( explosion ) ( gunfire ) NARRATOR: During the conflict in Iraq, the U.S. military could claim at least one undisputed victory: Wounded American soldiers survived their combat injuries in record numbers.

In Vietnam, one out of every four wounded died.

In Iraq, at times, the number would shrink to one out of seven.

Much of the credit goes to combat support hospitals-- or CSH units-- which provide state-of-the-art emergency medical care to the troops.

MAN: The CSH evolved out of the MASH.

I mean, most everyone has seen that television show all over the world.

"MASH" stands for "mobile surgical hospital," and "CSH" is "combat support hospital."

( all talking over one another ) The hospital itself is really geared towards surgery, towards battlefield surgery.

NARRATOR: These advanced medical centers are transported in containers and can be set up just about anywhere.

Basically, what we're setting up is a 44-bed jump package.

It is a basic CSH, which is a combat support hospital.

( artillery fire ) Once a casualty is injured on the battlefield, they'll fly in via medevac.

From the ambulance, they'll be brought here to our front door, which is our EMT tent.

DOCTOR: Blood pressure seems to be normal.

From that point, they'll then go into our O.R.

Our O.R.-- they'll be prepped.

DOCTOR: That's a big hole, whatever the hell it is.

My middle finger's what's holding it.

They'll go into O.R.

for surgery.

From that surgery, they'll then turn around and go to our ICUs, which is our intensive care units.

Okay, perfect.

From that point, they'll then be medevaced and go back to the United States.

NARRATOR: During the Iraq war, five CSHs were sent to the region.

One year later, NOVA looks back at the experiences of two of these units.

They had trained to take care of over 200,000 coalition troops, but what they encountered would test their training and shake their beliefs in ways that they could never have imagined.

DOCTOR: Two civilians on the way in.

We don't know their status.

NARRATOR: "Life and Death in the War Zone," right now on NOVA.

NARRATOR: Five weeks before the start of the Iraq war.

At their base in Fort Carson, Colorado, the elite 10th Combat Support Hospital, or CSH, has spent months preparing for a mission to attack Iraq through Turkey.

About 550 people-- doctors, nurses, technicians and support staff-- will uproot their lives to face an unknown danger.

Colonel John Powell is commander of the 10th CSH.

A doctor and a paratrooper with a long combat résumé, he is trained to practice medicine under battlefield conditions.

This CSH is a 296-bed hospital, okay?

It's just like a mortar-and- brick hospital up on the hill, but everything is under tentage.

We have gynecologists, we have a dentist, we have a facial surgeon, we have people who can take care of eyes.

I mean, we have infectious disease specialists, we have internal medicine physicians.

We have to be able to do all the same things that a regular hospital does, but surgery is our main focus, because during battle time, that's the big piece we want to make sure we know how to do.

Hospital!

ALL: Yo!

Attention!

If we've got to call today, where could we call you?

With Colonel Powell.

How about Colonel Powell's cell phone?

Cool, perfect.

NARRATOR: Powell's second in command is Colonel Dave Lounsbury.

Based at Walter Reed Medical Center in Washington, Lounsbury is the editor of the army's combat medicine textbooks.

Like most military doctors, he joined the service to pay his way through medical school.

LOUNSBURY: If you had said to me when I finished medical school that "24 years from now, you'll still be wearing a uniform and in the service of the republic," I would have just howled with laughter.

I had no intentions whatsoever of making a career out of this-- none.

Leave this Band-Aid on for about 24 hours.

NARRATOR: These doctors and nurses normally work at military hospitals with jobs just like their civilian counterparts.

Now on the eve of war, they're supplied with more than just stethoscopes and scalpels.

Most have had limited experience handling any weapon since basic training.

WOMAN: I'm getting an M-16.

First name?

( man laughing ) WOMAN: Be sure to grab your... ( multiple gunshots ) LOUNSBURY: What in the name of sweet Mary and Joseph is a surgeon doing with a holstered nine-millimeter pistol?

Why does an O.R.

nurse have an M-16 rifle?

Incongruous?

For sure it's incongruous.

Do they feel comfortable carrying a weapon?

I think many of them do not.

I... first and foremost, I'm not quite sure I know which end of the pistol the bullet comes out of, and I'm sorry you weren't here to see my target practice a couple of weeks ago.

Nine seconds for your mask and eight minutes for your MOP suit.

NARRATOR: The entire staff has to practice protecting themselves against chemical warfare-- at this point considered a real risk.

They are preparing to treat mass casualties on a contaminated battlefield.

Sergeant Christian Ramirez, a paramedic, is an expert in chemical and biological weapons.

A lot of the doctors are very knowledgeable about the effects of actual agents, biological and chemical and how they react with the body.

