M*A*S*H without the laughs
By Tony Parkinson
January 29, 2005
Photo: Craig Sillitoe
As US forces and Sunni insurgents engaged in ferocious urban warfare in the Iraqi city of Fallujah, swarms of medical evacuation helicopters descended on a makeshift tent hospital at the Balad air base, ferrying in broken and bleeding bodies by the dozen.
Melbourne neurosurgeon Professor Jeffrey Rosenfeld had seen the horrors of war before. But never quite like those eight days in November.
"We had a steady stream of casualties," he says. "There was rarely a moment when there wasn't an operation under way in the theatres. They were constantly in use."
It was a bit like M*A*S*H, he says, without the laughs. Rosenfeld was speaking to The Age in his office at The Alfred Hospital, after flying home from a three-month tour of duty as one of 20 Australian reservist medics attached to the 332nd Expeditionary Medical Group in Iraq. A man who in civilian life is best known for his pioneering surgery in the treatment of child epilepsy also carries the military rank of colonel.
He has served with Australian forces in Rwanda, Bougainville and East Timor - and, now, with coalition forces in Iraq.
Balad air base is about 60 kilometres north of Baghdad. In a hospital set up by the US Air Force, it provides the equivalent to level-one trauma care available in a major American hospital.
It treats wounded coalition soldiers, Iraqi National Guards and police, civilians and Sunni insurgents brought into Balad from the intense conflict in the so-called Sunni triangle, to the north and west of the Iraqi capital. These include victims of suicide bombs and rocket fire. The injuries are horrific.
"We were seeing severe trauma there, and often in bulk," he says. "We had mass casualties coming in, particularly with Fallujah. There were injuries often to multiple parts of the body. Burns involved as well.
"With blast injuries, you can get bruised lungs with hemorrhaging, burst eardrums from impact. Then, with penetration injuries, you get multiple pieces of shrapnel going into various parts of the body. Eye injuries are common, as well as head and neck injuries. That's why you need a neurosurgeon."
Terrorists are just going to kill, kill, kill. That's the enemy we're facing."
You also need a neurosurgeon with nerves of steel. The Balad air base has been the most frequently attacked military installation in Iraq.
"Sometimes, there were three or four bombs, rockets, mortars coming into the base each day," Rosenfeld explains. "They can land anywhere on the base, so there is a constant threat."
So why would a leading medical professional leave the comforts of Melbourne, clad himself in khaki and throw himself into this life-threatening mess?
"You are putting your life at risk by going into Iraq, no question about that," he says. "Although my risk was lower than that of the front-line troops, it was never far from my mind while I was there.
"On the other hand, I felt very strongly that I wanted to do something for Iraq, to help the war on terrorism, to do my bit, however small it was. I felt Australia was contributing strongly, and I felt very proud and privileged to be serving Australia in this way."
For those who might suspect these to be gung-ho sentiments for a man dedicated by vocation to the saving of lives, it is important to know Rosenfeld is a former national vice-president of the United Nations Association in Australia.
His credentials as a humanitarian and liberal internationalist are impeccable. Indeed, he says he had some serious misgivings about the decision by the Bush Administration to go to war in Iraq without an explicit imprimatur from the UN.
But having served in the war zone - and assessed the nature of the threat from those he describes as "the bad guys" - he has returned convinced of the legitimacy of the cause.
"Although there was some conflict for me to go as a soldier to Iraq, and supporting a coalition which obviously went in against the advice of the UN, and Kofi Annan as Secretary-General, despite that I felt personally that it was a legitimate mission for the US and the coalition to be in Iraq, to try and restore peace to the country.
"I am not really commenting on whether America should have gone in there and ousted Saddam in the first place. I have mixed thoughts about that. But the fact is they are there, and Australia is there to support them, and I felt it was a legitimate use of Australia's defence forces to be there.
"There is also some hope this will be a new beginning for the Middle East, particularly Israel and the Palestinians, that the development of democracy and freedom in Iraq will act as a springboard for the spread of this philosophy to other despotic regimes in the region."
The experience has refined - and hardened - his thinking on the issue of terrorism.
"Terrorism is sometimes said to be a tool used by oppressed peoples to bring about freedom," he reflects.
"But when it involves killing civilians - of the opposing side, shall we say - then it becomes terrorism, in my book.
"There is no justification for the killing of innocent civilians to bolster a political movement. I saw civilians - some children, some adults - who had been victims of bomb blasts, either directed at them or near them.
"We were very distressed to see these people coming in. Some died before our eyes."
It is the indiscriminate targeting by the insurgents that disturbs him most.
"They are going to do as much damage as they can, and kill as many people as they can," he says.
"They are not concerned whether they are civilians or officials, or Iraqis or Americans, they are just going to kill, kill, kill. That's the enemy we are facing. That's what terrorism and extremism is all about."
Rosenfeld says he cannot comment on the recent claims in The Lancet medical journal that 100,000 Iraqi civilians may have died as a direct result of the US-led military intervention. "I have no way of knowing," he says.
But one of his discoveries soon after arriving in Iraq was that the best hospital in the country had been the exclusive preserve of Saddam Hussein, his family and cronies. Elsewhere, Rosenfeld found total destruction of infrastructure. There had been no public health service of consequence for a long time.
"There are kids starving. There is malnutrition. Malaria is a problem, along with gastro-enteritis and pneumonia," he says. "I have no doubt the civilian hospitals are over-crowded and under-resourced."
At Balad, he is keen to emphasise, there was no discrimination on the issue of who had access to the most sophisticated, high-priority care.
But, as Rosenfeld readily acknowledges, no medical advances - no matter how miraculous - can extinguish the horror, suffering and brutality of the conflict the Iraqi people are enduring. His hope is they will emerge from these dark days with the chance of a better future, beginning with the fraught process of getting through this weekend's elections.
"The extremists will do everything they can to disrupt the democratic process," he says.
"It will need a lot of military protection for voting booths. There will be a high threat level. No doubt there will be suicide bombings, and people will be killed, injured and maimed."
He accepts the legitimacy of the election result will be questioned by some, given the threat of a Sunni boycott. "If the Sunnis decide not to take part, that is their decision.
"Eventually, I think they will come to regret it. They will want to become part of the process of restoring government and services to the Iraqi people, and I think they will come around to the idea that they have to take part and they have an important role to play.
"It may not happen at this election, but I think the insurgency will gradually peter out as the Iraqi people realise the government and the coalition are actually trying to help them and to restore their independence, and give them freedom - and not to steal their oil.
"That will take time. Freedom takes time."