As U.S. troops draw down, the Afghan military struggles to provide care for its countless wounded soldiers — on the battlefield and at home.
It’s a warm day in Kandahar as we wait in the parking lot of the airport on the whim of the Afghan army. We are supposed to spend three days at the Kandahar air base, in one of the most violent provinces in Afghanistan, documenting the plight of injured Afghan soldiers. In the long struggle for Afghanistan, the men of the Afghan army have borne the brunt of the fighting. But it has been an uncertain road to get here, not least because the government is reluctant to admit the extent of its own losses. Citing troop morale, the Afghan government stopped releasing official numbers years ago.
In January, the Special Inspector General for Afghanistan Reconstruction (SIGAR), which monitors the use of U.S. funds in Afghanistan, reported that a staggering 6,785 members of Afghan security forces had been killed and 11,777 injured in 2016. With an army of around 300,000 soldiers, the losses are unsustainable. Comparatively, only 10 U.S. soldiers were killed in Afghanistan the same year. If the army were winning, these figures would be tragic but maybe justifiable. But the Taliban control more territory than at any point since 2001, and the drawdown of international troops has left Afghan forces practically alone in battle against an emboldened enemy.
Finally, a khaki-colored pickup truck appears from around a corner, and a man in uniform waves at the three of us: writer, photographer, and translator. We throw our bags in the back of the car, and Khan Ali Ahmadi starts driving toward the base, only a couple miles from the airport. The city of Kandahar itself is almost an hour away from here. We are in the middle of a literal desert, entering a concrete jungle of bunkers, barricades, and blast walls.
The air base, where NATO forces are still stationed, has been attacked several times, the last in December 2015. As we make our way to the base, Ahmadi tells us that there used to be a bazaar here but that all the shops were incinerated during a Taliban attack. We drive past bullet hole-ridden ruins. “The savages didn’t even spare a mosque,” our interpreter says, astonished.
At the base commander’s office, we meet our next obstacle. We are carrying a sealed letter from the Afghan Ministry of Defense in Kabul that is supposed to allow us access to the air base’s clinic, the medics, and the injured soldiers. “It says here you are not allowed to interview the wounded,” says Cmdr. Parwani, a man with a stiff but friendly demeanor, inspecting the letter. We had expected problems; the high casualty figures are a sore spot for the army. After several cups of tea and endless stories of the commander’s adventures in Romania a decade ago, Parwani agrees to call the spokesperson’s office at the ministry. An agreement is reached. We are allowed to interview some of the wounded.
The base’s clinic is the biggest in southern Afghanistan. Physician Muhammad Sadiq Wardak is clearly proud of his clean and well-equipped facilities — a world away from most hospitals in Afghanistan. Cmdr. Azad, the head of intelligence at the base, has accompanied us to the clinic to make sure nothing goes awry. He is an imposing man in his 50s, with a bushy mustache reminiscent of old-school Bollywood gangsters. He never strays too far from us, eavesdropping on every single conversation.
Wardak’s clinic also treats civilians, although the vast majority of the patients come from the army or police. The clinic even has a room for treating injured enemy fighters, although it has been almost a month since a Taliban fighter was last here.
“At the end of the day, when he had recovered and everything was OK, he said, ‘If you want, keep me as a daily worker here.’ He saw what is going on here and became totally different,” Wardak says of the Taliban fighter.
Wardak is adamant that enemy fighters are treated exactly the same as everyone else, even though they are kept in a private room and are handed over to the intelligence services once fully recovered. Sometimes the soldiers even donate blood to the Taliban, Wardak says. But it is questionable whether the soldiers know whose veins their blood ends up in.
In the field, a Taliban attack usually starts with soldiers waking up to the deafening boom of a rocket hitting their checkpoint in the dead of the night. The situation is chaotic, with the Taliban continuing to shell the post as medics tend to the wounded. Rocket attacks result in serious shrapnel and burn injuries, often overwhelming the only medic in a unit of 10 soldiers. The medic — who may himself have been injured in the attack — has to help shift his comrades to a nearby clinic as gunshots and explosions sound in the background. From the clinic, the seriously wounded are then rushed by helicopter or ambulance to Kandahar.
