The medics had 20 minutes’ warning. A soldier badly wounded by a roadside bomb was coming in. It was only after the helicopter landed at the 28th Combat Support Hospital inside Baghdad’s green zone that they realised quite how badly.

As they cut away his blood-sodden bandages in the trauma ward they found that all four limbs had either been severed or were attached by little more than skin. He had 70 per cent burns to what was left of his body.

They worked frantically to keep him alive. All his remaining limbs were amputated except for the top of one arm. Within hours he was air-borne again – this time bound for Germany and an onward flight to the Brooke Army Medical Centre in Texas.

There, some time soon, he will wake to realise that life as he knew it is over.

Iraq timeline: five years of conflict

From accusations that the weapons of mass destruction dossier had been sexed-up to withdrawal of British troops from Basra

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He is 19. “They were devastating injuries,” said Lieutenant-Colonel Bill Costello, the officer in charge of the Emergency Treatment Section. “I’ve seen so many of them.”

For Western publics this is a sanitised war. Iraq is too dangerous for news teams to record properly the daily shootings, bombings and executions.

Next week’s long-awaited congressional debate on President Bush’s war strategy will be driven by abstract figures. But to glimpse the human agony behind those figures, it helps to spend two days with the 28th CSH – the China Dragons – a model of American medical excellence and generosity of spirit.

Two hours after the 19-year-old soldier arrived, another helicopter delivered a blindfolded, heavily sedated Iraqi detainee from Camp Bucca in southern Iraq. The medics removed the blindfold to find his eyeballs bulging out.

At first they thought his eyelids had been cut off by his fellow prisoners. Then they realised that both eyeballs had been gouged from their sockets and were hanging loose.

His fellow prisoners had also cut off his tongue.

They had beaten him so severely that all four limbs required faschioto-mies – the slitting of the skin – to release the pressure caused by internal swelling. “It was a stunning degree of cruelty,” said Major Won Kim, the ophthalmologist who removed the eyeballs.

Other victims arrived in quick succession – a seven-year-old Iraqi boy caught in a gunfight and hit in the abdomen; a two-year-old girl from Kalsu, south of Baghdad, with a bullet in her brain who survived; a 62-year-old Sunni elder from Doura, south Baghdad, with at least five bullet holes in his back – the target of a drive-by shooting for apparently crossing a criminal oil-smuggling syndicate.

A 22-year-old woman US soldier who had attempted suicide by overdosing on aspirin was flown to Germany for dialysis. An Iraqi gunner whose Humvee had hit an improvised explosive device (IED) was admitted with shrapnel wounds to his head and a fractured skull. Another young Iraqi boy named Mustafa, 8, had been shot in the head when his family’s car was waved through one end of a check-point just as a US convoy was entering the other. One of the convoy’s gunners opened fire. Mustafa will be brain-damaged for life.

“Who can prepare you for this?” asked Major William White, 43, the nurse manager of the emergency room. “I’ve been doing this 24 years and I’ve never seen this kind of stuff.”

What The Times saw in two days scarcely begins to cover the extraordinary range of patients treated by the 28th CSH – not least insurgents who injure themselves while attempting to kill US soldiers. “We’ve had guys suspected of being the trigger men for IEDs being treated next to the victims of those IEDS,” said Lieutenant Tom Waters, 25, a nurse. Each month the CSH treats half a dozen boys aged 10 to 15 who have been maimed while planting IEDs for the terrorists.

Occasionally, the medics find themselves treating a suicide bomber who has blown himself up but survived. More often, they find bits of them – a thumb, a fragment of bone – embedded in a victim.

Not all US soldiers understand why the CSH tries to save America’s enemies. “You’ll get soldiers coming up and saying ‘Way to go, Doc. You saved that guy’s life. He just killed Sergeant so-and-so’,” said Captain Sean Meadows, 39, a doctor.

The medics counter that they cannot decide in the heat of the moment who is and who is not an insurgent, and that those who are might later provide valuable intelligence. “We’re not judge or executioner. Our mission is extremely simple. We treat everyone who comes in here. We treat them the same and we try to save lives,” says Major White. The CSH even provides insurgents who cannot be saved with a Koran, an interpreter and someone to sit beside them until they die.

In the past 11 months, the 28th CSH has also treated escaped hostages, including one women who was severely beaten by her kidnappers and jumped from a three-storey window to escape; victims of chlorine gas attacks in Anbar province and numerous Iraqis hit by celebratory gunfire – ten alone on the night that the Iraqi football team won the Asia Cup in July.

Major Kim, the ophthalmologist, joined the 28th CSH in Baghdad six months ago. In the first two months he treated a spate of Iraqis from the US detention camps Cropper and Bucca who had been blinded by rubber bullets fired to quell riots. Since then he has removed a dozen eyeballs of detainees who have been stabbed or bludgeoned by other detainees.

“Sometimes it takes your breath away. They call this a holy war, and for this to be done in the name of God appals me,” said Major Aiken, the nursing supervisor of the 500-member unit.

Each medic has his own way of dealing with such horrors. Captain Meadows, a doctor straight out of M*A*S*H, hits a punchbag. Lieutenant Waters smokes Cuban cigars. Colonel Costello jogs around the helipad. Major Aiken photographs flowers, birds, sunsets – “things of beauty”.

Mostly they are able to remain dispassionate – until they find themselves treating someone they know. On July 10 a mortar exploded near by. Many were injured. Major White was called to a trolley and found himself staring down at one of his nurses, Captain Maria Ortiz.

“We’d been talking an hour before,” he recalled. “She told me, ‘I’ve just got my wedding dress. I’ve got to lose two sizes. I’m going to the gym to work out’. She was coming back from the gym when the mortar hit.”

She died, and her portrait is now stuck on walls all around the hospital.

The CSH has two mortuaries, one for Iraqis and one for the coalition. The bodies of Americans are taken away by helicopters on what are known as Angel Flights.

Is the war worth this price? “If Iraq turns around, if you give these people an opportunity to succeed and become a country that’s not oppressed any more then maybe it is worth it,” says Major White.

“You have to be optimistic. There’s no way you can watch all these people die and do all these amputations and not believe it’s going to work.”

Captain Meadows recalled a fellow medic rushing to help two wounded soldiers in the field and stepping on an IED. He was killed: “I loved that guy. I want this to be worth it. I can’t see us slinking away and saying it was all for nothing. You want it all to be for something.”

Survival rates

–– Improvements in US battlefield medicine have greatly increased survival rates. In the Second World War, 30 per cent of the Americans injured in combat died. In Vietnam, this dropped to 24 per cent. In the invasions of Iraq and Afghanistan, about 10 per cent of those injured died

–– Soldiers of the American Expeditionary Force in the First World War were the first to be accompanied by purpose-trained mobile medical units, the innovation of Joseph Marshall Flint, a Yale Professor of Surgery

–– The rapid evacuation from battlefield by air was pioneered by the US during the Korean War, as helicopters were first used to fly the wounded to Mobile Army Surgical Hospitals (M*A*S*H)

–– Decreased casualty evacuation times, from an average 45 days in Vietnam to four days or less today, has resulted in 90 per cent of casualties surviving during Operation Iraqi Freedom and Operation Enduring Freedom, compared with 76 per cent in Vietnam

Sources: www.1stcavmedic.com, www.mcatmaster.com, www.cdlib.org
New England Journal of Medicine; Yale University

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