Salvaging the human debris in Kabul

Dr Abdullah Salam has spent years dealing with the grim reality of war in Kabul.

KABUL // Having spent much of his life working at Afghanistan's main trauma centre, Abdullah Salam knows the horror of war better than most. "As a human being you have to forget everything, otherwise it is difficult to tolerate all of these problems," he said. Afghanistan is experiencing its bloodiest year since the 2001 invasion. Civilian and US military casualties are at record levels. But the difference between now and other tragic periods in the country's recent history is that the world is taking notice.

At Wazir Akbar Khan Hospital, in Kabul, Dr Salam was forced to watch when few other people cared. He started working as an orthopaedic surgeon there in 1992, just as a civil war was about to destroy large parts of the city. "When I was on duty I treated 35 patients in one night and I was alone. There was no space for the patients, so they were lying on the floor. There were no ambulances and no rooms because the number of patients was just increasing day by day," he said. That particular conflict killed tens of thousands of people, including colleagues of Dr Salam's when rockets hit the hospital. He can also remember victims being rushed in from across the capital with head wounds and their insides hanging out.

Militiamen even stopped ambulances from getting to the injured or commandeered the vehicles to help transfer weapons. "There were no rules for them," the doctor said. What followed is an era that is increasingly looked back upon with fondness by many Afghans. In the passing of the years, some have come to regard the Taliban regime as a time of relative tranquillity. Violent crime is now rife in Kabul, while elsewhere fighting between Nato-led forces and insurgents is tearing the country apart. None of these problems existed then, but Dr Salam is quick to point out that blood is being needlessly shed. "What do you mean by peace?" he said. "I remember Fridays were very bad days for doctors on duty. Every Friday we had two or three patients who had their hands cut off at Kabul Stadium and were brought directly to this hospital." As well as amputating the limbs of criminals, the Taliban enforced their strict interpretation of Islamic law in other ways that affected Dr Salam and his colleagues. Male members of his staff were forced to don turbans when going to work and the women had to wear burkas even when moving from one part of the hospital to another. Two Taliban were stationed on the premises to ensure the government's edicts were followed. "I came from the emergency room and my hands were full of blood. Then this man from the religious police just pushed me and said: 'Go to the mosque'," Dr Salam said of one occasion. "I said I had emergency cases, but he was not able to accept that. He said first I must go and pray, then I can treat the patient." In those days, the Taliban transferred their wounded from fighting what became known as the Northern Alliance to the hospital. In 2001, they took their injured elsewhere. The US military was initially "very precise" with its air strikes, Dr Salam said, but civilians continued to suffer. The majority of casualties from cluster bombs - which split into tiny bomblets that can lay dormant in the ground - were children. After a brief spell at the ministry of public health, Dr Salam is now director of the 210-bed hospital. Patients include people hurt in gunbattles over land disputes and victims of car accidents. Suicide attacks are another fact of life. In several cases the blasts have left behind corpses so badly disfigured they cannot be identified and ultimately go unclaimed. "Sometimes we are not able to keep a body for more than a month in the hospital," he said. Dr Salam comes from the southwestern province of Farah, but it is no longer safe to travel there. Insurgents regularly kill government employees across Afghanistan. The dilemma that men like Dr Salam now face is whether, after all that has happened, it is time to accept there will never be peace and finally leave the carnage behind. "To be an immigrant in another country is difficult," he said. "Here you are a doctor, you have a position. But if you go you will just have a low-level job. Psychologically it will effect you a lot, but it's the only way you can keep from all this." [e-mail]