Awoken at 2308 by a hail of gun fire from inside our compound.
Glossary:
ISOF: Iraqi Special Operations Forces
TSP: Trauma Stabilization Point
MSF: Doctors without Borders
VBIED: Vehicle Borne IED
Daesh: Arabic name for IS/ISIS/ISIL, possibly derogatory, largely interchangeable with IS/ISIS/ISIL. There’s more to it than that, but can we just generally agree, fuck those guys?
Preface:
This comes from a journal I kept during my time in Kurdistan and Iraq. As much as I could I did a brain dump at the end of each day. Most days I was exhausted from the jet lag, the work, the heat, and on some days from the emotional toll.
Some editing has been done for clarity, but I am intentionally keeping this a bit raw and in many cases using the words I wrote in country which are denoted by the italicized text.
I have redacted some details. War is hell. Other accounts of those details may come to light in time, but I have no intention of publishing them.
7/1/17
Open femur fracture on a child
Old superficial and partial thickness burns
More burns
GSW to the chest and arm
Child presented with respiratory distress
A 3 or 4 year old child was brought to the TSP by his mother. The kid was limp and looked sick.
Mom says she and the kid were walking in the street when he started having trouble breathing. Presented to us with agonal respirations and tons of clear fluid in the lungs.
James did a remarkable digital intubation in the TSP. We confirmed placement of the tube with present bilateral lung sounds and absent epigastric sounds. We suctioned at least 250mL of what looked like clean water from the ET tube. We had a 3 lead EKG and peds pulse ox but no capnography. The child’s pants were dry (probably not a drowning) and the mother was asymptomatic (probably not a chemical exposure, unless the kid ingested/inhaled something which the mother didn’t). I got clearance from Anthony to transport the kid to the MSF hospital. James and I went on the transport.
The kid maintained sats in the low-mid 90s during transport. At some point during the last few minutes of the transport the tube got dislodged. The roads are pretty wrecked and the ambulance drivers (literally what they are) drive at an expeditious pace. We went back to using a peds BVM and a mask and moved quickly in to the ER. The ER was in chaos and overwhelmed which was an average condition. We made it through the crowd and in to the “critical care” area but found no staff and we had a kid with rapidly dropping SPO2 sats. I grabbed someone in scrubs and after asking for a doctor several times using the little Arabic James and I had between us we gave up and moved on to caring for the patient ourselves. While this was whole process was unfolding the child’s heart rate dropped quickly and James began CPR while I used the BVM. The child’s eyes closed and the heart rate got down in to the 30s and 40s while his color turned ashen and cyanotic. Through pantomime and repeatedly saying “laryngoscope” and “suction” both appeared and I re-intubated the kid.
With the child re-intubated his sats and color slowly started to improve. The central cyanosis dissipated and was replaced with a more pleasing pink color. At some point in all of this an English speaking Doctor or Nurse (never got a title, but they were clearly the highest trained person) arrived and assisted us. With the kid as stable as we were going to get him for the time being we asked for the hospital’s vent to transfer the kid off the BVM.
We were informed that the one vent they had was in use. We had specifically come to this hospital because they had a vent and we had been told in the TSP that the vent was available. The information from the hospital to us goes through multiple people and it is possible that at the time the hospital had been originally contacted the vent was free.
Regardless, we now had an intubated kid and no vent. There wasn’t a clear quick fix to the underlying condition and the hospital didn’t have staff to spare to continuously bag the kid. The ED administrator (not really clear what their title was) suggested that she could locate another hospital which had a vent and the child could be taken there. We didn’t see a better option and agreed to that.
In that moment I failed to remember I was in a poorly resourced area overwhelmed by sick patients. In my mind, I was at a hospital and had now transferred care to said hospital so I could very soon return to the ambulance and go back to the TSP. When the ED administrator came back she said there was another hospital which had multiple vents available and a pediatric specialist. Then she said that we would need to take the child as there was no other way to get to the kid to the next hospital.
So back to our ambulance and off we went on another bumpy ride with an intubated child and a distressed mother who kept asking “Yes or no?” I didn’t know is she was asking if the child would live, if the child would die, if we could help the child, or something entirely different. I think we just replied “ana aasef, no Arabi” basically saying “I’m sorry, I don’t speak Arabic.”
