Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  TA medic Staff Sergeant Bob Steer opened the rear doors of an ambulance that had just arrived at the hospital to find an entire Iraqi family, ‘a lad, a baby, a mum and dad’, inside. Their house had been hit in a bombing raid. ‘The baby was burnt to a cinder, dead. The boy had had his arm blown off. It was my first real experience of major trauma and, though I had trained for situations like this, it knocked the stuffing out of me. I can still see the image of that family.’

  Lieutenant Colonel Paul Parker, a surgeon in one of the close-support operating teams, treated two small boys, brothers, both with terrible, suppurating leg injuries. Their distraught father did not want his five-year-old son’s leg amputated. ‘That was very emotional,’ Parker recalled, ‘especially when you have kids of your own, as I did. But I knew I had to amputate. If I didn’t he would die of infection. These are tough decisions, because you have to make them pretty much on your own. You are out in the field, miles from anywhere and you just have to get on and do it.’ This burden of responsibility was why he believed front-line doctors had to be experienced. A war zone, where decisions came thick and fast and the price of dithering could be an unnecessary death, was no place for juniors with L-plates.

  Parker felt the hand of history on his shoulder, linking him to an illustrious past, when, near Basra, in a cemetery by the River Tigris, he discovered the grave of a pioneering and reforming military doctor, Sir Victor Horsley. A major in the RAMC in the First World War, he did important work at Gallipoli, and then in Mesopotamia. He had been years ahead of his time, declaring his wish to get as near to the front line in any conflict as he could, because ‘there is no doubt that one can be of most use the nearer to the firing line, as the worst cases are the most difficult.’9

  That Parker was even able to make this journey into the Iraqi countryside to honour a long-dead medical hero was significant. It meant that in the immediate aftermath of the successful invasion of Iraq and the downfall of Saddam, there was a semblance of peace. One soldier recalled the joy of being welcomed as liberators by the local population. ‘Children lined the streets waving and hoping for ration packs of sweets and biscuits that we tossed to them.’ Parker felt safe enough to put on his lycra shorts and go jogging outside the camp, exposed and unprotected apart from sunblock. The locals waved, and he would wave back. The smiles, though, would not last.

  *

  Though Baghdad had fallen, Saddam was in hiding, and the then US president George W. Bush had declared the war was over, medic Bob Steer was taking no chances. He was in a convoy motoring from Basra – where the British forces were now digging in – to the town of Al-Amarah to pick up a nurse and escort her back to base. This being his first time out on patrol, he decided to wear body armour, much to the amusement of the driver of his soft-skinned Snatch Land Rover, a laid-back Liverpool lad who, in the intense heat, preferred the ease of a thin T-shirt. As they drove through the desert, Steer sweltered ‘like a stuck pig’, but was still reluctant to chill out. He jammed his helmet tightly on his head and clung on to the rifle he had just been issued with. He had the last laugh. ‘We were in the middle of nowhere and passing an old burnt-out tank when somebody opened up with a Kalashnikov. Bullets whizzed over the top of us.’ The driver hurled himself down into the well beneath the dashboard, and the vehicle swerved from side to side as he tried to steer, unseen and unseeing, from the floor, with just one hand above his head on the wheel. Steer tried to crawl into the back to return fire but was stopped short by the bulkiness of his body armour. By the time he freed himself, they were past the danger point. The ambush, brief and, on this occasion, bloodless, was over. But it was a sign of a changing situation.

  A new and deadly war was beginning. The conquest of Iraq had been pretty much a free ride for the coalition. The cost of hanging on in there to stabilize this benighted country and perhaps help it towards democracy would be enormous.

