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MSF Surgeon Recalls Kunduz Strike: ‘I Didn’t Need Convincing That I Was Going To Succumb That Night’

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On October 3 2015, MSF’s trauma hospital in Kunduz, Afghanistan, destroyed during accurate and repeated U.S. airstrikes. The assault killed 42 people, including 14 MSF staff members, 24 patients, and four custodians, and wounded dozens more.

Since 2011, the hospital had been free, high-quality surgical care to victims of general trauma, such as industrial accidents, as well as patients with conflict-related injuries. It was the only facility of its kind in the northeastern region of Afghanistan.

The attack has had devastating consequences for the victims, their families, MSF teams and Kunduz. Six months later, the hospital remains closed until further notice, leaving thousands of people without vital medical services.

Dr. Evangeline Cua is a surgeon from the Philippines who was working in MSF’s Kunduz Trauma Center in Afghanistan when US airstrikes destroyed the hospital on October 3. Here, she shares her narrative of surviving that horrific night.

MSF
Cua said she went through multiple debriefings, consults with psychiatrists and meditation techniques after the hospital attack.

It happened again last night. I woke up sobbing and disoriented. It had been three months since I went home from Afghanistan and, except for a fading scar on my right knee, that awful incident at the Kunduz Trauma Center was almost forgotten, squelched to memory.

Debriefings, consults with psychiatrists, meditation techniques, pages upon pages of journal entries to unload myself of the horror of that night–all of these were swept aside when memories came rushing back, triggered by a firework.

The acrid smell of smoking, the burning bodies and hair, the smell of fresh blood mixed with hospital cleaning agents, and the terror I felt that night became so real again that I had to resist the urge to panic, to operate, to seek shelter. Reminding myself that I am home now, I am safe, and nobody can hurt me, I started questioning why I was in the hospital on that awful night.

Anadolu Agency via Getty Images
Fire burns in the MSFhospital in Kunduz following the airstrike. Cua still remembers the “acrid smell of smoke, the burning bodies and hair, the smell of fresh blood mixed with hospital cleaning agents.”

We were like two headless chickens running in total darkness — me and the surgeon who assisted me in an operation. The nurses who were with us a moment ago had run outside the building, braving the volley of gunshots coming from above. I was coughing, half-choked by dust swirling around the region. Behind my surgical mask, my mouth was gritty, as if somebody forced me to feed sand. I could hear my breath rasping in and out. Layers of smoke coming from a nearby room stimulated it hard to see where we were. Blinking around, I caught sight of a incandescence, from a man’s hand holding a phone. He seemed mortally wounded but was still trying to send a message … perhaps to a loved one?

I stood transfixed , not knowing where to turning or “what were doing”. All around us, bombing continued in regular intervals, shaking the ground, sending rubble sweeping and flying. One. Two. Three. I tried to counting but there seems to be no abatement to the explosions. I stopped counting at eight and silently prayed that we could get out of there alive.

Fire licked at the roof at one objective of the building, dancing and sparkling in the dark, reaching towards the branches of the trees nearby. The ICU was burning. We decided that we had to go the other route, towards what had recently been the foyer of the hospital, where we could see a faint glimmer of light.

Trash crackling loudly under our feet as we headed in that direction. Loose debris continued to fall on us. Wires were hanging from the ceiling, and we were surrounded by mounds of junk, broken glass, timber, paper, cement, plastic, shreds and chunks of God-knows-what.

Pure chaos.

Fuck! The word came unbidden from my mouth. We had not constructed it very far when I tripped and fell down on something soft. A dead human body…or bodies? Oh, dear God! Stifling a call and fearing the worst, I slowly got up. There was a sticky wetness on the front of my operating room gown and my gloved hand. Hurriedly analyzing myself, I received a big gash on my right knee. Tiny pieces of glass were clinging on the surface of my OT gown. I ached all over. No major injuries, though. Good.

Walking slowly now, we decided to crouch near a wall in the only lighted area and waited for the bombing to stop. The stillnes was fazing. Everything was askew–the door was on the floor, a wheelchair was in the middle of the dorm, papers everywhere.

