IRBIL, Iraq — Three gurneys were crammed into the middle of a small ward of the West Irbil Emergency Hospital already crowded with patients, just some of the casualties from the seven-week-old campaign to retake Mosul overwhelming hospitals in the region.
Hospital staff prepared to defibrillate a woman with pale, clammy skin on one gurney while a man comforted a sobbing woman whose arm was bandaged tightly to her side on another. On a bed in the corner, a two-month old boy wailed into a respirator nearly as big as his face while nurses tried to comfort him.
Many of the patients had come from nearly 50 miles away, where Iraqi forces were battling to retake Mosul from the Islamic State group. Both soldiers and civilians are suffering heavy casualties amid escalating combat as the Iraqi forces advance toward the more densely populated areas of the city.
At the West Irbil Emergency Hospital, which has received more than a dozen new patients daily from the front, there is constant demand for its 13 operating rooms.
“This hospital is not built for this kind of war,” said Dr. Hazhem Mama, an orthopedic surgeon. “Sometimes we are obliged to delay some patients’ (operations).”
What’s more, the influx of wounded civilians, Kurdish fighters and Iraqi soldiers is straining the already thinly-stretched resources at the 165-bed government medical center built with more than $12 million in U.S. funding as part of a reconstruction effort.
An economic crisis brought on by falling gas prices has forced the government of Iraq’s Kurdish region to cut expenses and slash workers’ pay by as much as 75 percent. That has left the public hospital short on medical supplies, and its staff overworked, underpaid, and untrained for the types of injuries they are seeing from Mosul, officials said.
Most of the staff have been working on one-third their normal pay, Mama said, and the paychecks come not once a month but once every 40 or 50 days. They are continuing to work, despite the wage cuts and increased work tempo, but hospital officials say they don’t know how long that will last.
“We are facing a big problem,” Mama said. “I know some day (the employees’ commitment) is going to end because they have families, bills” and other financial obligations.
The hospital is already short of nurses. Some who have first contact with incoming patients lack training and experience to treat trauma cases, Mama said. For instance, they don’t know how to insert a tracheal tube to open an airway, and have to call senior staff members from the overtaxed operating rooms or other duties.
Another effect of the economic crisis is the hospital’s shrinking inventory of medicines and supplies. Even before the Mosul offensive, replacement levels could not be maintained. Some suppliers have begun refusing to ship orders to the hospital on credit, after years without being paid, Mama said.
All this comes as demand for medical services has jumped significantly.
“We are receiving lots of Iraqi army (soldiers),” Mama said, though he could not say how many the hospital had treated since the start of the Mosul campaign. They also receive Kurdish fighters and Iraqi civilians.
At least one suspected Islamic State fighter turned up for treatment at the hospital, claiming to be with a civilian family, Mama said.
Security officials checked into his story and took him into custody when the family said they did not know the man — but not until after he was treated and stabilized, said Saif Alden Samad, the hospital’s deputy general manager.
“Here we treat everyone,” he said.
They also treated an American volunteer fighting alongside the peshmerga who was injured in his knee early in the Mosul campaign, Samad said.
Patients often show up on ambulances from the front lines without any warning or prior coordination, and sometimes with few notes on treatment they’ve received at field clinics or aid stations near Mosul or en route to Irbil. It’s a trip that could be done in an hour or so under ideal conditions, but now can last six or seven hours. The protracted transfer time had forced doctors to amputate the limbs of a dozen patients, mostly civilians, Mama said, because tourniquets were being left on longer than the maximum two hours.
Kurdish forces, known as peshmerga, tend to come by airlift and their treatment is better coordinated with the hospital. But Iraqi soldiers arrive in ambulances or military trucks and are often dropped off alone without any army representative to consult with about their care, recuperation or discharge, he said.
Early in the Mosul campaign, two Iraqi soldiers being treated here had been sent to a private hospital for treatment the public medical center couldn’t provide, but the for-profit hospital tried to return them when they couldn’t determine how the bills would be paid.
“We could not take them back because of people — more patients — coming,” Mama said.
The hospital needs more resources — staff and medical supplies — as well as training, but it also needs motivation for those who are already overworked and underpaid, Samad said.
A recent morale-booster was a visit from Brett McGurk, President Barack Obama’s special envoy for the anti-Islamic State coalition, thanking them for their efforts, Mama said.
Outside the hospital in late October, McGurk said in an interview with the local TV channel Kurdistan24 that what he saw inside “is something I wish the whole world could see: Peshmerga heroes, sons, fathers, recovering together... and also right next to them, wounded from the Iraqi army and Iraqi counterterrorism service.”
Recovering at the hospital was Fars Saud, an Iraqi soldier with the army’s 16th Division, who was being treated for multiple wounds he received in a shelling in the Mosul suburb of Gogjali days earlier. With his brother Mohammed Saud, a soldier in the same division, by his side, he said he’d had his liver operated on and was recuperating.
Many of the hospital’s patients, however, were civilians. Across the hall from the room with the Saud brothers, two civilian men who had received chest wounds in mortar attacks in different Mosul neighborhoods were recovering after surgery. It was unclear who fired the mortars, but Iraqi army officials have said the presence of many civilians in Mosul neighborhoods has kept them from using heavy weapons.
Around the corner, 7-year-old Ahmed Younis Mohammed screamed in pain and put his hand to his forehead, then to his bandaged left shoulder, then pressed it against the wall. His father tried to console the boy, wounded in a mortar strike, who would need more operations to treat his injuries.
Hospital officials foresee even more casualties like these as the fight for Mosul, where an estimated 1 million or more civilians remain, enters bloodier stages with troops pushing farther toward the downtown center and into built-up neighborhoods where militants are using civilians for cover.
“We are really afraid,” Mama said. “It’s like a nightmare for us.”
garland.chad@stripes.com Twitter: @chadgarland
