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Yemen: "All of my patients were trauma cases"
Anaesthetist Sarah O'Neill spends one month a year working abroad with MSF. She is just back from Yemen.
I flew in on a 12-seater plane from Djibouti – there are few commercial flights into Yemen.
Landing in Aden, the first thing I noticed was the difference form the last time MSF had sent me there, four years earlier. This time, there were far more armed men on the streets, far more checkpoints, far more buildings with bullet damage.
“Aden used to be such a lovely city,” the staff at MSF’s surgical trauma hospital told me wistfully. But of course I couldn’t see any of it for myself, as I had hardly left the hospital in the three weeks I was there.
The security situation kept us inside, living, eating and sleeping on the first floor of the hospital building, and working one floor below. Being cooped up like that can be difficult – but at least I was never late for the morning meeting.
"The mother had been carrying her daughter in her arms when she stepped on a landmine"
All of my patients were trauma cases, from a mixture of causes. The frontlines of the war have moved three to four hours’ away from Aden now, but we still received some war-wounded patients.
In the weeks before I had arrived, there had been a couple of mass casualty events, when 10 or more patients arrive at the same time.
Gunshots, skirmishes and checkpoints
One day a mother and her five-year-old daughter were brought in from near the frontline. The mother had been carrying her daughter in her arms when she stepped on a landmine.
She took the brunt of the explosion and her leg was left hanging by a thread. There was no way we could salvage it, so sadly she had to have an amputation.
Her daughter had a nasty fracture on her lower leg. We reduced the fracture and carefully debrided the wound – these very dirty wounds can get infected very easily.
We also treated a lot of people with gunshot wounds as a result of skirmishes for control around the checkpoints in Aden itself, as well as victims of road traffic accidents.
High number of weapons
One of the problems with any conflict is the number of weapons in circulation, and there are lots of accidents from them not being looked after properly or picked up by people who don’t know what they are doing.
Despite the destruction from the conflict, the shortages of medical supplies and the fact that many Yemeni health staff haven’t been paid for over a year, there are a number of other hospitals in Aden – some functioning, others less so.
But beyond the city there is little medical care available, especially surgical care, which meant that many of our patients had travelled a long distance to reach us.
Often, they arrived very dehydrated or having lost a lot of blood.
The intensive care unit is vital. When a patient comes in who has been shot and badly injured, you often do ‘damage control surgery’ to stop the immediate bleeding.
Then you put them in intensive care overnight to try and correct their physiology – to make sure that they are warm and their blood is clotting – and the next day you take them back into theatre to do the slower and more meticulous work of repairing areas that have been damaged.
One woman was in intensive care for the whole three weeks I was there. She had been shot in the abdomen and had injuries to her bowel and a very large open wound over her left flank.
We had problems with infection and great problems with nutrition – she couldn’t take food orally because of her bowel injuries so we had to feed her via a drip.
But by the time I left, her wound was improving and her nutritional state was good. I’m hopeful that she’ll do well. She certainly wouldn’t have survived without the intensive care unit.
Next door to the hospital is a cholera treatment centre, but the epidemic is almost over in Aden and few patients were coming in – though cholera is still a big problem in other parts of the country.
Normal life is falling apart
In the street beyond the hospital, shops were open and people seemed to be going about their lives. I had the sense that normal life was carrying on – on the surface at least – but that underneath people were desperate.
Years of war, shortages of food and medicines and the destruction of basic services have left everyone struggling. Everyone I met knew families who can barely afford to eat.
The normal structure is falling apart.
Yet now, and throughout the worst of the war, the hospital has kept on running.
Even when there were tanks outside the front door, MSF made sure that the hospital always had supplies and electricity and that the staff had encouragement and support.
Throughout the conflict, MSF has provided reliably safe trauma care which wouldn’t otherwise have been there.