Heroine doc­tor: “the US bombed our hospi­tal”

Last Oc­to­ber, a Médecins Sans Fron­tières hospi­tal in Afghanistan was de­stroyed by a US AC-130 gun­ship. Aus­tralian doc­tor Kath­leen Thomas was in­side as the bombs rained down. She tells Bev­er­ley Had­graft how she watched 42 of her friends and pa­tients die, a


Dr Kath­leen Thomas knew the man on the makeshift oper­at­ing table in front of her needed blood. She knew, too, that she shared his blood type and could pro­vide it. Yet de­spite months of ex­pe­ri­ence deal­ing with the worst that war-torn Afghanistan could throw at her, she couldn’t re­mem­ber how to do that sim­ple trans­fu­sion.

Fear and adrenalin had turned her brain to mud and she had none of the nor­mal med­i­cal re­sources avail­able to her. “I was try­ing to fig­ure out a way to get my blood into a bag and into him, but I couldn’t think through that sim­ple prob­lem. I was just go­ing, ‘Holy shit, holy shit, how do I give blood?’” she re­calls.

Doc­tors rou­tinely sep­a­rate their emo­tions from their ac­tions so they can fo­cus on their pa­tients’ in­juries. Yet this was no nor­mal pa­tient – he was Kath­leen’s dear friend and col­league Dr Amin Ba­jawri.

Nor were these nor­mal cir­cum­stances. She and ev­ery­one around her had just en­dured an hour-long gun­ship at­tack on their hospi­tal in Kun­duz. Limbs had been blown off, shrap­nel rock­eted through bod­ies, 42 peo­ple had died, in­clud­ing 14 Médecins Sans Fron­tières (MSF) staff.

The mur­der­ous at­tack came at a time when the Kun­duz Hospi­tal medics were al­ready phys­i­cally, men­tally and emo­tion­ally ex­hausted. For the past week, they had been deal­ing with the re­sults of a Tal­iban of­fen­sive on their doorstep. Triage had col­lapsed un­der the pres­sure,

pa­tients were spilling into cor­ri­dors and the smell of blood, wail­ing of grief-stricken par­ents and tut-tut-tut of nearby ma­chine guns per­me­ated ev­ery work­ing second.

Al­though their fam­i­lies had begged them to leave, the ded­i­cated staff stayed, be­liev­ing the hospi­tal was the one place in Kun­duz where safety was guar­an­teed. Mil­i­tary per­son­nel from all sides – the Tal­iban, the Afghan gov­ern­ment, the US and its al­lies – had promised to abide by in­ter­na­tional laws which de­cree that hospi­tals can­not be at­tacked in war.

The com­bat­ants all knew the GPS co-or­di­nates for the hospi­tal, so no mis­take could be made, and prom­i­nent MSF flags flew out­side. The dis­tinc­tive cross-shaped build­ing was the only one to have lights on as staff worked through the night, saving lives. Yet none of that had saved the hospi­tal or the peo­ple shel­ter­ing there. No one could be­lieve what had just hap­pened.

To­day, back in Aus­tralia, Kath­leen has dis­cov­ered a sick­en­ing truth; that while laws say oth­er­wise, hospi­tals are not im­mune in war­fare. The truth, she says, is that they are ac­tively tar­geted. Ap­pre­ci­at­ing that she is lucky to be alive, Kath­leen has be­come an ad­vo­cate call­ing for Aus­tralia to break its si­lence and de­mand that the rules of war pro­tect­ing med­i­cal per­son­nel and fa­cil­i­ties are ap­plied and that, if bro­ken, the per­pe­tra­tors are in­ves­ti­gated and called to ac­count.

An in­de­pen­dent in­ves­ti­ga­tion into the Amer­i­can at­tack on Kun­duz has never been held – Afghan and US au­thor­i­ties re­fused to give con­sent – and as a re­sult the Kun­duz trauma cen­tre, the only one of its kind in north­ern Afghanistan, re­mains closed.

