The Ambush (Part 2 of 3): Flight

Note: This is the second in a three-part account of a security incident I was involved with in late 2007, in Sudan’s war-torn Darfur region.  Click here to read the first part.  I’m sharing this story for World Humanitarian Day (19 August), which honours aid workers, and remembers those killed and injured in the line of duty.

Please note that the story contains an account of violence that readers who have been exposed to critical incidents themselves may find disturbing.

Flight

“Stop the car!” I yell, looking back at the three wounded men behind me. “I need to help them.”

We’re twenty yards from the scene of the shooting. Issa is wrestling with the wheel, trying to steer the Land Cruiser in deep sand with one tyre shot out. He gives me a single look that says, You’re crazy, white man, forget it, and I instantly see the logic in his decision and I feel foolish. In a day during which I reckon I did a fair job of keeping my cool, this was the one moment where I definitely said something stupid.

I’m a Wilderness First Responder, and the sight of my three colleagues, injured and worse, makes me anxious to do something.

“Give me my first aid kits,” I tell Essam instead. I have two. He rifles through my pack and passes them to me. Unzipping one I pull out a pair of surgical gloves. The first one I try to pull onto my sweating hands tears, and I throw it away in frustration before unsatisfactorily fumbling two more on. It’s a simple gesture, a selfish (and ultimately futile) act to protect me from whatever bodily fluids I’m about to deal with when I finally get my hands onto my patients. It’s Mohammed who later tells me that this is the point when he starts to feel like they are going to be okay, that somebody with them knows how to help.

I wish for his confidence.

We bounce through the bush, the car banging loudly around the dusty potholes. The first vehicle starts rolling before we reach it, and the two of us lurch off in convoy again, as fast as we can over the broken terrain. As I look helplessly at the heavily-bleeding Abdul, I continue to pull items from my first-aid kit I think might be useful- spare gloves, a variety of bandages and gauze.

We pull up and stop. The first vehicle is waiting for us in a sandy clearing. We haven’t come far, just a couple of minutes. I guess maybe a kilometre, not more than two. It feels uncomfortably vulnerable, but I’m now thinking of the three shot men in the back and how to stop them from getting worse.

We yank open the back doors and start to manhandle Abdul out of the vehicle. Both Essam and Mohammed can walk unassisted. I try to tell them both not to help with the carrying because I don’t want them exacerbating any wounds they might have. They don’t listen, and anyway, Abdul is too heavy. I guess he’s at least a hundred kilos, and we need the hands on.

I try to explain to them how to carry him without twisting his spine as I’ve been taught, but now we’re having language difficulties. I’m speaking loudly and quickly without realising it, the adrenaline still coursing through my arteries, and I’m barely making sense to myself, let alone the rest of them who are Arabic mother-tongue. I try to support his head as best I can while they lug his limp body out of the back and set him in the sand. Within seconds I’m soaked in his blood. It’s smeared all down my front and my gloves are wet with the stuff.

Abdul is bleeding heavily and he’s my main focus, but I’m aware that I have two other men, both also wounded, one of whom looks really bad. My attention can only go one way at a time however and I focus on Abdul’s head-wound. It’s nasty. The bullet seems to have skipped off his cranium and it’s torn the scalp apart into three large flaps. I can see the pink-white of his skull where everything else has been ripped away. I’ve never had to deal with anything like this before.

The blood is dribbling past my fingers. I squeeze the pieces of scalp back into place then press it tight in an effort to stop the fluid loss. My gloves are slick and I have to ask Essam to open a pack of gauze for me because my digits can’t get purchase on the plastic wrapping. I clamp that into place over the wounds and keep the pressure on. The pad is soaked through in moments. The blood is curious- it is warm when it splashes onto my hands, but then quickly cools in the Sahelian breeze. Through the microfibrous gloves I can feel the texture of Adbul’s scalp beneath my fingertips. It is wet and spongy, the tight curls of his hair now sticky.

