MOSUL’S MEDICS: REFLECTIONS OF WAR, FOUR YEARS ON

Amid the chaos and intensity of the battle against ISIS in the Iraqi city of Mosul, a critically injured girl was rushed into a makeshift field clinic less than a kilometer behind the frontline. During her escape from ISIS-held territory, the child had suffered multiple gunshot wounds and many other injuries that put her on the very edge of survival.

Within seconds of arriving at the clinic, Katie Batrouney, a paramedic from Australia, dressed the child’s wounds, stemming the bleeding to buy her some time to reach a hospital. As Katie carried the child out into the street in search of an ambulance, military vehicles screeched to a halt outside the clinic carrying more and more gravely injured civilians in need of emergency medical care, overwhelming the clinic’s few medics and limited resources.​

In that moment, I decided to set my camera aside and accompany Katie in the ambulance, hoping that I might be able to help in some way or at least offer my support. ​As the ambulance sped along the dusty, abandoned, war-torn streets of western Mosul, the child’s terror-filled screams began to weaken until she eventually stopped breathing. With no gurney or medical supplies inside the ambulance, Katie placed the bleeding child onto my lap and instructed me to hold her still while she inserted a needle into her chest, allowing air back into her collapsed lung.

As I held the child on my blood-soaked lap, her terrified eyes locked onto mine, I looked at Katie and thought to myself, how did we find ourselves here!?

WARNING: Some of the images below are graphic.

In June and July 2017, during the final few weeks of the military offensive to oust Islamic State militants from the narrow and densely populated streets of Mosul’s Old City, I had the opportunity to photograph a team of medics working less than a kilometer from the frontline.

With very basic and limited medical supplies, the medics worked out of makeshift field clinics – or trauma stabilization points – which they set up inside abandoned buildings, moving forward as Iraqi security forces reclaimed ISIS-held territory. As civilians escaped across the frontlines, often under fire from ISIS snipers and exposed to air strikes and IEDs, those who were sick or injured were brought to the TSPs for emergency pre-hospital care.

Documenting the extraordinary lifesaving work of the medics, both Iraqi and international, was a defining moment in my professional life, and undoubtedly one of the most moving and challenging experiences of my life. I was especially moved by the strength and fortitude of the female medics, who, for several weeks, I photographed and watched in awe while they worked tirelessly around the clock saving lives under extremely difficult and dangerous conditions.

On July 10th, 2017, victory was declared over ISIS in the city of Mosul. Four years on, I recently reconnected with Katie Batrouney, Alex Potter and Kyirsty Unger – three of the remarkable female medics of Global Response Management – to ask about their motivations for volunteering in an active war zone, their reflections on the experience, and the impact it’s had on them since.

KATIE BATROUNEY, PARAMEDIC AND NURSE 

Can you tell me a bit about your background?

I grew up in Melbourne, Australia, and from a young age I wanted to participate in humanitarian aid. My first experiences with aid work were when I was 17 and I went on a school trip to Bangladesh. After that,  I knew I would be suited to a career in the medical field and had my heart set on Paramedics.

I’ve now been an Advance Life Support Paramedic for Ambulance Victoria for over 6 years and recently completed my Nursing degree. I’m also working as a Nurse at a Supervised Injecting room that focuses on harm reduction and provides safe spaces for people who use drugs.

I have had the privilege to support people in crisis in Australia and overseas. I find my heart to be cemented in my international disaster relief and aid work. It’s where I believe I can make the most difference and where the support is lacking for these communities in crisis.

The malnourished baby was quite moving for me also; I found myself with the time to pause with this infant and reflect on the life they had had up until this point.

The girl with the multiple gun shout wounds had an eviscerated bowel and a gunshot wound to her chest that had pierced completely through. She was extremely unwell. I was able to dress her abdomen with specially designed combat dressing and place chest seals on the front and back of her chest. I then put an IV cannula in and gave her pain relief. The girl was becoming increasingly short of breath as the bullet had pierced her lung. She was showing signs of a tension pneumothorax, which can be temporarily relived with a needle decompression. A needle decompression involves piercing the chest between the ribs with a specially designed needle to relieve the built-up pressure in the lungs. It can be a lifesaving procedure; however, it is only temporary and the child needed to get into surgery as soon as possible.

