The silver chain: How to save a life in Yemen

Independent. Neutral. Impartial. Australian doctor Georgina witnesses MSF’s values in action as an emergency unfolds at a hospital in war-torn Yemen.

Bullet wounds are common at Al Salakhana hospital in Yemen, which is in the midst of a civil war.

It’s half-past nine and somewhere in the house, a phone is ringing.

Ramadan is coming to an end and the mornings here are slow, lazy. 

I assume the shrill tone is calling someone else – logistics for an unexpected power outage, one of the office staff unable to come in.

But as it continues beyond my colleague’s footsteps, I run to my room. 

It’s the morning translator:

“Just a call to let you know,” he says, casual, unhurried.

“There’s a patient in ER with a gunshot wound... He's stable, under control"

Between the shoulders lie plenty of ways to kill a human being

With fluctuating tensions in the country and MSF projects closed following retributive attacks on patients, it’s the protocol to notify the project coordinator (my role) of all patients with gunshot wounds so they can assess and monitor the situation. 

That information I can pass on, but my responsibility is primarily to the patient and my local colleagues.


Al Salakhana hospital in northeast Yemen
Al Salakhana hospital in northeast Yemen

I’m now well acquainted with the damage a single bullet can do. I ask about the injury.

“Just the chest or maybe abdomen, but he’s stable, under control...”

Taking action

I throw the abaya and hijab (a cloak-like garment and head covering worn by some Muslim women) over my scrubs – my own security requirement for movements between our house and the hospital in a conservative rural area of Yemen – and hurry up the hill bound for ER.

The resuscitation room is far less animated than it should be. The patient’s vitals seem OK but the person below the monitor is pale and sweaty, with rapid, laboured breathing. 

It’s 10am and he’s saved a life...

There are fresh bandages swaddled around both the patient's shoulders, stemming the bleeding from entry and exit wounds inflicted from a single shot roughly an hour ago.

Between the shoulders lie plenty of ways to kill a human being.


Identifying the problem

He’s already had medication to stem the bleeding, control the pain and stave off the likely infections that come when a dirty, metallic missile rips through human flesh. 

As I place the stethoscope on his chest wall, the problem identifies itself immediately... below my hands his skin is crackling, pockets of gas popping, having escaped an injured lung. 

The team is waiting for an X-ray – a luxury that could delay life-saving treatment. But a bedside ultrasound confirms my suspicions as we see blood and air filling the chest cavity where the lung should be.

The silver chain

My colleague has never placed a chest tube, a procedure necessary to decompress the air and blood to allow the lung to continue to expand. But, he has all the theoretical knowledge.

He’s at the end of a quiet night shift but ready and eager. We take a moment to discuss the procedure, make a plan and prepare. My job here is all about capacity building and this is the perfect opportunity for him to grow.

I guide him through the procedure, step one, step two. For me at least, a choreographed dance learned from years of medical experience. 

He’s a little too gentle digging through the patient's tissues, but soon enough there’s a hiss of air, a gush of blood and a look of accomplishment on my colleague’s face. 

It’s 10am and he’s saved a life...


Emergency surgery at Al Salakhanah hospital in Yemen
Emergency surgery at Al Salakhanah hospital in Yemen

The patient’s family has already donated a unit of blood to replace the one that springs forth from the wound. Blood goes in one tube and out another.

As the patient is bundled off to X-ray, I notice that a small silver chain dangles from beneath his watch. I’ve come to learn this is the mark of the local militia. 

My colleagues, crowded around, were likely aware of this from the moment the patient was carried in.

They were impartiality in action.


Read more: About our work in Yemen

Yemen: Good complaints

Innovation: How WiFi could help our patients breathe more easily