https://www.bma.org.uk/connecting-doctors/doctors-as-volunteers-forum/b/blog/posts/remembering-kunduz-the-aftermath-and-the-future
3 Oct 2016
Remembering Kunduz: The aftermath and the future
The attack on a Médecins Sans Frontières (MSF) hospital in Kunduz Afghanistan last year led to the deaths of 42 patients and staff.
In the run up to a memorial event commemorating one year since the attack, the BMA is reproducing an account of the bombing written by Australian intensive care specialist Dr Kathleen Thomas, who witnessed the attack.
Part three: The aftermath of Kunduz & attacks on the medical mission
The repercussions of the attack in Kunduz were to reach far beyond the lives lost and those injured.
As a result, all of northern Afghanistan was left without any trauma facility. The injured now had to make their way all the way to Kabul, way too far for many trauma victims.
In 2015 alone, 75 MSF hospitals, predominately in Syria and Yemen, but also in Ukraine and Sudan, were attacked.
Only some of these attacks attracted media attention because of their international profile and NGO status.
The reality is that medical care is under fire, our colleagues around the world are under fire. We are under fire.
Where once a red cross would ensure protection in warzones, now hospitals in both Syria and Yemen are built underground, staff disguise themselves to hide their occupation, and their GPS coordinates are kept secret.
International humanitarian law clearly protects hospitals and medical personnel in any armed conflict.
Despite calls from NGOs such as MSF and even a UN Security Council resolution, hospitals continue to be bombed with impunity.
Why is this the case?
In regards to Kunduz – accountability for the attack is complicated. But enforcement of International Humanitarian Law is inherently problematic and when four of the five permanent UN security council members are involved to varying degrees in these attacks, it is easy to imagine the barriers to enforceability.
Just before being evacuated to safety after the bombing, leaving behind my surviving colleagues in the ruins of the hospital in a city still in the midst of war, the last thing that was said to me was: ‘Please, please tell the world our story.’
As I have watched hospital after hospital bombed in Syria and Yemen, I realise that it is not just the story of the Kunduz hospital attack that I must tell.
It is the story of countless patients and medical staff attacked in hospitals around the world.
The attack on a Médecins Sans Frontières (MSF) hospital in Kunduz Afghanistan last year led to the deaths of 42 patients and staff.
In the run up to a memorial event commemorating one year since the attack, the BMA is reproducing an account of the bombing written by Australian intensive care specialist Dr Kathleen Thomas, who witnessed the attack.
Part three: The aftermath of Kunduz & attacks on the medical mission
The repercussions of the attack in Kunduz were to reach far beyond the lives lost and those injured.
As a result, all of northern Afghanistan was left without any trauma facility. The injured now had to make their way all the way to Kabul, way too far for many trauma victims.
In 2015 alone, 75 MSF hospitals, predominately in Syria and Yemen, but also in Ukraine and Sudan, were attacked.
Only some of these attacks attracted media attention because of their international profile and NGO status.
The reality is that medical care is under fire, our colleagues around the world are under fire. We are under fire.
Where once a red cross would ensure protection in warzones, now hospitals in both Syria and Yemen are built underground, staff disguise themselves to hide their occupation, and their GPS coordinates are kept secret.
International humanitarian law clearly protects hospitals and medical personnel in any armed conflict.
Despite calls from NGOs such as MSF and even a UN Security Council resolution, hospitals continue to be bombed with impunity.
Why is this the case?
In regards to Kunduz – accountability for the attack is complicated. But enforcement of International Humanitarian Law is inherently problematic and when four of the five permanent UN security council members are involved to varying degrees in these attacks, it is easy to imagine the barriers to enforceability.
Just before being evacuated to safety after the bombing, leaving behind my surviving colleagues in the ruins of the hospital in a city still in the midst of war, the last thing that was said to me was: ‘Please, please tell the world our story.’
As I have watched hospital after hospital bombed in Syria and Yemen, I realise that it is not just the story of the Kunduz hospital attack that I must tell.
It is the story of countless patients and medical staff attacked in hospitals around the world.
https://www.bma.org.uk/connecting-doctors/doctors-as-volunteers-forum/b/blog/posts/remembering-kunduz-the-week-leading-to-the-attack
23 Sep 2016
Remembering Kunduz: The week leading to the attack
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?’
30 Sep 2016
https://www.bma.org.uk/connecting-doctors/doctors-as-volunteers-forum/b/blog/posts/remembering-kunduz-the-attack-on-the-hospital
Remembering Kunduz: The attack on the hospital
The attack on a Médecins Sans Frontières (MSF) hospital in Kunduz Afghanistan last year led to the deaths of 42 patients and staff.