Kath­leen pro­duces a photo of one of the many pa­tients now at risk as a re­sult. Her name is Shaista, she is three. Her leg and part of her but­tock and back were blown off in the con­flict, ne­ces­si­tat­ing a ma­jor am­pu­ta­tion and a stoma bag. The night of the hospi­tal bomb­ing, Shaista had been re­cov­er­ing in the In­ten­sive Care Unit (ICU) and was the only sur­vivor after a nurse snatched her up and ran through the flames to save her.

Yet she needs on­go­ing treat­ment. Her fam­ily has sold ev­ery­thing they own to get her treat­ment in Pak­istan. To­day, they are left with noth­ing but their night­mares.

Kath­leen dreamed of work­ing for MSF and mak­ing a dif­fer­ence in de­vel­op­ing com­mu­ni­ties even before she started med­i­cal school. Once she felt con­fi­dent and com­pe­tent enough to make a con­tri­bu­tion, she ap­plied, then waited for an of­fer. When that of­fer was Afghanistan, “I felt a mix­ture of ab­so­lute ex­cite­ment and ab­so­lute ter­ror,” she says.

She and her partner Sascha Sa­harov, also a doc­tor, re­searched the is­sues ex­ten­sively. “To­gether we came to the con­clu­sion we thought it would be safe, that MSF run­ning a hospi­tal in a war zone had a level of pro­tec­tion in line with in­ter­na­tional hu­man­i­tar­ian law. That’s what ev­ery­one at MSF be­lieves,” she says.

In May 2015, Kath­leen flew out for a six-month post­ing as the su­per­vi­sor of the emer­gency de­part­ment and in­ten­sive care unit at Kun­duz. Newly re­fur­bished in 2011, it had top fa­cil­i­ties, in­clud­ing four much-needed life support ma­chines.

Within hours of ar­rival, Kath­leen was re­sus­ci­tat­ing a lit­tle girl who’d been elec­tro­cuted and for the next four months she barely stopped.

It was the start of the fight­ing sea­son, so she’d work on the wards all day and be on the phone, check­ing on new ad­mis­sions, all night. Often she’d have mass ca­su­al­ties – such as the group of teenagers hit by a stray mis­sile while study­ing. She was con­stantly deal­ing with the hor­rific in­juries caused by bomb blasts: deep wounds, mas­sive loss of blood and con­stant in­fec­tions.

Kath­leen kept her spir­its up with Skype calls home and by forg­ing good friend­ships with her Afghan col­leagues, who end­lessly im­pressed with their ded­i­ca­tion and work ethic. There was Dr Mo­ham­mad Os­mani, for in­stance, loved by ev­ery­one for his en­thu­si­asm,

Ev­ery time I turned my back, a new pa­tient needed my at­ten­tion.”

com­pas­sion and ready smile. He had re­cently quit Kun­duz to spe­cialise in ophthalmology in Kabul, about 340 kilo­me­tres to the south, but know­ing the need for ex­pe­ri­enced doc­tors, re­turned ev­ery week­end to help out, driv­ing eight hours across a dan­ger­ous moun­tain pass to reach his pa­tients.

Then there were the ICU nurse and cleaner who told Kath­leen of their plan to es­cape Afghanistan and get to Europe – a treach­er­ous mis­sion.

“I asked, ‘How could you risk your life for this?’” Kath­leen re­calls. “Dr Os­mani told me, ‘But ev­ery day here we are dy­ing. We have no se­cu­rity, no hope and no fu­ture for us or our chil­dren.’

“How could I com­plain of tired­ness or get up­set hear­ing that? I was a guest and would leave. The guys who lived here dealt with stress and trauma on a daily ba­sis. They didn’t have an out.”

Al­though the sounds of war were a con­stant, the fight­ing was mainly in the Kun­duz dis­tricts, but at the end of Septem­ber, the Tal­iban moved into the city, driv­ing out the Afghan mil­i­tary. The fight­ing was fierce and the hospi­tal was over­whelmed. “Ev­ery time I turned my back, a new pa­tient would be laid down with ma­jor in­juries and needed my at­ten­tion.”

