When you are lying in a pool of your own blood, unable to move, the sound of an American soldier saying, “Can I help you, ma’am,” is a Godsend.
When you’re an injured soldier under fire, and you hear the “thwup, thwup” of a combat rescue helicopter, you think, “I just might make it.”
It’s the same feeling of relief for refugees and those trapped by fighting when they spot a truck bearing a red cross or the blue and white symbol of the U.N. driving into their embattled neighborhood, with the food and water that will keep them alive for a little bit longer.
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These rescuers are the disparate faces of those who run into the fight when others are fleeing it, intent on reversing the destruction of war. From scooping up the injured to negotiating with warring sides to delivering aid on the battlefield, this army of caregivers is facing an era where wars do not seem to have an end. Their endless tasks are a reminder of the consequences of war and a cautionary tale against future action being considered by the administration in places like North Korea.
Just in Iraq and Syria, the numbers are staggering. More than 6 million Syrians displaced inside their own country, and another 5 million outside Syria, and 3.2 million Iraqis driven out of their own homes inside Iraq. Iraq also hosts nearly a quarter-million Syrian refugees plus another 50,000 other refugees inside Iraq, according to the UNHCR.
Technology on the modern battlefield has made lives easier to save, but it’s also made them easier to take, and rendered destruction of cities, towns and villages more complete. Car bombs and roadside bombs or small pockets of explosives buried under a mud hut’s front step take lives and limbs so often that it barely registers on international broadcasts.
And the explosive force of battles in Iraq, Syria and Yemen have, in many cases, literally bombed cities and towns back to Stone Age-levels. Aid workers used to help map out how to repair damaged water, or electricity, hospital or school systems. In today’s wars, there’s simply nothing to fix.
The sheer scale and seemingly unending nature of the conflict makes most Americans turn off, and turn away. The Daily Beast talked to a hardy group of rebels who do the opposite.
Very Joyful—And Very Dangerous
The battle for Mosul was a meat grinder. The so-called Islamic State used Iraqis as human shields, and when the Iraqi army or coalition launched a bomb at an ISIS sniper nest, dozens of Iraqi men, women and children were killed and wounded in the process.
Adnan Baayo, 30, of the International Committee of the Red Cross, worked to get surgical teams to the front lines, setting up in blown up houses or even tents to provide immediate trauma care to Iraqi civilians.
“It’s really the first 10 to 15 minutes that count to keep someone alive,” Baayo said by Skype from the ICRC base in Erbil in Northern Iraq. Dozens of medical specialists from a hodgepodge of countries cycled in and out, performing surgeries on a battlefield – part of a latticework of NGOs that set up similar trauma centers ringing the besieged city.
The ICRC is part of a network of organizations that work with UN Humanitarian Coordinator Lise Grande to figure out what the Iraqi government needs where, and which group has the resources to step in. Picture a long to-do list/sign-up sheet listing areas needing medical aid, water supplies, demining, and so forth, and various government and non-government agencies raising their hands saying, “We can do that.”
Baayo knows the mission well because he’s been a volunteer since he was 12, living under the rule of Libyan strongman Moammar Qadafi. He volunteered with ICRC “cousin,” the International Red Crescent, and when war hit Libya, he ended up with a full-time job for the ICRC.
The International Red Cross and Red Crescent Movement focuses on reminding combatants of the Geneva Conventions – the laws of war that most nations honor that require the humane treatment of prisoners and avoiding hitting noncombatants whenever possible. That means going to the center of the battle to remind fighters of their shared humanity.
U.S. taxpayers fund a quarter of the ICRC’s $1.6 billion budget, with more than 90 percent of that funding going to missions overseas. The ICRC makes public a 600-page-plus budget every year so donors can track their money.
Baayo, with his multiple advanced degrees, could have done something else.
“The spirit of the teams, of humanitarian environments is fascinating,” he said of work that has already taken him to the heart of war in two countries. “You’re basically mingling with the most intellectual, understanding and beloved people you can find. It’s very joyful.”
It’s also very dangerous. In the past two months, the ICRC has lost seven of its people in Afghanistan and another in South Sudan.