I press hard and watch dark beads of fluid gather in the sand as they form a dirty puddle. Essam is crouching beside him, trying to talk to his friend. Abdul is conscious but it’s hard to communicate with him. We’re all having a hard time hearing, our ears still ringing from the impact of the gunshots. Abdul is shocky and not able to understand everything that’s said to him. I’m talking too fast and Essam is having trouble interpreting my requests. I’m trying to gauge Abdul’s level of consciousness, but I can’t get through all the questions before something else happens. I try and take his pulse, but my fingers are throbbing in the aftermath of the surging adrenaline.

I look at Essam and at the bullet-hole in his arm. There’s blood wetting down the front of his sleeve and the material is torn, but he doesn’t seem to notice. Every time I ask him about it he dismisses it and returns his attention to Abdul. I’m worried in that wounds can be deceptive to those who receive them, but he’s showing no signs of shock or internal blood-loss, and the fluids leaking out of him aren’t prolific either. I do my informal triage and move on.

Mohammed scares me more. He’s standing a little to one side, looking a fragile but oddly calm as he watches on. I’ve never seen so much blood on one person before. There’s a slick stringy substance all down his chest and I’m terrified he’s taken a bullet through the lungs but can’t feel it courtesy of shock. He tells me he’s fine, but I don’t trust him until he’s taken his shirt off and turned around for me while I watch him, still kneeling at Abdul’s head and clamping off the bleeding.

Mohammed’s only wound appears to be the one to his head, and that’s now nearly stopped bleeding. The rest has come, he says, from Abdul, who fell on top of him. I later learn that both he and Abdul were knocked unconscious in that first barrage of shooting when both were struck in the head, and he has no recollection of the rest of the ambush.

I look over and I see the two drivers gathered around a jack. I think to myself, What are they doing changing a tyre at a time like this? I don’t learn about the shot wheel until later in the day, and to this day still have no recollection of the additional rounds fired into the vehicle. I find the process disturbing, however, as I’m starting to feel very exposed. We’ve been out here for several minutes, and I’m starting to have images of the gunmen re-emerging from the bush and reneging on their decision to let us walk.

Abdul is plunging into shock. In my limited experience with patients I’ve never come across anything like it, although I know exactly what’s happening. His skin temperature plummets and he sweats hard. He’s in a great deal of pain and his eyes are rolling around a lot. He and Essam are talking as best they can. It’s taken mere minutes, but he’s cold to the touch and his colour is a sickly purple hue. After a couple of minutes, he retches. We roll him onto his side and let him vomit bile into the sand. It’s Ramadan, and none of the men have eaten or drunk anything. This realisation and its implications for patient care hit me immediately.

I look up, and Issa is sweeping the mat of broken glass and congealing blood out of the back of the vehicle, where it clumps into the sand. I feel a burst of desperate irritation. I just want us moving. I don’t know where we’re moving to, because we’re only getting further away from Nyala, but I know we can’t stay here. But the ex-policeman is, once again, right.

I again give poor directions to the guys as we load Abdul head-first back onto the floor of the four-wheel-drive. I control his head and try and position him as comfortably as possible. I manouevre him into the recovery position so that he can keep throwing up as needed. He tells me his head hurts. He’s in a lot of pain. In moving him the bleeding has started up again and I try and get it back under control, while keeping his body in position and protecting his head and spine. I crouch on the balls of my feet beside him on the floor of the vehicle and it’s awkward.

We drive. The journey is hell. I don’t know where we’re going, I don’t know how long we’ll take to get there. I do know that the closest thing to medical care is in the other direction, and between us and it is the ambush site. We have no option but to press on into the bush.

Physically, it’s tortuous for me. I can’t begin to think what it is for Abdul. The car pitches and jolts across the back-country terrain. I’m locked into a crouch, holding a heavy man on his side, trying to stop him from rolling back, trying to protect his head from banging each time we yaw into a pit, trying to keep him from bleeding out. Every couple of minutes he vomits again, bringing up more bile, or just dry retching. Before long my legs and back are screaming with the pain of the position I’m holding.