Outside, the constant humming from above pointed to the presence of something. Was it an aircraft? Was this an airstrike? Why the hospital? Why us?

Then, without warning, another tremendous, earsplitting explosion shook the building. The ceiling came crashing down on us and the last remaining illuminates were to turn, sending us into total darkness. I called in terror as wires pinned me to the ground. That was the last thing I could remember.

MSF
“The ceiling came crashing down on us and the last remaining lightings were turned off, sending us into total darkness. I screamed in terror as wires pinned me to the ground, ” Cua wrote.

I was 12 years old when I read a famous female surgeon’s biography. I dreamed of becoming a surgeon since then. “I am going to wear a scrub suit, ” I thought to myself. “With a scalpel in my hand, I’ll make a difference in other peoples’ lives.”

The desire to work in a war zone came later but it was prominent in my bucket list. I feel like I won the gamble when I got accepted by Medecins Sans Frontieres as a field surgeon. Physicians Without Borders! Despite the reminders and warns from well-meaning friends and relatives about the dangers of working in a conflict zone, I eagerly prepared for my first mission.

In a 100 -bed trauma center in a war zone, I was expecting to be inundated with patients, operating day in and day out, to be so exhausted that all I could do was crawl into bed and fall into a deep slumber each night. I wanted to do complicated suits. Bomb blasts. Gunshots. Cases I had only read in textbooks. Anything.

But I felt useless in my first few weeks in Kunduz. Except for the occasional liver injury sustained during motor vehicle accidents and some elective general surgeries, the majority of cases I encountered involved bones and fractures, something I have minimal knowledge about. And there were eight Afghan orthopedic surgeons who were so hotshot at what they were doing that I began questioning if I was of any use there at all.

I was bored. I wanted to operate on patients. I wanted to do more. It was the reason I was there, after all. I merely had two weeks before the end of my mission and, with a few exceptions, my life in Kunduz was one monotonous routine.

That is, until the fighting began.

Dan Sermand
At the time of the airstrike, operating theaters were in use, and surgeons and anesthetists were attending to patients. This photo shows an operating theater destroyed after the airstrike.

Car doorways … windows unlocked …. jump ….. vehicle …. stray bullets. No …. contact … stopped … the way.”

It was a few days before the bombing. Last minute instructions were being given to us. I couldn’t concentrate. The field coordinator’s voice drifted in and out of my consciousness. My belly was growling and I hadn’t had any sleep since last night.

“Okay? ” Four heads simultaneously nodded. I was barely paying attention. Trying to fix my head scarf with one hand, I was also busy writing a message to send back home.

Surgical team going to the hospital. No wifi there. Will call once I’m back in the staff house. Tell mom and dad not to fret. We’re safe. 🙂

Message sending failed.

Message sending failed.

Message sending failed.

Darn! Procuring my knapsack, and trying to hide my annoyance, I hurriedly climbed into the vehicle where a female nurse superintendent was already awaiting. The male orthopedic surgeon and anesthetist were in the other van.

Heart pounding and pulse racing, I tried to posture myself as low as possible near the door, ready to spring up and jump out of the car if necessary. I had lots of questions in my mind–what are we going to do if a bomb was thrown our way, if they wouldn’t let us pass, or worse, if we were kidnapped? I chose to be silent, to maintain an appearance of calmness, to focus instead on the journey to the hospital. The sunshine was already rising in the eastern part when the audio of detonations temporarily stopped and the surroundings became relatively quiet. When the run signal was given, the gates of the staff home were opened and two vehicles entered the deserted streets of Kunduz.

The atmosphere that dawn was in stark contrast to the previous weekend. Eid had just objective, which is a happy and celebratory time in the Muslim world. Not a single shooting was heard that weekend. Roses were in full bloom and the weather was perfect. Afghan humen were shaking hands and hugging each other; kids in their finest garment were playing in the streets, candies in their pockets; food was shared; people were freely strolling in the street, going to relatives’ houses to pay visits.

