Frenzied effort to treat and save the injured

PAKISTAN : Aziz Khan pushed impatiently through the crowd outside Mansehra hospital, carrying his blood-splattered son, Javed…

PAKISTAN: Aziz Khan pushed impatiently through the crowd outside Mansehra hospital, carrying his blood-splattered son, Javed, behind him. Moments later, the 11-year-old boy was lying on the emergency room table, a bare metal bed frame in a chaotic room filled with quake victims and littered with bloodied swabs.

He moaned as a doctor knelt down to examine a deep gash across the back of his head.

"Please don't inject me," he groaned, curling up into a foetal position. Dr Abdul Samat Khan appeared not to hear and pushed a syringe into his head, injecting slowly. Javed wept softly, then appeared to pass out as the young doctor started to stitch the wound. His exhausted father watched with silent anxiety.

They had only made it to Mansehra, 33 miles from the regional capital, Muzaffarabad, a few hours earlier, Mr Khan explained. A tumbling wall hit Javed on the head, but rescuers had been unable to reach Bagar, their remote mountain home, because of landslides.

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About 350 people had died in Bagar, Mr Khan said. The survivors had neither food nor shelter. "All I have taken is water from the stream," he added.

After waiting for help which never came, Mr Khan and his son set off on foot.

Dr Khan applied the final stitches to Javed's head and shook the boy awake. Wiping his brow, the young doctor from Karachi said that he had treated an "uncountable" number of patients in the makeshift emergency room over the previous three days. "But I am not tired yet. This is my nation and I have to serve it," he said.

Emergency aid to save the survivors is gathering pace as relief starts to arrive in the worst-hit corners of Kashmir and North-West Frontier Province.

But for many of the injured who escaped the quake zone alive, the first stop is the hospital in Mansehra. Like much of the aid operation so far, it is strained, chaotic and disorganised. "It is more or less a war hospital," said Prof Iftikhar Jan, leader of 31 volunteer doctors from Karachi.

Prof Jan's team, which was flown in on Sunday, is battling a flood of patients and crowded, dirty conditions. On Monday and Tuesday they had treated 6,000 people, he said.

The main hospital has been closed since the earthquake cracked the side walls, so the operating theatre has been moved to a converted bus, the emergency room is in a dormitory, and the wards are scattered across a sea of tents pitched in a nearby field filled with hundreds of refugees.

A local charity is funding the hospital, but it is hard to tell who is in charge. The scouts, wearing brass Baden Powell badges, stretcher the injured to their tents. A religious organisation hands out free medicines and bottles of juice. Some emergency room operations are spectator events, with crowds gathering around to gawk or take pictures with mobile phones.

"We need some proper co-ordination here," said Prof Jan. "There's plenty of aid coming in, but it must be properly used."

Most of the wounded arrived with crushed limbs, head injuries and, in some cases, broken backs. The initial surge of victims came from Balakot, the flattened town at the quake's epicentre, but a new stream of casualties is arriving from areas which had been cut off until yesterday.

Some come with stories of extraordinary struggle. Muhammad Sabir (27), a fruit seller, said he had carried his injured wife, Asma, for 13 miles from their remote home in Jabori. Along the way they had to stumble over four landslides and had one narrow escape, he said after her operation yesterday: a pile of boulders crashed across the road moments after they passed, crushing a neighbour following behind.

Back in Jabori, a village still thought to be inaccessible, hundreds were dead, he said. "There is no food, no water, no help. I don't want go back there, ever."

In the mobile operating theatre Dr Tariq Hussain operated on a moaning woman. Her thigh was badly infected, he explained as he cleaned the flesh, but she was too weak for a full anaesthetic. A fan whirred furiously overhead as beads of sweat ran across his brow. "The air-conditioning is broken," he said. "And we don't have many of the surgical tools that are needed for these operations."

Many patients also suffered deep psychological wounds. Taimur Khan sat staring at his feet in a makeshift ward, wondering which toes would be cut off. His roof caved in while he slept, he said, surrounded by his family. "It felt like the heavens had come down on top of me." That night he slept outside in the rain, listening to the cries of trapped neighbours. "They were calling out 'For God's sake, save us. Is anyone going to help us'?" he said, shaking his head slowly.

The chaotic conditions have forced some patients to return home. Near the hospital gate, Baidullah Wali loaded his son, Bilal, whose legs were cased in plaster, into a taxi. They were returning to Shohal Mori, near Balakot, even though their house had been destroyed.

"The doctors say there is no more room, so we have to take him back," he said. "Where else can I go?"