Fighting in the city of Kunduz in north-eastern Afghanistan ended on August 8. During the clashes, Medecins Sans Frontieres (MSF) transformed its office into a temporary trauma unit. It is now closed, and on August 16 all patients were transferred to the nearly finished Kunduz Trauma Centre that MSF had been building since 2018. As a medic in MSF’s Kunduz team, here’s what happened during the fighting. It was busy but calm, we were recruiting staff, including a new mental health team. The final stages of finishing the hospital were happening all around us. Then one evening there was continuous bombardment and shooting. We had to rush to the bunker and stay there all night, without any sleep. Patients were unable to reach the trauma unit at that stage. The following morning, we got news of multiple victims arriving at the unit, but we could not get there because of fighting. Our colleagues were asking for help urgently because they had a patient who had a gunshot wound in his chest and stomach. He needed to go to surgery and they needed assistance. A moment came when the guns were quieter and it was possible to move – three of us ran to the other side of the road to the operating theatre. The patient had just lost their pulse, so we started chest compressions while the anaesthetist looked for an airway. I cut two holes in the chest to make sure blood could drain out and allow the lungs to expand. Meanwhile, another colleague was trying to stop the bleeding below the sternum. We could tell pretty quickly that the bullet had probably hit part of the heart. It rapidly became clear that we could not save him. That was the start of our day of hell, and the first time our team got completely overwhelmed. There were a lot of other victims who came in and had to go to surgery, many with gunshot wounds and injuries from bomb blasts. Many of our staff could not reach the unit. The night-shift team worked through the day. Some would take naps while others worked so that we could keep going from morning and into the night. At about 6:30am the next morning, an ER doctor called me for help. As the fighting had receded a bit at that moment, I ran with the surgeon across the road. When we got into the unit, it was crammed. Four patients urgently needed emergency surgery – at the same time. We started doing life-saving surgery on two patients, while doing everything possible to keep the other two alive. The two who were waiting survived and we proceeded to operate on them. In the end one patient died, but three survived, which is still quite impressive. They all had very severe gunshot wounds and bomb blast injuries. While doing this, we still needed to assist other patients who had come in and needed care. So this was a heavy day to get through. One of our patients was a young boy. He was brought by his father to the ER with a bandage already on his arm. He wasn’t crying and was just very silently looking ahead of him. I was supervising the ER along with the Intensive Care Unit nurse. The boy looked comfortable and very much okay. There was no immediate urgency for me. Because the fingers sticking out of the bandage looked well-circulated and warm, I took my time in demonstrating to the staff how to do a proper investigation of the hand for nerve damage. Strangely enough, the boy didn’t seem to feel anything on his whole hand, which suggested all three different nerves were cut. I continued and was gently unwrapping the bandage off his arm. I remember the moment the bandage opened and you just saw a gaping hole in the forearm of this child. There was more of the hole than tissue remaining. The father told me that a stray bullet had hit him while the kid was playing. I remember the faces of the staff. We packed up the wound again and tried to stabilise the hand. For some reason the only thing remaining was the artery going all the way to the fingers, but the nerves were all broken. Medically, we all agreed that amputation was probably the best option. The father didn’t agree with this. He wanted to give it a chance. We did our best to clean the wound and keep the tissue alive. We attached a metal bracket to hold the bones in place to try to let it heal for as long as possible. Today, the boy still has his hand, although with permanent injury. The father was friendly but the little boy cowered from doctors, thinking they would bring him more pain. He didn’t smile at any of us, only at his father. After the fighting died down, more patients came in. Many of them had already received some sort of emergency treatment, but would come to us as soon as they could. Here in Kunduz, the rebuilding of our hospital has been going on for quite a while. On 16 August, we transferred the patients from our temporary clinic to the hospital for the first time. It was a huge step to open the hospital, although it is not completely finished yet. Today we see fewer active gunshot and bomb blast injuries. Now it is mostly follow-up complications from previous treatment, as well as road traffic accidents, which are increasing sharply as society opens up again. Everyone here drives on their motorcycles without a helmet. When they fall, they suffer head traumas, which are hard for us to treat as we don’t have neurosurgeons. In the Kunduz Trauma Centre, we’re doing our medical work while construction is ongoing. The speed at which the building team are working is amazing. We saw a stretcher-bearer going to get a patient and having trouble because of rubble. In no time, there were people helping. It’s quite incredible how the builders are helping so hard to fix all our problems as medical staff. We have the same support from the team who are responsible for the hospital compound. One of them is always on a bicycle, cycling from one department to the other, fixing things rapidly. The same goes for our suppliers. Medical items just appear outside our departments. And that’s how it feels for the moment – all the teams helping each other, trying to just make it work. <i>The contributor is a medic working with MSF in Afghanistan. At the author's specific request, we have kept their identity anonymous</i>