It had been a delight to see children, and even adults, waving at us as our vehicle passed through the street of Kunduz going to the hospital. The local staff and custodians greeted us with smiles. Eid Mubarak! Happy Eid, physician !

But two days after that idyllic weekend, after fierce fighting between government troops and the opponent, the city of Kunduz, after 14 years, was once again back in the hands of the Taliban.

I lost track of hour. The clock on the wall reminded me that it was already late afternoon. A barrage of gunfire and explosions continued in the distance. I had just finished my sixth surgery and was slowly drying my hands with a piece of cloth. My scrub suit and shoes had splatters of blood on them. I probably got them from the pregnant girl who was hit by a stray bullet in the neck, I thought to myself.

I was depleted. I had been on my feet for virtually nine hours already and my legs were aching. All I wanted to do was to eat a hot meal and sleep.

From somewhere, I heard a nurse went on to say that armed humen were outside the gates of the hospital–but had respected our “no guns” policy. “That’s good, ” I wailed to his direction, trying to audio cheerful. Hastening to the empty office, I opened my locker and got a packet of instant oatmeal. I missed breakfast and lunch; if casualties would continue arrived here the hospital, there was little chance that I could have a meal on time that night. So, I slowly ate, savoring every morsel of my food. A big “EATING IS NOT ALLOWED HERE” sign on the wall was the only witness to how hungry I was. I stayed in that spot for what seemed like an infinity, opposing off sleep, mentally reviewing the cases I did that day.

Then I heard my name being called.

“Doctor, can you find the patients at the ER and tell us who’s going to surgery first? ” There was urgency in his voice.

“Now? ”

“Yes , now.”

I was immediately given a white doctor’s gown to put over my soiled scrubs. Following him outside the operating room, it was a moment or so before I realized the strangeness of the scene before me. There were at least a dozen people on the floor. More were lying on stretchers parked on both sides of the ER lobby. There were women with blood-spattered shalwar kameez, one of them pregnant, another staring blankly at the ceiling; humen with tattered, bloody clothes; and a little kid moaning in pain, blood pooling where his legs should have been.

Men. Women. Kids. All were victims of violence.

I was shocked at the scene I watched. I strolled gingerly between patients, swaying gently, feeling light-headed. Wounded people were everywhere. And more were still coming in. I didn’t want to look and yet I had to.

Overwhelmed, I asked one of the local surgeons to accompany me to check patients’ traumata and their vital signs. We decided whom we should prioritize and wrote it on their respective charts. “This one goes to the OT first, this one’s next. The one with the bomb detonation on the abdomen is next at room two. And tell the caretakers we need blood.” And on and on we went. Twelve patients needed immediate surgery; the rest could wait.

It was going to be a long night for all of us.

Andrew Quilty
MSF’s trauma center was the only facility of its kind that provided high level life- and limb-saving trauma care in the whole of Afghanistan’s northeastern region. Here, Qudus brings his four-year-old daughter to the MSF hospital.

I walked slowly back to the operating room with a forlorn look upon my face. I was startled when an old wrinkled man with a full beard and kind eyes stopped me, and uncharacteristic for an Afghan man, tried to touch my limb. With a pleading voice, he asked me in halting English, “Doctor, please. My son is right there. Could you please take a look at him? ” pointing to the black zone.

Oh , no! The black zone is where fatally wounded patients who have very slim chance of survival are placed in the triage area. I wanted to send him away, to gently tell him to ask the assistance of nurses nearby. I was aware that I could not do anything more for his son–and unsure if I could stand the sorrow on his face if I told him about his son’s condition.

But I went with him, asking him what happened.

He was trying to evacuate. Reached by a bomb. No vehicle. Took them a long time to bringing him to the hospital.