I then escorted the patient to the closest hospital in the Ambulance while holding her on my lap as there was nowhere else to place her. During the Ambulance ride she began to re-tension, which is when I asked you to hold her still while I inserted another needle into her chest. The little girl made it to hospital, and I handed over to the surgeon who hoped to be able to operate on her soon.

Can you tell me a bit about your background?

I’m originally from Minnesota, but since graduating from college I’ve bounced around a bunch. I went to school for nursing but had always loved writing and photographing, even small stories for local agriculture publications when I was young. Throughout high school and college, I followed the coverage of Iraq and Afghanistan closely, and was really drawn in by the photos of something so different from where I grew up, and the idea that one could chronicle history in real time.

KYIRSTY UNGER, NURSE PRACTITIONER 

Can you tell me a bit about your background?

I live and work in the United States. I am currently a family nurse practitioner in Portland, Oregon, but I have a background in emergency and critical care nursing. I’ve worked in adult and pediatric emergency department, trauma center, and a burn critical care unit. Prior to this experience, I have had several experiences working and volunteering overseas in austere environments, which led me to look into disaster medicine and seek out training under that umbrella.

When did you travel to Iraq and what motivated you to volunteer as a frontline medic? 

I traveled to Iraq mid-June 2017. I had been involved with an organization called Global Outreach Doctors who referred me to GRM. They were seeking nurses with trauma and burn experience. When I read what the environment was like, I thought about all my training and disaster experience and felt it only made sense to put it into practice.

I thought, ‘if volunteering on a frontline wasn’t for me, who was it for?’ This realization was a strong force that pulled me to this assignment. I think it takes a certain type of person to put themselves out of a place of comfort into an environment of severe uncertainty. My personal life had led me to a place where uncertainty and discomfort felt normalized and I felt as though I would have been resilient enough to handle the experiences and danger. With that, I felt like if I could do this, I could be of use and make it out alive and spiritually sound then I should go. In a weird way, I felt called to it.

How long did you stay in Mosul? 

I was in Mosul for about a month. I traveled back and forth between the frontline area to Erbil so there were moments of rest within that time. My friends and I also tried to go back a few months later but were unable to get into the country due to the politics at that time.

You were working extremely close to the frontline – what were the main dangers you faced?  

The most incredible thing that I learned on this trip was the idea of ‘relative danger’. Prior to going to Mosul, I had plenty of discussions with my veteran friends and those who served in the Middle East. I researched IEDs [improvised explosive devices] and had reviewed some survival/worst-case scenario trainings. However, when I got there, I remember driving into the Old City, holding my breath waiting for bombs to drop or guns to fire at me, but it was never like that.

The danger surrounding me was insidious, but I rarely felt directly unsafe. Gunshots and airstrikes were blocks away. Strategically placed roadside bombs were detected and detonated by specialists. Stray bullets flew above my head. I think about it a lot. At home in Portland, in the United States, I would feel unsafe if a bomb went off across the country in Boston. However, in Mosul, the violence was close but never directly impacted me, and for that I was lucky.

Honestly, we were just well protected by the circumstances we were in. There is always an opportunity to be killed but I felt safe as ever. After the first three days, it all felt normal and by the time I left I wanted to be closer to that direct danger so I could be of more use and help more people. It was an incredible arc of acceptance.

What are some of your reflections on that period of time? What was the experience like for you? I remember being so moved and inspired by how calm and composed you and the other medics were all the time – how did you cope working in such an intense environment?  

I feel as though you could ask me this question every day and I could have a different answer. I wish I had kept a journal and had asked myself this directly after I returned home versus now.

In hindsight, I see my experience as incredibly personally informative. I learned so much about myself, the world, the military, and human capacity for strength and perseverance. While I was there, I felt enthralled to know I was actually doing something that was helpful. I think in health care, the systematic issues are confining and it’s easy to feel disconnected from the reasons and motivations one originally seeks in these types of positions. However, this was visceral. It was hard work as well as heartbreaking, exciting, and frustrating, while moving all at once. It made it hard to feel normal. It was hard to go back and hear people complain about their problems that seemed so abstract by comparison. At the time, being there didn’t register as stressful. The stress of my position was only hard when I returned home, and at times I feel like I’m still chasing the feeling that I really have something to offer.