‘If They Wanted to Treat Them, They Could’

If Nasir had been able to read the papers, he would have learned that American surgeons at Craig Joint Theater Hospital saved Zobair’s life with a battery of sophisticated procedures. The incision on Zobair’s abdomen was from a laparotomy that enabled the doctors to repair his lacerated spleen, colon and kidney; the pouching system was to collect feces from an ileostomy, where a section of damaged intestine had been removed; and the four tubes sticking out of his sides were internal compression sutures helping to hold his abdomen together. Curiously, the only future treatment recommended for Zobair was to “follow up with a surgeon in six months to have the ileostomy takedown” — that is, to have the intestine reattached and the temporary pouching system removed. According to Nasir, he was not given any guidance about what to do for the internal sutures and 52 metal staples, though both were meant to remain in place no longer than a week or two, after which they posed a risk of becoming infected.

The ambulance took them to a Red Cross orthopedic center in Kabul. There, doctors saw immediately that Zobair was in no condition to have been discharged. He could not even sit up. (A spokeswoman for Craig Joint Theater Hospital said that “in accordance with accepted international clinical practice, the patient had recuperated well enough to be considered by his physicians for discharge.”) The Red Cross told the Afghan escort accompanying the ambulance that Zobair required further medical attention before the orthopedic phase of his recovery could begin.

When the ambulance left with Nasir and Zobair, the staff at the Red Cross assumed they were returning to Bagram. Instead they were taken to Kapisa’s provincial hospital, Mahmud-i-Raqi, where doctors informed Nasir that few if any public hospitals in Afghanistan possessed the special tool required to remove the metal staples that were used on Zobair. “They said they were not able to fix this problem,” Nasir told me, “and they sent us away.” Craig Joint Theater Hospital says that it previously arranged to transfer Zobair to Mahmud-i-Raqi and secured its consent to accept Zobair before his discharge. But the director of Mahmud-i-Raqi, Dr. Mustafa Faiz, says this is untrue. According to Faiz, no one from Bagram ever contacted the hospital about Zobair.

I visited Mahmud-i-Raqi twice. Part of the hospital is made of free-standing plywood and sheet-metal rooms with corrugated tin roofs, while the main building suffers from severe disrepair. Paint peels from walls; water creeps from ceilings; and the floors are covered in dirt. The first time I went there, I arrived at around 3 in the afternoon, but I was told that all the nurses and doctors had gone home early. The second time I visited Mahmud-i-Raqi, it was overrun with people jostling to be seen. Faiz, the director, gestured at the melee and asked, “Why would a hospital like the one at Bagram want to send a patient here?” He explained that Mahmud-i-Raqi could never accept a patient like Zobair for the simple reason that it had no surgeons. He then asked me if I could procure his staff some medical textbooks the next time I went to Bagram.

Nasir says that when Mahmud-i-Raqi refused to admit Zobair, the Afghan escort from the ambulance called Bagram and asked what to do. When he got off the phone, the escort told Nasir: “Zobair didn’t have much problems. He only needed his dressings changed. He said we could take him home.” The ambulance returned to Bagram, and Nasir hired a taxi to drive him and Zobair back to Tagab. The following afternoon, an elder from the village visited Zobair to help with his dressings. When he saw the incision, the elder told Nasir that he needed to get Zobair to a hospital immediately. They went to Emergency’s medical center in Panjshir Valley the next morning.

The only patients Emergency does not accept, however, are those who have already been operated on at NATO facilities. They adhere to this policy very strictly — some might say brutally. In the past, Emergency used to treat patients like Zobair, “but we stopped,” Emanuele Nannini, the program director for Afghanistan, told me. “They kept dying in our hospital.” Nannini describes NATO’s practice of discharging injured Afghan civilians requiring further care as an unethical one, which Emergency has opted not to participate in. “They don’t take responsibility for the patients,” he said. “They start a job, and they give all the complications to somebody else.” He added: “If they wanted to treat them, they could. That is the point. They have the capability.”

One nurse at Emergency who helped make the decision to turn Zobair away later told me: “It was a disaster. The incision was not clean. It was infected.” When I asked Radaelli, the medical coordinator, whether Zobair was in danger of dying from the infection, he said, “If someone doesn’t take him, for sure.” He added, “We see this all the time.” Nannini, the program director, is strident on the subject of NATO’s discharge policies, going so far as to characterize them as criminal. “They did nothing for this patient,” he said of Zobair. “It’s better to let him die than to suffer while going from one hospital to another.”