Today was not a typical Monday. It had begun normally enough with a meeting with my team leader to discuss issues in the project where I am working. We reviewed the upcoming schedule for the week, medical assessments, the mass casualty plan (how we respond to events that need extra staff or resources) and we were discussing our policy on treatment for babies aged under six-months.
Then the phone rang. “Hello?” the team leader said and after a second she flicked her eyes up to me with slight concern on her face. “When?” she asked. “Ok we’ll get onto it.” Then she hung up.
09:57 am – “There has been a blast on a train.” That is all she says and we are both on our feet. We have just finished discussing the plan for exactly this type of situation. I had been thinking we needed a mock incident to test the plan and see if there were any flaws.
09:59 am – We are in the office next door, reviewing the facts with the person in charge of security for the MSF project. Preliminary reports suggest that ten people had been injured in the blast, in a town 30-minute’s drive away. We are the closest hospital. We will have to get involved.
10:07 am – We meet with the Medical Superintendent of the hospital to discuss what they need from us. We run selected services within the hospital, which is run by the Ministry of Health. They request some additional personnel and possibly some additional resources.
10:12 am – I leave the meeting room and organise some male staff to assist while my team leader organised some additional female staff.
It is around this time that I notice how busy the hospital grounds have become. There are armed police officers at each gate and several others scattered throughout the grounds. There are people everywhere, lining the outside walls of the Ministry of Health emergency room and many bystanders with cameras at the ready. There is an anxiety in the air, an anticipation of the upcoming uncertainty. I have been an emergency nurse for some time and involved in many intense trauma situations. It takes a lot to make me nervous. This time I share in their anxiety.
10:22 am – The first patients arrive while I am completing the set-up of one of our temporary wards. I check the male emergency area. There is a flurry of action, needles, drips and bandages. A quick assessment indicates that these patients are not severe. These are the walking wounded; more will follow.
10:36 am – I find myself at the female emergency ward checking on the patients there. They have not received any patients in the first wave, as they were all males. Through the door bursts two stretchers, each carrying its own blast victim. Both are covered with a fine grey dust which smells metallic. I can still smell it. They are transferred onto the temporary emergency beds and we go to work.
I begin examining the first lady with the doctor. She isn’t awake and I check for a pulse. None. “Her pupils are dilated and not reacting,” the doctor informs me. I checked for reflexes. None. I listen for a heart beat or the sound of breathing. Nothing. She has expired, the doctor and I agree. I know there are other patients I have to see urgently. I take a deep breath and move on. Behind me a relative collapses at the patient’s side and starts weeping. As I begin to assess the next patient I am aware of other family mourning and crying behind me, knowing that there is nothing more to be done and that their loved one has become another victim of senseless violence.
A few patients on, I am looking at a young boy no older than six or seven, who is having his head bandaged by a nurse. He is covered by the same grey dust as the ladies, who were family members. He has a swollen left eye, cheek and several small cuts. Blood is soaking through his bandage. I finish assessing him and everything else appears to be fine. He looks directly at me and begins to cry. I want to pick him up, hug him and tell him it is all going to be ok, but I can’t. I can tend to his physical injuries, most of which will soon heal. It is the psychological damage that will remain.
11:05 am – Another two ambulances arrive. None of the patients in these cars are alive.
12:45 pm – No more patients are expected to arrive; some have reportedly gone to other hospitals. I transfer my final patient and any that remain are expected to be discharged after a short observation period. I send the extra staff home and we remain on standby.
The MSF staff acted beyond their normal scope and proved to be an efficient and effective team. As with all incidents, there are lessons we can learn. I believe we eased the pain and suffering of those who needed help the most. Later that evening I debriefed with the staff and wanted it to be known that we are all here to support each other and that everything they are feeling is a normal reaction to an abnormal situation; they are free and safe to talk to anyone here if they like. I also needed to hear myself say those words for my own peace of mind.
The effects of an attack like this can’t be accurately represented by reporting the number of dead or injured. How many people were affected? It is impossible to truly know. The immediate, traumatised victims of the violence will carry with them physical and emotional scars. The people who helped rescue, receive and treat these patients will put on a brave face but they too will feel the effects as time ticks on. Families, friends and the community have all suffered today, not only with the loss of their loved ones but with the fear and uncertainty of future attacks.
Attacks on innocent people are evil. These people are good people – they will endure despite this adversity.
David is an Australian nurse working with MSF in Pakistan remotely managing obstetric projects.
MSF Field Blogs reflect the views of the author alone and not necessarily those of Médecins Sans Frontières