Why I’ll never forget my first day as a surgeon in Iraq

Martin Kašpar is a Czech surgeon currently on his first assignment with Médecins Sans Frontières / Doctors Without Borders (MSF) in the city of al Qayyarah, Iraq. In this blog, he writes about his dramatic first day, treating young patients involved in tragic incidents.

I have found out that the name of this city -  Al Qayyarah - originates from the word for “tar” in the local language. Apparently, this is because there is plenty of natural tar stemming from the earth in this area.

Following this logic, the Czech city of Znojmo could be called “Wine”, as it is at the centre of a well-known wine-producing region.

So, I came to the conclusion that my new workplace could have a lot in common with my hometown.

One thing the two towns have in common is patients. They are here as well.  In Al Qayyarah the catchment area of our small hospital (meaning the area where our patients live) is around 250 thousand people. (I checked the number twice.)

The journey to Al Qayyarah

It´s quite difficult to get here, to Al Qayyarah.

First I had to travel to one of the MSF operational centres (Paris in my case), to go through several training sessions and briefings led by a fellow surgeon and colleagues from the HR and security departments.

The following day I flew to Baghdad via Istanbul.

Somebody decided to place a booby trap bomb on the road. Unfortunately, three brothers walked by the device in the morning…"

After getting my visa, I jumped onto my fourth plane in 48 hours and headed off to the city of Erbil, in northern Iraq, from where MSF coordinates its activities in the region.

There were a few team members sharing houses, like in the series Friends, while they work to provide humanitarian assistance. It would be a similar set-up for me, as I would find out later.

My final transfer was to Al Qayyarah, this time by car.

A hospital made of containers

You might wonder how soon you adapt to the work with MSF? Very quickly.

Suddenly, you end up in a brand-new world, where a few containers bolted together like a Mercur toy kit (a Czech version of Meccano) form a hospital – an emergency room, intensive care unit, a patient burns unit, male, female and paediatric units and two operating theatres – covering an area populated by around 250,000 people.

You would like to stay stunned for a while and maybe even ask someone some questions. But there is no time.

MSF's hospital at Al Qayyarah in Iraq

MSF's hospital at Al Qayyarah in Iraq
MSF's hospital at Al Qayyarah in Iraq

There was a young man who had been waiting in the emergency room since the night before with his right hand injured by an engine propeller. My colleague from Japan had been called to another emergency case so it was logically my turn. There´s no place for huge reconstructive surgeries in MSF projects. All the work has to be done simply and to maximal effect.

A short while later someone who had been in a car crash was rushed in. It was a little girl, nine years old, with injuries to her face and mouth.

I was trying to fix her wounds as best I could. I didn´t even ask how the others were doing because I guessed that there are often whole families travelling in cars, with many more passengers than the capacity of the car should be.

Three brothers and the booby trap

My first day at work also happened to be during the Eid feast – the long-awaited celebration to mark the end of Ramadan – an opportunity for Muslims to celebrate the end of the holy month together with their families. Even during the morning rounds, the ward was in a festive mood.

Unfortunately, not everybody celebrates the day in this way. Somebody decided to place a booby trap bomb on a road approximately 50 kilometres from our hospital.

Even hardened surgeons would struggle listening to descriptions of the surgery."

The road had been in daily use by both pedestrians and cars for several months since Mosul was taken by the Iraqi army.

Unfortunately, three brothers walked by the device that the morning…

Surgeons operate on a patient in Al Qayyarah

Surgeons operate on a patient in Al Qayyarah
Surgeons operate on a patient in Al Qayyarah

One of the brothers died immediately. Another died a few hours after arriving in our hospital’s emergency unit. The last brother, I operated on.

Even hardened surgeons would struggle listening to descriptions of the surgery.

However, after a couple of days, I can now say that the boy’s intestines are holding together, his lungs are working, his legs are intact, and although some pieces of shrapnel remain, they will not bother him in future.

Even if my assignment had ended on that very first day, there would be many things I’d never forget.

What is happening outside of the hospital door, and why it is happening, is difficult to understand and not the role of MSF. But, inside the hospital, everybody - regardless of race, ethnical origin, religious or political belief - is simply a patient.