Evacuation of war-wounded in Libya: first-person account by MSF nurse

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Editor's note: Alison Criado-Perez, a nurse with Doctors Without Borders (Medecins Sans Frontieres, or MSF) shares this first-person account of evacuating war-wounded people out of Misrata. Ali is a nurse working for MSF in Libya and Tunisia. She has previously worked in Nigeria, Colombia, Uganda and Central African Republic. The video embedded in this blog post shows Ali actually treating a patient on the boat described in the account shared below.


It's 11.30 on Sunday morning, and we are sitting in international waters, 20 miles off the Libyan coast, trying to make a vital contact to give us the all clear to enter the port of Misrata. The tension is rising, as we only have enough fuel to wait for another half hour or so. We've been here on stand-by for several hours – where has our contact disappeared to? Earlier this morning, in a briefing, we're told of precautions to take in a war zone……. Am I really doing this? It's all rather surreal.

We are a team of 13, a mixture of international MSF expats and Tunisian volunteer medics, who have opted to come on this mission to rescue war-wounded from Misrata and transport them to the safety and medical care of Sfax in Tunisia. The trip has been discussed and planned for a couple of weeks, following a plea from overwhelmed medical staff in the hospital of Misrata for assistance, but the final green light only came a day or so ago. We left early yesterday evening, aboard the 216-seater San Pawl ferry, converted to carry about 60 patients on mattresses, and 30 walking wounded. We don't know what the exact patient list will be, especially as Misrata was shelled last night, but the potential list of 90 includes a couple on ventilators, many open fractures and amputations, those with multiple organ injuries, head injuries, post-gunshot chest injuries. It's all very daunting.

We've done our best to medicalise the boat, but the conditions will limit us. The boat has been pretty rocky since we boarded, and we rolled around like drunks as we worked flat out, shifting boxes of drugs and medical materials, intravenous fluids, bottles of oxygen, vital signs monitors to create a small intensive-care space as well as two separate wards, one for critical and severely-wounded patients, the other for less critical and walking wounded. All the material needs to be readily accessible as there'll be no time to hunt for things, and moving around in the limited space will be difficult. Our log, Annas, has tied thin rope between all the pillars, so that we can hang up intravenous infusions where they're needed. But the final organization can only take place once we've off-loaded the 6.5 tons of medical equipment and drugs (a mama elephant and a baby I'm told would be a pretty good visualization), which MSF is donating to Misrata. At the moment the cargo takes up half one of the ward spaces.

Finally, at midday, Helmy, the emergency coordinator comes "We've made contact, we have the green light!" Helmy, the emergency coordinator, announces with relief and excitement. We all cheer. It looks like we'll finally make it.

A pilot boat guides us into the harbour. We've refused offers of military protection, on grounds of MSF's neutrality and policy of lack of arms. But Misrata seems quiet as we pull into the dock. The whole team and crew form a human chain and we off-load the hundreds of heavy boxes onto the quay as quickly as we can, so that we can get mattresses onto the floor of the two wards and position our equipment before the patients start to arrive. Which they do within a few minutes: two doctors on the quay are carrying out a triage, and I'm waiting inside with Kate, the other expat nurse on board. The trickle quickly becomes a flood as the patients pour in through the doors, on stretchers, on crutches, with iv lines and drips and drains, young and not-so-young. There's a boy, a child of 13, with horrific burns to his face from the explosion of a petrol bomb. His father is beside him. There are young men – many young men – who will never walk again, paraplegic from gun-shot wounds to the spine. And those who've had amputations, who'll need prosthetic limbs. Some of them are very recent; I hope they don't start to haemorrhage. A couple have blood transfusions running. There are open fractures, terrible abdominal injuries, chest injuries causing pneumothorax and needing chest drains. One young man, with a tracheostomy because of severe burns to his face and neck, can see nothing as his face is covered in gauze. He has no caretaker with him to explain what is happening, but I see that the wonderful Egyptian nurse who has joined us in Misrata is talking to him.

There's another young boy, only 16, who fell from a fleeing pick-up and has sustained severe head injuries. He was in a coma for 6 hours and is barely conscious now. And a patient who needs one-to-one care in our small intensive-care unit has suffered multiple bullet wounds all over his body, an amputation to one leg, open fractures on the other, with severe blood loss. Misrata has been utter carnage.

How are we going to cope with this devastation? There are 71 patients in total, and our medical staff, although officially 12, is mostly down to four or five on the ground. Sea-sickness was an unlooked-for hazard and has decimated the medics. But we just get on with it, doing what we can, checking patients are stable, their intravenous infusions are running, administering analgesia and antibiotics as needed, emptying urine bags, changing drainage bottles, trying to keep patient notes up to date. I worry we are not meeting everyone's needs.

We have to crawl on the floor in the narrow space between mattresses to reach the patients: the boat is so rocky that if we try walking we run the risk of falling on a severely-injured patient, a frightening prospect. The work is incessant, exhausting, as we work through the night.

I hardly notice dawn approaching. But suddenly we hear, "Docking in 30 minutes!" The crossing to Sfax has taken nearly twelve hours. I am stunned by the welcome sight on the quayside: 36 ambulances, and scores of Red Crescent volunteers ready to carry stretchers off the boat. The immigration authorities are thankfully very unobtrusive and we manage to start disembarking the patients quickly.

Kate's patient in the intensive care unit takes her hand. "Was it worth it?" he asks her. "Yes," she says quietly. What else can she say? Tears come to my eyes as these tragic young men, with whom we have spent such an intense 12 hours, are put into ambulances and taken off to hospitals in Sfax. The Tunisian doctor organizing the transit is calm and helpful.

Suddenly it is all over. The ambulances and film crews have all left, and only the boat crew and mission staff remain on the dock. The bubble we have been living in for the past 72 hours is slowly dissolving into the real world.

As we drive back to our base in Zarsis, five hours south of Sfax, our driver Said suddenly says, "They are talking on the radio about Medecins sans Frontieres ……about the evacuation from Misrata to Tunisia. And they want to send you a present – a song of thank-you from the Libyan people." A haunting tune, with words of love and loss, fills our ears as we drive back home.

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More about MSF's work in Tunisia and Libya: msf.org