As Afghanistan war ramps up, one hospital hunkers down to treat soldiers – and Taliban

Medics at a British base in Helmand – the epicenter of the Afghanistan war – cope with sadness, stress, and the ethical pangs of caring for the ‘enemy.’

A Chinook helicopter rumbles ominously overhead, quickly followed by ambulance sirens as another critically injured soldier arrives at Camp Bastion's field hospital.

It is a grim ritual punctuating days and nights at the British base in Helmand Province, a frequent reminder that the insurgency shows no signs of abating despite the deepening winter.

NATO forces suffered a deadly 2009, the worst in eight years of war in Afghanistan, with the most intense fighting taking place in this province.

Medics here are all too aware of the grinding conflict. On bad days they admit flurries of British, American, and Afghan troops and civilians – and even Taliban fighters – to the emergency department, one of the few permanent structures in the vast, bleak, rubble-strewn camp.

And tough months may be ahead, as President Barack Obama's troop surge crescendos, putting more boots on Helmand's IED-studded ground.

"Neither side wants to be out in these conditions, but it seems like the Taliban are prepared to brave it this time round," says Col. Peter Gilbert, commanding officer of 256 Field Hospital, the British unit leading the care. "We've seen several significant episodes since November, whereas perhaps we were expecting the fighting to slow down."

A steady flow of patients

Col Gilbert's unit is staffed by 90 National Health Service (NHS) volunteers, working long hours alongside 60 US Navy medics for three or four months at a time.

There are few creature comforts at Bastion to break up the monotony of the eat-sleep-work “triangle” that a tour entails.

But the routine is made bearable by the great pride the medics take in their work. They have made many “remarkable saves” at the hospital – patients who in previous wars would have almost certainly died – and the unit is rapidly becoming known as the world's leading center for trauma surgery and aftercare.

It is a reputation complemented by a fast-flowing treatment “passageway,” which sees injured soldiers picked up from the front line, operated on, stabilized, and evacuated to Europe within 12 to 48 hours.

"Many of the ones who don't make it are young lads. That's something everyone feels deeply," says Capt. Simon Cook, who is part of the resuscitation team.

Of the British deaths last year, 61 were under age 25. The increasing sophistication and size of the Taliban's IEDs has also maimed dozens of young men.

"With those patients, it's the recognition of the journey that lies ahead of them that plays on your mind," says Maj. Sue Snaith, who in civilian life is a pediatric expert in London.

More so for the Afghan children wounded in crossfire, bombings, or mine blasts.

United Nations estimates suggest around two thirds of civilian casualties are caused by the Taliban, with the remainder hit by NATO forces.

Treatment of Afghans brings its own challenges. Medics are expected to be sensitive to Afghanistan's rigorously patriarchal culture.

Recalling the case of a boy who had stepped on an IED, Snaith says the culture clash can sometimes be daunting.

"The boy's biggest worry was what his dad would say when he saw him, so he hid his lower legs under a sheet," she says. "It was heartbreaking to see."

Treating the Taliban

Under the Geneva Convention the Taliban are also entitled to care – a fact which sits uneasily with many soldiers who believe the brutal asymmetry of the Taliban's tactics should disqualify them from treatment.

On a recent visit to the hospital, a Taliban fighter sat upright in a bed in the Intensive Treatment Unit, his thick beard wrestling free from underneath a large blindfold. Though heavily sedated, he was accompanied by an Army guard even as he was wheeled into surgery.

Privately some medics are uncomfortable with treating the enemy, but stick to the ethical code governing their profession.

Others, such as Capt. Andrea Blay, second in command of the ITU ward, try to step back from the emotive debate on patching up the Taliban.

"They don't like being treated by women, that's for sure," she says wryly.

"But some of them are kids – 14 or 15-year-olds paid to do something stupid. Do they know the consequences of what they are doing? When you see them in here, some look almost apologetic. They are human, and we treat them with that respect."

Her colleague Capt. Raj Nathwani takes a similarly nuanced view.

"I hope I am able to still see the wider picture here. They are fighting for a cause, and perhaps my feeling would be very similar if foreign forces were in my land," he says.

"I hope for the Afghan people we are doing the right thing here, because a lot of people are being hurt."

Not everyone at Bastion is so sanguine. Outside, a weary-looking Marine from Washington expressed shock that medical resources are spent on the Taliban – an enemy he has yet to see in seven months patrolling northern Helmand.

"They are killing our guys, so why should we help them?" said the young man, who did not want to be named. "They hate our way of life so let them fix themselves up."

It is never too long before the thump of helicopter rotor blades again ranges into earshot, bringing another casualty from a remote front line.