By Brian M. Scheele
I was seeing it everywhere, the war to liberate Mosul from ISIS, in the newspapers, on TV, on my Facebook feed and I knew it was real but it seemed so distant and untouchable. It was a horror, civilians being killed, tortured, no one was doing anything about it at home and I wanted so badly to help. I am a doctor who specialises in emergency medicine, this was an emergency, and I wanted to make an impact if only for one patient at a time. The non-profit humanitarian and disaster relief organisation NYCMedics reached out to a group of physicians interested in international medicine and I applied right away to join them at one of their Trauma Stabilisation Points (TSPs).
The TSP was a new concept implemented during the World Health Organization’s response to decreasing morbidity and mortality during this conflict. The WHO, whose response is usually present during times of disease outbreak, like the all-too-familiar Ebola outbreak in West Africa, was now focused on organising a response to decreasing the burden of trauma (gunshot wounds, blast injury, burns, etc). The TSP is a mobile emergency medical team of physicians, physician assistants, nurse practitioners, nurses and medics positioned near the battlefield frontline, manned 24 hours a day, to manage acute traumatic pathology. Trauma is an interesting and simple pathology, often death can be prevented if we can diagnose quickly or perform surgery as soon as possible following the injury – hence the need to be close to the frontline.
It was a few weeks from deployment and I received a call asking me to fill another position alongside the one at the TSP – to run a trauma referral system created by NYCMedics. This position was created as a central point of contact for the ambulances and trauma field hospitals around Mosul. It was able to receive information about civilian and military mass casualties from TSPs on the frontline and distribute the casualties to the appropriate field hospitals in Mosul so as not to overwhelm one facility, thus allowing for quick and appropriate management of trauma. The goal of this job was simple – to decrease preventable death after trauma.
Jumping into this position at the end of the conflict in Mosul, staying on during the immediate return of civilians to the city and during the battle for TelAfar and Ayadiya, was an opportunity I welcomed during this violent humanitarian crisis. I had to decide where to send handfuls of casualties from the front line in TelAfar to the closest, prepared trauma field hospitals in the decimated city of West Mosul – these decisions could either cost a life or save a life.
Who was there to receive the casualties? It was Medicins Sans Frontieres, the International Committee of the Red Cross,Qatar Red Crescent,Aspen Medical, and Samaritan’s Purse. The doctors, nurses, administrators, and whomever else they employed had left their warm and comfortable homes for months at a time to work long hours with overwhelming patient volume in a place full of threats, bombings, and challenges for a population of people that was not their own. And they did it all in the name of humanity. They are some of the unsung workhorses in this conflict, and undoubtedly selfless too.
Iraq was hot, dusty, and people were suffering. Mosul was destroyed: IEDs continued to go off, gas explosions occurred daily, the fighting continued just west of Mosul, gunships flew overhead, artillery rang out, people were shot, injured, killed, and burnt often and badly. Everyone was affected: children, women, civilians and soldiers, Sunnis, Shia, Kurds, foreigners and aid workers. This war and what it left behind was ugly. In the thick of it all, as I mentioned above, were individuals and organisations that shined so brightly in such a dark place, that it lifted your soul and provided motivation to keep helping. The look on the face of that little girl after her family was killed by a land-mine and her legs were blown off, this too provides motivation to push onward, to use your training, your mind and whatever you have to save a life.
I worked at the TSP and cared for civilians and soldiers while helicopter rotors thumped overhead and smoke filled the sky, which I assumed came from the location where our patients were being brought. My stay there was short-lived this time as the battle for TelAfar and Ayadiya lasted just a week or more. Those days though, blood running down your hands and your arms, covering your shoes while you work to stop the bleeding – those days were valuable – we helped.
When I look back on the management of the trauma referral line, I remember being on the receiving end of a call from a healthcare worker who was in the thick of patient care. They were calling for help, to consult or for an answer to a question about their patient’s injury. They were hoping to hear that you knew a place they could send their patient, somewhere that could provide the lifesaving care they didn’t have in front of them.
Both experiences, the TSP and the referral line, were fulfilling and they helped. Being there at the time of injury to care for those who may otherwise have died, to see the suffering in their eyes and make clear decisions to prevent their mortality felt good. Also, being on the receiving end of a telephone call from a Spanish nurse volunteering in West Mosul, or a French doctor working with MSF calling for a referral that may provide life-saving care for their patient, this too was rewarding. Helping others treat their patients. Treating the patient first hand and providing a safety net for others, these were welcome moments, sometimes heartbreaking, often filled with joy and laughter in the face of what felt like overwhelmingly difficult odds. However, in the end, pressing on for that little girl or that foreign nurse in the rubble of West Mosul was the only option.
In the days ahead, the people of Iraq are faced with the battle against ISIL in Hawija and Shirqat, suicide bombings throughout their country, a referendum on Kurdish independence that may fill the streets with blood. It is the people of Iraq who have been suffering. I can just tell you of my experience, but the Iraqis, they are hurting and they push onward, as I envision they will continue to do. In my mind, I see no light in the near future, just more blood, broken lives and hurt children.
NYCMedics and the WHO will try to provide care to decrease this burden on the people in the coming days, weeks and months, and the Iraqis continue to help themselves and each other. The suffering will continue but in the midst of this chaos, people will find moments of hope and brightness to keep them moving forward.
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