Friday, February 5, 2010

Hospital on the edge

This post contains graphic images.

Above, toddlers slept two or three to a bed in the children's intensive care unit at Mirwais Hospital, Kandahar.

I spent some time at southern Afghanistan's biggest public hospital working on another development story for National Public Radio. Read and listen to Soraya Nelson's NPR report here. The story was part of an end-of-the-year, in-depth series on the direction Afghanistan is going as a whole.

As security has deteriorated in Kandahar, many international NGO's have pulled their staff from the area or shut down their regional offices, cutting off the flow of money and people in a region where they are badly needed.

Despite the worsening security situation, development continues at Mirwais Hosptial, where the International Committe of the Red Cross (ICRC) conducts training and assists the local staff. ICRC is one of the few humanitarian NGOs with a foreign staff living and working in Kandahar.

Mirwais is a vital health treatment center, the only public hospital serving five southern provinces. If they are able, wounded and sick people travel from Helmand, Zabul, Uruzgan, Paktyka and throughout Kandahar province to reach this group of buildings near the edge of town.

Above, children's ICU.

The hospital has six departments: surgical, infectious diseases, pediatric, ophthalmology, obstetrics/gynecology, and emergency/intensive care. Two-thirds of patients come to the emergency department and around 50 percent of all clients are trauma patients. (That's a lot.)

By documenting daily life inside, I wanted to give an idea of what life is like outside the hospital walls--why development is both difficult and so very needed. Mirwais Hospital is in the middle of a war zone where Afghans are kidnapped and injured by bombs, and the violence makes development work dangerous. But poverty and under-development create a desperate need for clean water, health care, roads, electricity and sanitation.

Mirwais has a tiny neo-natal intensive care unit, with three or four incubators. Above, ICRC nurse Kristina Alho of Jyvaskyla, Finland, prepared an underweight baby girl to see her mother.

Infant mortality and maternal mortality rates are among the highest in the world. In rural Afghanistan, women sometimes start having children at a very young age, don't have access to birth control and are often the last to receive health care. It's a lethal combination for mothers and babies.

Accompanied by two female hospital staff members, Nurse Alho carried the baby girl through hallways to see her mother in the women's intensive care unit. Alho was on a six-month ICRC contract to work at Mirwais.

The preemie baby was delivered by Caesarian section and had been unable to breast feed, and the family had no money for milk. Convinced that the baby's weight and overall health would improve dramatically if the mother, Jana, could just get her milk to come, Nurse Alho tried to help.

But the milk wouldn't come.

Jana looked despondently at her baby girl, shortly before offering the child to NPR correspondent Soraya Nelson, my colleague.

A dimly-lit hallway on a women's floor.

Shakofa, 2, recovered from burns to her chest and feet in a children's burn unit. Many Afghans use open fires, propane or oil for cooking and heating.

The fires sometimes cause severe burns, especially over the winter. Above, 18-year-old Abdul Rahim, of Shawali Kot District, Kandahar Province, tried to rest in the men's burn unit. Two months earlier, Rahim was standing too close to a fire in his home when his clothing caught fire.

A toddler played on the floor next to Abdul Rahim.

A man was wheeled into the emergency department.

Regular people, civilians, get caught in the crossfire of Afghanistan's conflict and end up at Mirwais after being wounded in kidnappings, roadside bombs, by landmines and air attacks.

Above, Mohammad Nassim, 35, lay bruised and groaning in bed. Nassim and another man, 28-year-old Sher Mohammad, were kidnapped by Taliban from a municipal water wheel construction site where they were working, in Takhtapoul District. They said they were blindfolded and tortured for four days, before being released to warn others against working with the government.

Sher Mohammad's bruised back.

I was standing near the entrance to the hospital one morning when something unexpected happened. A truck carrying the dead bodies of two Afghan border policemen arrived.

And that's how I found myself in the hospital morgue.

The day before, Ahmad Shei, 25, and Hamidullah, 22, were in an unarmored truck carrying material to a checkpoint in Zabul Province. A roadside bomb detonated near their vehicle. Ahmad Shei and Hamidullah were killed; four other border policemen were injured and taken to Kandahar Air Field to receive medical treatment at the foreign military hospital. The two dead were taken to the morgue at Mirwais Hospital before being transported to their home provinces in the North for burial.

The second man from the left facing the camera, helping to lift the body of Ahmad Shei, is Atullah, 20. His brother was Hamidullah, the other dead policeman. Atullah told me he and his brother were from northern Baghlan province, and their parents had died much earlier. Their other siblings were working in Iran, and for quite some time, it had been just the two of them.

Minutes later Atullah wept outside the morgue while his brother's body was washed and prepared for burial. He had just lost his best friend, brother, parent and comrade. I shot a couple of frames and then sat quietly next to him for a few minutes. I told him that I have a big brother too.

I couldn't help wondering how these two guys from way up north had found themselves in Zabul of all places. Had they been serving their country? Earning a paycheck? Keeping each other safe?

Imam Gul, 25, stood next to the body of Hamidullah, while the body was washed inside the morgue.

I don't know why they let me in. Maybe they wanted their sacrifice to be recorded. Maybe they didn't know what to do with the random foreign woman with a camera. Maybe they were too tired and shocked to care.

Imam Gul and Amanadin watched while a white shroud was pulled over their fellow policeman Hamidullah's body.

This picture is still hard for me to look at. The look on Amanadin's face mirrors my own shock.

I feel like most editors would think a photograph of a dead man with his legs blown off was unnecessarily graphic and would turn people off in a bad way. I guess this is the only place I feel like I can share this image and how it felt to be there, taking it.

Because this is the cold, hard truth.


Stella Wong said...


Erin said...

Holly, wow. More moving and yes, heartbreaking photos and stories here. You are so brave friend, as are your subjects. Thanks for sharing the cold, hard truth.

dust n roses said...

i'm glad you are able to get in their and get these flicks out their. they tell a story that even most foreigners working in afghanistan don't know....while there is nothing "sexier" then pictures of men with guns or turbans all up in the battle fields, if we really want to engage in counter insurgency and reach the population, it's in places like the hospitals that MORE work like that of ICRC needs to be done...every element and group has a role to play in this effort, but it's interesting to observe where the money tends to go...anyway, NICE WORK!