TILLIL AIRFIELD, southern Iraq — In a hastily created hospital, American military doctors and nurses during a hectic 24 hours treated more than 100 casualties of fighting in nearby An Nasiriyah.
The casualties, mainly Iraqis but a handful of Americans too, began arriving after Iraqi soldiers late Wednesday launched their most organized attack so far on U.S. troops near the city.
Some of the victims waited until Friday for surgery at a derelict building made into a hospital by a forward element of the 86th Combat Support Hospital earlier this week. The hospital is on an airfield now controlled by U.S. forces that Iraq closed several years ago to comply with no-fly zone restrictions.
Most of the Americans who came to the hospital suffered from relatively minor shrapnel wounds. They were taken to a better-equipped hospital in Kuwait Friday. The hospital also took in the body of a young Marine who was killed when a vehicle accidentally ran over him.
By far, most of the patients were Iraqi soldiers and civilians.
Inam Mhssen, 40, was near An Nasiriyah after fleeing Baghdad with her shopkeeper husband and their four children. Caught between Iraqi and U.S. forces, she took shrapnel in her back. Her husband and one of her sons were killed.
Capt. Robert E. Burnette, an emergency medicine doctor with the 86th, decided who needed help first, who could wait, who could be saved and who was beyond help.
The worst was a 3-year-old girl, who was shot when some men got out of the bus she was in and started a firefight with American forces. She had a head wound with obvious damage to the skull and brain. With no chance of survival, she was moved aside in favor of those who could gain from quick surgery or other treatment.
"That was the toughest decision," said Burnette, 32, of New Orleans. "The younger they are the harder it is. That was hard."
Even as hospital personnel spoke Friday with pride of the lives they had saved Wednesday and Thursday, they grimaced at the mention of the 3-year-old.
"I let my guard down on that one," said Sgt. Wendy Oehlman, a 24-year-old nurse from Long Beach, Calif. "I stepped over for a moment to pray for her." Then, with a stethoscope to the little girl's chest, she heard the child's last gasp. "That just about finished me off," Oehlman said.
One Iraqi man arrived with a severe brain injury. By Friday, he was sitting up and moving, though not speaking.
"We thought there was almost no chance he would make it," said Col. Harry Warren, a 45-year-old orthopedic surgeon from Houston, Texas, who is the hospital's commanding officer. "It's the things like that that make up for what we had to deal with."
Warren worked in a combat hospital during the first Gulf War. His patients then were Iraqi prisoners of war who came in slow, steady numbers, nothing like his experience of the past two days. First, two U.S. Marine helicopters came overloaded with almost 30 patients each. Two Army Black Hawk helicopters and an Army ambulance brought dozens more.
Hospital unit officials brought what they thought were enough medical supplies to last for six days, but they used half of them in a day. The 86th has two operating rooms running at the airfield, a third nearly ready, and a digital X-ray machine that feeds images to a laptop computer.
While there were 180 medical personnel to help, at times there was just one translator to bridge the gap from English to Arabic. So the medical troops carry cards with translations for phrases such as: "Are you in pain?"; "Where does it hurt?"; "I will give you a bandage."
"Even though most of them don't understand a word we say, it helps just to talk in a soothing voice," Warren said.
As in most of southern Iraq, a film of dust clings most everywhere in the hospital. And when winds kick up, doctors and patients alike don surgical masks to keep dust out of their lungs.
While American wounded have been sent to Army hospital beds in Kuwait, some of the Iraqis are bound for the USS Comfort hospital ship in the Persian Gulf.
Others remain about 100 yards from the Tillil runways, prisoners of war in tents surrounded by concertina wire. Iraqi civilians stay mostly in the building that is the hospital's headquarters.
In an ad hoc, 20-foot-square pediatrics ward, two women nursing their own children have been breast-feeding a 5-month-old girl, Zahra, who was wounded by a bullet that grazed her feet. She sleeps in a bassinet fashioned from an Army medical chest. When the women cannot feed her, she sucks infant formula from the finger of a surgical glove made into a nipple.
"She's our sweetheart," nurse Oehlman said. "Nobody can resist her."