But as for actual hands-on training, they're not as familiar as, like, soldiers of the CSH that are here on a permanent basis.

Now is the time to get them ready.

POWELL: I think the fear of the unknown is the worst piece of it.

And I think there's always, in the back of your mind, even though this is a hospital, there's always the potential that something could happen to the hospital, and we'd have some people in the hospital get hurt or even get killed.

And I know my children are very concerned about what's going on, and I know my wife is, too.

NARRATOR: Sergeant Ramirez isn't worried about leaving his family behind.

He's married to another member of the 10th.

The couple will be going to war together.

We dated about four months, which is kind of short, but we kind of... we've been inseparable since we did meet, so... And we just went to the justice of the peace for now.

We hope to have a nice ceremony later, but since all this stuff come up, then...

When you stop to think about the reality of... what can rea... what can happen, it's... you don't want to go into that.

I mean...

I don't want get shot.

I don't want her to get shot, you know?

I don't want any of my friends to get shot.

I don't want to see, you know, 18-year-old boys coming in missing limbs, you know, bleeding from bullet wounds and...

But at the same time, you know, I do want to go.

Uh...

I'm scared, but it's not going to stop me, you know.

I'm...

I have a mission, and that's my focus.

POWELL: Their training is complete.

They know what the briefings are about terrorism and personal protection, and they know how to get their MOP suits on, and they have been issued all the gear they'll need to take with them.

So, basically, they're ready.

NARRATOR: But on the third of March, after three months' intensive preparation, the 10th CSH's mission is put on hold when Turkey refuses access to American forces.

MAN: There's no question that the Turkish approach would have been a preferable approach, but other approaches are available.

There are other options from a military point of view, and the president has every confidence that those other options will indeed be militarily successful.

( explosion ) NARRATOR: The 10th is forced to watch the first advances on television.

Finally, the unit is assigned a new mission: to support the army invading from Kuwait.

POWELL: Take your seats.

Everybody's got questions about the mission.

So do I, okay?

Everybody remembers Somalia and what happened when you get a small group of people who are really determined to keep you out, okay?

And I suspect those folks are, all right?

That's home for them; it ain't it for us.

All right?

Thanks again for all your attention and for your smiles and your patience.

NARRATOR: On the 30th of March, two weeks after the start of the war, the 10th Combat Support Hospital leaves for the Gulf.

Despite all their preparation, what they encounter will be completely unexpected.

( explosions ) In the first two weeks of the war, it's already clear that U.S. casualties are relatively light.

As American troops take Baghdad on the ninth of April, there have been 87 U.S. soldiers killed and a few hundred wounded in action.

Turn round.

Kneel down.

NARRATOR The survival rate for the coalition wounded is high.

( artillery fire ) For the first time, ceramic body armor is worn by most combat troops, and total air supremacy means any casualties can be quickly evacuated.

News reports reveal the appalling conditions of the Iraqi health care system.

They have no power, no water, no drugs, and the morgues are overflowing.

The little that's left is taken by looters as law and order breaks down.

( man coughing ) While the 10th CSH waits in Kuwait, another combat support hospital, the 21st, based at Fort Hood, Texas, gets the order to enter Iraq.

Even though Baghdad has fallen, skirmishes and ambushes are common along the way.

( artillery fire ) ( machine gun fire ) All right, my mission is to get you up north, a hundred miles... approximately a hundred miles north of Baghdad in a safe and sound manner so you can execute your mission.

Cool?

ALL: Cool.

NARRATOR: Major Chris Niles, an anesthesiologist, has left a wife and two daughters back in Florida.

He is relieved to finally have a mission.

There's a lot of opportunity for us to do some good to help the people here of Iraq, because it looks like they've been just brutalized and had no health care, no infrastructure, and I think there's going to be a chance for us to really help a lot of people.

So I'm definitely looking forward to it-- getting back doing my job.

All right, let's pray.

Our gracious eternal father, at this time, we do need to call upon you to watch over each one of us, for we have a long journey ahead, O Lord.

And yet we understand that you have already marked out that path for us, and for that, we are eternally grateful to you.

Now, bless us, protect us.

In your holy and precious name.

Amen.

SOLDIERS: Amen.

( horn honking ) NARRATOR: Without any escort, the staff of the 21st CSH heads for a captured air base in Balad, northwest of Baghdad.

The three-day drive takes them through the heart of the recent fighting.

At rest stops, the CSH has its first contact with Iraqis-- civilians begging for food and water or trying to trade bundles of the local currency for a dollar.

For Captain Suki Quattlebaum, a nurse, it brings back painful memories.

I was born and raised in Korea right after the Korean War, and things were very scarce.

Water and food was very scarce, and when I see these kids, they remind me of when I was growing up.

I was doing the same thing in the street-- begging for food and water from GIs.