  13. Under Siege

  For British troops in their fortified camps in the southern Iraq provinces of Maysan and Basra in the summer of 2003, each day’s dawn was signalled by ritual recitations from the Koran amplified from the minaret of a nearby mosque, followed by the rapid crackle of AK47s. In the early days of the British occupation, the guns were fired into the air by local men as a daily demonstration of joy at the demise of Saddam Hussein, long hated in this region of marshland, waterways and oil wells two hundred miles from Baghdad. The soldiers were irritated at being woken from their sleep in this way, but also concerned. The indiscriminate loosing off of volley after volley indicated that the local population had no shortage of either guns or ammunition. The question was: how much longer would they be content to aim them harmlessly over their own heads?

  The truth was that, very quickly, the British presence came to be resented. The people in this area had a fierce tradition of independence. They had been unusual in defying Saddam over the years, and had been persecuted by him as a result. They had thrown out his ruling Ba’athist party in the very first days of the invasion, and chased away his soldiers days before the British even arrived. They were not grateful for being liberated, because – as they saw it – they had liberated themselves. And now – as they saw it – they were under occupation. All too soon the early-morning fusillades began to represent anger, not joy. However, it would take some serious casualties before the politicians calling the shots on the coalition side grasped that the mood had changed and that the isolated, under-strength and under-equipped British contingent was facing a growing insurgency.

  What began with graffiti and stone-throwing turned into gun-slinging and full-scale fighting in a frighteningly short space of time. It was the way in this part of the world. Iraq, as historian Richard Holmes explained, was not only dangerous and unpredictable, but ‘its stark, shocking violence is binary, full on or full off, often with little warning that the switch has flicked.’1 Six military policemen, soft red berets on their heads rather than hard hats, and only lightly armed, for a friendly, hearts-and-minds visit to the civilian police chief in the town of Majar al-Kabir, were caught out by the mood swing. A mob turned on them and butchered them in cold blood. A platoon of paratroopers on a separate mission in the town was outgunned in a fierce firefight and barely managed to escape. A Chinook helicopter sent into the town on a rescue mission was forced away by rocket grenades, narrowly missing crashing into overhead electricity lines as the pilot piled on the power and pulled away from trouble. A hundred bullet holes shredded its armourless skin, and seven of the twenty-man quick-reaction force on board were hit. Back at base, a bullet was found just inches from the gearbox. If the aircraft had been brought down, there would have been little chance of survivors.

  Territorial Army medic Bob Steer was waiting at the helipad with four ambulances when the Chinook arrived back. His job was to guide it smoothly in. ‘I could see it way out in the distance, then it came straight on and did what I can only describe as a handbrake turn on to the landing site. The pilot ignored my signals and just got her down fast.’ This was an emergency. ‘The ramp went down, and the loadmaster frantically signalled us forward. Inside was complete carnage, with Paras yelling and screaming, and blood and guts everywhere.’ All the casualties he had received until now had come in ones and twos, and generally been stabilized and sedated by the time they reached him. But this was a job lot of frightened boys with fresh wounds, suffering badly. The half-mile drive to the base hospital was nightmarish, and remembered by him as testing in the extreme. The casualties were handed over to the A&E trauma team, and Steer stayed to help, putting up drips and taking blood pressures. ‘I was glad to be doing my job, being part of a team.’2

  The Majar al-Kabir incident in June 2003 was glossed over. To the anger of the squaddies (and the families of the dead men), the murder of the six Red Caps went unpunished, subsumed by the political imperative of trying to remain at peace with the local populace. But it was a pointer for the future. The days of relaxed patrolling were over. Helmets went back on heads, body arm
our was routinely donned, and rifles were cocked as the British forces increasingly became an army under siege. Deaths and injuries would rise inexorably in the coming years and, by the time the British garrison withdrew in the spring of 2009, a total of 179 troops had come home in body bags and more than 400 suffered serious battle wounds.

