Dispatch - Urgent deliveries

Urgent deliveries - Filling the gap where ambulances are rare - All photos ©ICRC/HOLT, Kate

Urgent deliveries - Filling the gap where ambulances are rare - All photos ©ICRC/HOLT, Kate

Second Dispatch by Monica Campbell, a San Francisco-based freelance journalist. This article is part of a series by Ms. Campbell, who reports from Kandahar, Afghanistan.

The taxi driver sped through the darkness down a remote road, from a remote village. His passenger could not speak. His face strained in pain as he looked down at his knee, where his leg now ended because of a land mine. A third man, crouched in the back of the ragged Toyota hatchback held an intravenous fluids bag its tube inserted in the wounded man’s left arm.

“We are ten minutes away,” the driver said through a shortwave radio. They were minutes from reaching the provincial capital of Kandahar - and help. Once there, they pulled into the International Committee of the Red Cross (ICRC) compound. In seconds, Alexis Kabanga, a physician from the Congo, surveyed the man's severed leg for excessive bleeding and sent off immediately to Mirwais Hospital two blocks away, run by Afghan health authorities with ICRC support.

“Go! Go!” he said. 

The driver, a stocky thirtysomething, quickly jumped back in the vehicle and pulled out. The heavy metal gate that protected the compound shut behind them.

In Afghanistan, ambulances are rare. Government resources to offer such services are neglected or limited. The ongoing threat of roadside bombs and attacks by armed or criminal groups further complicates access. In Kandahar, Afghanistan’s second-largest city with an 800,000 population, only about two dozen ambulances exist. In the countryside, that number falls to zero.

To help fill the gap, the ICRC created its first-ever program to train and equip taxi drivers to double as makeshift ambulance operators, delivering war wounded in Afghanistan's violent south to a medical facility. And while the pilot project, which launched in 2010, is still small, its network of 35 drivers spread throughout Afghanistan’s four desert provinces is singular. 

"Is it an ideal situation? No," said Marcus Geisser, head of the sub-delegation for the ICRC in southern Afghanistan. But until the government is able  to provide such services, the program is considered a stop-gap solution to access Afghan civilians in war-torn areas, whether it is woman who steps on a land mine, a child caught in the crossfire, or a man wounded in battle. They are the wounded who form part of the non-networked Afghan population: isolated and often unable to communicate quickly with a local Afghan police officer or soldier, or fear doing so if their injuries raise suspicions or possible retribution. And they are far from relying on the combat medic or helicopter transport available to coalition troops. 

“We provide aid to all parties of the conflict and are quite transparent about that,” said Geisser. “That understanding is crucial in order for us to treat people despite what side they fall on, including if they are a member of the armed opposition. It’s key to our medical mission. Things happen so fast here. You can’t ask yourself if the man you’re treating may have contributed to the wounds suffered by the man in the next room. We’re not here to blame anyone for their actions.”

Kabanga, who runs the taxi program, selects drivers through a process that relies on recommendations by Afghans who the ICRC works with to run first-aid posts in rural areas. Community leaders also vet the drivers.“They must be recognized by villagers and considered reliable,” said Kabanga. Once on board, the drivers get first-aid training, receive a basic medical kit and dressing materials. They are also equipped with a laminated identification card that features the Red Cross emblem—a symbol that helps to identify them as medical evacuation transport and perhaps provide a layer of protection.  

Back at the ICRC compound, the taxi driver returned ten minutes later. He bunched up the bloodied sheet in the back of his car and wiped sweat from his brow. For the Afghan cabbie, who lives in a small desert village and normally shuttles families to rural markets, his second job as a makeshift ambulance driver was nearly done for the night. “I’m exhausted and now have a long drive home,” he said.

For the service, the ICRC pays drivers more than the ride's normal fare to compensate for the risks. To be sure, picking up Afghans wounded by everything from bombings and land mines to firefight might mean precarious night rides or carrying an injured fighter who could be hunted down. There have been losses. One driver was killed by unidentified gunment while driving his car and delivering a wounded man to the ICRC’s Kandahar compound. Another died the same way earlier this year. “Security is a huge, huge challenge for all of us," said Kabanga, who knew both drivers.

For tonight’s driver, all that was left was a debriefing with Kabanga. Where was the injured passenger picked up? In a field? From a home or first-aid post? How long ago did the injury happen? The checklist of questions about the journey is one way for aid workers to get a better idea of what happens—namely, what type of health care exists in parts of the country still too dangerous for most foreigners to access themselves. 

The driver, who requested anonymity for his safety, said that he picked up the wounded man from an outlying district, a battle zone about an hour west of Kandahar city. The man holding the IV bag was one of the injured man's relatives, he said. 

"And who applied the tourniquet to the man's leg, or did that happen at a first-aid post?" asked Kabanga.

"I did that," the driver said in Pashto through a translator.

"Okay," said Kabanga. "Good, good." 

The driver, who was illiterate, next dabbed his right thumb with blue ink to imprint his signature at the bottom of the checklist. 

With that, he took his fare, climbed into his car and headed home.

Monica Campbell was commissioned by Intercross to report from Afghanistan. Her work has appeared in The Christian Science Monitor, The Chronicle of Higher Education, Boston Globe, The San Francisco Chronicle, Public Radio International's The World and Newsweek. From 2009 to 2010, she was a Nieman Fellow at Harvard University.