Into the Valley of Death "Equestrio Feature Story"
Friday, 25th November 2005

"It's catastrophic; the worst I've ever seen", said the doctor leading the field hospital operation. "Nothing on this scale has ever been tackled before. This is worse than the Tsunami."
While the official death toll still stood at around 50,000, aid workers on the ground a week after the earthquake ripped Kashmir apart on October 8th estimated that between 250,000 and 300,000 people had already been killed, and that up to 1.2 million were still completely cut off and yet to receive any aid or
medical help.
Grasping the size of the disaster is not easy. Most news reports have centred around the destroyed cities of Bagh, Mussafarabad and Balakot, but two thirds of the population of the affected area live in remote mountain villages that are
impossible to reach overland because of the level of destruction and the precarious state of the precipitous quake-damaged terrain.

Af tershocks measuring up to 6.2 on the richter scale strike constantly, causing treacherous landslides and collapsing those buildings not already totally levelled by the first quake.

THE SICKLY, CLOYING STENCH of dead bodies is everywhere. Those who are alive stink as badly as the dead, as necrotic, blackened flesh rots on their living bodies. The stench of gangrene is the scent of calamity. The smell of death is everywhere; on the living and the dead. It wafts up from piles of rubble and out of the ground from which no one can extricate their dead relatives. This is life and death in the Jhelum Valley.

The first, and so far only, aid to arrive in the Jhelum Valley north of Bagh City came, not from an international agency or an NGO, but from an IT company, LMKR based in Islamabad, who reacted immediately to a distress call from an employee
whose family lived in the area. In the city of Mussafarabad the first effective operation on the ground was the Pakistani NGO The Citizens Foundation (that builds schools across Pakistan in deprived areas) tha t assigned its considerable resources to earthquake relief. Both organisations found themselves running field
hospitals in a desperate attempt to deal with an unprecedented volume of seriously injured casualties.

The international agencies remain conspicuous by their absence and chaos and lack of coordination hamper those who do wish to help. Four days after the quake a specialised team of search and rescue medics from South Africa arrived in
Islamabad only to spend two days stuck at the airport trying to arrange transport to the affected are where they were desperately needed. That team arrived, by chance, and after a lot of perseverance, at the LMKR Field Hospital in Sudanghali - the most northerly aid outpost in the Jhelum Valley, and the only facility
operating in the area.

Staffed by a revolving team of some 100-plus volunteer doctors from across Pakistan and abroad - supported by assistants more familiar with building websites than saving lives - the LMKR Field Hospital receives an average of 1000 patients a day. The majority of these are seriously injured. In the Jhelum
Valley 'seriously injured' means gangrenous, stinking wounds, septicaemia and debilitating fractures that are likely to result in the loss of limbs, or in permanent paralysis. For every patient who arrives at the hospital, four or five lay injured and unattended in the open air beyond the reach of rescue teams.
The only thing more concerning than the condition of the wounded is the news they bring of those they left behind.

Survivors report an average death rate in their families of up to 50% with 40% of all surviving members seriously injured. They also talk of the mountains opening up and 'swallowing' an entire village - of which there is no visual evidence left. There were 300 homes in the area they talk of. "It's a disaster", said Dr. Daniel Nevin from South Africa, a specialist trauma medic and leader of the voluntary rescue team that reached the LMKR Field Hospital. By midday on the second
day of his stay at the hospital Dr. Daniel had carried out, or overseen, 30 operations, delivered one baby and had a another woman in labour awaiting delivery. One of the operations that he performed on a plastic covered picnic table in a makeshift tent 'theatre' was a 'faschiotomy', a procedure to relieve a buildup
of pressure in a limb that threatened to cut off the blood supply - which would have resulted in amputation. The patient was an eight month old baby.

As torrential rain drenched generators and electric lights failed in the 'theatre' doctors were forced to carry out vital amputations in the open air. Once gangrene has entered the bloodstream patients only have hours to live. All patients who
had been operated upon needed to be admitted so that their wounds could be revisited by surgeons repeatedly to remove further necrotic tissue until healthy granulation appeared and the peeling process began. But the sheer volume of patients needing attention invariably delayed that process - more doctors and more hospital space were needed. They simply weren't available, and even if they had been there was no flat ground upon which to put any more tents. "I'm discharging patients I shouldn't discharge", said Dr. Daniel in despair. "Within three days they will be back again and the gangrene will be worse. The whole situation is desperate." Within 24 hours of arrival in Sudanghali the LMKR team had received mo re than 3000 patients and established what was effectively a
full hospital operation with outpatient, theatre, accident and emergency
departments and several wards. This was housed in three makeshift
tents on grass that had dissolved into swampy mud. "We need to evacuate
people from here", said Dr. Daniel. We need to set up a proper military-style field hospital that we can get them to." To that end, LMKR are now extending their relief operation to establish a large base-camp field hospital on lower ground to which they can evacuate patients from the existing hospital and a second one
that they are setting up. From those most northerly mountain bases small 'SWAT-style' rescue medic teams are battling further into the mountains to reach, treat and evacuate casualties.