And they were nice enough to throw out chocolates and candies and water, and they was... they just made my day.

So it's get very emotional when I see these kids, so my heart breaks when I just pass by them without giving them anything, because I know that was me, that was me.

MAN: All right.

If you don't know, we're about to go through Baghdad.

If something were to happen, you need to be divided into two sections.

If we need to fire, this side will fire towards your side, and this side to that side.

Let's not cross fire.

It's not a nice thing, all right?

Keep your Kevlar on.

Stay down, and hopefully nothing will happen.

Stay safe.

God bless.

Here we go.

NARRATOR: The 21st CSH is split into two units.

The smaller unit goes to northern Iraq, while the larger section will set up here, at the Balad air base.

The hospital is packed inside 48 milvans, or military containers.

The CSH has just three days to build a 44-bed hospital from what's inside them.

As a sandstorm whips up around them, they mark exactly where each tent will go.

The hospital will be made up of interconnecting tents and hard containers, which fold out to form rooms and wards.

Once everything is in the right place, the priority is getting the emergency medical treatment sections set up.

Medical workers become construction workers.

Take it all off.

NARRATOR: The man in charge is Sergeant First Class Renaldi Toledo.

A senior medic with 22 years' Army service under his belt, Sergeant Toledo was just two weeks from retirement when he was mobilized to come to the Gulf.

TOLEDO: What we're doing here is we are erecting the emergency medical treatment section, very much the equivalent of a civilian or military fixed-facility emergency room.

Once we get started, once these milvans hit the ground and we crack the doors open, we have 72 hours to receive patients.

After this goes up, then we'll start setting the operating room up, and then the nuts and bolts of the hospital will start falling in place after that.

So, this is a big step for us.

I mean, this is great.

We can start seeing patients soon.

NARRATOR: The operating room is in one of the containers that folds out to form a space three times its original size.

This is our operating room suite, and there'll be two operating room tables where we can do two surgeries simultaneously.

This is all a positive-pressure environment, which means clean air is pumped into here, so that none of the surrounding dust gets in there.

It's going to be a nice sterile operating suite.

NARRATOR: But this is still dangerous territory.

During the night, the base comes under attack.

( artillery and machine gun fire ) After a sleepless night, many are trying to recover from their first encounter with hostile fire.

( laughing ) I'm in denial right now.

WOMAN: I'm trying to pretend it's something else.

Yeah, it's just firecrackers.

It's getting louder, but we're... we're in denial.

WOMAN: So we don't get freaked out.

I'm not too worried personally, because I know it's off at the gates and there are guards up there, and I'm not worried.

It'll be dealt with.

NARRATOR: The CSH's sleeping quarters don't provide much protection, from enemy fire or from the elements.

Roughing it like we never have.

They like to tell us that we're in "austere conditions," but I don't think I was really expecting it to be this bad, where we're not even going to be able to describe to our family and friends how bad it really is.

Mosquitoes everywhere.

You can be covered up in your sleeping bag with your sleeping bag over your head-- the dust got in, the dirt got in, and the mosquitoes got in.

WOMAN: Half a mile walk to the bathroom at night with ditches everywhere.

Good times.

Yeah.

( laughter ) NARRATOR: All the living conditions are primitive.

The latrines are nothing more than a public hole in the ground.

You've got a couple of techniques.

One is facing the lumber and hanging off over the back side, and the other one is with your backside to the lumber trying to shoot between those slats.

And you can see some people have had a little trouble with their aim.

NARRATOR: In time, the 21st will get proper latrines, showers and laundry facilities.

But creature comforts take second place.

The priority is getting the hospital ready to treat casualties.

Even the senior surgical staff help get the O.R.

up and running.

After 48 hours, the different departments are starting to take shape.

Colonel Bob Lyons is a plastic surgeon.

In times of peace, he specializes in breast reconstruction following mastectomies.

At the 21st CSH, he's the senior physician.

LYONS: Right now we're in our emergency medical section tent.

This is where most of the acute injured patients will arrive.

Then they'll be assessed by our... our emergency medicine physicians and prepared for surgery if they need surgery or sent to the ward if they're just medical patients.

This is on line with the main line of the hospital.

As you pass through this line, the next thing you'll see is the pharmacy being set up off to our left.

It's right off the main section of the hospital.

That's accessible to the emergency section, the operating room or the ward sections for whatever medications the patients may need.

We have everything a standard hospital would have.

We have anesthesia, we have surgeons, we have nurses, we have an emergency room, we have a laboratory, we have... there is no difference, for all intents and purpose.

NARRATOR: By the afternoon of the third day, all that's left is to put the finishing touches on the hospital.

With just a couple of hours to go until the 72-hour deadline, the commander of the CSH, Colonel James Bruckart, makes a final inspection.