We had a 40 minute ride from the first hospital to the second. At times the mother seemed numb and other times she seemed distressed. I was sitting on the bench seat, perpendicular to the child, and James was the child’s head continuing to use the BVM. I was monitoring lung sounds, heart rate, and SPO2 using our little 3 lead EKG. The mother sat on the stretcher and touched the child’s legs.
We got the kid to the next hospital and we were pretty relieved when we were brought to a field ICU with an empty bed and a ventilator standing by. I was able to turn over care to a RN, RRT, and MD. I don’t know what the outcome was. My suspicion is that the kid didn’t survive. If the kid did survive I wouldn’t be surprised if he suffered an anoxic brain injury resulting in a diminished quality of life.
This night I would be sleeping at a large 4 floor, multi-bedroom, home that was occupied by ISOF. There was one room reserved for the medics. This building also served as an equipment cache and back up casualty collection point (CCP) for those hurt overnight.
Part of our team was staying here and the other part was staying at a larger compound which was the primary overnight CCP. The building felt a bit like a barracks but the ISOF guys are pretty relaxed off duty so it was easy to forget that this was a pause in the fighting for them. There would be guys laying around listening to music, drinking chai, talking on their cellphones, or sitting outside smoking shisha. In the kitchen there were typically a few guys cooking for themselves, brewing more chai, or cleaning up in the large sink.
I didn’t think to take many pictures of this place so here’s one of the only ones I have. This is from the bedroom, specifically looking up from where I slept.
The bedroom was a small room without windows, but fortunately had the overhead fan seen and a large AC unit nearly obstructing the entrance. We each had one of the firm mats which are common for sitting and sleeping.
Awoken at 2308 by a hail of gun fire from inside our compound. Unclear what is going on but definitely small arms fire and maybe a dushka as well from here going out. First time I’m actually a little concerned. The lack of info and knowing the effective range of an AK is a little concerning. I watched what our other guys are doing… they slept through it…
I remember being awoken by both the gun fire and a lot of angry Arabic spoken by guys running up or down the stairs inside the building but outside the concrete box that was our bedroom. My armor was next to me and so I reached for that to start putting it on at which point I realized everyone else in the room was still sleeping. I paused, took a few breaths, and listened to what was going on. I could tell the fire was out going only and I started to run through possible scenarios. A suicide bomber running towards the building would have been cut down already, multiple suicide bombers/attackers was certainly possible but unlikely, a weaponized drone was possible and fortunately they have a small payload and there are several layers of concrete between me and the roof, an unarmored VBIED was the worst case scenario I could come up with. The unarmored VBIED could withstand a lot of gun fire before being detonated by the driver or command detonated. A VBIED could be large enough to level the building or might be the means to breach the wall for a follow on ground attack. While I worked through these scenarios I remained aware that the others in the room with me had barely stirred. I balanced my concerns about them becoming numb to living in a war zone with the knowledge that they have developed a sense of baseline for the area and clearly what was going on had not surpassed that baseline. I also recognized that one of the guys might be drunk enough to not wake up but the others were very light drinkers or abstained all together.
The gun fire and angry Arabic continued for a few minutes before dying down. No one came to our room so there hadn’t been any casualties reported and I never heard anything incoming. After a little while I put my armor back next to the mat I was sleeping on and fell back asleep.
I learned the next morning that there was a drone overhead which was eventually shot down by the Iraqis. No telling if it was weaponized. More likely it was one of the dozens of journalists in Mosul trying to get some good footage of airstrikes at night. The folks that relayed that information to be did so very matter of factly. It was just another night in Mosul.
Shell casings on the steps in front of the house the next morning. Most of the shooting was on the roof but a few guys were firing from the front stairs and courtyard.
In case you are not aware of the tactic of weaponizing drones here’s a quick video showing the deployment and use of a drone. This is from an Daesh propaganda video and shows footage where they are attacking and likely killing people. The video is not explicitly graphic due to the high elevation it is shot from. It is important to know the tactics which may be employed against you.
