October 20, 2005
"From their eyes, you can see how disturbed the children are," says Silke Krämer, a surgeon with Doctors Without Borders/Médecins Sans Frontières (MSF) in Muzaffarabad, Pakistan, one week after the earthquake. The German surgeon has been providing emergency aid here for four days now and has been distressed by the number of wounded children. "Many have serious injuries to the head. Sometimes they have holes in their skulls the size of the palm of your hand. Yesterday, I saw a child whose ear was only hanging on by one small piece of tissue."
The 44-year-old starts by helping the staff at a hospital in Muzaffarabad, in which local doctors started offering makeshift service a few days after the earthquake. Initially, operations take place in normal clothing. The following day, the operating staff members have green sterile clothing. Early on, the working conditions change from day to day. As soon as there is even the slightest chance of medical supplies arriving, the teams from MSF set off in an effort to reach remote areas by helicopter, car, or even on foot.
"Away from the towns, the valleys of Kashmir are very sparsely populated," says Silke Krämer. "This is why we stop our vehicles wherever we find injured people." As soon as they do, people who have brought their injured on boards or stretchers they have built with branches surround the vehicle.
The team quickly gets out the emergency medical supplies and treats the injured by the side of the road. One 12-year-old girl has had her foot crushed by the rubble. In the rush of the day's events, Krämer cannot remember her name. The girl's wound is open and very infected–the surgeon rinses it with iodine, bandages it up, and then takes the girl to the nearest open hospital for further treatment. A few minutes later, she and the Pakistani nurse Isfahan cobble together a splint with cardboard to stabilize a two-year-old's broken arm. Plaster casts are due to arrive the following day.
During the first few days, Silke Krämer is mostly busy cleaning wounds, providing splints for broken bones, and administering antibiotics. The longer the wounds go untreated, the greater the danger that the injured could die of infection. But that, of course, is not the end of it. Many injuries have to be treated further, some with operations. The surgeon is also certain that some of the injured will end up having limbs amputated.
The mobile clinic is brought to a halt again and again where the sections of road have slid down into the valley or been blocked by rocks and debris. At this point, the team has to rely on local information and continue on foot to the next place where there are supposed to be injured people–weather and daylight permitting.
Most of the hospitals and clinics collapsed during the earthquake. Where this is the case, the team puts up a tent for treatment. Seriously injured people are then flown to the capital Islamabad as soon as the weather is good enough and one of the few helicopters can be commandeered.
Silke Krämer explains that the Pakistanis are extremely willing to help. "People who have lost half their family come to us and help wherever they can. After all, people need a minimum level of constant medical attention alongside shelter for the winter."
At the hospital in Muzaffarabad, she came across the 12-year-old girl with the foot injury again. "But I couldn't bring myself to ask what had happened to her parents." Many survivors will need psychosocial counseling to carry on after such a tremendous loss.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)