At least, that’s how it’s supposed to work. “If the patient is evacuated on time, the result will be good,” Wardak says. But that’s the rub. The U.S. forces used to provide medevac support to the Afghan army, but this stopped in 2014 as the drawdown of troops began. Now, with Afghan forces in charge, evacuations reportedly take much longer than before — often several hours, in an environment where lives can bleed away in minutes.
Finally, we are taken to interview a couple of injured soldiers who were carefully preselected.
Shireen Agha, 33, was in the middle of an operation to liberate an area from the Taliban in Uruzgan, a southern province to the north of Kandahar, as three bullets hit his arm. “As soon as I was injured, the help came, and we were taken to the hospital,” he says as Azad hovers over my shoulder, giving threatening looks to the soldier. The other patients tell us the same unconvincing story of smooth efficiency and prompt treatment.
The next day, we visit a smaller clinic inside the base, accompanied by visiting generals. There, we meet the physician in charge of medical evacuations, the long-bearded Abdul Majid Khan. He spends most of his time in the field, where he is responsible for calling in helicopters to lift out wounded soldiers. Khan has something important to tell us, and he wants to wait for Cmdr. Azad and the generals to leave us alone for a moment.
“Once, we were very far from the base, and two soldiers who had been injured actually died because the helicopter couldn’t get there in time,” Khan says.
“Since the Americans stopped supporting us, we have had difficulties with air evacuations because the aircraft we have aren’t suited for the mountainous terrain of Afghanistan,” he adds. “Now, because we don’t have a lot of ambulance helicopters, and the few that we have must go all over the country, we have to wait for our turn. This is what causes the long delays.”
On our way back to the guest house, Azad is equally conspiratorial. “We have some bad people inside here,” he whispers. “We have received reports that the Taliban held a meeting in Quetta to attack this base.” Insider attacks are not rare; just a few weeks back, an Afghan army base in the city of Mazar-e-Sharif was attacked, supposedly with the help of insiders. Hundreds of soldiers were killed.
“Now everyone knows there are foreigners here. You should leave.”
We are not sure if Azad just wants to get rid of us or if the reports are legitimate.
Cmdr. Parwani invites us to his office for lunch. Suddenly, we are told there is an evacuation flight that day bringing wounded soldiers from Uruzgan to the clinic in Kandahar, after heavy fighting in the province the previous night.
Can we go? we ask. “Absolutely not,” Parwani says. “Besides, the plane has already left for Uruzgan.” Frustrated, we ask to be allowed at least to go to the airport to see the wounded being transferred into ambulances and to the clinic. “We cannot take you to that part of the airport — we don’t have permission to enter there,” Parwani responds. We are told to turn to two Polish special forces soldiers based in the Kandahar airfield, whom we met by chance the night before.
Luckily, they show up promptly to pick us up from outside the Afghan base and take us through numerous checkpoints to the airfield. Soon we find out the plane hasn’t even left yet, despite what the commander claimed.
There is no sense of hurry at the airport, although there are seriously injured soldiers waiting to be evacuated from Uruzgan. The pilots are not there yet, we are told. Surprisingly, the Afghans in charge of the airport agree to help us and get us on the flight when the pilots finally show up three hours later.
We climb on board the plane, a Cessna 208 Caravan, along with a few soldiers and medics. The plane takes off as we listen to flight control talk in an American accent to the pilots. The plane heads north over the mountains toward Tirin Kot, the capital of Uruzgan.
When we land 45 minutes later, there are no ambulances waiting at the Tirin Kot air base. It’s already 5 p.m., and most of the soldiers were injured either in the morning or the night before. The injured have been given basic first aid in the city, but now they must be evacuated to the clinic in Kandahar, where they can receive better treatment.