Kath­leen ran be­tween build­ings, ter­ri­fied of be­ing hit by a stray bul­let. She had to make life or death de­ci­sions: can we help this per­son or not?

Staffing was her big­gest chal­lenge. It was too dan­ger­ous for any­one to leave the hospi­tal, so she couldn’t get re­lief staff in or ex­hausted staff out. The three oper­at­ing the­atres worked round the clock with one anaes­thetist run­ning be­tween them. Ev­ery­one snatched sleep when they could in a safe room 50m away from the main hospi­tal or in the base­ment be­neath.

For the first time, Kath­leen saw her col­leagues cry at the hor­ror of what they were deal­ing with. She her­self de­liv­ered three dead ba­bies from moth­ers who’d just been sit­ting qui­etly at home when they were struck.

The night of the at­tack, on Oc­to­ber 3, was rel­a­tively calm. Kath­leen even saw a child out­side the com­pound fly­ing a kite. The sur­geons de­cided to catch up on their work­load and Kath­leen on her sleep. She headed for the safe room.

At just past 2am, she was star­tled awake by a sound so loud she cov­ered her ears to stop her eardrums rup­tur­ing. VOO PAH! In­stinc­tively, she pulled on a head­scarf, think­ing she’d be needed in the hospi­tal. As the gun­fire con­tin­ued, how­ever, she re­alised it was too dan­ger­ous to step out­side. She and the three nurses who were with her pushed the heavy me­tal door shut and sat in the pitch black, just lis­ten­ing.

“I felt this grip­ping fear. My whole body was shak­ing,” Kath­leen re­calls.

Twenty min­utes later, they heard a voice. An emer­gency de­part­ment nurse stood out­side. Back­lit, it was like a scene from a hor­ror movie. His left arm was hang­ing from his body by a lit­tle piece of skin, a piece of me­tal was stick­ing out of his back. Blood ran from his eye and he was cov­ered in thick dust.

As he col­lapsed, Kath­leen dragged him in­side. “Where were you when you were hit?”

“In­side the emer­gency de­part­ment,” he replied.

Kath­leen pre­sumed he hadn’t un­der­stood her. “No, you weren’t in­side. You were out­side,” she in­sisted.

“I was in­side,” he re­peated. “Many have been hit. Many are dead.”

A phone rang. A lo­gis­ti­cian was trapped in the burn­ing hospi­tal, beg­ging for help. By now, other staff mem­bers were stream­ing in, vom­it­ing and

scream­ing in shock and pain. Kath­leen and her nurses did what they could to treat their in­juries. The mo­ment the ma­chine gun fire stopped, they ran back to grab es­sen­tial sup­plies, in­clud­ing much needed mor­phine.

Kath­leen breaks down as she re­counts the list of friends she lost that night.

“The first was Tah­seel, the phar­macy su­per­vi­sor. He’d re­cently mar­ried and was ex­pect­ing a child. He’d vis­ited his fam­ily in Kabul, but risked his life to re­turn. He was struck by a ma­chine gun as he ran through the hospi­tal. I saw him car­ried in. He was still alive, but I could see al­ready it was too late and I had to move on. It was an aw­ful mo­ment.”

Dr Ba­jawri was brought in. Al­though ev­ery­one sensed that he was also past saving, they put him on a kitchen table and pre­pared to op­er­ate. A few min­utes later, he also was gone.

An­other young trainee, Dr Abdul Gha­far Ra­ma­kee ar­rived. He had two young sons and a wife, and had been des­per­ate to join them in Kabul, but in­stead stayed with his pa­tients. Now he was cov­ered in de­bris and blind and deaf, the re­sult of a pres­sure wave in­jury from a very close ex­plo­sion. Luck­ily, that was tem­po­rary. He was able to ex­plain he’d been in ICU when the first mis­sile hit. The cleaner who had wanted to es­cape to Europe had been hor­ri­bly in­jured. Two nurses were re­duced to dust and bones in an in­stant. Dr Os­mani died call­ing out for help that never came while his pa­tients burned in their beds.

The sun was ris­ing by the time Kath­leen fi­nally ven­tured out­side. The sight of the dev­as­tated hospi­tal, fires still smoul­der­ing, “took my breath away”.