  Sergeant Major Dave Falconer of the 1st battalion of the Princess of Wales’s Royal Regiment – who were dispatched to Iraq in 2004 – gave a solemn, and deeply important, promise to his men that, if they were wounded, he would personally come and rescue them. At the end of every pre-battle briefing session, like an old-fashioned police sergeant sending his officers out on the beat with a cheery ‘And be careful out there…’, he reassured them with his pledge: ‘I will get you out.’ He converted a Warrior tracked troop carrier into his own ambulance, with stretchers, oxygen, intravenous fluids, chest seals, dressings, morphine and painkillers, plus a medic in the back to administer them. Whenever the call came that one of his men was down, he would race to the scene in minutes. ‘The soldiers needed to know that, when things went wrong, I would be there, through thick and thin,’ he explained, ‘that I was going to get them off the ground and back down the chain.’3 It was this assurance that sent them into battle with the confidence to give of their best.

  But being in a Warrior was no guarantee of safety, as Sergeant Adam Llewellyn was to discover. By now, a full-scale insurrection had taken hold, orchestrated by the so-called Mahdi army of Shia militiamen which had collected around a militant ayatollah, once an opponent of the Sunni Saddam, now an implacable enemy of the kafirs (non-Muslims) occupying what he saw as his holy land. Virtually every patrol that went out was being ambushed. What the military theorists were describing as asymmetric warfare, between forces of totally different sizes, with no fixed lines and an irregular enemy concealing itself among a host population, was being enacted in every town and along every highway. Its weapons were not those of mass destruction but small, precisely targeted and very effective.

  Majar al-Kabir, where the Red Caps had died, had become a complete no-go area. In Al-Amarah, the provincial capital of Maysan, the soldiers were tasked to take back the streets and reassert the authority of the tottering coalition-backed civilian authorities. They set out from the aptly named Camp Cherokee into Indian country. In his Warrior, Llewellyn was standing in his turret, the last but one in a line of vehicles driving slowly through the town, when a small boy, no more than ten years old, he reckoned, darted from cover and hurled a petrol bomb. It smashed on the front of the troop carrier, and the flaming fuel exploded around the sergeant. His screams pierced the air, and he jumped to the ground, rolling around, on fire and panic-stricken.

  The sight was terrifying. The rest of the patrol ran to help him, doused the flames and, mindful of the possibility of follow-up sniper fire, bundled him into the back cabin of his Warrior. His mate, Sergeant Chris Broome, tried to ease his burns with water, but the inside of the Warrior was so hot that the scalding liquid just burned his skin even more. ‘I gave him morphine, but it didn’t seem to work. His screams were going right through me. His shirt was completely burnt from his arms, and the skin was hanging off in a terrible mess. His hands were just raw flesh.’ Above them, the turret was still blazing, and the flames were beginning to lick towards the Warrior’s ammunition locker. Broome broke off to put out the fire with an extinguisher and then returned to his badly injured mate, comforting him as best he could before they were taken to safety. It would be many painful skin grafts later before Llewellyn was anywhere close to recovery. His hands and arms were unusable for a long time.

  The fact that a child had been responsible for such devastating injuries angered the troops. Major James Coote had to calm first himself, then his men. ‘We had been stoned by kids before, seen gunmen using women and children as human shields and as weapons carriers, but this was the first time someone had sent a child to physically attack us. My initial reaction was to go back in and hand out some retribution, but that would have undermined what we were there to do. After a few difficult talks to my soldiers, we went back into the area as peacefully as we could.’4

  Their restraint was commendable, but still the security situation deteriorated. Three months later, during a hot encounter in Basra, Major David Bradley was directing operations from a Warrior turret, trying to pinpoint an enemy firing position in a nearby building, when an RPG struck. It hit the rifle he was carrying, and the blast knocked him aside. He remembered a voice (his own) in his head saying, ‘This is bad, very, very bad.’5 He lifted up his right hand and saw it was cut in two. His body armour was burning. Just then, his driver leaned up from his seat below, grabbed him by the belt and tried to haul him down inside. But that was not the direction in which the major wanted to go. His instinct was to get out, and he began climbing from the turret until he was slumped on top of it. ‘The noise was incredible. Bullets ricocheted off the vehicle, and the crackle of high-velocity rounds intensified as the Mahdi militia tried to shoot me off.’ Somehow he slid himself back inside the turret, and the Warrior drove at high speed through the streets back to base, the gunner alternately firing his chain gun at anyone who looked threatening and poking the major in the ribs to stop him falling into a coma.

