It was two days after the surgery that the doctors first noticed the smell. They had patched up the bullet wounds in the 22-year-old college student’s leg, which had shattered bone and torn a hole in his flesh. Now, the wound was emitting a distinct odour, described in the medical literature as “offensive”. It strongly suggested a bad infection, perhaps life-threatening, and it was not getting better.



Realising that the normal antibiotics were not working, the doctors at the Médecins Sans Frontières Trauma Centre in Aden sent a blood culture for analysis with MSF’s microbiology lab. The centre opened just last year, the only one of its kind in the region with high-quality equipment that can detect multi-drug resistant infections. The result was a Gram-negative bacterium, Acinetobacter baumanni, which was resistant to most standard antibiotics. Nobody knows how the student - known as AS to preserve his anonymity - acquired the infection, but it is so common in Yemen it could have come from the bullet itself or the sand on the ground when he fell, said Dr Nagwan Mansoor, the chief doctor in MSF’s antibiotic stewardship program.

The MSF doctors began a program of specialised antibiotics that are not normally used because of their potentially dangerous side effects. AS also required numerous surgeries: seven in all. What would normally have been a five-day stay became three weeks, during which AS was put into isolation to prevent him infecting other patients. When his family came to visit, they could not touch him without wearing protective clothing.

In the end, AS survived. “We captured the patient from the mouth of death,” said Dr Nagwan.