The fear is worse. Because I’m not longer really doing anything, this is the first time I’ve really had a chance to be scared. In some ways this seems odd, because the rest of us appear to be out of danger, but then we’re still in a war-zone, and we have no idea what lies ahead. There could be another ambush. My imagination spins. I wonder what will happen if we’re stopped and they find that everything of value has already been taken? Maybe they’ll just execute us on the spot. I look down at Abdul and I know he’s in mortal danger. I wonder whether he’s going to die in my arms. When I look at Essam and Mohammed, crouched in the back with me, I see the same fear.

We pray, Muslim and Christian together. I to Jesus, they to Allah. I in English, they in Arabic. We agree with each others’ words. I punctuate my agreements with al-Hamdulillah: Thanks be to God. Crouched over our mortally wounded friend, there’s no religion. Only faith.

I don’t know how long we travel for, but in hindsight I guess it’s somewhere shy of half an hour. Then we reach Bul-Bul.

Bul-Bul

I don’t really get a chance to see it as we arrive, and my memory is one of a tremendous sense of relief as I learn that we’re pulling up to a police checkpoint. After the journey we’ve just had, it feels for the first time that I can breathe normally again. My concentration is still on Abdul, but I’m briefly overwhelmed by a sense of lightness.

Emmanuel and the driver in the first vehicle begin to explain our situation to the soldiers at the checkpoint. No sooner is the sense of relief over me than I feel a pang of irritation. We’ve got a guy who could be dying here, I scream in my mind. Stop messing us around.

Curious faces appear at the window. I glower at them. Their expressions visibly yaw as they take in the four of us in the back, dressed in macabre crimson robes, then wave us hurriedly on with orders to go straight to the health hut.

We pull up outside the little compound. The village is classic Sahel. It’s open and set amidst a cleared area in the grassland. Round mud-walled huts with dry reeds for roofing- I know them as Tukuls– are dotted around at generous intervals. Some properties are walled with cracked-mud walls. There are patches of grass, and patches where the grass has been trodden into hard-packed ground.

The health-hut is a simple two-roomed mud-brick clinic staffed by a small grey-haired man who I learn is a trained nurse. We look around for something to use as a stretcher and eventually settle on a bench that we load Abdul onto and manouevre inside, setting it on the poured-concrete floor. The nurse immediately puts a drip into the man- an act I have no doubt saved his life- while I find more gauze and set about stopping the bleeding that has once more resumed.

People are moving everywhere. Things are still frenetic. Emmanuel explains to the officials what has happened, then he goes to try and raise Nyala. The two vehicles have both had CODAN HF radios fitted in the past, but both are defunct. Our Motorollas don’t have the range on them to reach the city, and there’s no cell network out here. There are rumours of a landline telephone and he and the driver disappear in an effort to find it.

With Abdul temporarily stabilised, the nurse and I turn our attention to Essam and Mohammed for the first time. Essam’s wound looks relatively minor. A bullet or significant portion of one has pierced his right bicep, a clean entry wound like a pair of pursed lips and no exit; we guess the slug is resting close to the bone. He still has movement (I can’t get him to stop moving it) and the bleeding has stopped. He refuses any fuss over the thing and quickly steps out to help Emmanuel arrange our evac. Ordinarily gracious with a quiet tone and manner, he seems to be smouldering this afternoon, and I sense a fierce anger in him that he none the less keeps to himself. Later, the word I find wraps itself around him with ease is ‘stoic’.

Mohammed is cheerful but a little weak. His loss of consciousness coupled with poor food and fluid intake means he’s fragile, and the nurse takes him to the other room and puts him on a drip too. Later he gets his head bandaged. In a while, when Abdul’s wound finally stops bleeding, I go in to see him where he rests on a guerney. He smiles sadly but his words are encouraging, and he assures me he’s fine. We have a discussion as to whether or not God will frown on him for having a drip when he’s supposed to be fasting. I’m humbled. Later, he sleeps.

