A Day in the Life Of a Baghdad ER

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At the explosion site, the arrival of a police patrol finally signaled that it was safe to approach the three wounded men. Even then some people in the crowd were motivated not by sympathy but by greed: they tried to steal money from Abu Karam's pockets. "I was shocked when I saw some policemen taking money and new clothes from the damaged cars," says Hasan. But the crowd also included some selfless Iraqis who decided to take the injured men to Yarmouk rather than wait for ambulances to wind their way through the gridlocked traffic.

All three were still bleeding copiously on arrival at about 8:15 a.m. Salah was unconscious, Abu Karam barely awake. But although they could not have known it, they were very, very lucky. Theirs was the first (and, it turned out, only) bombing of the day in Baghdad, and they were the only seriously injured victims. This meant they would get the undivided attention of the ER team. "On other days we have had 20, 30, even 50 people here," says Emad, "and in the confusion, patients can die from simple things, like blood loss."

Another stroke of luck: the hospital had just received a fresh supply of blood, which was vital for Salah, who had lost so much that he needed a transfusion. By the time the rest of the TIME Baghdad staff was alerted and arrived at the hospital, the ER workers had done what they do best: stopped the blood loss and patched up the wounds. The ancient X-ray machine revealed that Abu Karam and Salah had many pieces of shrapnel lodged in their bodies, but there were no serious internal wounds.

In the absence of any other diagnostic equipment, however, the doctors had underestimated the seriousness of the injuries to Salah's left arm. "It looks superficial, and we have stopped the blood loss," said Emad. But he was unable to see that Salah had suffered two torn nerves, damaged tendons and, most dangerous of all, two torn arteries. The only blood flow to his arm was coming from collateral circulation, from minor blood vessels and capillaries in the skin. Left in that condition, the hand would have been irreparably damaged in two or three days.

The more immediate danger was the threat of secondary infections. The ER was the filthiest I have ever encountered. The floor was littered with medical debris--old bloodstained bandages, syringes, broken vials. The garbage bins had no plastic liners and were spattered with coagulated blood, gobs of spit and other fluids. Sweepers came through every hour with dirty mops and pails of brown disinfectant, but their halfhearted labor was quickly overwhelmed by the sheer numbers of patients and visitors. Nobody paid any attention to the NO SMOKING sign, not even the doctors and nurses. Broken windows allowed dust to enter, and swarms of flies buzzed around the patients; we used the X-ray films to swat them away. "All the rules of hygiene we learned have been broken here," said veteran nurse Hadi Abdel Karim as he paused for a cigarette break in a corner of the ER. "But we have no time and no money to spend on cleanliness." When I complained about the risk of secondary infections, Karim shrugged. "Infections?" he said. "First and foremost, the patients are at risk of dying from lack of the right medicines and equipment."