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For the past 45 years, Médecins Sans Frontières (MSF) aka ‘Doctors without Borders’ have seen doctors and medical staff from around the world volunteer to care for patients in war zones around the world.
Under article 18 of the Geneva Convention, hospitals are designated protected status meaning that ‘in no circumstances’ can they be targeted by any parties involved in a conflict.
Despite this, in the early hours of 3 October 2015, a MSF hospital in Kunduz, Afghanistan came under repeated attack by the United States Air Force.
The attack, which went on for more than an hour, resulted in 42 patients, care givers and staff being killed.
Tragically, almost a year on from the attack at Kunduz, hospitals and medical facilities in conflict zones around the world have continued to come under attack, including the bombing of an MSF hospital in Yemen on 15 August this year.
The BMA and MSF will be holding a special memorial evening at BMA House on 3 October to mark the first anniversary of the attack, as well as explore the efforts being taken to prevent future such tragedies.
As part of this memorial, the BMA is reproducing an account of the Kunduz hospital bombing, including the lead up and aftermath by Dr Kathleen Thomas, an Australian intensive care specialist present on the night of the attack.
The names of patients and some staff have been changed to protect their privacy.
Part one: The week leading to the attack
It was about two in the morning when I was woken from sleep by the sounds of intense fighting.
Having been in Kunduz for five months of the “fighting season” I had grown accustomed to the sounds of war, but this was different. It was close, heavy, and coming from all directions.
So, as had also become a habit when fighting became audible, I waited for the phone call from the ER announcing the onslaught of patients and the request for help.
It took hours for that phone call to arrive – the fighting was too heavy for anyone injured to actually get to the hospital… but then, as the sun rose on Monday, 28 September, the fighting slowed momentarily, the call came, and began what would be the longest week of my life.
The Kunduz Trauma Centre was an MSF-run, 92 bed hospital in Northern Afghanistan providing emergency surgical care for victims of accidental and violent trauma, and was staffed mostly by local Afghanis.
As one of 18 expats, my role was as supervisor of both the hospital’s emergency department which saw about 100 patients per day, and the eight-bed, four-ventilator, intensive care unit (ICU).
My first day was chaos – over 130 patients poured through our doors in only a few hours. Despite the heroic efforts of all the staff, we were completely overwhelmed. Most patients were civilians, but some were wounded combatants from both sides of the conflict.
Reflecting on that day now, brings back so many memories.
The smell of blood that permeated through the emergency room (ER) and the touch of desperate people pulling at my clothes to get my attention begging me to help their injured loved ones.
The wailing, despair and anguish of parents of yet another child lethally injured by a stray bullet whom we could not save.
My own sense of panic as patient after patient was carried in and laid on the floor of the already packed emergency department.
Rising above all this in the background the tut-tut-tut-tut of machine guns and the occasional large boom from explosions that sounded way too close for comfort.
The hospital swelled far beyond our capacity that week.
Dr Osmani was my right hand man in ICU, a bright, young, open-minded doctor full of infectious energy.
He took great interest in his country and the rest of the world. A few weeks earlier he had mentioned the new Australian Prime Minister to me, before I had even heard the news of the changeover.
Having actually resigned from the hospital several months earlier to start Ophthalmology training in Kabul, he had generously agreed to return to Kunduz every weekend to work in ICU, helping us to train the new doctors hired to replace him.
He had told me: ‘MSF has given me so many opportunities and I have learnt so much, now I wish to give back to them.’
The persistent fighting took its toll on all of us. By the end of the week we were physically, mentally, and emotionally exhausted.
There were moments when a sense of hopelessness overwhelmed us.
Dr Osmani expressed these sentiments on the final day, following a tragic incident where a family trying to escape Kunduz was caught in crossfire, killing several children at the scene, with two more dying in our ER and operating theatre (OT).
With the remaining children being treated for severe injuries, he stated: ‘the people are being reduced to blood and dust. They are in pieces. Oh God, is there anybody who can hear their cries?’
This blog is the first part in a series. Read part two.