As fighting rages in Pakistan's tribal areas, the ICRC is using its extensive expertise in war surgery to treat a growing number of patients.
Tent hospital is best hope for civilian war wounded
Peshawar // Wasif Khan is six years old. Less than a month ago he was travelling by foot with his family and their livestock in the tribal area of Bajuar when there was an explosion.
Thirteen members of the family were wounded. Wasif lost part of a leg - a neatly stitched stump protrudes from the folds of his blue pyjamas - and a female relative lost an arm. "We are not sure what happened. Some soldiers told us not to move forward. We were trying to control the animals when suddenly a blast occurred, maybe it was a landmine," said Mashuq Khan, 55, speaking from his grandson's bedside.
With stoicism typical of the ethnic Pashtuns caught up in the conflict between security forces and militants in this strife-torn area, Mr Khan said he was grateful to the Pakistani army for arranging transport to take his wounded family to the International Committee of the Red Cross (ICRC) Hospital for Weapon-Wounded in Peshawar. "Some four or five of us are in this hospital," Mr Khan said. The ICRC's tented field hospital, which lies behind nondescript security gates in Peshawar's University Town area, was opened in February.
While many other leading relief organisations have been criticised for their slow-footed response to the fallout from Pakistan's insurgency, the ICRC was one of the first to start providing emergency aid for citizens. The Pakistan army says that in the past three months more than 1,500 insurgents and 130 soldiers have been killed in operations in Swat Valley and the neighbouring districts of Dir and Buner in the North West Frontier Province from where more than two million people fled the fighting. Although in Swat the fighting has largely abated, the number of civilian casualties is unknown and the region's toll is expected to increase steadily for years to come as fighting is ongoing in all seven of Pakistan's tribal areas and across the border in Afghanistan.
"The ICRC initially supported local hospitals, but it soon became apparent that they lacked the expertise. War surgery is very specific, and the ICRC has developed standard methodology and institutional experience in the field," said Dr Bart Janssens, the head of ICRC medical programmes in Pakistan. At present the tented hospital in Peshawar is the ICRC's only functioning, independently-run hospital for war wounded patients.
An ICRC hospital in Lokichokio, Kenya, which dealt with war wounded from neighbouring Sudan, was handed over to the Kenyan government in 2006. Since it opened in February, the Peshawar hospital has treated more than 420 patients. Without it many patients would have died or been left more seriously disabled. The 72-bed field hospital, which is fully equipped with six wards - five male and one female - an operating theatre, X-ray, physiotherapy and intensive care facilities, has been provided by the Finnish Red Cross.
"We have been at maximum capacity when the fighting was at its heaviest in Swat," said Dr Sabahat Gillani, the hospital's health officer. When admissions to the hospital are at a maximum, a shaded area where cars are parked serves as a triage unit so that the injured can be sorted into groups based on the urgency of their needs. Most patients cannot afford to pay the fees of private clinics. The ICRC's treatment is free and each patient is given 2,000 Pakistani rupees (Dh90) for the cost of transport to reach the hospital. "We have had a constant flow of patients from both sides of the border. We have field teams that create an awareness about the hospital and where possible they have transported patients here," said Kirrily Clarke, an Australian nurse who has been working with the ICRC for seven years. "There are plans to expand bed-capacity but we never turn anybody away who needs treatment. We always find a way to accommodate them," she said.
The sharp end of the business is the surgery where surgeons amputate and clean, repair and stitch wounds, often working through the night as each patient usually needs three or more surgical operations. "I have treated wounds that I have never seen in my life. They are multiple wounds and complicated by the long duration of time that it has taken many of the patients to reach here," said Pierre-Marie Noterdaeme, a Belgian surgeon nearing the end of an intensive three-month stint in Peshawar.
"They arrive any time between three and 20 days after they are injured so the wounds are infected. Almost all are bomb blast wounds," he said. Mr Noterdaeme gave up his work at home to "go freelance" and work on contract for the ICRC. "It's typical war surgery. There are no two wounds that are the same. Bullets or shrapnel hit every part of the body, each presenting us with a different challenge," he said.
"We treat all the weapon-wounded patients who come to us, no questions asked. We don't know who they are, where they came from, what ethnic group they belong to or how they got injured. We just try to save their lives and limbs as best we can," he said. The long history of the Red Cross in the region, particularly in neighbouring Afghanistan where many relief organisations are viewed as partisan to the West, has given locals a deep-rooted confidence in its work.
The ICRC began providing treatment in Pakistan in 1981 when it established hospitals in Peshawar and Quetta to treat victims of the Afghan war. In one of the male wards, Alim Khan from Lower Dir explained how he was wounded in fighting. "The militants took over my petrol pumps and so the military launched an operation and I was caught in the crossfire. I am here for the past 47 days. I do not know what the future holds as my home also was destroyed," he said.
Ghaufranullah Khan, 35, who worked in a travel agency in Swat's capital Mingora, had ignored a curfew and left his house to pray at a local mosque. "Some soldiers saw me and shot me. I faced great hardship to reach here because of the curfew. My relatives carried me and then pushed me in a wheelbarrow for some 70km. I was wounded on May 8 and I reached here on May 11," he said. Both men were being treated for shrapnel wounds in their legs, arms and torso.
Pointing to the tented wards, Ms Gillani said that they were a temporary measure. "The tent is not the proper solution for this hospital, so we need a concrete building for that," she said. The ICRC is expanding its work to treat the increasing flow of wounded from the conflict along the Pakistan-Afghan border, and has nearly quadrupled its budget in Pakistan from 24.1 million Swiss francs (Dh81m) to 90m francs for the coming year.
Along with 19 specialised expatriate staff, the ICRC has hired local doctors, technicians and nurses who are learning specialised skills and methods. The ICRC is about to begin training doctors from the tribal areas and is considering opening airstrips there so that it can reach people in the most remote and inaccessible areas of the conflict. firstname.lastname@example.org