Usually, the nature of their mission keeps them safe, Baayo said.
“We are not there to judge. We are not there to help one party over the other. We are there to provide for the civilians and alleviate suffering,” he said. “But we always risk being misunderstood.”
Back to Iraq
Emily Dakin left her job as corporate lawyer back in 2009, in search of something more meaningful, and headed to Iraqi to work for a nonprofit aid agency. She was able to roam the country so freely that she invited her parents to visit her from Vermont, to see her work helping to rebuild a country still recovering from U.S. military occupation, and an internal war against al-Qaeda and other insurgents.
She left just a week or so before ISIS took over in 2014, for a new job with the U.S. Agency for International Development in another war-torn country, Juba, South Sudan.
While she was gone, ISIS undid her work.
She returned to Baghdad this year to run a Disaster Assistance Response Team from USAID, under the umbrella of the Office of U.S. Foreign Disaster Assistance (OFDA). It's an alphabet soup of acronyms that means she’s the face of U.S. humanitarian assistance in Iraq, coordinating with the government and the UN, and other NGOs to get immediate medical aid to pop-up trauma clinics, and food, water and other supplies to refugee camps that dot Iraq.
That also means she’s a steward of a large portion of the U.S. aid devoted to staunching the disaster after ISIS -- and the fight to dislodge them -- buzz-sawed its way through Iraq, leaving towns and cities uninhabitable in its wake.
And she’s one of the few U.S. government civilians who gets to leave the cloistered compounds of Baghdad’s government area known as the Green Zone – a claustrophobic maze of high-walled concrete blast walls where the university-campus-like U.S. embassy is tucked. The streets of Baghdad are deemed too dangerous for most American diplomats, where car bombs hit every few weeks and traffic jams make a quick escape nearly impossible.
Dakin has to travel with heavy security on carefully planned sojourns to meet Iraqi officials in their ministries, but that’s far more than most. She’s even been able to visit a refugee camp, but she relies mostly on memory of her past time here to picture the people she’s helping.
Iraqi officials weren’t initially so gracious about international help. They wanted the money, supplies and the resources, but they wanted to organize camps and other parts of the mission themselves, sensitive to the criticism that they were inviting a former occupier back in. Iraqi officials griped to The Daily Beast that certain international agencies were trying to tell them how to help their own people.
Members of those international agencies griped right back that Iraqi-run camps were poorly designed, without thought to things like water runoff or making space for a school to keep the children occupied for what could be a months-long stay.
The Daily Beast visited one of those Iraqi-built camps last December, and found standing water and mud throughout, and ankle-breaking trenches dug around rows of tents in an attempt to draw the water away – all a function of putting a camp in the wrong place, as Iraqi officials had stubbornly refused to rely on the advice of international donors.
Deacon would only say that coordination took a turn for the better between Iraq’s government and the international aid and NGO community last January.
“It was rocky at the beginning, but significant steps were made,” she said in her best diplomatese, by Skype from Iraq on a Friday-her one day of the week off, which she was working as she usually does.
Another aid worker from the region said that at least the arguments are over Iraq being assertive, where in other war zones, international aid agencies often find a “let the foreigners fix everything” mentality.
Deacon, too, sees a “pull themselves up by their bootstraps” mentality.
“I have always seen a level of hope and resiliency in Iraq and among the Iraqi population that I find inspiring,” Deacon said. “I love going to work. You’re in a unique position to help people who have lost everything.”
‘It’s Not Just Roadside Bombs’
U.S. troops also had a hiatus from Iraq—after President Barack Obama ordered them to withdraw in 2011. Then ISIS came sweeping back in, grabbing Syrian and Iraqi territory, and now some 5,000 U.S. troops are deployed in Iraq and roughly 500 special operations forces in Syria. Together with an international coalition, they’ve helped Iraqi forces drive ISIS out of most of Iraq, and they’re close to driving them out of their de facto Syrian capital of Raqqah.
The longer the fighting has gone on, the closer U.S. advisors have been allowed to get to the front line, now fighting and raiding alongside those they train.
Some have come home injured, and some will never come home. As of mid-September, the Pentagon reported at least 45 troops had died (12 from combat injuries and 33 from “non-hostile deaths), and 53 injured.