“He’s a nice human, physician. My youngest son.” He was saying the words to me proudly, a hint of a smile on his face. I managed to suppress a gasp when I considered “the mens” on the stretcher near the wall. He was young, in his early 30 s perhaps. Multiple meanders of various types of sizes covered his extremities. Bomb blast. On his chest, a big gaping meander gave me a view to his partially exposed lung. He already had a glassy look in his eyes and had no palpable pulsing. Trying to do something, anything, I adjusted his intravenous line. I gently encompassed his chest with hospital linen and, in a breaking voice, told the old man to excuse me and that I’ll ask one of the nurses to tend to his son.

The grateful look in his eyes, as if I had given his son a second lease on life, will haunt me forever.

The constant element of my nightmares was the thundering sound and panels of timber crashing down on us. And shriekings. Mine. Then me tripping and landing on the floor.

I vividly remember that moment. My ears echo and the wind was knocked out of me after the explosion. My heart was slamming against my chest. I was too stunned to move. Lying there stiffly, I became aware of a hand holding me, tugging at me.

“Get up! Come on.”

I slowly stood wincing in pain, trying to see him in the dark. “Stop pulling me! ” I wailed. A thick cable was on my chest, restricting my motion. My body hurt, like somebody hit me with a leading tube, yet I knew we had to get out of there. There was no time to waste.

I clumsily tried to free myself from the tangle of wires and cables, wondering where the others ran. A moment before, while we were huddling near the wall waiting for the bombing to stop, a group of five kids and two women–each holding an infant–had joined us.

A hair-raising scream from a young voice shattered the stillness. Then there was another screaming, of anguish this time. Running steps followed. Then, as if nothing happened, it was quiet once again. Oh, God, I said with dread. Somebody just got hit.

Freed from the cables, my colleague and I starting running out of the building. It was still dark outside. The outlying houses were meters away and it was too dangerous to run in the open field and go there.

Where? Where? He seemed to be saying. He was looking at me, asking me which direction we should operate. Doing a quick assessment, I realized that operating towards the gate of the hospital, towards the streets, would be an unwise choice. We had no idea what’s going on beyond the gates. Then I insured the unmistakable slanting roof. The cellar! Thank God.

“Left side. Running to the cellar! ” I screamed. We operated and jumped into the hole. To our horror, and big frustration, we detected ourselves inside the exhaust of the cellar window. Surrounded with thick cement walls, about seven feet below the ground, it was covered only by a thin sheet of roof above. An abyss. A dark space. Dead objective. The basement was on the other side of the wall.

We were like two mice who ran into a trap. Resigned to our fate, I mutely reminded myself that we had done everything. If this is where we are going to die, then so be it. Settling down beside my colleague, I closed my eyes, hopeless, worn out, but feeling curiously safe and comfy. Absent, dreamy. Must be hypoglycemia.

“It’s going to be alright. We will get out of here.” He was trying to reassure me but there was a hint of anxiety in his voice. I could hear his heart beating loudly. His breathing was fast. “Yeah, perhaps, ” I answered, trying to convince myself, too.

The wind was blowing to our direction, fanning the smoke towards us. Coughing, tears streaming from our eyes, we struggled to not inhale the smoking. The voice of crackling wood and foliages were the only other indication that there was a flame nearby. Bombs continued dropping in the hospital. At one point, the ground shook so hard we thought it was the end for us.

“Pray with me, ” I heard him saying with terror in his voice. “Allah…” I merely heard the first term of what he said.

“What? Say it again. Slowly.”

Patiently, like a teacher, he guided me through the prayer.

La…La, I repeated.
Ilaha…ilaha
Illa….illa
Allah…allah
La ilaha illa allah

I barely heard him from the cacophony of noise above us. In all honesty, I did not understand what I just recited but I prayed it with all my heart, holding on to any hope I was being offered. Maybe Allah, in his goodness and mercy, would keep us safe. “I am not Muslim but I pray for your protection. Keep us safe.” I silently begged Him.

At the same time, I was thinking of my mommy. What would she feel if I was returned home in an urn, merely a mound of ash? Worst, if I would burn to demise here and nobody would recognize my remains. Unidentified. Missing for eternity. I shuddered at the thought. I wanted to spare her from that agony. But how? How?