It takes almost another hour for the khaki-colored army ambulances to appear on the runway. The vehicles drive all the way up to the plane, and medics start helping the injured onto the aircraft. Some of them are able to stand on their feet, although with great difficulty. One of them lies on a stretcher, conscious but clearly weak. These men joined the army in the hope of a better life; many of them hail from the north and are completely cut off from the culture and language of the south. Jawad, 20, struggles to sit up straight at the back of the ambulance. There are blood stains still visible on the pants of his police uniform. He was injured the same morning. “I was lucky there’s a flight today,” he says, breathing heavily.
“I was inside a Humvee, and my commander told me to go save some injured soldiers from the field and bring back the dead bodies. When I went, the Taliban opened fire on me.”
A bullet pierced his stomach, and he lost a lot of blood, he says. “My friends wanted to come and help me, but I told them not to because it was an open area and they could easily get hit, too.”
Jawad had to use his shirt to tie the heavily bleeding wound. In the end, it was civilians who helped him get to a clinic. Jawad belongs to the Hazara minority not native to this area. He does not speak Pashto, the dominant language in the south and east.
The ambulance pulls closer to the plane, and Jawad is helped on board.
After him, a coffin wrapped in an Afghan flag is pulled out from the back of the ambulance. The medics and pilots salute as the coffin is carried past them.
The coffin dominates the plane, and we squeeze around it uncomfortably until finally we are ready to start our flight back to Kandahar. As we take off, the sun begins to set behind the mountains that surround the airfield. The pilot suddenly takes a deep curve to the left, tilting the plane sideways, avoiding the mountain wall that rises at the end of the runway.
Only one medic is on board, and he stays close to the man on the stretcher, who seems to be in the worst shape. The medic, however, doesn’t have any equipment with him.
After 40 minutes, we begin our descent toward Kandahar. The landing goes surprisingly smoothly. This time, ambulances are already there waiting for the injured. Finally at the clinic, the injured are brought into the emergency room. The doctors start asking them for information.
The man on the stretcher identifies himself as Fazal.
“There was a rocket attack close to me this morning. Everywhere there is war,” Fazal says, sighing as the doctor inspects his arm that was injured in the attack.
“I was bleeding, and I asked my friends and my commander to help, but they all escaped and left me there,” Fazal says. He fell unconscious and woke up inside a clinic in Uruzgan; he does not know how he got there.
Suddenly, Azad appears. He interrupts the interview and forces us out of the clinic.
We decide it is time to leave Kandahar.
We take a commercial flight to Kabul the next morning. As we sit comfortably in the cabin, we see five more coffins wrapped in the red, black, and green of the Afghan flag being taken out of ambulances and loaded onto our plane.
Sardar Daud Khan Hospital in Kabul is the main treatment facility for the Afghan military, with a capacity of up to 400 patients. The facility is spread out over a large area behind blast walls and numerous security checks. This is where the injured are transferred from regional clinics if they need more time to recover.
Yet, despite all these measures, the hospital was attacked in March, resulting in around 50 people killed and dozens wounded. The Islamic State claimed the attack, although some have disputed this, saying it bore all the hallmarks of a Taliban attack. According to some eyewitnesses, the attackers were wearing white doctor’s coats and received help from insiders.
As we climb up the stairs to meet with the patients, it is hard not to notice the bullet holes still visible in the windows. The firefight between the attackers disguised as medical personnel and the army lasted six hours.
“I jumped out of the window on the second floor,” one of the doctors says, describing his desperate attempt to escape from the attackers.
Many of the patients, unable to move, were not so fortunate. They were murdered in their beds.
In one of the wards, we meet Sirajuddin, a 22-year-old soldier who was brought here the day before from Kandahar. His leg is severely fractured, and the doctors have had to use an external fixator. “There was an attack on our checkpoint in Mianashin. They used to attack our checkpoint every single night. This time, they came with bombs and rocket-propelled grenades. Many others got injured, too,” Sirajuddin says. He was the only one with serious injuries, however, after one of the bombs went off.
