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August 2007

Getty Images photographer Marco Di Lauro recently travelled to Afghanistan to investigate the work of medics in a war zone. Here he explains in his own words how a British Army field hospital is saving the lives of locals and soldiers alike.

The most advanced hospital in southern Afghanistan is housed in a tent in the middle of desert and provides life-saving treatment to injured ISAF soldiers, Afghan government troops, Taliban fighters and the innocent civilians caught in the middle of the conflict.

The British Army Field Hospital in Camp Bastion, run by the United Kingdom Joint Forces Medical Group, has developed groundbreaking trauma management practices to improve the survival rates of causalities among the personnel of NATO’s International Security Assistance Force (ISAF) operating in Helmand Province. The patients are British, Danish, Estonian, Czech and American troops operating under the command of Task Force Helmand, but also significant numbers of Afghans from the Afghan National Security Forces, the Taliban and the civilian population.

By including consultants in its Medical Emergency Response Team, medical personnel ensure that clinical assessment can be started the moment a casualty is retrieved from the battlefield. This unique method of reducing time spent in medical reception and stabilisation has enabled patients to move from the helicopter to the operating table, via accident and emergency, sometimes in less than twenty minutes.

The hospital boasts a five-bed accident and emergency department equipped with two portable digital x-ray machines, a CT scanner and an operating theatre where two patients can undergo surgery simultaneously. Ward space is provided for 25 casualties, including up to eight patients in intensive therapy beds, although the number has surged to 50 patients at one time. In addition to accident and emergency, surgical and ward care, the hospital also has physiotherapy, pathology, dental and welfare departments.

I arrived at the British Army Field Hospital at Camp Bastion May 5, 2007, and immediately had to deal -- photographically and emotionally – with the scene of six British casualties brought in by helicopter from the front line by the British Army Medical Emergency Response team.

© Marco Di Lauro/Reportage by Getty Images

It was the beginning of my six-and-half-week embed with the British Army in Afghanistan and I was already facing the horror of the war: young British troops seriously wounded by an RPG (rocket propelled grenade) attack carried out by the Taliban.

Photographing casualties in a military hospital is usually a very sensitive matter to the military and, of course, I didn’t want to be in the way of the trauma teams operating in the RESUS (resuscitation department), during the resuscitation process and dealing with multiple casualties simultaneously, so I decided to photograph from a corner. Also, I imagined it must have been a little bit awkward for them as well to have a photographer working in that situation.

In all, over the next six and a half weeks, I spent about 10 days at the hospital with the British military medical personnel from the UK Med Group. By the end, they were accustomed to my presence and seemed pleased to have me documenting their work. It got to the point where, when casualties were expected, they would make sure I was there to photograph and even that I was wearing a protective vest to protect me from the radiation of the portable X-ray machine used to assess the casualty before moving him into the operating theatre.

It was not the first time I saw massive amounts of blood gushing from an open wound, but I had never seen such a sight in a Western military hospital and never from Western soldiers whose cries I could understand. My past experience had been mainly with civilians in remote countries where I couldn’t really understand the language. It makes a big difference. I could understand clearly the meaning of the words of the trauma team and of the soldier lying on the stretcher. I could understand his pain, his worries and complaints. One was crying and screaming, and the trauma team kept telling him to calm down, that he would be fine. But it was clear they were simply trying to keep him calm because they didn’t really know if he still would be alive by the end of the day.

Outside the temperature was about 45°C and although the tent is air conditioned, it was hot and very humid inside. I could smell blood mixed with the body odour of the soldier, who probably hadn’t washed for days because of the lack of water at the FOB (forward operating base) where he was stationed.

Especially against the dusty sun of the desert, the scene was graphically overwhelming: the red of the blood and of the vests worn by some of the trauma team personnel and the green of some of the surgeon’s vests all mixed with the tent’s white fabric walls and the soldier’s khaki uniform stained with blood.

© Marco Di Lauro/Reportage by Getty Images

I was sweating both from the heat and the stress. The soldier had such a horrified, pained, resigned expression; his face and torso were full of blood and he had numbers written with a marking pen on his forehead. I later found out that the numbers were his blood pressure and pulse readings, written there by the British Army Medical Emergency Response team that picked him up at the front line.

The trauma team was able to stabilize him and then move him to the operating theatre were he underwent surgery to extract all the shrapnel from his body. He was flown back to a military hospital in the UK a few hours later, as is standard for all the soldiers passing through the field hospital.

British Army Major Andy Bruce, a surgeon, gave me a better understanding of the real proportions of the war in Afghanistan by describing the number of casualties they were receiving from the front line and the amount of stress and hard work the medical personnel faced.

Major Bruce said he had been at Camp Bastion seven weeks and he had performed about 130 surgeries. He said a surgeon back in the UK usually does no more than two or three surgeries a week.