The first stop for many of the wounded is Qayara Air Base where Sgt 1st Class David Ueland, runs a team of medics for the 37th Engineer Battalion, 2nd Brigade Combat Team, 82nd Airborne Division. He says most of the time, his team is dealing with sprains and colds at the base clinic.But his combat medics go out with route clearance troops “to make sure the roads stay open,” Ueland said on a holiday weekend, or a weekend that was a holiday back in the states anyway.
And seven or eight times on this tour, his team has dealt with multiple combat casualties, including a group of Iraqi soldiers that had to be patched up at the air base so they could survive the flight to a military hospital in Baghdad. Iraqis have their own system, but the rules dictate if a patient is about to lose their life, an eye or a limb, the U.S. can assist.
“We’re dealing with significant trauma,” from blood loss to limb loss, he said. “It’s not just roadside bombs; it’s everything.” That means gunshots, mortar fire, car bombs or house bombs – houses wired to blow up after ISIS is forced to flee a neighborhood, meant to kill the troops pursuing them or the citizens who try to move back into their homes.
The horror show of injuries is good training for his green medics, most of them barely out of their teens, faced with stretcher after stretcher of wounded coming off of a helicopter or truck from the front.
When they’ve had those frenzied moments, Ueland moves among them, treating patients but also watching his team for signs they’re getting overwhelmed.
“Some people can take a lot more than others,” he said. When he sees one of his people tensing up, and getting panicky and rushed, he steps in and reminds them to take a breath. The mantra that keeps them going: “Smooth is fast.”
The velocity of weapons of war produce injuries markedly different than those back home, and that changes how you treat them. The normal acronym medics – or anyone learning basic lifesaver skills – are taught, is the “ABCs,” i.e. airway, breathing and circulation. In practice, when you approach a group of multiple injured people needing care, you go first to the ones who aren’t speaking or screaming, to clear their airway or restart their heart.
In a war zone, however, the top killer is blood loss. The acronyms Ueland’s troops learn is “MARCH.” They are taught to first look for signs of massive bleeding, because a soldier with a femoral artery cut can bleed out and die in under 5 minutes. Then they check to make sure the airway is clear, that respiration is good with no signs of a penetrating chest wound, check circulation for signs of shock like an inconsistent pulse, and finally, they look for signs of head injury like uneven pupils or mental confusion that spell a damaged and swelling brain.
“PAWS” comes next – administer something for pain control, an antibiotic and wound dressings.
The explosive force of blasts or gunshots on the body also means you can’t just stitch the wound back up like you would a deep laceration. The velocity of the bullet or bomb fragment doesn’t just penetrate, but it also sends shock waves through the surrounding tissue, damaging it. So the medics stabilize the wound until the patient can get to a team of surgeons and a long road of multiple surgeries ahead, including opening up the wound to remove dead tissue that might not be obvious just after injury.
Dealing with this kind of trauma in limited numbers of wounded means his medics are learning - but they’re not getting burned out like he did when he was deployed to Iraq in 2008 to 2009. His deployment was longer – a full year – and the pace was punishing. More injuries more often, and he was out on patrol more and exposed to more danger as the U.S. troop surge bought time for Iraqi forces to catch up and do their own fighting – or at least, that was the idea at the time.
He said the constant deployments wore troops down, but recently they’ve faced a different problem – not enough deployment to keep their skills fresh.
“We’re better at our jobs now,” he said of the hands-on training.
Back home in Renton, south of Seattle, Washington, Ueland keeps some of those skills fresh in his day job, as a firefighter.
“My dad was a police officer and my mom was a 911 dispatcher,” he said, explaining why he’s south of Mosul, patching up U.S. troops. “I kind of got born into that public safety/public service situation. I really enjoyed the kind of adrenaline rush that came from being the guy that everyone looked to.”
His five-year-old son already says he wants to be like dad, but not as a soldier. “He’s really stuck on firefighter right now because he saw me drive around in a fire truck.”
The ‘Golden Hour’
The team that gets those patients to the medics is led by people like Capt. Steve Donaghey, Platoon Leader, Company G, 1st Battalion, 189th Aviation Regiment.
