„When it comes to war, normal people get crazy and crazy people get useful“ *

 

June/July 2017:

Three weeks as a medic in Mosul, three weeks in a warzone.

 

It was my first time in a warzone. Not the first time as a medic during a humanitarian crisis: I had already worked with refugees in Germany as well as in Greece and on the Balkan Route before that. But injuries caused by gunshots and explosions, multiple traumas, severe burns and acute psychological trauma were all subjects I've only dealt with in theory before. I prepared for the worst regarding my own living conditions as well as the general situation and its medical challenges. This turned out to be a good approach, because my worst expectations were almost met. People torn to pieces by explosions and missing limbs, bodies perforated by snipers, heavily injured children who were covered in blood and had lost everything. The patterns of injuries as well as the stories of those people who made it out of Mosul's IS occupied city centre alive, again and again filled me with wonder about the things the human body and soul can endure. I could cope with all of this myself thanks to the fact that I could do something to relieve the suffering (even just for a little while) and to save lives. In a way, I found it easier to act than just helplessly watching all of this in the news.

Sometimes everything happened so quickly that immediate action was required and there was no time to process what had just occurred. There were also things so terrible that my brain simply refused to memorise them – or it suppressed them, such as the pictures of the many dead who sometimes haunt me at night and in quiet moments as a reminder that the war isn't over yet…

Some scenes will stay in my mind forever.

For example the emaciated old man who had been imprisoned by IS in his own home. He survived the collapse of the house with grave burns and a laceration on his head. For another three days he was lying beneath the ruins with no water, food and medical care, and yet he was turned in alive and with good vital signs even though he could do nothing but groan anymore. As soon as he saw us and felt that he was being helped, his burned features turned into a smile.

A little child arrived dehydrated, famished and apathetic. The eyes barely open, there was no reaction as flies were sitting down on the corners of their eyes, mouth and open wounds. It only took a little bit of oxygen and a few drips of water fed by a syringe, and the child opened its eyes and started to cry: Life returned to the little body and they shook off the flies.

A man who had suffered multiple gunshot wounds in his chest with one shot having barely missed the cervical spine was bleeding badly from the vertebral arteries and kept losing his consciousness. Against all odds he reached the hospital alive. During transport (30 bumpy minutes through ruined Mosul in a shaky local ambulance) I knelt next to him and stopped the bleeding with compresses while simultaneously trying to calm him and holding the infusion in the other hand. Surgery was performed on him immediately and he survived.

A little boy, about ten years of age, was brought to our TSP without relatives. He too was dirty and injured but most importantly he was so famished that he wouldn't let go of a banana he got from an aid worker, even though the hand clawed around the banana had suffered a large meat wound. All my attempts to remove his hand from the banana in order to treat the injury failed. He just wouldn't let go of it. His whole body was a testament of toughness and will to survive. We don't know how long he had lived among the ruins, but he eked out a living somehow. He survived in spite of injuries, fear and hunger. And there is hope that his relatives will be found.

A young woman, mother of several children. She is covered in layers of black garbs, but as soon as she has left IS controlled territory she gets rid of the veil covering her face. She arrives at the TSP soaked with sweat and dirt, having marched several hours through the heat, holding her youngest child on her arm. She always keeps an eye on the children, but additionally she is agitatedly talking on her phone and also caring for her neighbour who accompanied her. As soon as she made sure that her children are treated by us, everyone has gotten some water and the neighbour is doing fine, she suddenly blacks out due to exhaustion.

All these examples of human strength and hope in the middle of one of the most terrible wars of our age gave me the courage and power to carry on and to believe in the meaning of the mission, despite the many dead and the impression that my own work would be nothing but a drop in the ocean. Even though you can always discuss the political impact of humanitarian missions, their meaningfulness to me is justified and indisputable. It is a sign of solidarity, of not looking the other way. If you think a bit further, providing direct aid in a TSP is a sustainable work as well, as every saved live can help to rebuild and remake this country in the future and warn of another war. Inshallah.

Elisa talks to a patient. Photo: private

Sometimes I would be resting after a long day of fighting off death on a camp bed in our garage-dwelling, fully clothed at 46 degrees Celsius (114,8 degrees Fahrenheit) as injured could be turned in every moment, and suddenly I would realise that I didn't even notice the background noise made up of explosions, artillery shelling and airstrikes anymore. I'm frightened about the way I not only got used to the heat, the food and the presence of soldiers in my “living room“, but also to the sounds of war. Sometimes I wonder how I could still laugh, read and simply live on while a few hundred meters away people were dying. Had I numbed myself to all of this? I don't think so. I believe it is a lifesaving necessity to get used to extreme circumstances in order to stay capable of acting without being crushed by the realities around you. I couldn't change the reality of war, so I had to get used to it in order to be able to help the people affected by it. I was concentrating on everyday occurrences, single moments, immediate encounters and interactions. Because whenever I allowed to sink in the madness that was happening around me and that all the pointless suffering and dying we were stemming against was man-made, I was close to throwing in the towel.

