MOSUL, Iraq — For two weeks in early April and again in June, I was embedded in Mosul with an emergency-response division of the Iraqi army, which is fighting to retake the city from ISIS. The nonprofit organization I work for, NYC Medics, was contracted by the World Health Organization to run a trauma stabilization point clinic in Mosul. Our team consisted of doctors, nurses and paramedics.
The clinic has been running since January. It is the first stop off the battlefield for patients with trauma injuries. The clinic moves frequently, following the fighting. It is usually about three miles from the front and is just out of ISIS mortar range. Patients with gunshot, shrapnel, blast and crush injuries are our primary focus. Our mission is to keep them alive long enough for transport to hospitals where they can receive surgical and other advanced treatment.
Nongovernmental groups, even medical ones, do not normally operate this close to the battlefield. Other members of the team had considerable experience in such places as West Africa, treating Ebola patients, and in Haiti after the 2010 earthquake. But the Iraq frontline situation was unique for all of us.
I am a paramedic with the New York City Fire Department. Gunshot wounds are something we treat often. The injuries in Iraq, however, represent a different scale. They are inflicted by high-velocity military weapons and explosives that cause terrible damage.
Our team was billeted with our clinic in abandoned, bombed-out houses. The roof of the last house was covered with bullet casings. Sniper holes had been punched in the walls. Street fighting preceded us. For several miles around, there were few intact buildings. The landscape looked like Berlin at the end of World War II. No civilians appeared in the streets. The only road traffic was a constant stream of bullet-ridden humvees and other military vehicles.
Conditions were primitive. Electricity was available only through generators, which frequently broke down. Medical procedures, such as removing bullets and shrapnel, were often performed by flashlight. All the water lines were out. Bottled water for drinking and washing wounds was available. The tank with water for bathing and flushing toilets ran out every few days. The summer heat on some days reached 115 degrees. A-C was nonexistent. We slept eight to a room on the floor. The heat made restful sleep difficult. We woke up in the morning tired and soaking wet.
Our difficulties were petty and insignificant compared with the suffering of our patients. We were getting 30 to 60 injuries a day. Iraqi ambulances and humvees would bring in the injured. We shared our quarters with the ambulance guys. They went right up to the front. They are brave, dedicated men. A few weeks earlier, one of them had been killed by sniper fire. They brought in a mixture of military and civilian patients. And they came in at all hours, 24/7.
Wounded and dying children were particularly heartbreaking. There was a 2- or 3-year-old girl the ambulance guys found alone on the street. No family. No identification. She said something about her father going out and not returning. She had many wounds. We unwrapped her dressings. They were bad but not fatal. Then we unwrapped a large dressing on her right hand. It was hard to look at. The hand had been destroyed: only bone and connective tissue remained. It would have to be amputated. Throughout the ordeal, she smiled and did not cry.
The next night a boy of about 2, also alone and with no ID, was brought in. He had horrible burns all over his body. He was very quiet and covered in blood. Both of his eyes had been burned out. I thought he was unconscious. One of my colleagues got a juice container and put a straw to his lips. He sucked on it eagerly. Then he winced from pain when I started an IV line. I think he had a chance of surviving. What would his future bring as a blind, disfigured child without a family?
Most of our patients were soldiers, young men. If the ambulances found dead soldiers, they brought the bodies in for transfer to the Iraqi military morgue. Some days, we had to step around the body bags to do treatments. On our third day, a dead 20-year-old was brought in. The soldier’s father, who was in another military unit, came in and was distraught when he saw his dead son. Similar scenes played out again and again.
The battle for Mosul to defeat ISIS is a war with no quarter given by either side. We never saw a live ISIS combatant. I think if one were found alive, he was immediately shot. I am sure ISIS did the same with Iraqi army soldiers. Many civilians are trapped in ISIS-controlled neighborhoods. They are valuable as human shields and shot down if they try to escape.
And disturbingly, there were virtually no civilian male patients. We treated soldiers, women, children and old men. Every man of fighting age is a combatant. One time, a man in his 20s was carried in. We were told he had been in ISIS but escaped and managed to get to a refugee camp. The taint of ISIS followed him. He came in, having been tortured, with broken ribs and facial lacerations. We patched him up and sent him to a hospital for further treatment.
A few days later, a pickup truck came to the clinic. The driver pointed to the back. There was what looked like a dead body covered with dirt. Then I heard a moan. We wiped the dirt off his face. It was the same young man from a few days ago. He had a noose around his neck. We cut it off. Apparently, after his release from the hospital, he was recaptured by the same Shiite militia group that originally tortured him. This time they broke his arms and buried him alive. Somehow he dug himself out.
Many nuances exist in the Mosul battle. The tortured young man reflects these complications. The Iraqi troops all come from the southern part of the country. Most are Shiite. Mosul is predominately Sunni.
ISIS captured Mosul under the banner of liberating the Sunni people. Their rule turned out to be harshly repressive. The recapture of Mosul is partly a religious war. Disturbingly, many Iraqi military vehicles fly huge flags with the image of a Shiite martyr, Mohammed’s grandson Hussein.
The war has roots that go back more than a thousand years. The city will eventually be taken back. But it will be an ambiguous and uneasy victory by an army that is part friend, part outsider occupation force.
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Mark Shilen is a former paramedic with the New York City Fire Department. For 25 years before that he owned an art gallery in SoHo in Manhattan dealing in antique tribal weavings. He studied at the University of Wisconsin and lives in Brooklyn, N.Y.