The last test of the hospital's readiness is the O.R.

Is it prepped to perform surgery?

( inhaling ): Even smells like an operating room, doesn't it?

Ah.

You're going to get some perhaps really sick patients come through here.

What are you going to do?

I'm going to...

I'm going to open up 12 beds and tell them the hospital's functioning tonight.

NARRATOR: It doesn't take long before the first serious U.S. casualty arrives.

( groaning ) Right on the pain button!

NARRATOR: Private First Class David Mason from the 101st Airborne Division has broken both his ankles in a bad fall.

WOMAN: You see this here?

Usually... and this is supposed to fit up and up there right in the bone, and that's just all ( whoosh ).

NARRATOR: The orthopedic surgeon is concerned that he will face long-term disability.

MAN: It's a very severe injury.

The top bone of the foot is shaped as a dome with a snout that sticks off the front, and he fractured where the snout meets the... the top portion through here.

SEARLE: Because the longer it stays like this, the higher your risk of having problems down the road.

What is likely to happen once this is all said and done is you're probably going to have at least some achiness in both your ankles, probably forever.

So road marching and running long distances and that sort of stuff<http://www.pbs.org/nova/combatdocs>[type:PROGRAM][name:NOVA "Life and Death in the War Zone"][114F] may not be something that you're going to be able to do in the future.

NARRATOR: David's career as a combat soldier is over.

He has to be evacuated because the CSH is not equipped to provide the complex operations and long-term care he needs.

Anyone needing treatment taking more than a week is stabilized and airlifted to hospitals in Europe or the U.S. David was injured near Mosul, 160 miles to the north.

With a population of just under two million, Mosul is the third largest city in Iraq.

In the months to come, Mosul will be the site of several deadly attacks on American soldiers, including the downing of two Black Hawk helicopters.

But for now-- late April 2003-- things are relatively quiet.

A forward unit of the 21st Combat Support Hospital is just outside Mosul.

Iraqis injured in the fighting over the last several weeks, who can't get treatment in their own shattered hospitals, are now lining up at the CSH, but only some will get in.

According to army policy, CSH units will provide emergency care to any Iraqi who's in immediate danger of losing life, limb or eyesight or who's been injured by American forces.

Ala, an Iraqi soldier, is a typical case.

He was badly hit in both legs during the fighting.

He's come to the CSH because the local hospital cannot treat his wounds.

( Ala shouting ) MAN: He's been treated in a hospital apparently here in town for the last 28 days.

That's what... what his father told me.

They don't have any access to medicines, they don't have any access to orthopedic instrumentation, orthopedic hardware.

WOMAN: You guys ready?

NARRATOR: Major Doug Prevost is the chief orthopedic surgeon for the 21st CSH's Mosul unit.

The son of a Special Forces sergeant major, he's a graduate of West Point and is a father of five himself.

PREVOST: This is always a bit of a surprise for us.

We haven't had a chance to really see his wounds yet.

This is a little bit like opening up a Christmas package that you really have no idea what's in there, because it could be anything.

NARRATOR: Ala has endured three weeks without any antibiotics, and Major Prevost soon detects that his wounds are dangerously infected.

PREVOST: As we stand here and look at this wound, we can smell a fairly characteristic odor of a certain type of bacteria called Pseudomonas, which is a fairly difficult infection to clear in these types of injuries.

Taking care of war wounds is quite a bit different than taking care of normal trauma that we see.

Typical war wounds are much more contaminated and they're much more high energy, and the soft tissue is damaged to a greater extent than what it would be if there was a car accident.

So one of the things that we've learned over the years is that to close a war injury the first time you're there is a mistake.

These wounds tend to become infected if you do that.

What we need to do is leave them open and let them drain for a long period of time and let them fill in on their own.

Rarely do we close war injuries definitively like we would normally.

Oftentimes, people want to see the skin edges back together and everything closed, but that really is a mistake to do that.

NARRATOR: All that Major Prevost can do is clean the wounds of all shrapnel and cut out any infected tissue.

Clean conditions and antibiotics may help control the spread of the infection.

After so long without proper treatment, the outlook for Ala is poor.

He'll probably end up with amputations on both sides below the knee.

NARRATOR: The CSH has not had to deal with the mass U.S. casualties they'd prepared for.

So far, the injuries are mostly minor: scorpion stings... You know, the scorpions here?

Nobody ever dies from them.

NARRATOR: A variety of cuts and bruises... And several heat-related injuries.

These are the typical cases on May 1, when President Bush addresses the nation.

( "Hail to the Chief" playing ) ( applause and cheering ) BUSH: My fellow Americans, major combat operations in Iraq have ended.

In the battle of Iraq, the United States and our allies have prevailed.

NARRATOR: But even after May 1, seriously injured Iraqis continue to appear at the CSH seeking care.

