds to the abdomen and chest.

For some of them there is nothing we can do, like the first two men who arrived already dead from shrapnel wounds to their abdomens and heads.

The patients requiring immediate surgery are taken to the operating room.

I am responsible for anesthesia, so I’m waiting there. Together with the local nurses and the surgeons we prepare everything necessary.  We check the medications, oxygen, and confirm that the surgical equipment is sterilized.

The first patients arrive. In room #1, there is a patient with the femoral artery bleeding, in room #2 we start an abdominal exploration.

Then arrives a man, disfigured from the shrapnel, he doesn’t breath. He cannot wait, so we perform a tracheotomy, right away, still in the hallway.

That evening an account of the day is made: 50 injured, 12 dead on arrival, 21 had surgeries and now sleep in their ward beds.


Nadia de Pretis

Translated by Michele Isernia