Battle Hospital: Medics at War

Bill Kirkup

public health physician

Channel 4, 27 February at 7 30 pm

Rating: **

"We have stood up against tyranny and won," said the padre conducting a service for the personnel of 202 Field Hospital just across the border from Iraq as the conventional phase of the recent war ended. The rest of this documentary on the work of the hospital would have given most viewers a different impression. Nearly all admissions were Iraqi civilian victims of trauma, many of them children. Cue close-up after grisly close-up of surgical debridement, skin grafting, unstable fractures, punctured bowel. Modern war inevitably generates such scenes, and television lets us all share the resulting sense of horror and futility.

Battle Hospital followed the 650 men and women of 202 Field Hospital through the war and just afterwards. Although thankfully few of the 200 beds and seven operating theatres were needed for British soldiers, there was plenty of scope to film civilians injured directly or indirectly through the conflict, and the programme makers seem to have missed no opportunity. Later, when the conventional war was over and the Iraqis repatriated, more reflective footage showed staff questioning the war, the reasons for being there, and the need to stay. The programme ended in a distinctly minor key.

At about the time that the field hospital staff were wondering whether war could be justified and why they were there, I was beginning a stint a few hundred miles away as public health adviser to the Coalition Provisional Authority in Baghdad. It was clear that the Iraqi population faced major immediate public health threats, from cholera and other waterborne diarrhoeal disease, from childhood infections, meningitis, and tuberculosis, and from vector-borne disease, particularly leishmaniasis and malaria. These were not the result of the war, although they surely killed and disabled far more people. They were partly the result of the systematic running down of public services by Saddam during the 1990s?for example, health spending in 2001 had fallen to about 10% of the level in 1991. Remaining services then suffered badly from the lawlessness after the war. Generators, refrigerators, and air conditioners were stolen, transformers, cabling, and heavy equipment stripped for their metal, and other equipment simply destroyed. Many vital services, including water and sewage treatment, primary healthcare centres, immunisation clinics, hospitals and laboratories, were inoperative.

Coalition personnel, many of them military, threw themselves wholeheartedly into countering these problems. Just how much the security problems hampered us from the start is now more widely realised. My own experience was that almost all Iraqis welcomed the removal of a repressive regime, and wanted a properly constituted Iraqi government?although they may with good reason still be afraid to say so too openly. There are a few, however?those who previously benefited from Saddam?s wealth, power, or privilege?that want something different. They wish to prevent reconstruction, regardless of consequential damage to the innocent. They have plenty of cash to bribe poor and unemployed people to shoot from behind crowds, throw grenades at guard posts, and fire rocket-propelled grenades at vehicles and buildings. They offer thousands of dollars for killing a soldier, and issue death threats against those co-operating with the coalition. They attack the houses and families of those who will not be intimidated. The security precautions that such actions make necessary are disproportionate to the number of perpetrators, and very disruptive (although not always effective).

Watching Battle Hospital, I remembered all this, and more, very clearly. I remembered the frustration of a young US army captain, moved to tears because he could not work quickly enough to ease the plight of the Iraqi population, although he went "in harm?s way" two or three times every day carrying medical supplies where they had been previously withheld by Saddam. I remembered standing in a huge area of crumbling earth, surrounded by fragments of bone and clothing, shock turning to rage at the realisation that these were the mortal remains of thousands of murdered Iraqis. Finally, I remembered the team from a US civil affairs battalion that most often provided my transport and escort. Their professionalism was impressive, their comradeship and good humour unfailing, their sense of purpose in righting wrongs unflagging.

Two weeks after I left Iraq, the US newspapers reported an attack on that team. Thanks to the worldwide web, I can see pictures of the two trucks that I sat in so often, one a hardly recognisable mass of twisted metal, the other a burning wreck. Three of the soldiers that I knew as comrades were seriously wounded by shrapnel and gunfire. Another is dead. Our Iraqi interpreter, who asked me to come back soon as we said our farewells, was also killed. They were going to check a water treatment plant.

Can war be justified? How do you trade off the wounding and death of soldiers, civilians, and children against the ravages of mass murder, starvation, and deliberate deprivation? I don?t know, but I?m with the padre on this: a cruel despot has been overthrown, and the world is better in consequence. I think my friends?and 202 Field Hospital?deserve to be remembered for that.