In the middle of the night, a young Iraqi is brought in, critically injured by a grenade.

Hey, get the O.R.

ready.

WOMAN: We're ready, we're ready.

NARRATOR: This is the kind of life-or-death combat casualty that the CSH is set up for.

Shrapnel has torn into his body.

He is dying from blood loss through multiple wounds.

His heart stops before he reaches the operating room.

Major Betty Kim, a cardiothoracic surgeon, cuts his chest open and massages his heart by hand.

She gets it started-- he now stands a chance.

Although he's an Iraqi soldier, the surgeons fight as hard to save him as they would an American.

DOCTOR: Guys, we don't got an option-- we're going in, because he's bleeding.

NARRATOR: It is now a race against time to find the source of the bleeding and stem the flow.

DOCTOR: All right, I've got my finger on it right now.

DOCTOR 2: What is it?

NARRATOR: After 15 minutes, it's clear that major blood vessels behind the bowel have been severed.

Another surgeon, Major Yong Choi, pinches the leaking vessels to stop the flow.

But even this is not enough.

The man is hemorrhaging faster than they can squeeze plasma into him.

Then his heart stops again.

As a last resort, they try to shock it into action.

DOCTOR: Everybody clear.

( clunking ) DOCTOR: He's dead.

NARRATOR: But to no avail.

Members of the family are waiting outside.

( helicopters whirring ) WOMAN: The first death that I saw was very hard on me.

I had such a close relationship with the patient.

This is when I was on the ward.

After that, I hate to say it, you kind of distance yourself a little bit from that so it doesn't hurt you as much.

But it does affect you every time someone dies.

NARRATOR: After three days, the doctors' efforts have made a remarkable difference for Ala, the young Iraqi soldier with wounded legs.

The cleaning and antibiotics have saved his limbs.

MAN: If he had stayed where he was in the condition he was, personally-- if I'm just going to go ahead and lay my cards on the table-- I don't think he'd have lasted another six weeks.

I think he'd be pushing up daisies.

NARRATOR: Private First Class Torin Howling Wolf is a Cherokee who grew up in the White River Tribe in Kansas.

HOWLING WOLF: The Cherokee have a really strong tradition of training their people as warriors and healers.

I mean it... it wouldn't do any good to just run willy-nilly through the countryside, you know, maiming, slaughtering and killing, because we're... we're not... that's not our goal here.

Our goal here is to help an oppressed people.

Our goal here is to restore one of the most ancient and beautiful civilizations of all time.

NARRATOR: Howling Wolf and his colleagues have saved Ala's legs and made a friend out of an enemy soldier.

But Ala needs long-term rehabilitation and further surgery.

The CSH is not set up to provide this.

He'll have to be sent back into the devastated Iraqi health care system that has failed him once already.

When American soldiers need long-term care, they are evacuated to U.S. military hospitals in Europe or back home.

David Mason, the airborne private with shattered ankles, is ready to fly out.

MASON: They said I'm going to Germany, to a hospital there.

I'm going to get surgery, get screws put in, then probably go on home.

It's a good thing I'm going home, but it's a bad thing I'm not going with my buddies.

I mean, I want to go home, but I'd rather go home with all my buddies, you know, go through this... you know, go through this whole war with them.

NARRATOR: David is flown down to Baghdad, where he'll be put on a plane to Germany.

Back at the Balad air base, more and more wounded Iraqis who cannot get treatment locally keep arriving.

The issue of who the CSH will or will not treat is becoming more acute.

Among them is a 14-year-old girl.

( girl moaning ) NARRATOR: She is not critically injured, but the guards on the gate took pity on her and let her through.

We don't know if it was an unexploded ordnance or if it was some type of powder.

She was playing with that and had a big flash, and that's what caused her burns.

She's got burns on her face, her right side of her body and on her chest.

NARRATOR: The medics aren't quite sure whether they should be treating this girl.

We have certain guidelines that we have to follow.

One of those guidelines is that she be... before she becomes a patient, she needs to be needing to be treated for life, limb, or eyesight loss.

The other instance that she would be required for us to treat her was if she was injured due to something that we-- American soldiers-- had done to her.

And in this particular case, that's not what happened.

WINN: We're going to put some bacitracin ointment on her, and on her face.

Since she can't really bandage that off, we're just going to put that on her face as a cream.

We did give her some pain medication, though, before we started this treatment, because it is awfully... there are some secondary burns which are very painful.

But we're just going to do the best we can and then send her probably on her way home.

HOWLING WOLF: If I had, you know, a magic wand to, you know, "poof," I've got, you know, all the gauze I could handle, um... sure, I'd love to be able to treat everybody.

Um... you know.

