The unpaid, unsung medical corps of the Libyan rebels works through supply shortages, lack of funds and harrowing conditions.
Libyan medics battling to survive
AJDABIYA // Four months of bloody civil war have left tens of thousands of Libyans killed or wounded and the rebels' volunteer medical corps battered and plagued by dwindling funds and supplies.
The front-line fighting was especially heavy last month when the rebels made the first of several attempts to take the city of Brega from the forces of Col Muammar Qaddafi.
As the rebel army advanced on the oil-rich city, both sides were brought under a furious barrage of Nato air strikes.
Through the bursting bombs and shellfire raced a Libyan Red Crescent ambulance van. Inside were five volunteers who had just rescued a rebel fighter who would later lose both legs, but survive. The team had rushed him from the front to the nearest field hospital in Ajdabiya. They turned around at once and returned to collect more of the injured.
"Bombs were dropping all around us," said Mohammed Musrate, a medic with the crew. "We were under heavy fire from Nato and Qaddafi's men."
Hurtling back across the desert, the ambulance was struck from behind by a fierce explosion. Shrapnel and glass tore through the rear doors, and three of the crew were hurt. A metal shard tore through the rib cage of the team's leader, Dr Salah Al Awame. Minutes later, four days after his 28th birthday, he died on the way to the hospital as Mr Musrate struggled to revive him.
"Doctor Salah was my friend," Mr Musrate said. "The night before we ate together and told jokes. I still can picture his face that morning when we left for the front."
Dr Salah's death has become an all-too-familiar fate amid the rebel's war against government forces. Ill-equipped, poorly-armed and with little military training, estimates of the number of rebels killed vary widely - from 10,000 to 30,000 - and the death toll continues to soar.
Amid the carnage, hundreds of doctors, nurses, drivers and medics have been working in hospitals, ambulances and ad hoc field facilities. The rebels' medical volunteers work day and night, often in unspeakable conditions, with minimal supplies, outdated equipment and no pay.
"We don't even have any gauze," said Dr Abdulla Glessa, head of surgery at Al Jalaa Hospital in the rebel stronghold of Benghazi. "Patients are suffering and we don't have the equipment to operate … We are struggling to treat even non-critical patients now."
Even before the war began, Dr Glessa said, health facilities and access to medical care in eastern Libya was abysmal.
He said that for the last 42 years, Al Jalaa has been the only hospital in the region, home to two million people, equipped to treat traumatic injuries.
Since casualties began streaming into the hospital from the front lines, Al Jalaa has been overloaded with thousands of patients.
With this sudden influx, cash, blood reserves and medical supplies have been stretched thin. No wage has been paid since March, Dr Glessa said, adding that not one of the 180 staff doctors have even inquired about their salaries.
He said Al Jalaa is operating entirely on donations from aid groups - in particular the International Red Cross and Red Crescent - and local and foreign businessmen.
"At the beginning there was an influx of aid. Egyptian doctors came. Many western doctors volunteered. Supplies came in from Egypt. We received support from Red Cross and Doctors Without Borders," Dr Glessa said. "But with time this dwindled."
From the early influx of western physicians, only three remained at the start of this week; a German expert in vascular surgery who arrived a few days ago and two Italian doctors.
The rebel leadership, the National Transitional Council (NTC), has been recognised as Libya's legitimate government by a growing number of governments, most recently the UAE.
The UAE, as well as other Gulf and Nato nations, have provided humanitarian aid but Dr Glessa said much more is needed.
"The NTC cannot offer us any money, so we must ask for donations from the Red Cross, embassies and other governments," he said.
"I hope the fighting ends soon because if it continues much longer I think we will just break."
With the rebels engaged on three fronts - pushing west from Ajbadiya, defending Misurata and in the western Nafusa mountains - casualties continue to arrive by land and sea in Benghazi.
In besieged Misurata, where the main hospital has reportedly treated more than 4,000 victims since February, supplies are so low patients suffer for days without painkillers while waiting to be transferred to Al Jalaa in Benghazi.
Meanwhile, ambulance teams such as Mr Musrate's are frantically carrying injured fighters from the front to the mobile field hospitals, such as the Free Libya Field Hospital in Ajdabiya.
The Free Libya unit, which sets up as near as is safe to the fighting, has been moved five times since it was opened on February 26, according to its director Dr Ahmed Alegnashi.
He said the mobile hospital has 26 doctors, six nurses and 25 other staff who serve as drivers, labourers and assistants. All are volunteers, he said.
"We can reach the front in 15 minutes," said Dr Alegnashi. "The vehicles are prepared, even our clothes are ready. Everything is on standby. We just need to jump in and go."
In its three and a half months of existence, the field hospital has suffered the death of Dr Awame and an unspecified number of others. A four-man ambulance team was captured last month by Col Qaddafi's troops, their whereabouts remain unknown. Another volunteer lies in a coma in Al Jala after his ambulance overturned during a battle.
"Emotionally it's very hard, but what can you do?" Dr Alegnashi said, "It's a war and it's a dirty war."
Dr Alegnashi said the field hospital is used only for triage, resuscitation and stabilisation. The most severe cases are transported to Al Jala in Benghazi.
On June 12, after a day of heavy clashes as the rebels once again made an unsuccessful push towards Brega, the Free Libya hospital received 16 new patients, four in critical condition.
Despite pledges of aid and financial help from around the world, doctors in Benghazi said only support from the Libyan community is keeping the hospitals open at all.
Dr Glessa said money and supplies have poured in from local families, individuals, private pharmacies and clinics. He said one man donated 5 million dinars (Dh15m) to the hospital.
Dr Glessa also recounted how elderly woman interrupted a busy day of surgery to deliver to him a box of small plasters, saying she wanted to give all she had to help the injured fighters.
On the Benghazi waterfront, in the centre of what has become the rebel's "freedom square", a line of people gather each night in front of a Red Crescent blood bank operating out of a van.
"I do not have a gun, but I have my blood," said Mohammed Mufta, 22, as Dr Ramadan Salem inserted a needle into his arm.
The overwhelming number of casualties have kept a constant strain on blood supplies. It is this small, unassuming van that has kept them from drying up completely.
Dr Salem, 42, who trained as an opthamologist but volunteers here, said 20 donors is an average night but, when supplies are critical and an urgent call goes out from the freedom square platform, that figure can rise to around 200.
"If you came earlier you would have seen even small children coming to donate blood," he said.
Earlier this week, the wards and corridors of Al Jalaa bore grim hallmarks of the ongoing war.
In one room, three young men, barely out of their teenage years, were each missing a leg. Others wore bloodstained bandages over head injuries, shrapnel cuts and bullet wounds.
Across the hall, 23-year-old Abdul Al Hamid nursed an arm shattered by a tank shell. Mr Hamid, one of the many hundreds of patients transferred from Misurata hospital, had already been shot in the thigh but returned to fight 15 days later.
Despite his new injury, Mr Hamid, like many other rebels in Benghazi, remained determined to battle the Qaddafi regime. "We started this fight," he said. "And we must end it."