A few hours later, she and the rest of the ex­pats were evac­u­ated. As they drove to the air­port, Kath­leen looked back at her Afghan friends left be­hind. “That was heart­break­ing.”

At MSF’s head­quar­ters in Brus­sels, a de­brief­ing and re­mem­brance cer­e­mony were or­gan­ised. There was much grief, but also as­ton­ish­ment and anger as MSF learned the at­tack had been per­pe­trated by an Amer­i­can gun­ship. “I couldn’t un­der­stand why they had tar­geted us,” Kath­leen says.

There were al­le­ga­tions the Afghans had pro­vided false in­tel­li­gence claim­ing there were Tal­iban holed up in the hospi­tal. Even­tu­ally, how­ever, Amer­ica ad­mit­ted it was a “tragic mis­take” caused by a cat­a­logue of hu­man and ma­chine er­rors.

A 3000-page in­ves­ti­ga­tion by the US mil­i­tary, only one-third of which was re­leased (and that heav­ily redacted), con­cluded the crew of the gun­ship didn’t know they were strik­ing a med­i­cal fa­cil­ity. They claimed they were tar­get­ing the Na­tional Direc­torate of Se­cu­rity head­quar­ters 400m away.

Back home in Wol­lon­gong, re­united with Sascha and read­just­ing to work in a Syd­ney hospi­tal, Kath­leen started notic­ing that Kun­duz wasn’t the only hospi­tal to be hit by armed forces. Hospi­tals had also been hit in Ye­men, Syria, Ukraine and Su­dan. In 2015 alone, a shock­ing 75 MSF or MS-Fas­so­ci­ated hospi­tals were at­tacked.

These were no ac­ci­dents. Ev­i­dence sug­gested they were de­lib­er­ate tac­tics of war­fare. There were even re­ports of dou­ble tap bombs – when the mil­i­tary drops one bomb, then cru­elly waits for res­cuers to ar­rive before drop­ping the second. On May 3 this year, the UN Se­cu­rity Coun­cil passed a res­o­lu­tion or­der­ing forces to stop at­tack­ing hospi­tals in war zones.

How­ever, this is dif­fi­cult to en­force un­less other coun­tries use their po­lit­i­cal in­flu­ence and, so far, they haven’t, so Kath­leen is urg­ing read­ers to write to politi­cians. “By not de­mand­ing the pro­tec­tion of pa­tients and care­givers in war zones or push­ing the US to ac­cept an in­de­pen­dent in­ves­ti­ga­tion, Aus­tralia tac­itly ac­cepts a world where war has no rules,” she says. “Al­ready in Syria [where there have been nearly 350 at­tacks on hospi­tals] and Ye­men, they’re build­ing hospi­tals un­der­ground and don’t re­veal their GPS co-or­di­nates. I don’t know how those brave doc­tors and nurses keep work­ing there.”

To­day, Kath­leen, 32, is still in con­tact with her col­leagues in Kun­duz. Ev­ery­one is des­per­ate for the hospi­tal to re­open but that can’t hap­pen be­cause they can’t get a guar­an­tee the fa­cil­ity will be re­spected. “It’s dev­as­tat­ing,” she says. “And it’s hard sit­ting here in my lovely peace­ful coun­try. I’d def­i­nitely go back and work for MSF. Once your eyes are open, it’s hard to close them again.”

Op­po­site: Dr Kath­leen Thomas (front right in a blue head­scarf) strug­gles to save a life just after the bomb­ing and (this page) safe back in Aus­tralia.

Shaista (pic­tured with her par­ents and brother) was the only ICU pa­tient to sur­vive the US at­tack.

Left: The Kun­duz Hospi­tal was com­pletely de­stroyed. Kath­leen says hospi­tals are be­ing tar­geted, in vi­o­la­tion of in­ter­na­tional hu­man­i­tar­ian law.

Above: Médecins Sans Fron­tières staff protest in Geneva a month after the at­tack. MSF is call­ing for an in­de­pen­dent in­quiry.

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