  When they got to Camp Cherokee, medics from the Royal Horse Artillery took charge of Bradley and found that shrapnel, including fragments from his own rifle, had blown clean through his body armour and deep into his chest. There was also metal in his right eye and a large cut on his face. His teeth and jaw were intact, which was a relief. ‘The prospect of facial reconstruction and eating through a straw for months was very unappealing,’ he later recalled. Also intact were what a sergeant demurely referred to as his ‘family jewels’. Bradley was grateful for this information. ‘Every soldier is concerned about his manhood at times like this.’

  He was helicoptered to the calm and air-conditioned field hospital at Shaiba, the airfield south of Basra which was the main base for British forces in Iraq, and hurried into the operating theatre. Just before the anaesthetic took effect, he told the surgeon to ‘sort me out so that I can go back and kill those fucking bastards!’ The doctor opened his chest and removed the shrapnel, some of which had penetrated perilously close to his heart. A massive bleed almost got out of control, and he arrested. Twice the monitor registering his heartbeat flat-lined, but the crash team went to work and pulled him back. All this he learned later. His first recollection after being given the pre-op anaesthetic was waking up in hospital in Birmingham four days later, hooked up to electronic monitors, his face and body swollen and covered in blood – but alive.

  His wife Lara was by his side. She had been at his bed for two days, waiting for him to come round. The fight to survive was over, but the battle to get better was only just beginning. There would be dozens more operations, large and small. His damaged hand was grafted to his stomach for three weeks to let replacement skin grow over the area destroyed by the RPG. One finger was amputated, and the bones recycled to repair the others. Slowly, he came back to life, coming off the feeding tubes in his throat and eating normally again. Physios worked on his limbs and lungs. Two months after that crushing strike in a Basra street, he was well enough to leave hospital and go home.

  *

  Just a week before Major Bradley left Iraq in a coma, on a stretcher and badly burnt, part-time medic Bob Steer had returned to duty. It was a year since the Territorial staff sergeant’s last posting there and, as he took his place on the trauma team, he could see instantly that the situation had massively deteriorated. ‘Same place [Basra], same hospital [Shaiba],’ but the wounds he was dealing with were of a different order altogether. Victims of road accidents and small children who had toyed unwisely with scatter bombs and mines had previously been the A&E’s staple diet. Now, there was a flood of military casualties from roadside bombs (IEDs) and shootings. The tension had gone up several notches and, with it, the caseload. ‘People were coming in with arms and leg
s missing and their bodies ripped apart by bomb blasts.’ On his very first shift in the hospital, a British soldier died on the operating table after an IED strike. ‘He was covered in blood and had lost a leg. I’d seen death before, but this was different. He was in our care, and it was hard to see him alive one minute and dead the next, you know, finished, final, all over. He was only in his early twenties. It brought home to me that what I was doing was for real. I had to ask myself whether it was worth it – not politically, but in a personal sense.’

  There was always plenty of routine medical work to do, and days went by with a run of minor injuries to deal with – cuts and bruises, a bad case of sunstroke. But over everyone hung the fear of a major incident. It became a reality one hot, sunny Sunday. A roadside bomb exploded underneath a Toyota pick-up crammed with Iraqi policemen. An American convoy coming in the opposite direction saw what happened, stopped, and not wishing to hang around in case of a second attack, hurriedly stashed all the bodies in a Humvee armoured car and drove straight to the hospital. Steer remembered them arriving without warning, ‘cars screeching to a halt, doors slamming and then these casualties being hauled in. There were ten of them, all Iraqi police apart from a detainee, and he was dead from head injuries.’ It was like a hospital in the UK being hit with a massive motorway pile-up or a train crash. ‘They all had fragment injuries and were screaming and shouting. There were broken arms and legs, and head injuries.’