Outside, Essam and Emmanuel are trying to get the news through to Nyala that there’s been a security incident and we need an emergency evacuation. It’s that, or drive back the way we came, and that doesn’t appeal as an option.

I only hear Emmanuel’s side of the story much later. How when they hear the gunshots they move forward a safe distance, then wait for us to come. How they try to reach us on the radio they get nothing back. Then a garbled message saying we’re on our way, and to go quickly.

Emmanuel tells me without shame how when the vehicles first stop and Abdul is carried semi-conscious from the back of the truck, he sees us all covered in blood and he’s so stunned he can do nothing but stand there and stare. How when he reaches Bul-Bul he stays in the car for ten minutes talking to the police officers and explaining what happened, not because he doesn’t want to get out and do anything else, but because his legs are shaking so hard he can’t physically stand. I think of my own fingers, throbbing with adrenaline, and I understand fully.

***

I stay with Abdul. My training says I should continue to care for my patient until I hand him over to somebody more qualified to look after him. Ordinarily a nurse would suffice, but I have no idea how well trained or experienced this one is.  I can’t speak to him, and I doubt he’s been prepped to deal with gunshot wounds. Drip aside, he’s certainly not paying much attention to Abdul, save to periodically check his heart-rate, which he doesn’t write down and doesn’t share with me. I’m worried, because I want to monitor his vitals, but I’ve lost my translator and can’t communicate with the nurse to see what he thinks. I try to take Abdul’s pulse myself, but my own fingers are still trembling and all I can feel is my own heartbeat racing through them. This won’t change for the rest of the afternoon.

Curious villagers come to see the commotion. Women, weeping tears of sympathy, gather around Abdul’s bed and coo. Then the soldiers barge in. They’re local militia, government-allied troops there to maintain safety. On the one hand I’m kind of pleased to have them nearby because it gives me hope we won’t be attacked in the next few hours. But they’ve come into the small cell out of morbid curiosity. They quickly fill the space, jostling around shoulder-to-shoulder to see the injured man. I grow tense when one inadvertently pokes my face with the muzzle of his Kalashnikov assault-rifle as he manouevres for a view. A little too close to recent events for comfort. I start to shoo them outside, and then we barricade the doors with a bench to stop more intruders.

I start to feel exhausted. It’s now early afternoon, a couple of hours since the attack. Abdul is in and out of consciousness. He speaks, but is having a hard time hearing. He tells me often in broken English that his head hurts. We wrap him in a blanket to counteract the chills of shock, and eventually move him onto a table so the warm draft can’t get at him from underneath. Then he complains he’s too hot. We strip off the blanket and I wet his fingers and fan them to cool his bloodstream. He still vomits periodically. One time he brings up some pink blood in his bile, and I have a pang of panic, but reassure myself that he’s probably ruptured a vessel in his gut from all the retching. Flies buzz. It doesn’t smell great in here.

I use my walkie-talkie to find out what’s going on from the others who have spread out in the village, but news is vague. They’ve managed to contact HQ who have been in touch with the Africa Union peackeeping base in Nyala. A chopper is being despatched. It’ll be here very soon. Maybe in the next half an hour. But half an hour passes. Then another. And a third. I start to feel very, very tired. Somebody brings me a bottle of water. I look at Abdul. He’s not cold any more, but I’m worried about him. I know he’s lost a lot of blood, and I don’t know enough about drips to know what effect they have, or whether he needs another one. I’m concerned about decompensatory shock, but because I can’t access his vitals I can’t tell what’s going on. I only know that he’s disoriented and showing signs of head injury, which is a bit of a no-brainer really, as he’s been shot in the head.

I take a walk outside to get fresh air and clear my head. I greet some women sitting in the courtyard and they look at me with wide eyes, returning ‘Salaam Aleikum‘ with hesitation. I realise I look horrible. I am drenched in drying blood. It’s splattered on my cap, it’s on my face, it’s soaked into my vest and into my pant-legs, it’s all over my boots and it’s caked solidly up to my elbows. I’m directed to a lightless side-room where there’s a plastic jug with a stopcock on it. I scrub at my hands and the water flows from my fingers pink. I discover that I’ve been cut by shrapnel and flying glass. There’s a thin cut running up my elbow from where my hand rested along the seat-back when the first blasts blew out the windows. Later I’ll find several bullet splinters embedded in the flesh of my upper arm.

