Huge rise in wounded Afghan civilians

By Harvey Thompson
30 December 2010

An investigation by Britain’s Channel 4 News has revealed a dramatic increase in the numbers of war-wounded civilians in southern Afghanistan, following the military troop surge initiated by US president Barack Obama earlier this year.

Channel 4 News spoke to staff at three of the biggest hospitals in the south of the country, an area where counterinsurgency violence involving US-NATO forces has been amongst the bloodiest.

Mirwais Hospital, Kandahar, supported by the International Committee of the Red Cross (ICRC), witnessed a 163 percent increase on the number of war-wounded civilians admitted in the first 10 months of 2010 to 3,056, compared to 1,159 in the whole of 2009.

The Emergency Hospital, Lashkar Gah, run by Italian NGO Emergency, saw 158 war-wounded civilians admitted in October 2010 alone, a rise of 77 percent on the same period in 2009.

Boost Hospital, Lashkar Gah, supported by Medecins Sans Frontiere, does not take in trauma patients for operations, although it admits for post-operative care. It reported that civilians with other illnesses were “prevented from reaching them in time by war.”

Military hospitals across Afghanistan have experienced an increase in civilian casualties and often had more civilians than soldiers treated in its facilities. All of the hospitals surveyed said they were now experiencing major increases in war-wounded civilians.

Channel 4 News reported, “Staff at all of the hospitals said that the war also caused ‘indirect’ casualties which affected the poor Afghan communities they serve. The health system in Afghanistan has been decimated after thirty years of war, with poverty and malnutrition also major issues.”

The figures contained in the investigation are corroborated by a recent United Nations report on Afghan civilian casualties, which showed that civilian deaths and injuries in Afghanistan had increased by 31 percent year-on-year, to 3,268 in the first six months of 2010. The figures obtained by Channel 4 News on civilian injuries are even higher due to the intensity of the fighting in the south of the country.

The Afghanistan Rights Monitor (ARM), in its mid-year report, said that more than 1,000 civilians had been killed by occupation-related fighting in the first six months of 2010, while another 1,500 had suffered injuries.

Matteo Dell’Aira, the medical coordinator of Lashkar Gah surgical centre in Helmand, told Channel 4 News, “We have more war wounded than we have ever had in our six years of being here.”

He explained that many injuries are caused by mine explosions, bullets and shells. “There are lots of losses of limbs—we are full of amputees and people who need prosthetics,” he said. “Our staff now are highly trained and experienced. It depends on the injury [if people survive]…. Infection is quite easy to control here. But it changes every week. For example, last week we had to amputate three limbs on the same person—one arm and two legs. We obviously do our best but he came after I don’t know how many hours and had lost a lot of blood. We lost him after two to three days.”

Michiel Hoffman, a representative of Medecins Sans Frontieres in Lashkar Gah, said, “The warring parties have an obligation to minimise civilian casualties but at the end of the day it is a war and if you are near a convoy or motorcycle that gets blown up, you will get blown up. War is not pretty.”

Hoffman told Channel 4 News that the biggest danger for Afghans was how long it took them to get to the hospital for treatment as a result of having to avoid the fighting.

“There is no such thing as a nice war wound,” he said. “Even the simplest weapon has devastating medical consequences. But the biggest danger is for Afghans travelling any distance to get here. The biggest problem is them arriving late in terms of their disease.

“So a two hour peace-time journey could take two or three days as they go around the checkpoints, with the result that the disease has progressed much more seriously to life threatening in some cases.… We hear lots about how dangerous it is for doctors, but the biggest danger is for the poor farmer with the sick child.”

Christian Schuh, a paediatric nurse at the Mirwais in Kandahar, agreed:

“In our situation, sometimes the [children] arrive after five days or seven days because of the situation we are working in and they are living in here.

“And then sometimes there is nothing any more that you can do for those patients because they are in really severe respiratory distress.”

She continued, “The World Health (WHO) says 30 percent of children in Afghanistan are underweight. Our feeling is that it could be even more. WHO also says the mortality rate for children is 267 out of 1,000. That is so unbelievably high. One out of four does not reach school age.”

The numbers of children falling victim to occupation-related fighting has risen sharply. From January to October of this year, there was a more than 500 percent increase in war-injured children.

Dell’Aira estimated that the average age of a child patient was just six years of age.

Having instigated a cycle of violence across much of the country, US-led military forces had virtually closed off the most sophisticated medical facilities in the country to injured civilians—the military hospitals. Channel 4 News found that when the military facilities are full, civilians are transferred to local and NGO-run hospitals because rehabilitation is a “local responsibility”, according to International Security Assistance Force (ISAF) medical commander Colonel Castle.

Markus Geisser, head of the sub-delegation for the ICRC in southern Afghanistan, explained that poor people, or the vast majority, affected by the fighting had no other option than to go to the charity-run hospitals, while the wealthy elite could go to private clinics.

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