But there's only so many of these kids, as you can see, walking around in tattered clothing and malnourished that you could take before you have to close your eyes and turn away from it or it's going to make you sick.

NARRATOR: The doctors, nurses and medics, by training and inclination, would treat everyone.

But the choice is not always theirs to make.

The Army provides guidelines, but how they're enforced on the ground is left to the discretion of the CSH commander.

For Colonel James Bruckart, commander of the 21st CSH, his mission is clear.

BRUCKART: The primary purpose of the hospital is to take care of our soldiers, but we will provide emergency treatment to stabilize a local, or even our enemy.

But we're very selective.

What we try to do is wait for somebody who we can save their life, we can save their eyesight.

Those are the ones we think are the most needing of our care.

NARRATOR: Today, officers from the army's Medical Brigade, which oversees the CSH, are on their way to the local hospital in Mosul.

Iraqi doctors are hoping that they'll approve the transfer of some injured patients to the CSH.

MAN: The military can only provide care for very specific circumstances, and those circumstances are immediate threats to life, limb or eyesight.

So if somebody happened to have a grenade explode on them right in front of our gate, well, of course we're going to take those people and stabilize them.

If we were... if some of our troops were in action with some other people and innocent bystanders or other soldiers from the opposing side were injured, we would take care of them to stabilize them.

NARRATOR: The hospital has survived most of the looting intact.

Many of the doctors are highly skilled, but their expertise is useless without supplies.

MAN: Everything we need.

Everything.

We need antibiotic, enough drugs for patient, enough intravenous fluid, enough oxygen, enough power, enough water.

Everything we need.

NARRATOR: In contrast, the CSH is well equipped, so the Iraqi doctors are eager to transfer any patients that might meet the army's guidelines.

This soldier was shot in the stomach a month ago.

After multiple operations, his wounds still have not healed.

It's difficult, the problem.

This is a bullet, and it passed through the body making different problems in the body.

Multiple perforations in the intestine.

NARRATOR: The doctors are worried that without clean dressing and antibiotics, the patient will die from his infected wounds.

He was shot by Kurdish coalition fighters under the control of U.S. forces.

But that doesn't appear to be enough.

Well, there's no real connection to the U.S. military here.

It was the Peshmerga fighters in this case that injured him in the first place, right?

The U.S. Army doctors will probably not take this case.

NARRATOR: In this case, injuries caused by America's allies don't guarantee admission to a CSH.

This young man has been partially paralyzed from the neck down.

He is one of Iraq's Christian minority.

MAN: The doctor say many shells affecting the neck.

He say that one of the shells is still inside till now.

NARRATOR: This time, it seems U.S. forces are directly involved.

His mother says their village was bombed by American planes.

Who were the aggressors in that?

( all talking at once ) MAN: Yes, U.S.-- U.S. rocket.

She say that a bomber plane... a bomber plane attacked the house by rocket.

WIESEN:Okay.

This is the same as we were talking about-- the other soldier.

The U.S. military probably won't do this case, but we can facilitate getting the nongovernmental organizations and other governmental organizations to get the appropriate equipment here.

WIESEN:Okay.

WOMAN: Thank you.

You're welcome.

Yeah, well, it's the same, you know, situation as in the beginning.

They were, you know... certainly weren't targeted as combatants, but, you know, aerial warfare-- that does happen.

And, you know, and we try and atone for our mistakes the best we can.

NARRATOR: Even though coalition forces may have contributed to the injuries, the medical brigade concludes that both patients are in stable condition, so the CSH-- designed primarily as a trauma center-- is not the place for them.

WIESEN: The U.S. government's policy is that the most fair and equitable way to get help to those people is not through military sources.

The military is there to provide a safe and secure environment for the other governmental and nongovernmental organizations-- the humanitarian organizations-- to provide that care.

Sometimes the army is funded to do humanitarian assistance missions, but it wasn't from the military budget.

Congress really maintains control over that.

And you'll see-- certainly with the combat support hospital-- they really want to help, and I think... these constraints are put on us, financial constraints are put on us, because there are many, many, many things we could do here.

( children shouting ) LYONS: The frustrations in who we can treat and who we can't treat are enormous.

There are many illnesses we've seen, especially in developing a relation with the local Iraqi hospital...

There are many situations that are easy for us to treat.

Many situations they confront in their hospital that we could treat easily in this hospital, yet I cannot use these resources to effect those changes.

That's very frustrating.

NARRATOR: But when two young Iraqis arrive with life-threatening burns from exploded ordnance, there are no questions asked.

They're in good hands: Colonel Bob Lyons is the Chief Plastic Surgeon at Brook Army Medical Center in San Antonio, home to the military's only specialized burn unit.

LYONS: This young man is burned more seriously than the other, with 60% total body surface area burns.

We calculate those surface areas because it helps us with managing their fluid requirements.