There was stillnes between us, occasionally interrupted by a explosion of gunfire or a big explosion that seemed far away. I could only ensure his outline in the dark but I knew he was deep in thought, too. I was drifting in and out of consciousness. Dog-tired and hungry, all I wanted was to sleep.

My mind wandered to five days prior, when existing conflicts started. It had been a blur of surgeries, which sometimes meant staying at the operating theater for 16 hours straight-out. My limbs were red and raw from constant scrubbing. I would wince in pain whenever I prepare for surgery. “You’re losing weight, ” one of the local surgeons told me. I did. I lost appetite from ensure all the wounded day in and day out.

Sleep was a luxury. I tried sleeping in the dressing room whenever I could–on the narrow bench, even on the cold floor sometimes. There was no stopping the flow of injured people seeking therapy at our hospital. There was just too much to do and I feel like we were not doing enough. But the anguish on the faces of mothers with injured children was enough to keep me going.

I was functioning like a robot on those days–emotions off, merely concentrate on the task at hand and do as much as I could to save lives. There was no time to get emotional even if I wanted to cry. Crying was always bad for morale.

The day before the bombing, October 2, it was quiet at the hospital. We were woken up–me, the other surgeons, the anesthesiologist–from deep slumber. “Morning meeting guys, it’s already 8 a. m .! ”

I woke up refreshed; eight hours of sleep, that was good! It felt like things were going back to normal. We could now stroll across the open field to the hospital without fear of getting hit by a stray bullet. And there were very few patients’ names on the white committee outside the OR. I did rounds in the outpatient department, something we had missed doing for almost a week.

Life was good in Kunduz, again!

We scheduled a young man at the ICU for surgery. Two more of my patients at the ICU also needed repeat surgery. We wanted to finish all the cases scheduled on the board that night.

We had been doing the first surgery for almost three hours and “were in” exchanging gags and narratives to violate the monotony of the activity. It was already 2 a.m. when I glanced at the clock. I scrubbed out, asking the local surgeon to finish the operation while I wrote the operative technique. “Let’s eat after you finish. I have some food in my locker, ” I said.

Then the bombing started.

Andrew Quilty
“I am not Muslim but I pray for your protection. Keep us safe, ” Cua prayed to Allah with her colleague as bomb fell around them, she recalled.The remains of a bed frame in a room in MSF’s Outpatient Department building.

I was leaning on my colleague’s shoulder in the cellar when he shook me hard, waking me in panic.

“What ?! ” I asked in alarm.

“Are you alright? ’’ he asked, fear in his voice.

I nodded.

The smoke was becoming stronger and he was afraid we might suffocate. “Let’s get out of here.”

“No, I’m staying here! ” I told him firmly. I’d rather succumb of carbon monoxide gas poisoning than be hit by a stray bullet outside. “Just close your eyes, ” I absentmindedly added. In a normal situation, I might have laughed at my suggestion. Close your eyes? Genius solution!

“Okay, we stay here. But encompass your nose with this, ” meeting the hem of my OR gown and handing it to me. I lost my mask earlier. “I don’t want you losing consciousness.” And with a giggle, continued, “I might not be able to carry you out of here.”

Zzzzzziiiiiinng!

Out of nowhere, something tore through the roof and landed inches away from our feet. A stray bullet missed us by a few inches. A few freaking inches! The hair on my body stood on end. We could see the extent of the flame above through the hole the bullet constructed on the roof. I didn’t require persuading that I was going to die that night. There was just no way we were going to get out of there alive.

Stringer Afghanistan/ Reuters
“I didnt need persuading that I was going to die that night, ” Cua wrote.

All tracings of sleepiness now gone, we began discussing what we would do if we were still alive in the morning. We had been hiding in that hole for what seemed like an hour. Nobody knew I was there, that I was still alive. I asked if I could go with him.

“Of course! Let’s going to see my house and conceal there temporarily.”

“Okay. But do you have food? Basement? Is it safe there? ”

“Yeah.”

