The Air Force Theater Hospital at Balad emergency room.
Image courtesy of Michael Mason
He has no face. There is a mashed pulp where his nose should be, a sticky, black suggestion of what may have been a mustache. A plastic tube runs into a hole once lined with lips. His entire head is a swollen, weeping burn. The blast disfigured him so badly that even relatives would have a hard time identifying him. The man doesn’t know where he is, but I do.
He is in the intensive care unit for Iraqis at the Air Force Theater Hospital at Balad Air Base (AFTH Balad), some 40 miles north of Baghdad. When I look away from the man, I see there are more patients like him in neighboring beds. The Black Hawk medevac team who brought him to AFTH Balad said that the patient might be a member of the Iraqi Police Service, a civil force maintained by the Republic of Iraq. They could not be certain, and given his level of trauma, the man could not—cannot—speak for himself. A ventilator breathes for him. He occasionally twitches his hands.
“They brought in another guy recently who we had heard rumors was a police officer,” explains Nicole A., a source who asks not to be further identified. “He lost both limbs and had burns on 30 percent of his body. I’ve been trying to figure out who he is, but the Iraqi police have no system for keeping track of their own.”
According to Iraq’s interior minister, out of a force of about 190,000, more than 12,000 Iraqi police have been killed since the United States–led invasion.
“There’s a lot of corruption inside the Iraqi police,” says Nicole. “Some people we trained were setting up IEDs [improvised explosive devices]. They are police by day and insurgents by night.”
“You’re saying that we are inadvertently training the insurgents?” I ask.
“Correct, correct,” she says.
With all those assumed to be insurgents, nurses bandage the patients’ eyes for the entire time they are treated at AFTH Balad. At the first opportunity, the insurgent will be questioned. In the case of the patient before me, the man without a face, there was no need for that measure. He no longer had eyes.
Image courtesy of Dr. Gene Bolles
“Every day is different, and there are constant challenges,” explains Maj. Charles Stresino, a patient liaison officer at AFTH Balad. “The bulk of the work is figuring out what we can do with the injured Iraqis. There are just not many good options.”
For a few precious days following an injury, all Iraqis at AFTH Balad—police, detainees, and ordinary civilians—will receive unparalleled medical services, courtesy of the U.S. Department of Defense. A similar level of care in the United States would run tens of thousands of dollars per patient. In order to extend that level of care to Iraqis, military doctors must keep beds open, and that means quickly transferring them out of AFTH Balad and into an Iraqi facility. As a result, the 200 Iraqis treated at AFTH Balad each month have an average length of stay of less than a week before they are discharged.
“There are a number of patients that we transfer into the Iraqi health-care system who will not survive,” says Maj. Jack Emps, a nurse on the Iraqi intensive care unit. “Unlike in the States where we have the resources to take care of anything to any degree, they don’t here.”
I ask Emps what was the most common sentiment he heard expressed from the Iraqi patients who could communicate.
“Fear of being discharged,” he says. “They know what they are going to. They know care is not as good. If they are missing limbs, or if a female is disfigured, then they’re not of much value, and will pretty much be scorned. Outcast. In the hospitals, they’ll receive stabilization, and if they are severely injured, it is not unusual for them to be put aside and given comfort care.”
Comfort care involves primarily pain management, hydration, and little else. Patients are expected to die.
Working with a doomed population has battered Emps. His face is weary from the long hours and the unpredictable surges of incoming injured. In the past two days, over 35 wounded Iraqis have been brought to AFTH Balad, and there are rumors that another, larger car bomb has just been detonated in Baghdad. The pain the Iraqi patients endure is carved into the heavy stress lines in Emps’s face.
“I have been here over four months now,” he says. “When you see this suffering of war day in and day out, women and children, innocent civilians, it is hard. You have a lot of emotional conflict and a lot of sadness. I am still not used to dying children. It is all I can do to get through a day.”