We debride off all this dead skin so our antibiotic ointments can help protect the wounds from getting infected.

As you can, see his face is all debrided now.

You can see his legs are all debrided of the dead skin.

In America or Britain, the prognosis for this guy would be very good.

He may need skin grafting of these feet, but he would get aggressive burn treatment and physical therapy.

NARRATOR: But that won't happen here.

There's no fully functioning burn unit in all of Iraq, even at the CSH.

After cleaning him up and giving him antibiotics, all the doctors can do for the patient is try to ease his pain.

NILES: He's extremely critical.

These burn patients have a tough time.

They have a lot of... a lot of issues going on with thermal regulation, their temperature, their fluids in their bodies.

It's a huge shock to them, and he's... he's extremely critical right now.

NARRATOR: To keep the patient completely still, the doctors would like to use a paralytic agent called vecuronium, but it's in short supply.

LYONS: We have a dying patient in there now.

I have a certain amount of a certain drug that I can't consume on him because I have to be able to operate.

So I had to make the decision that we don't use that drug on him.

We'll use other drugs, maybe not as effective, but I have to be able to save other people's lives.

I have to make those decisions for the other physicians.

That's my job.

NARRATOR: Three days later, the badly burned young man dies.

Most Iraqis seeking treatment at the CSH are soldiers wounded by U.S. forces.

But others are civilians hurt in accidents-- some by unexploded ordnance-- or simply sick.

The ethical dilemmas this produces are troubling the doctors.

NILES: You know, we raced up here with not really a true mission.

Obviously we're going to take care of our troops as best we can.

But... then after that, what do we do?

What's our mission?

Is it humanitarian?

Is it not?

It's been very frustrating, because we have local Iraqis coming to the front gate asking for us to help them and us not being able to give it.

NARRATOR: Some of the doctors are asked to be gatekeepers to judge who gets treatment and who doesn't.

Major Nhat Nguyen-Minh, a general surgeon who escaped Vietnam to come to America in 1978, goes to the front gate to assess a patient.

We're going to one of the gates.

Apparently there's a two-year- old child that's coming in, that she has some type of burns.

They say it's a second-degree or a third-degree burns.

I know there's second-degree for sure... ( child crying ) NGUYEN-MINH: Sorry, baby.

( crying resumes ) I'm sorry, I'm sorry, I'm sorry.

I think we cannot bring her in.

She has a ten-days-old burn.

But what can you do?

This is not life, limb or death.

MAN: Apparently they went to the one in Baghdad, and they told them they couldn't be there because there was some kind of virus or some stuff.

Yeah, so they need to go to the Balad hospital.

MAN: Balad?

Balad Hospital.

MAN: They need to go to the Balad.

Yeah, we cannot take...

I'm sorry, we cannot take care of her here.

You know, it's a lot of emotion involved in that.

You know, you see a little child, you don't want to be leaving her.

You know that most likely she won't... she won't... get the medical care that she will get like she will here out in the Balad or any local hospital.

So you would like to take care of her, but she doesn't meet the criteria.

And if we're going to start bringing these... these... in, we're going to be... they are going to... everybody around this area is going to be bringing them in and we're going to end up taking care of all these local Iraqis, and then we won't... you know, we'll soon be running out of the resources to take care of our own soldiers.

BEAVERS: What happened?

We... we saw them and we sent them away.

We told them to go to the Balad hospital.

Oh, beautiful, excellent.

Thank you.

They may whine and cry about it... That's what... yeah, that's the right thing.

Thank you.

All right, sure.

Okay.

NILES: Who do we let in the gate, literally and figuratively?

Do we let this child but not this child?

Or these adults?

And so it's been very frustrating for those who've had to go out to the gate and look at a patient, look them in the eye and say, "No, we can't help you," and send them away.

I think it sends a mixed message to the Iraqis: We're here to help them and make them better, and yet we turn them away.

NARRATOR: While Major Niles struggles over how the resources of the CSH are deployed another fully equipped American hospital is sitting unused in the Kuwaiti desert.

( snoring softly ) NARRATOR: Weeks after arriving in the Gulf, Colonel Powell's 10th CSH is still waiting for a mission.

Colonel Lounsbury hasn't treated a single combat casualty.

There's a humanitarian disaster of some sort going on north of here and no one attending them.

The hospitals are full and the care is inadequate and it makes me feel terrible.

I think we have a role to play.

I think we could do it, do it well and do it effectively, do it efficiently and we could relieve some of that agony and suffering.

For God's sakes, let us be part of that experience.

Let us be part of taking care of those people.

CHRISTIAN RAMIREZ: We want to get up there, set up, start treating.

We went from a combat mission to a humanitarian mission.

Hey, you know, either way, we're doing our job.

You know, we're all ready.

