Started the day with burned civilians and soldiers from a vbied. Greater number of suicide attacks today.

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?

The order of text is not chronological, but rather as I wrote it more likely reflecting what my mind deemed most significant about the day.

Things got very dark… they have been capturing more ISIS fighters. Some we treat, some get brought past the TSP to a mosque where they are interrogating them. They are extra judicially executed once they are deemed to be of no further value.

I did not witness the torture or executions. I treated restrained prisoners with recent injuries who did not come from a combat zone and I witnessed several instances of prisoners in the TSP being handled roughly by their captors. Many of those responsible for the prisoners did not wear full military uniforms so I do not know from which department they came. The extrajudicial executions were reported to me by Iraqi soldiers as well as an Iraqi fixer working with western journalists. This information would be confirmed in news reports later.

Business Insider: Iraqi officer admits to executing multiple ISIS fighters in Mosul

Independent: More than just revenge

This conduct clearly violates the Geneva convention. It is easy to say that and condemn the actions of the Iraqis. I have the luxury, the privilege, of visiting a war zone and then leaving. I did not lose my home, my family, my tribe as a result of Daesh. I did not watch friends and loved ones being tortured or beheaded. I did not have to lay awake at night wondering if at that very moment my brother was being burned alive or suffering another even worse fate. I don’t know any of the soldiers I interacted with on a daily basis who did not lose one or more people close to them to Daesh.

One of the Iraqis I became closest with is the only survivor of his four brothers. The three who died were in the Iraqi Army or Federal Police and had either been killed in combat or captured and were presumed dead.  If memory serves, a mass grave was found at the prison where his missing brother was believed to be held.

I still wrestle with the ethical implications surrounding these issues. The best I could come up with is that my own conduct needed to be inline with international humanitarian law and the professional standards of a medical provider.

In no way do I condone or support what was done. Despite my animosity towards Daesh I do not believe that revenge serves a positive purpose. I don’t know if a restorative justice model would work with these monsters or if it could even be carried out at the scale needed given the number of Daesh fighters captured, especially during the fights that followed Mosul including Hawija and Tal Afar.

From a very pragmatic standpoint obstructing the Iraqi Army or Police could mean the removal of GRM from the TSP and possibly from Mosul. Should that happen I have no doubt that more people would die due to lack of care including many civilians.

If you, the reader, have strong feelings about this please do not take to the internet to attack me. Let’s sit down over a coffee and talk. Before we have that conversation please attempt to see this from my perspective and from that of the Iraqis.

Started the day with burned civilians and soldiers from a vbied. Greater number of suicide attacks today.

Daesh continued to target civilians fleeing and deployed multiple suicide bombers on foot and in the form of VBIEDs to do so. Keeping civilians within Daesh controlled areas caused Iraqi and coalition troops to be much more cautious about employing airstrikes and explosives. Several families reported that at least one of their children had been taken by Daesh to force the families to stay.

A pseudo-NGO setup across the street to provide food and water for civilians, but they also decided to suture a large, very dirty head lac without analgesia. One of the reporters in our TSP, Kenny, heard the screaming and grabbed me. The NGO was putting on a great show for a film crew, but providing awful patient care. We ended up bringing a litter over and just taking the patient from them. We sedated him, opened the sutures, irrigated, found a lot of foreign debris, packed the wound, started antibiotics, and did a pressure dressing on a small arterial bleed in the wrist.

I don’t know what to really say here. Basically there was very little control over who did what and where provided they didn’t get in the way of military operations. Each group was left to govern itself. The actions of GRM, NYC Medics, and several other groups show the positive effects of the lack of regulation. On the other side is what I described above. I can still see the thick suture silk being pulled tight to approximate the wide and grossly contaminated wound. From several feet away I could see the concrete chunks in the wound. It was absolutely horrific to see. I still don’t know the name of the NGO or the level of training the person placing the sutures had.

Mother who was pale, had been at an ISIS hospital 24 hours before said she coded there, post airstrike. Patient proceeded to brady down and nearly code. We did some quick airway work, transported with a BLS airway and decent SPO2. She needs a [blood] transfusion.

I don’t know the outcome of most patients including this one. Provided she didn’t develop an infection and the hospital had enough blood to give her she could have had a positive outcome. Last I saw her was several hours later in the ER where she was receiving the transfusion and her family was with her.

Two ISOF soldiers died to get a baby out of a house under sniper fire. One was carrying the child when he sustained his mortal wounds. The kid will be fine. They named the kid after the soldier who was carrying him.

This story took place more than once. In this instance the soldiers were aware of the sniper’s existence when the rescue attempt began and still went to save the kid. I’m guessing an airstrike was being called in to target the sniper and that strike would have likely killed the kid.

A good fixer dropped by and talked to us, Chlorine and mustard gas are being used. He had pictures of civilians with massive blisters.

He reported that the most recent picture was from a week or so ago. The large liquid filled blisters without evidence of thermal burns seen on the injured civilians looked like fairly classic mustard gas (or other blister agent) injuries.

At that moment I regretted not having more chemical weapons training and protective equipment. This is a deficit I am correcting for future trips.

GRM had seen these patients in the past and reported what they saw to the UN. I don’t believe we ever got an official report confirming our suspicions.

Reports by Iraqi troops from May of 2017, just a month before I arrived, stated that chlorine or mustard had been deployed by Daesh.

The National: ISIL Resorts to Using Poison Gas

One concern shared by my teammates and I was that perhaps Daesh had a large stockpile of mustard, sarin, or maybe even radioactive materials that would be released at the final moment before Iraqi victory. We jokingly imagined a large red button in a tunnel somewhere under the old city with a Daesh fighter waiting to press it.