The hospital had three surgeons – an orthopedic, a general and a neurosurgeon – but Major Bruce, the orthopedic surgeon, was the busiest since most of the casualties had injuries to their limbs. The soldiers wear a bulletproof jacket that protects their upper bodies, but leaves their limbs vulnerable. In addition, many of the injuries suffered by both civilians and military are caused by shrapnel due to road side bombs, IODs (improvised ordinance devices), land mines and RPG attacks.

The days passed and almost became routine as casualty after casualty came through the hospital and I followed them through what I call “the patient journey”. I would go out on a Chinook helicopter with the British Army Medical Emergency Response team to pick them up from the front line, carry them back to the hospital where RESUS worked to save their lives and stabilise them, then into the operating theatre and on to the intensive care unit or to the ward, if they were in better condition. Then they would be flown back to the UK.

One day, when I did not have the authorisation needed to go on the helicopter, I left the hospital to go with the ambulance troops to the landing zone to pick up a casualty. When the helicopter arrived, I saw four British soldiers come out with a body bag instead of a stretcher. I knew the soldiers who were carrying the body because they were from a unit I had been embedded with just a few days earlier.

© Marco Di Lauro/Reportage by Getty Images

The soldiers were British Army Company Sergeant Major Wayne Scully from the 1st Battalion Grenadier Guards Regiment and his comrades carrying the body of Guardsman Neil Anthony Downes, killed in action on June 9, 2007 from a roadside bomb.

I was there and I was photographing, and one of soldiers looked at me and said: ”It happened where we slept the first night. Do you remember? It’s Tony in the body bag!”

Tony, his fellow soldiers and I had been together in the same place, eating the same food, sleeping in the same tent. We had all slept in sleeping bags on the road during a manoeuvre in the exact same place where he was killed. Now I was taking pictures of them carrying him in a body bag.

This is probably the most distressing part of taking pictures during an embed with the military: one day you are photographing the life of a soldier – spending days or weeks with him and sharing feelings and emotions – and the next day you might be taking pictures of his death.

Also distressing is seeing the injured Afghan civilians, especially the children, looking at their eyes asking you how they got trapped in a war that is bigger than they are and why US fighter jets mistakenly bombed their villages.

The first time I entered Ward 1 of the hospital, I saw an Afghan girl wearing a red shirt, recovering in her hospital bed. Her face had been completely burned.

© Marco Di Lauro/Reportage by Getty Images

Eight-year-old Felishima was injured after the roof of her house collapsed on her following a mistaken US bombing on her village during the fighting between ISAF and the Taliban, according to her relatives and the British military medical personnel from the UK Med Group.

As soon as I approached her to take a picture and brought my camera to my eye, she started to cry. I felt so guilty being there to photograph her that it took me several days to approach her again.

I was totally moved by the smile of another little patient of the hospital, Malalia, a 5-year-old Afghan girl who was run over by an Afghan National Army vehicle while she was walking. Her right arm was crushed against a wall, causing potentially catastrophic damage to the bone, muscle and skin.)

© Marco Di Lauro/Reportage by Getty Images

She was taken directly to the operating theatre in the military field hospital and, initially, doctors thought an amputation was the only possible solution. But in rural Afghan society this would have resulted in her being ostracized, so British Army surgeon Major Andy Bruce promised her father that he would do everything possible to save her arm.

The dead and damaged muscle was cut out and the bone repaired with makeshift external scaffolds of wires, plastic tubing, aluminum bars and plastic ties because of the lack of specialised pediatric equipment. She required further surgery every two days for 16 days, then skin grafting was performed. Five weeks later, against all initial expectations, the arm had healed and Malalia was able to move all her fingers. It seems she will be able to use her arm again.

I was amazed by the commitment of the British military medical personnel from the UK Med Group in saving as many people as they could, no matter who they were; by the number of surgeries and people admitted into the hospital, and by the long hours worked by the staff. Sometimes I saw them working 24-hour or even 48-hours shifts without giving in. Those people were a lighthouse of humanity in a horrible war.


Marco Di Lauro’s equipment:

EOS-1Ds Mark II

EF50mm f/1.4 USM
EF24mm f/1.4L USM
EF35mm f/1.4L USM
EF85mm f/1.2L USM
EF24-70mm f/2.8L USM
EF70-200mm f/2.8L IS USM

Canon Speedlite 580EX
5 batteries for the EOS-1Ds Mark II
3 batteries for the EOS 5D

For this particular story Marco mostly used:

EOS-1Ds Mark II
EF35mm f/1.4L USM
EF50mm f/1.2L USM
EF85mm f/1.2L USM

Biography: Marco Di Lauro

Marco Di Lauro

Italian photographer Marco Di Lauro has been shooting for Getty Images since 2002 after working as a freelancer for The Associated Press. He has covered conflicts in the Middle East, Afghanistan, Africa and The Balkans, winning prizes along the way.