It's a different situation than providing humanitarian aid during natural disasters for example, which weren't caused by humans and where there is no relation to yourself. But here we were confronted with a situation which was to a degree caused by our own actions, by European and also German foreign policy, arms trade and other factors. Also, we are talking about a conflict where many different factions are involved and which is so complicated that you really can't differentiate between “good guys and bad guys” so easily – at least I couldn't. Further, we are not dealing with sicknesses and injuries which you could regard as cruel fate, but with the results of violence inflicted on human beings by other human beings. This makes one's own emotions such as anger, desperation, sadness, fear and so on even more complicated. One thing is always sure: War sucks!

Unfortunately bitter reality in a TSP. Injuries, blood and death become temporarily everyday life. Photo: Kenny Karpov

There were difficult conflicts between my own worldview and medical ethics. Often IS fighters were brought to us. Sometimes we knew for sure they were Daesh (local term for IS) followers, sometimes it was just a suspicion. In that case, the suspect would be held until his personal data was matched with local and international anti terror databases. Often the fighters were severely injured and I was confronted with a dilemma: Should I regard the person in front of me as a terrorist mass murderer or as an injured human being? While I was saving someone's life and treating his wounds, I had to imagine how this person would kill, torture and rape other human beings. It was the biggest moral dilemma I had to deal with in my profession: To treat, or not to treat… in the end, the Hippocratic oath always prevailed as well as my conviction that it was not unto me to decide about life and death of another human being. This would be resumed by the state of Iraq or the international anti terror coalition.

I was even more troubled when the IS fighters' women and children were my patients. I never gave a second thought about treating the children – children are innocent, no matter how they were raised and even armed child soldiers are victims in my opinion. But I often wondered about the women: Were they forced to support the jihad by their husbands, fathers or brothers? Had they taken an active part in their holy war? Had they joined IS on their own account? All this was possible but usually I never had enough time to find out about my patients. It wouldn't have influenced my work anyway.

Some of the women had travelled alone from Chechnya, Pakistan, Uzbekistan and so on – had they gone to Mosul on their own, in order to fight for the Islamic State? My conceptions about victims, perpetrators and gender issues are getting shook up a bit. Not to mention the questions of transiion between cognisance and perpetration…a question of guilt which recalls the issue of responsibility in Nazi Germany after World War II.

But not only the work in our TSP, also the general conditions around us were challenging us in ways I hadn't considered before. Cooperation with the Iraqi military for example was a necessity we couldn't avoid due to security reasons. For me, this is problematic for a start. According to my political beliefs I would prefer living without state, borders, armed forces and police. The military's presence, with its hierarchical and patriarchal structures, makes me uncomfortable. By and by I learned to appreciate individual persons, to see the people making up the organisation and find ways of cooperation in our daily work. But I was struggling with my own political antagonism all the time – and also with the fact of being a woman.

This was a point I hadn't considered. I knew that Iraq is a Muslim country, with Mosul being ruled by the IS Caliphate for three years, and I knew that Islam's view on women is quite different from ours, to put it mildly. I was aware of the fact that women are being opressed here, which I always considered unjust and terrible, but I thought it wouldn't affect me. The one thing I was wondering before my departure was whether I would have to wear a hijab or veil. And no, I wouldn't. Covering ankles, shoulders and upper arms would do, so I was wearing trousers and an elbow length sleeves top. At 48 degrees Celsius (118 degrees Fahrenheit) in the shade, I would often have preferred tank top and shorts, but I could deal with it. Especially when I considered the many layers of clothes – undergarments, dresses, gloves and veils – that local women had to wear. One thing I could deal with far less easily, was always being taken for a female nurse and not a doctor when working with the military personnel (including military surgeons, nurses, generals and so on) and patients. To straighten this out: I have great respect for the nursing profession and consider it to be equally important in the medical occupations. I would love to see much less hierarchy and the same degree of appreciation for all healthcare professions. But if people are making differences at all, I don't want gender to be the single reason. Typically I would be called by the words „Elisa come, we need a female nurse.“ It was absolutely natural to assume that a young woman has to be a nurse. Locals had a hard time accepting the existence of female doctors who would travel to muslim countries in order to work there on their own, treat heavily injured persons, drive cars and occupy an equal position in an NGO team. I tried not to be sidetracked by this treatment and just to carry on. I wouldn't be angry because often male crew members would be acknowledged more often, my work would be appreciated less and I would even be pushed aside sometimes. But when I was asked to be more quiet and less dominating and also to wear a longer T-shirt, I ultimately realised that the view on women in this country was affecting my work after all.

My conclusion: I will definitely go on a mission with CADUS again. But there is also a lot left to do at home. The fight for global justice and women's rights, against racism, classism, capitalism and militarism, is interconnected closely and has to be fought everywhere!

*Words by a friendly Australian paramedic, who has been working in humanitarian aid in conflict areas for many years, usually describes his experiences with volunteers.