A Day in the Life Of a Baghdad ER

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The day had begun routinely. Salahdin (Captain Salah) Mahmoud, 47, an interpreter for TIME, and bureau assistant Talal Abu Karam, 50, were driving to an assignment when they found themselves sandwiched between two U.S. military patrols at a busy intersection in the western district of al-Qadisiyah. Both men knew immediately that their risky commute had suddenly become a lot riskier. Military patrols are frequently attacked by insurgent groups, and passing civilian vehicles often end up as collateral damage. As Abu Karam stopped to let the second patrol pass, Salah said, "This is not good."

Moments later, a huge blast ripped into the powder blue 1981 Toyota Corona, hurling it across the three-lane road. An improvised explosive device, intended for the patrols, had gone off just 10 feet from the car. The two men were slammed against the windshield, shattering it, and were showered by a hail of shrapnel. Salah's left arm and hand were torn to shreds below the elbow, and blood spurted from two gaping wounds in his left thigh. Both men were lacerated by shrapnel and burned. A shard of glass cut a deep gash in Abu Karam's neck. The blast also damaged a second car, with shrapnel hitting its driver, university student Leith Waleed, in the back of his head.

Some 200 yards behind them, taxi driver Emad Hasan watched as Salah and Abu Karam dragged themselves out of the burning wreckage and collapsed on the road, their clothes in tatters and both bleeding profusely from multiple wounds. As they lay moaning, a crowd of commuters gathered--but kept their distance. "Nobody dared to go near them for 10 minutes," says Hasan, "because we were all afraid there might be a second blast."

The explosion could be heard two miles away in the Yarmouk Hospital. Dr. Jalal Taha Emad told his crew to prepare to receive the wounded. "I heard the explosion in the distance," he says, "and I guessed that the ER was going to get very busy."

Prepping the ER is a simple business; there is not much to get ready. Apart from their stethoscopes, the only diagnostic tool available to the surgeons is a Soviet-era X-ray machine. Ultrasound equipment? No. CT scans? No. MRI? No. There are two thoracic surgeons for chest wounds, the most common kind of injury in bomb blasts, but the hospital lacks the equipment needed to perform actual surgery. Pleas for funds and tools have been ignored by an Iraqi health ministry that doctors say is underfunded, mismanaged and corrupt. "There are days when we don't even have enough sutures," Emad says with a hollow laugh.

The one commodity the Yarmouk Hospital has in abundance is doctors. A medical college next door supplies a steady stream of residents. Many of the best doctors fled Iraq before and after the war, but the demobilization of Saddam Hussein's army has left the country with a surplus of military surgeons, who are grateful for a hospital job that pays $350 a month. Their experience in battlefield medicine gives them the ability both to manage expectations and to improvise. "If a patient leaves the ER still breathing and not bleeding, then I would say we have done our job," says Qais Mohammed Ali, a thoracic and vascular surgeon. "We are not in the miracle business."