Out in the courtyard there’s a debate going on. I see two olive-colored pickup trucks with a bunch of uniformed gunmen in them. One has a fifty-cal machine-gun mounted onto the cab. Elsewhere it’d be called a ‘Technical‘. Emmanuel and Essam are discussing what to do next. The soldiers have offered to escort us back up the road to Nyala with their guns. We still have no confirmation as to when- or even if- a chopper is really inbound. What do I think?

I consider driving back through the ambush site and my stomach clenches. I recall the roar of gunfire pounding through the Land Cruiser. In my mind I imagine what a stray burst of bullets would do fired out of the bush as we pass by once more, and I have all the fodder I need. I think it’s truly terrifying. Then I think back to the journey away from the attack site, crouching holding Abdul’s body. I think of the pain in my own body. I think of the way his head slammed against the floor and against the bulkhead each time the car hit a rut. I know there’s no way I can manage him for over an hour back to Nyala like that, and I’m pretty dubious about his chances of survival in his fragile state. I tell them as much, pointing out I can’t guarantee that he’ll make it back home if we do that. They nod, take my counsel on board, and to my great relief, agree that they’ll wait for the chopper for now.

The thought of spending the night out here with Abdul slowly waning doesn’t fill me with hope, but selfishly it’s still infinitely preferable to riding back along that road.

I wander with Essam and Issa to our Land Cruiser. It’s the first time I’ve seen it properly. It’s a grounding sight. Glass in most of the side-windows on both sides of the truck has been shot out. There are bullet holes in the fuselage. One above the driver’s door a couple of inches above the man’s head.

I don’t really do the maths until later. It’s funny what sticks in your head. For some utterly illogical reason I assumed just three shots were fired, because I heard three loud bangs. This fit with the three bullet wounds that my colleagues had. Seeing the car for the first time, I begin to realise this is far from the case. More likely, the gunman just squeezed off whatever was in his magazine.

I climb inside. Blood is dried everywhere. Splashed on the seats and pooled on the floor. Dribbled down the inside walls. I think of photos I’ve seen from the Middle East after militants are assassinated in their vehicles- broken glass, bullet-holes, dark red-brown stains.

I look forward. The strut behind my seat has taken rounds. Two dark holes are torn into the frame, inches behind my back, between myself and Essam. A third has gone straight through the bolt mounting the shoulder-strap of my safety-belt into the vehicle, right behind my head. I take the information in with considerable detachment. It doesn’t really compute just yet, but it explains why I’m still having a hard time hearing anything out of my right ear.

I try again to find out what’s going on with the chopper. It’s now mid-afternoon, but I have the same response. They’ve been told the chopper will be coming soon. But nobody knows whether it’s actually left Nyala yet, or if we’re being told something by somebody who doesn’t know anything.

I go back inside to sit with Abdul. He’s in and out of consciousness and when he’s with it, he tries to smile and tell me he’s okay, but he’s in a lot of pain. I can’t possibly know it right now, but the impact of the bullet slamming into his head has fractured his skull and shoved two splinters of bone into his brain tissue. He’s paralyzed on one side of his body, and his blood-pressure is becoming critically low.

I wander to the window that looks out over fields and the bush at the back of the village, and in my mind’s eye I see hordes of Janjawid fighters hurtling towards us. I really, badly want to be gone from this place.

Part 3: Evac, next

Images:

1. Stuart Price/African Union Mission in the Sudan, via Reuters, from http://www.david-kilgour.com: ‘Despite Aid, Malnutrition in Darfur Rises’ (link embedded in photo)

2. Uncredited, from http://www.studentsoftheworld.info (link embedded in photo)