Everybody's ready to go do it.

NARRATOR: The staff of the 10th CSH were never given the humanitarian mission they craved.

After four months in Kuwait, the 10th Combat Support Hospital will be sent back to Colorado, though some staff and supplies will go to Iraq.

Back at the 21st, the "life, limb and eyesight" policy has allowed the CSH to admit Najla.

Her mother says the eight-year-old was injured when a U.S. missile blew up an Iraqi tank.

Najla was trapped at home for several weeks, her family too scared by the fighting to venture out.

Now on top of her original injuries, she's severely malnourished.

She's in such bad condition, the doctors appeal for help from back home, and the University of Michigan Trauma Burn Center agrees to take Najla.

NILES: If we can get her back home to the States, we'll be able to get some big IVs in her and start getting her fed and getting her better.

So I think her only hope right now is to get her back to the States and get her taken care of.

NARRATOR: It's a challenge to help Najla in a combat hospital equipped to treat soldiers, not children.

But no one wants to back away from this case.

NILES: It's hard.

It's, uh...

It makes you feel bad.

It makes you go home and say your prayers and thank God that your kids are okay.

I've got two little girls at home, and I see her and her parents and it breaks my heart.

It's... it's terrible.

So it's, I guess, a little extra motivation to... try and do the right thing.

NARRATOR: A plane is due in the following day to take Najla to America.

If Major Niles can get her stabilized overnight, she will get the best care in the world.

Seeing the conditions endured by children like Najla is starting to affect many in the CSH.

MAN: Pretty sad, though, seeing little kids over there, hungry and stuff.

MAN 2: It kind of made me think about my kids, you know.

MAN: We come over here and we see what they don't have and we think about where we came from, where we live, how we live.

And then we think about all the stuff that we take of granted back home.

And there's a lesson learned for a lot of us, and I bet you that when we go back home, a lot of the stuff that we take for granted, we're going to... going to just stop and smell the roses every now and then.

( soldiers conversing in background ) NARRATOR: The next morning, Najla is getting worse.

Major Niles and the team are now struggling to get her ready for her flight to America.

What do we know about her flight home?

Do we have any information about it?

MAN: Got an update... NARRATOR: There's a medevac plane on its way, but Major Niles is worried Najla may be too ill to travel.

Her extreme malnourishment could lead to complete organ failure.

Right now we're just trying to see if can keep her well enough to send her back to the States.

University of Michigan has accepted her, um, and we just need to make sure we get her taken care of and set to go, so we can get her home and get her taken care of.

NILES: Okay, princess... ( sighs ) ( whispering ): Oh, God help us.

NARRATOR: With no time to lose, Major Niles asks for blood tests to ensure that Najla will survive the trip.

NILES: Um, how much do you think you need?

Let me take it all with me.

Can you hold on here?

And let me run down to the lab real quick.

And I want to make sure I get what I want.

All right, here's the deal.

NARRATOR: He asks the lab to test for electrolyte levels to check her metabolic condition and for arterial blood gases to see if she'll be able to breathe unassisted on the plane.

NILES: I'm going to run down and see if I can get this.

Would you mind waiting here to bring this to me?

TECHNICIAN: No problem.

NARRATOR: When he comes back to the intensive care ward, it's too late.

( woman weeping ) I can't take these children coming in, man.

WOMAN: This is the hard part.

This is why I don't do peds.

Oh, I won't do them, nope, no more.

( sobbing ) WOMAN: Do they have anyone to sit with her?

NILES: Do we... can we get a couple of screens or little curtains that we have?

Maybe ask at one of the wards, and just give the... give Mom some privacy, just at least around here so the whole world's not... We did everything we could.

NGUYEN-MINH: Yeah.

I know-- it's never easy, though.

Yeah, I know, yeah.

NILES: She was, you know, as we suspected, very sick, and kids have a pretty good reserve.

They can go for quite a while until they, uh... hit the edge of the cliff.

And, uh, she just fought as long as she could-- she was a fighter-- and she did very well for how sick she was, so... Not a good day to be a doctor.

Not here.

( mother continues crying ) NARRATOR: After NOVA left Iraq in May 2003, attacks on American soldiers increased dramatically, and the wounded flooded the combat support hospitals in the region.

Since they opened their doors, the two units of the 21st have treated more than 30,000 patients.

At the same time, the 21st CSH has been working closely with local Iraqi hospitals, where conditions are gradually improving after the devastating effects of sanctions, Saddam and the war.

Captioned by Media Access Group at WGBH access.wgbh.org To order this show or any other NOVA program for $19.95 plus shipping and handling, call WGBH Boston Video at 1-800-255-9424.

NOVA is a production of WGBH Boston.

NOVA IS A PRODUCTION OF WGBH BOSTON.