“How could we go there? ”

His car was in the parking lot, several hundred meters from where we were at the moment.

“We could run. Then you can conceal in the car. I’ll drive fast”

“I don’t have any identification card or travel documents with me.” I left all my things at the OR. All I had in my pockets when we operated out were the keys to my room and locker.

“Don’t worry. My father and my uncle will find a way to get you to Kabul.”

Agreeing eventually to what we should do next, we noticed flame darting in and out of the windows simply above where we were hiding. Without notification and any reluctance, he hoisted himself up the wall and successfully jumped out of that cavity and ran into the open. I was left in the dark … alone.

Following his example, I jumped and tried to reach the leading edge of the hole but was unsuccessful. I stood up and tried again, this time, placing my body against the wall and putting my feet on the opposite side to gain traction. I fell down with a loud thud. I was panicking. The fire was slowly feeing the window above the roof encompassing the hole and I could feel the hot. I hollered for him to go back, to help me get out of there. I heard his voice calling back my name, telling me to get out of there immediately. Then, stillnes. Nothing. I was becoming desperate so I jumped again but failed miserably.

ASSOCIATED PRESS
An MSF employee walkings among the remains of the hospital after the airstrike. Cua said she was almost trapped inside a build asfire darted in and out of the windows.

I slumped on the floor, weeping, all tracing of hope now gone. I was weeping for myself, the dreamings I had yet to achieve, all the plans for the future. For their own families back home, for giving them so much heartache–I have been able to spared them the agony if I had chosen to stay at home and had a private practice instead. For my friends–I was not going to see them again. For the patient I just lost at the OR table–he was still so young. For the old man who lost a son. For all the work we poured into this hospital. For the person or persons of Kunduz.

“I merely asked You for one thing on my birthday, to keep me safe, ” I wept into the darkness. “One wish and You could not even grant it.” I arrived in Afghanistan on my birthday and it was my sole hope. My heart was filled with bitterness.

I was angry. I wanted to lash out at someone, anybody. I wanted to punch person in the face. I was enraged. I detested both sides involved in this stupid war. I wanted them to see all the damage they have been causing to civilians and let them imagine that those are their families. Let us see then if they would still continue this senseless war.

I was also afraid. I don’t want to be burned alive.

The tears came in a cloudburst, bringing all my annoyances into surface.

Denis Balibouse/ Reuters
MSF personnel demonstrate in Geneva one month after the bombing of the Kunduz hospital. “Even war has regulations, ” one of the bannerreads.

Then, surprisingly, there was calm and clarity. I was back to being a surgeon again. “Okay , nobody will help me now but myself. What should I do? ” After removing my shoes, I stood and studied the small space I was in. No crevice on the wall to put my foot into and the wall was really too high for me.

Then I insured a small piece of steel protruding out from the right corner, so small I scarcely ensure it the first time.

With all my might I jumped, aiming to grab it. It was hot but I didn’t “lets get going”. My shoulder joint would be in danger of dislocate but I didn’t intellect. I didn’t know how or what else I precisely did but in a few minutes I was out of the hole. With a big sigh of relief, I find my colleague sprawled on the ground near the rose garden, awaiting, a big grin on his face when he saw me.

I ducked and ran to where he was, hearing him say, “Get down! Get down! ” I felt my OR gown catching a small fire from the embers falling from the burning building. I rolled on the ground. When the volley of shoots in the surrounds stopped, we started crawling towards a building several meters from where we were. We were halfway there when a figure came out from the darkness. Fear gripped me. I did not survive the fire to only be kidnapped! No, please.

Then the man, who was wearing traditional Afghan attire, uttered the words that I would always recollect: “Follow me, there’s a safe place here.”

This tale was originally published at The Development Set .

Read more about the attack on the MSF hospital in Kunduz:

Afghans Haunted By U.S. Strikes On MSF Hospital Want The Truth, Not Money And Apologies
Inside The Last Refuge For Afghanistan’s War Wounded

Read more: www.huffingtonpost.com

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