That this is necessary is in no doubt. A handwritten plea for help written in English came from a stranded village, delivered after an eighthour walk across treacherous slopes. The message was frighteningly clear. "The population of our village, Banilungrial, is 6,000 peoples. 4,000 peoples are dead but 2,000 peoples are injured. Things of eating are not available. Please help us." The man who carried that message was Safeer Ali Ghal, an elderly man who had carried his desperately injured 18 year old daughter to Sudanghali. Safeer was the last man out of Banilungrial before a landslide destroyed the only road to the village.
The only thing more horrifying than the message he carried was his human cargo. Maryam was 18 years old and had been buried alive for three days.

She lay crippled by agonising pain with half her skull missing, her brain exposed, her face pushed obscenely towards where her chin should have been so that her mouth was frozen in a grotesque smile below her left ear. The nasal cavity in her skull was clogged with maggots and her skin blackened with gangrene. She was alive, but those who tended to her could have been forgiven for thinking it would have been better if she hadn't been. Unable to do anything more than stop
the pain, doctors pumped her full of morphine and called in a helicopter. The journey to possible survival and agonising rehabilitation started with a 30-minute climb up a near-vertical hillside to reach the only patch of ground on which 'helis' are able to land and takeoff fully laden. As the evacuating aircraft skimmed the
mountainside bound for Rawalpindi with its horrifying cargo onboard the attending doctor shook his head and muttered, "God help her... please."
Maryam's injuries were appalling, but not atypical of those seen. With every day that passes the condition of the wounded deteriorates. The logistical challenges of reaching those cut off deeper in the Jhelum Valley, in the area between Sudanghali and Mussafarabad, are mind-boggling. The devastation extends east,
west, north and south from Sudanghali. Every valley, every mountain is, or was, filled with villages and isolated homes in which people lay dead or dying beyond the reach of help. The terrain is so mountainous that helicopters are unable to land in most places, even when weather conditions permit them to fly. Most of
the tiny mountain roads and tracks have slid off the hillsides, taking villages and their inhabitants with them, or are blocked by rubble, trees and tons of mud. Up to 20 feet of snow is expected within days.

One mountain expert who flew over the area returned and put his head in his hands. "What we need to do is to evacuate the entire population and dynamite the hillsides to bring the loosened earth down", he said. "The entire region is about to fall off the mountains, it's all lethal. I've never seen anything like it." More than a million people are estimated to be trapped in that area. It
has become uninhabitable and desperately dangerous, but the people cannot get out and rescue teams cannot get in. As the population becomes more desperate the security situation worsens. The infrastructure has been totally destroyed
and the people running Kashmir have been killed, as have the army stationed in the area. Military replacements struggle to navigate and survive in unfamiliar terrain and to open and secure roads. No sooner is one opened than a landslide destroys it. Aid camps and hospitals have to be secured from a desperate population with looting on their minds and convoys must travel with military
escorts to ensure their safe passage. Weather conditions ground helicopters constantly, making it impossible to airlift aid in, or people out. Those who are evacuated lay in corridors, or sleep and suffer under makeshift tent wards at hospitals in Islamabad and Rawalpindi that are struggling to cope with the volume of patients.

The need for field hospitals is enormous - both in the mountains to receive casualties and on lower ground to receive evacuated patients and deal with the overflow from existing hospitals. And then there is the issue of shelter and food.
The indigenous population has absolutely no shelter whatsoever. The tents seen in photos of other affected areas have yet to arrive in the Jhelum Valley and, frightened to seek shelter in damaged buildings that are the equivalent of deathtraps, most survivors simply sit dazed and traumatised, huddled together for warmth in the bitter cold. In desperation some are returning to their wrecked homes for shelter - a move that is likely to result in yet more death and injury.
Even the arrival of new life is depressing in the Jhelum Valley. "Imagine being born into this hell", said the doctor who had delivered the first arrival at the LMKR Field Hospital in Sudanghali. "God help these people, please."

www.lmkr..com
www..thecitizensfoundation.org