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The fight to force ISIS from the Iraqi city of Mosul has resulted in more casualties than expected, both for combatants and civilians. That has led the Iraqi government and international aid groups to step up emergency care. NPR's Alice Fordham went to a clinic where they are trying to get medics closer to the front lines.
ALICE FORDHAM, BYLINE: In this field hospital a few miles from the Mosul front lines, there's no intensive care unit. They just wheel in casualties and start treating them right in the lobby.
FORDHAM: I get out of the way as two Iraqi troops arrive. They were hit by one of the suicide car bombs ISIS deploys every day on the battlefield.
UNIDENTIFIED MAN: (Foreign language spoken).
FORDHAM: One calls out the name of the other. Where is he, my brother? Both are conscious and expected to survive but confused and in pain, with hastily bandaged shrapnel wounds that need attention. Many such cases arrive during the day. In a tent next door, I speak with another man who took a bullet in his shoulder a few hours earlier.
ALI QASSEM: (Foreign language spoken).
FORDHAM: Ali Qassem says he was among the government forces that took the strategic airport back from ISIS and powered through into the next neighborhood. They thought they had cleared it.
QASSEM: (Foreign language spoken).
FORDHAM: But then, as a bunch of police gathered together, ISIS fighters shot them with rifles and mortars.
QASSEM: (Foreign language spoken).
FORDHAM: "There were two, three, four, several people injured. It's still going on," he says. And this is happening a lot. ISIS is expected to lose Mosul, but its fighters are inflicting a terrible toll as they fight their losing battle. The numbers of civilians and combatants killed and injured far exceeded what was predicted, with land mines and booby traps adding to the danger.
Most medical facilities are far from the fighting. And when I meet with Dr. Altaf Musani, the representative for the World Health Organization in Iraq, he says many died for lack of urgent care.
ALTAF MUSANI: There is really a window within minutes that someone should be stabilized
FORDHAM: That usually means stopping the heavy bleeding caused by bullet or shrapnel wounds and making sure the patient can breathe on their own while they await more treatment. Musani says typically in conflict situations, if they're stabilized, there's what's called a golden hour to get them more treatment.
In the first months of the battle for Mosul, that wasn't happening because the nearest functioning hospitals were hours away along bumpy roads. Musani says no one knew what would happen in the fighting, which made it hard to plan.
MUSANI: It wasn't anticipated that people would be stranded, caught inside east Mosul.
FORDHAM: The impact on the Iraqi Armed Forces has been colossal. Iraqi officials won't give figures, but American military officials have told reporters some divisions had casualty rates of 30 percent, without specifying whether the men were killed or injured. Now, Musani says the World Health Organization, charities and Iraq's health ministry have scrambled to move medics closer to the front lines to stabilize those first crucial cases.
MUSANI: And this is very difficult because you need a certain level of medical expertise, equipment and mobility to be out in front lines in order to capture cases. The other big lift that we're working on, again in support of the government, is putting down three additional field hospitals.
FORDHAM: Their services are likely to be badly needed. The battle for the densely populated west of the city is only just getting underway. Alice Fordham, NPR News, northern Iraq.
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