Published: December 2006
Iraqi Wounded
Against the Odds: U.S. Medical Teams Offer a Measure of Hope to Injured Iraqis
By Neil Shea

On the second floor of the military hospital, tucked away in a back corner, a tiny blond boy mumbles in the secret language of babies. He shudders beneath blankets and bandages, belly down on a large bed. Helicopters thump overhead, but the noise does not wake him. He is used to it now.

His cheeks are pink, his hair so fair he could be Norwegian. But he is an 18-month-old Iraqi from a town near the Syrian border. He was severely burned in his home, and his parents sought help at a U.S. military base. Soldiers took him in, then flew him to Ibn Sina, the American-run hospital in Baghdad.

The boy, above, was not an unlucky bystander. He was not collateral damage. None of the forces fighting in Iraq pull blame for his burns. It was a domestic accident, his parents said. There was a boiling pot of soup. A confused scalding. Screams.

In a way, he is fortunate because of the war. Thanks to it, he now sleeps in the best hospital in Iraq. Drugs soften his pain. American surgeons have begun grafting skin over the raw red patches on his arms, legs, and buttocks. Under Saddam Hussein, this would have been impossible. The boy might have died of the infections that follow burns.

Scores more Iraqis than Americans are wounded or killed each day in Iraq. The hospital wards at Ibn Sina reflect this. After the car bombs and ambushes, the raids and street battles, Iraqi police, soldiers, civilians, and enemy insurgents flood into American emergency rooms. The U.S. is obligated to care for anyone injured as a direct consequence of war.

Others, like the boy, are admitted too: children with insect stings, pregnant women, men with sexually transmitted diseases. They get in with the help of sympathetic soldiers and medics. They get in because doctors everywhere swear the same oath. Ibn Sina is an island of hope.

The Americans work hard treating Iraqis, as hard as they would for anyone. Doctors slice charred skin away, neurosurgeons tug chunks of metal out of skulls, nurses stop bleeding in legs blown to hamburger.

But in Iraq, the problem is what happens after. Military hospitals are not prepared to treat Iraqi patients for long periods. At a certain point, doctors must send their Iraqi charges—no matter who they are—back into the Iraqi healthcare system. And the system is ruined. Once upon a time, Iraq's hospitals were the best in the region. But Saddam Hussein's threats and violence eventually drove many doctors from his country. Iraq's hospitals began to rot under the dictator and the sanctions imposed on the nation after the first gulf war. By 2003, when American soldiers charged in, the system was a shell, broken and looted.

In his small office at Ibn Sina, a hospital once used by Saddam and Iraq's ruling elite, Lt. Col. Mark Smith, deputy commander for clinical services, explains that the U.S. is trying to repair the broken system, pay doctors' salaries, provide new equipment. But violence and chaos have blunted the effort. It seems, at times, like scraping a hole in sand.

"We really can't take care of all those Iraqis," says Smith, who must sometimes decide when to send Iraqi patients away. "There's got to be a way to build that medical infrastructure right now." But he knows it can't happen while the country tears itself apart. Someday, Iraq's hospitals may function well, fully staffed and provisioned. But Smith doesn't believe it'll be soon. "I would say we're a generation away from that."

Smith's medical teams generally hold patients until they're stable. Sometimes they keep them longer, knowing that—for the gravely injured—chances of recovery drop outside Ibn Sina. When patients can no longer stay, they're collected by family or loaded into military ambulances and trucked to the gates of the Green Zone, the walled and guarded enclave that houses Iraq's government and the U.S. bureaucracy. At the gates, patients transfer to Iraqi ambulances. Sometimes the ambulances are merely old vans, the drivers not paramedics but repairmen or cabbies. Packed aboard, patients hurtle through Baghdad, hoping for safe passage.

The doctors, nurses, and medics don't follow patients as they are ferried to new hospitals. It's too dangerous. For the Americans, who rarely see Iraq beyond the walls of the Green Zone, it is as though their former patients had fallen into a dark void. Sometimes they hear stories, rumors, about what happens to the Iraqis, about the ambulance drivers who don't know enough to keep squeezing a patient's lung pump, or nurses who steal their patients' food. None of it can be confirmed, but it might as well be true. Anything is possible in the void.

In the Intensive Care Unit, the burned boy's father sits bedside, anxiously scanning the faces of the nurses. He speaks no English, has the pimpled face of a teenager. At a nearby bed, nurses haul an Iraqi man up on his side. A large hole, like an angry mouth, gapes behind his left shoulder. A piece of shrapnel about as big as half a credit card tore through him, leaving him a paraplegic.

The burned boy has lain here six days. Eventually he will be turned back into the care of his parents. The nurses in the ICU worry. Nearly all of them say the worst part of their job is treating injured children, and lately there have been many. The boy's odds of infection and other complications will jump when he leaves. And there is more: The nurses suspect the boy's parents abuse him.

Maj. Christian Swift, a nurse from Maine who manages the ICU, says the parents' story detailing how the boy was injured didn't add up. They said he fell into a pot of boiling soup. Or that he pulled it down on himself. The story changed. Back home in the States, nurses would have called in child protective services. "It raises a lot of red flags," Swift says. "But we don't really have the social infrastructure to dig any deeper. You can't pass judgment, but the question was raised. So you've got it there in the back of your head."

The boy's small body shakes with each sleeping breath, his blond hair soft as corn silk. Army nurses check in as he burbles through his dreams. They coo at him when he wakes. Soon he will leave, his bed taken by another Iraqi. But for now he is safe, his pain dulled. At least, the nurses say, we can do this for him.