Gogjali, Iraq: More than a dozen times a day, the doctor and his skeleton staff at a makeshift trauma centre near Mosul repeat a ritual: identify a wound, try to stabilise it, wait for an ambulance and hope the patient survives the journey to a better-equipped facility up to a two-hour drive away.
Most of the patients were shot by Daesh snipers or injured when mortars hit their homes, and not all of them will make it.
The stopgap medical centre is part of a network that Iraqi and international health workers are racing to establish, staff and supply to cope with a tidal wave of critical injuries.
Doctors in an array of medical facilities around Mosul — including military-run field clinics and mobile treatment centres — are struggling to keep up with demand as the offensive against Daesh grinds on.
As Iraqi forces have pressed deeper into crowded neighbourhoods, more than a third of the civilians fleeing require trauma care, a significantly higher proportion than international health experts have seen in other conflicts.
Altaf Musani, who heads the Iraq mission for the World Health Organisation (WHO), said the worst may be yet to come, with the most densely populated portions of Mosul still in militant hands.
The WHO, together with Iraqi health authorities, is coordinating medical efforts for those in Mosul and about 100,000 displaced residents, more than half of whom are sheltering at nearby camps. International organisations including the WHO have trained doctors in trauma care, provided surgical supplies, and fielded several dozen mobile clinics.
Ahmad Doberdani, a senior health official for Nineveh province, where Mosul is located, said officials reporting to the Iraqi government and the nearby Kurdish regional government had been working for months to position medical staff and supplies as close to Mosul as possible. Still, he acknowledged, the needs since the offensive began this fall have exceeded what officials can provide.
“This is a huge military operation, and the scale of the injuries to civilians and military personnel — especially civilians — has been very big and surprising,” Doberdani said.
Medical workers say patients with ordinary health issues — heart problems, diabetes or childbirth — are also struggling to find treatment in and around a city torn apart by war.
Health groups are working to set up better facilities in the camps and establish or rehabilitate facilities in recently cleared areas to shorten travel times to functioning hospitals.
Closer advanced medical centres could make all the difference for patients like the ones treated by Arshad Khalid Mohammad, the sole physician at the trauma point in Gogjali.
When Mohammad’s home was shelled, he moved his family into a building behind the clinic, and now can attend to patients when they need care. “I’m alone with the service staff, on call day and night,” he said.
Once his patients are triaged, they are put in ambulances to begin the drive to the closest functioning medical facilities, often to the region’s two sole trauma hospitals, more than 50 miles away in the city of Arbil.
When patients reach the borders of Arab-controlled northern Iraq, they are transferred to a Kurdish ambulance, adding more time to the journey. If checkpoints are backed up, the drive to Arbil can take up to two hours.
There is also a shortage of doctors and nurses in Nineveh province because so many have been displaced by the fighting or remain trapped behind Daesh lines, experts say.
Some Iraqi officials have criticised health-care providers for not establishing facilities around Mosul earlier. Faris Al Brifkani, a radiologist from Nineveh who is on the Iraqi parliament’s health committee, said the government hadn’t coordinated properly with local authorities to prepare.
Humanitarian officials, meanwhile, say they lacked the resources to plan for such a large-scale emergency.
Even the best-equipped trauma hospitals near Mosul are struggling to cope with the crush of serious injuries. Since the operation began, the 65-bed Emergency Management Centre in Arbil has treated more than 650 patients, most in serious condition.
The hospital is running low on certain medicines, while salaries have been slashed for the dozen doctors on staff amid a local economic crisis, hospital administrator Pishtewan Bagok said.
In the women’s unit, 69-year-old Sharia Sharif described being hit by a mortar shell near her home. Sharif’s leg was badly broken, but she was trapped in her home by fierce fighting, unable to get treatment, until Iraq evacuated her three days later.
Mosul residents say that Daesh, which captured the city in June 2014, kept its hospitals open, but that the facilities often lacked medicine and staff. The militants ordered public servants to report to work and threatened to execute doctors fleeing the city, but some left anyway or stayed home.
Sabrin Fawad Hamadi, 19, had her first baby in Mosul shortly after the militants arrived.
Nearing the end of her second pregnancy this fall, she and her family decided to leave the city’s Hay Al Bakr neighbourhood, which came under intense shelling after it was taken by Iraqi troops last month.
Now Hamadi is one of tens of thousands of people at the Khazir camp east of Mosul, where bare-bones medical facilities are crowded with people seeking care.
To help deal with maternal health needs in the camps and recently liberated areas, the United Nations Population Fund in Iraq has deployed mobile delivery rooms on the back of trucks. Four of the rooms are in use, with hot water, a power supply, and delivery and recovery beds.
Hamadi slowly climbed the stairs into the mobile unit at Khazir camp. Inside, Nada Khalil Ebrahim examined her. Hamadi was in labour but wasn’t ready to deliver.
The mobile unit would normally suffice for a routine birth like Hamadi’s, but she would need to be sent to Arbil because no doctors would be on duty in the evening when her baby was expected to come.
“Take a breath,” the doctor told her, as another contraction hit.
As they waited for the ambulance, Hamadi’s mother, who also fled the bloodshed in Mosul, said they would name the child, a boy, Massoud.
It means “fortunate”, to mark the fact they were lucky enough to have got out.