

As Kabul ambulance driver Zemari Khan raced a bleeding patient to hospital on Thursday, he came to one of the city’s latticework of checkpoints. A long line of vehicles had suddenly been waved through, but Khan was ordered to stop, hand over his ID and open the rear door so a police officer could check if his patient was real.

In the week since the Taliban detonated an explosives-laden ambulance on a busy shopping street, killing 105 people, life has become harder across the Afghan capital – but particularly so for its paramedics.

“Police were very nervous with me,” Khan, 55, told the Guardian. “When I moved half a metre forward by mistake, an officer rammed the butt of his gun against my windshield. It makes me so sad. My patient was suffering. Ambulances used to have respect, but now everyone is suspicious of us.”

People are adapting to a new hardship in the endless war. According to the Kabul ambulance service, which operates the city of 4.5 million’s fleet of 20 official vehicles, callouts have dropped by 40% since the attack, as ambulances face long, invasive searches on their way to hospitals. Many people, say drivers, are now using taxis instead.

“It’s more comfortable in taxis at the checkpoint now,” said Khan.

Rarely has Kabul needed a nimble, first-aid trained emergency response more. In the past two weeks, Taliban and Isis insurgents have killed more than 130 people, an unprecedented strafing in a city previously seen as safe enough to attract thousands of refugees from the war-torn provinces.

Even for the hard-bitten drivers of the Kabul ambulance service, the bloody churn has come as a shock. At the ambulance station in the centre of the city, one hoses down the gurney of his vehicle. There has not been time to fix the glass of another’s windshield, shattered by the blast.

Play Video 0:35 Aftermath of fatal Kabul ambulance blast – video

Nasir Ahmad, 31, reached the site of the explosion near the old Ministry of the Interior minutes after the bomb went off. “The security forces wouldn’t let us out of the car,” he told the Guardian. “People were missing hands and legs and police were just throwing them in the back of my car.”

Adding that it was the “worst thing I have ever seen”, Ahmad said he and all the other drivers had struggled to eat after their shift and that he still could not shake the images from his mind.

Blame for the attacks ricochets between different targets. Some point to Pakistan, which the Afghan government accuses of harbouring Taliban fighters, including those who killed 23 people at the Intercontinental hotel on 20 January. Some blame Donald Trump, whose fire-and-brimstone bombing raids have provoked the Taliban. Others berate the government of President Ashraf Ghani for failing to keep citizens safe despite the warren of roadblocks, concrete bollards and bomb detectors that make travel through the city a daily nightmare.

But the most tangible result is the police clampdown on ambulances. According to Khan, police have turned ambulances away from one-way roads and VIP lanes previously open to them.

Although the government has offered no official account of the 27 January bombing, it is widely thought that the Taliban dummy vehicle claimed to have a patient on board, helping it pass one checkpoint. In response, one police officer at a riverside checkpoint in central market district of Pol-e-Bagh Otomi said searches of ambulances have become “much more strict”.

“We are especially checking the patient in case they put stuff under them. Is this patient real? Or is it a patient packed with explosives?” said Mye Agha.

Claiming that intelligence reports have warned of a second potential suicide bombing in an ambulance, he added, “It’s better that we die on the checkpoint than let them through and there is another massacre.”

Najib Danish, a spokesman for the Ministry of Interior, said: “When we have reports of a threat, we search more, including ambulances.”

But delays can prove fatal for hurt Kabulis. Taking “10 or 20 minutes” to search an ambulance is far too much, Dr Asim Aslam, director of the Kabul ambulance service, told the Guardian. Pregnant women need midwives. Patients can bleed out. With gridlock in the city, it can already take an hour and a half to transfer someone from one hospital to another – the new system adds dangerous time to the clock.

New wave of Afghans seek a way out as fear grips Kabul Read more

“I have said to the Ministry of Public Health that they should search us,” said Dr Aslam, “but not as long. It can cost the lives of patients.”

On the site of the bomb attack, piles of glass and rubble line the road. The force of the blast has mangled corrugated iron doors partway down Chicken Street, a row of carpet shops and jewellers once thronged with tourists. Returning to work, shopkeepers who survived are just recovering from their wounds; concussion, a shard of shrapnel just above the eye.

On Sunday, the office of the chief executive officer, Abdullah Abdullah, said the government was considering executing Taliban prisoners, and a military spokesman promised renewed offensives against the insurgents, who according to a BBC survey now pose a threat to 70% of the country.

Yet such methods are unlikely to shield civilians from what analysts expect to be a particularly bloody phase in a conflict where civilian deaths have risen steadily, to a 16-year peak of 1,662 in the first six months of 2017, according to the UN.

“God knows, nobody can protect us,” said nine-year-old Azmat Ullah, kicking his foot against a pile of splintered wood inside a shop a few metres from where the ambulance blew up.

In Kabul, a city where residents have started to carry notes of their blood type in case they become the next victim, even ambulances are no longer safe.