He had to wait all night to be evacuated because the fighting kept on going. It was only in the morning that they received more forces to help them. “I was taken to Uruzgan, and then I caught a plane to Kandahar,” Sirajuddin says, where he had to undergo an operation. After five days, he was brought to Kabul.
Despite the risks and daily attacks, Sirajuddin is determined to rejoin the fight once his leg heals. This will take at least two more weeks, the doctors say.
Inside another ward, a more depressing case awaits.
Mohammad Nasib, 29, was injured when the Taliban fired a rocket at his checkpoint in a district in Kandahar province.
His speech is slurred, and he has a confused look on his burned face. The doctors say he was brought in the previous day, but he himself believes he’s already spent a week in Kabul.
“As soon as the rocket hit, I went outside. I pulled my gun and started shooting — I managed to hit someone. I noticed my head was bleeding, but I had to finish the fight,” Nasib says.
The fire from the rocket blast had burned parts of Nasib’s face and injured his head. Once the fighting finally stopped, an ambulance came and took him to the clinic in Kandahar.
“Thank God my eyes are OK and my body is OK. I will always fight against the Taliban, and I would definitely go back and serve my country,” he says optimistically.
The doctors, however, are not sure if this father of three will ever fully recover from his head injuries.
What happens to soldiers like Nasib, if their injuries remain crippling?
At the end of a bumpy dirt road on the outskirts of Kabul, a man is waiting for us with a little girl hanging onto his arm — the only one left, since his right arm has been amputated. The sky is murky, predicting a storm coming our way. Despite this, Abdul Agha, 32, wears sunglasses.
Agha had served in the Afghan police force for a little more than 10 years until he was injured two years ago in the eastern province of Logar. The incident left him severely disabled and put an end to his career.
Agha and his colleagues had been called to the provincial capital to investigate an explosion that had targeted a commander’s car. When they got to the scene of the attack, another bomb went off.
The impact of the explosion threw Agha so far that it took his colleagues half an hour to find him. He was first taken to a local clinic in Logar, but there was nothing they could do. Agha had to be brought to Kabul to the emergency hospital, run by an Italian nongovernmental organization.
Later, Agha was told that when he arrived, he was in a total coma and his heart was pumping blood at only 15 percent of its capacity.
“My left leg was fractured from three places, and my right arm was severely injured, as were both my eyes,” he says, lifting his sunglasses to reveal pink eyes that can no longer see even shadows.
His right arm had to be amputated, and his vision could not be saved.
“After two months in the hospital, they came and gave me a letter saying I’m no longer in the police,” Agha says as his oldest daughter sits on his lap.
Six months later, he had recovered enough to be discharged. “I went to the ministry and asked them why they had cut my salary.” Agha was told that he was now on a pension. But in two years, he has received only six months’ worth of his pension. This is a common problem, and the Afghan government often runs late with payments due to financial problems.
Agha lives in a rented house with his mother, wife, and three small daughters. Now there is no one able to earn a living in his family.
“I have raised my voice several times, but the government has done nothing,” he says.
Agha says he has had to borrow huge sums of money from his relatives and friends. Besides this, he has privately received help from Zubair Massoud, the nephew of the legendary Ahmad Shah Massoud. Massoud sent him twice to India for treatment, but to no avail. “The doctors said there’s no possibility to get my sight back.”
“My time is over now. I’m injured and unable to do anything. But I’m very concerned about the future of my children,” Agha says.
“I served my country for 10 years. In these two years that I’ve been home, no one from the government came to visit me.”
“More than the Taliban, I’m angry at the government of Afghanistan.”
It’s time to leave. As Agha stands outside his house to see us off, passersby stop and stare at him. Luckily, he cannot see their reactions.