In Massachusetts, he’s a state police trooper, with a background as a paramedic. In Iraq, he commands a flying ambulance, dropping into areas under fire when necessary to scoop up injured troops, though he won’t say how often it’s been necessary in his nine-month tour.
“There’s always the potential to fly into harm’s way,” Donahy said via Skype from a tent in Qayara Air Base south of Mosul. The air field was only taken back from ISIS about a year ago, and became one of the main bases of operations for the fight to take back Iraq’s second largest city.
Donahy flies a specialized HH 60 Black Hawk, with all the life-saving equipment aboard to keep a patient alive during that key “golden hour” while rushing them to a hospital team. Trauma surgeons have found patients have a better chance of survival if they’re treated within an hour of injury.
“From the time of an injury, our job is to go out and respond to the site, treat their injuries en route and provide a higher level of care,” Donahy said.
He and his air crew and medical personnel can get the aircraft airborne and headed to pick up injured in under 15 minutes.
“It’s a hyper state of alertness – every person has a very specific function...It’s very controlled and deliberate,” he said, describing the managed frenzy of getting everything they need onboard.
That includes taking time to get a security brief on wherever they’re flying, and the status of the patient, as relayed by the “9-line” Medevac request from soldiers on the ground. A 9-line describes the area they are flying into, and the injury to the patient, including whether they need to bring special equipment like a hoist or a ventilator, and whether the area has been contaminated with chemical, biological or nuclear weapons. (Coalition forces at Qayara were on the receiving end of a mortar shell thought to have been filled with mustard agent, though the U.S. never revealed how badly anyone was affected.)
Unlike trauma medicine back in the States, military doctors and medics can test out technology that’s not yet approved for the mass market back home, making combat medical care a proving ground for cutting edge technology. One science-fiction-like treatment is a syringe of tiny, compressed sponges that medics can inject into a wound to stop bleeding until they can get the wounded soldier to a hospital.
Donahy won’t go into details of where he’s flown or what kind of danger he and his team have faced. The U.S mission against ISIS includes supporting local Syrian and Kurdish allies inside Syria, backed by U.S. special operations forces. Before U.S. Special operations chiefs recommended establishing the special operations task force in Iraq with smaller outposts in Syria, they made sure medevac teams like Donahy’s could get to those troops in Syria within that golden hour.
Other soldiers told The Daily Beast of bracing flights into Syria at night, under fire from ISIS, with hard landings that have banged up the would-be rescuers. They managed to grab the injured and get out.
Donahy wouldn’t talk about anything like that, sticking to how much he enjoys working with a team of likeminded lifesavers – not just Americans but the mix of nationalities that make up the anti-ISIS coalition, with many of them operating out of Qayara Air Base.
He says his wife back home is supportive, even though his deployment meant one of their two kids was born while he was in Iraq.
“The same thing that drove me to be a state trooper – just the desire to help – that’s the common thread among all the responders over here. We take it very seriously,” he said. “This has been one of the most rewarding experience of my life.”
Author note:
Getting these people to talk about themselves is a challenge, because their job is about focusing on others, and because one of the ways they do the job is to lock down their emotions about what they’re seeing and doing every day.
But in an era of seemingly never-ending wars in Iraq and Afghanistan, with ISIS spreading to 18 countries, and North Korea threatening nuclear annihilation, they offer a measure of hope.
I’ve lain in that pool of blood after a car bomb hit a U.S. Army patrol my CBS News team was filming in Iraq in 2006. The car bomb killed Army Capt. Alex Funkhouser, his Iraqi translator “Sam,” and my CBS colleagues Paul Douglas and James Brolan.
Like four other badly injured soldiers around me, I was saved by a soldier who tied two tourniquets on my bomb-shattered legs, and I thought the helicopters circling nearby scanning for danger were there to take us out (we actually drove) and that was a comfort.
I’m glad they’re still out there, doing the job. I also worry they have a depressing level of job security, with worse to come.
Go inside the fight against ISIS like never before, with AT&T Audience Network's "The Volunteers," premiering Nov. 11 and 12, at 10 p.m. ET/PT.