In the run up to a memorial event commemorating one year since the attack, the BMA is reproducing an account of the bombing written by Australian intensive care specialist Dr Kathleen Thomas, who witnessed the attack.
The names of patients and some staff have been changed to protect their privacy.
Click here to read Part one
Part two: The attack on Kunduz Trauma Centre
During the week leading up to the attack, the expats had set up camp in the hospital meeting room. This room was located in the office complex about 50 metres from the main building which housed the ICU, ER, OT and outpatient departments (OPD).
This is where I was when, as I slept, on 3 October at 2.08am, I was ripped awake by the first explosion. I could feel the vibrations in my chest and I instinctively covered my ears to protect my eardrums from rupture.
This was a totally different type of sound to anything previous and much, much closer. I had hardly managed to sit upright before the next explosion. I felt adrenaline pumping through my body – my legs tingled, my mouth was so dry, my hands shook.
I scrambled to put on my jacket and headscarf while looking at the terrified expressions of the three expat nurses with whom I shared the room. ‘It sounds like they’re bombing the hospital.’
More explosions followed in quick succession. We had no idea what was going on. It was dark in the room but we didn’t dare turn on any lights.
One of the nurses tried to look outside on several occasions, but every time he opened the door, heavy debris would hit the walls. I tried phoning everyone that wasn’t in the room with us, unsuccessfully – the ICU and ER staff and all of the other expats.
We scurried around the room like rats in a cage trying to figure out the safest place to be in case we took a direct hit. But we knew by the magnitude of the sounds - in a direct hit, there was no safe place. We were overwhelmed with this gripping fear.
The explosions continued, one after the other, separated every now and again with a short pause, presumably while the AC130 Gunship circled around. Every now and then we also heard heavy machine gun fire.
The message, as to what was going on, was delivered with our first patient. We heard a voice outside calling for help. Jecs, one of my colleagues with me in the room, opened the door to the sight of one of our ER nurses. All four of us froze as we absorbed a scene from a horror film.
He looked like a zombie; backlit, his left arm hanging by a small piece of skin and coated in thick grey dust. His bloody clothes were shredded. Several large wounds gaped and a piece of metal stuck out of his back. His right eye streamed blood. Then he collapsed.
We pulled him inside by his feet. Panic welled up inside me as I leant over to ask: ‘Where were you when you were hit?’
‘I was in ER.’
I was struck with disbelief. Did he misunderstand my question? He couldn’t have been inside the ER. ‘No, no, no. You must have been outside ER!’
‘No. I was inside the ER. Inside.’
This was the moment reality hit. It really was the worst case scenario. They really are bombing the hospital.
Soon after, our meeting room and the three surrounding rooms filled with injured people bringing absolute chaos. Most of them colleagues, friends and some patients, all covered in the same thick dust.
The injuries were the same as what we had been treating in patients all week – penetrating chest wounds, open fractures with extensive soft tissue wounds, traumatic amputations.
At first there was just me, three nurses, and a basic first aid kit. It’s hard to describe being surrounded by friends and colleagues, with life threatening injuries, calling out your name begging for help that you have no capacity to give them. It was horrendous.
Dr Osmani, Dr Ramakee, a training ICU Doctor, and two cleaners, were all in the ICU isolation room. Dr Osmani and one of the cleaners, Nasir, suffered devastating injuries and were killed.
Dr Ramakee, suffering blast injuries to the eyes and ears, managed to run out of the room literally dodging shells that rained down through the ceiling. One of those shells landed right in the middle of the ICU hitting and killing two of our nurses instantly.
He then hid in the laboratory until it caught on fire then escaped through a window. He recalls hearing Dr Osmani's cries for help fade into silence over about 20 mins, but was unable to get back to him.
We had seven patients in ICU at the time of the attack. Three were on ventilators. One was our injured Head ER nurse Lal Mohammed, the other two were chest and spinal cord injured patients.
I hope with all my might that Lal Mohammed was sedated enough to be unaware of the situation, but I know the other two were awake. Even if they’d been able to rip themselves off the ventilators, their paralysis would have prevented escape.
When the shells ripped through the ceiling in ICU, and the whole unit went up in flames, all those patients were killed, witnessed burning in their beds.
Our final intubated ICU patient was in theatre at the time of the attack, found dead on the operating table.
The only surviving patient in ICU was a three-year-old girl named Shaesta who had suffered horrific blast injuries yet was recovering in ICU.
The rest of the main building suffered the same fate including the ER, theatres, OPD where many staff were sleeping that night.
People fleeing the main building, like Tahseel, were picked off by machine gun fire. Forty-two people were killed, 14 of them were our staff. Countless others were injured, many suffering injuries making them unemployable in Afghanistan.
Josie Long 
