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Pakistan’s wounded soldiers fight uphill battle for attention



Muhammad Yousaf, 29, a Pakistan army casualty, lies in the rehab ward of the military hospital in Rawalpindi, Pakistan. At least 6,710 Pakistani soldiers have been injured in the battle against the Taliban



RAWALPINDI, PAKISTAN—Lt. Muhammad Ali is one of Pakistan’s wounded and forgotten soldiers,

Six years after his left foot was blown off by a land mine in South Waziristan, a remote and mountainous region of Pakistan used as a safe haven by the Taliban, Ali is still battling to get proper care for his injury.
Pakistan is Canada’s ally in the fight against the Taliban, and its beleaguered military is paying a high price. While critics charge that the South Asian country’s fight against religious extremists is half-hearted, the Pakistani army argues that statistics say otherwise. It has lost more soldiers than all of its Western allies combined.

Canada, the U.S. and other coalition force countries have suffered a collective 2,058 soldier deaths; Pakistan’s military has already lost 2,348 soldiers.

The number of wounded Pakistani soldiers is similarly sobering.

In neighbouring Afghanistan, Canadian soldiers face their most dangerous threat from improvised explosive devices (IEDs) and anti-personnel mines. The same holds true in Pakistan, where sinister and silent bombs below the ground have been the weapon of choice for Taliban fighters in Swat and South and North Waziristan.
At least 6,710 Pakistani soldiers have been injured in battle, according to government statistics. “IEDs are our biggest problem, so you get an idea how many soldiers we have who need amputations and prosthetics,” said a senior army officer.

Even at a time when the military would seem to control the purse strings of this convulsing country, officers assigned to the Armed Forces Institute of Rehabilitation Medicine (AFIRM) here in Rawalpindi say they are drastically understaffed and underfunded, and are struggling to cope with a growing list of casualties. Amputees like Ali are left languishing.

The 29-year-old, tall and handsome with a touch of grey hair, has already had three amputations on his left leg, because of infection and other problems. He may need another.

The first cut, just above his ankle, came just days after his injury.

The second, months later, was eight inches below his knee. In 2006, Ali had a third amputation in which doctors left him with four inches of leg below the knee. But even now there’s too much loose skin below the sawed-off end of his femur and the skin is easily irritated when he fastens his artificial leg onto his stump.

It’s unclear when Ali will be admitted for another surgery.

The institute is the only hospital of its kind in the country, yet just 20 of 100 beds are reserved for amputees. It can take more than a year for some patients to be admitted.

Even after a soldier secures a bed, it might be months more before a prosthetic is made for him. The institute employs seven technicians who fashion prosthetics out of a mixture of resin, chemicals and engineered parts imported from Germany. At least 40 more technicians are needed to keep up with the demand, staff members say.

The hospital boasts just a single speech therapist, crucial for helping soldiers suffering from brain injuries, and just one occupational therapist, again important for teaching amputees to adjust to their artificial limbs.

“These soldiers have been forgotten by their own government,” said Maj. Omer Jamshed Khan, a doctor at the institute.

While some Canadian soldiers suffering from post-traumatic stress disorder and other injuries have complained they have been abandoned by their own government, consider that the average Pakistani soldier earns about 20,000 rupees ($231) a month. One patient at the institute suffering from brain trauma after having been shot in the head receives a monthly disability benefit of 1,600 rupees ($18).

Home to the army general headquarters, Rawalpindi is a mere 15-minute drive from Islamabad, yet the facility has never been visited by a Pakistani politician.

“The minister of defence, the interior minister or the health minister? None of them have ever bothered to come,” said one of the institute’s officers, gesturing to the bed of a 31-year-old lance corporal who lost his left leg and badly fractured his right in a January 2009 IED explosion. “This is important. The prime minister himself should be coming here to see these heroes.”

Khan said U.S. army officers have visited twice. “They’ve offered us training and some student-exchange program,” he said, “but that’s not what we need. We need funding. The Pakistan military has to buy bullets, tanks, life jackets.”

A visitor pointed out that the U.S. has pledged to contribute $7.5 billion over five years to Pakistan.

“Yes, it’s funding,” Khan said, “but they do things like count every drop of fuel used by their helicopters here, every bullet shot, everything, and count that as aid to our country. It’s not like they write us a cheque.”

Officers here say they face resistance even within Pakistan’s army.

In the field, military doctors aren’t educated about how to properly amputate a limb.

“We’re still fighting our own doctors,” Khan said. “They need to bevel the bone, not saw it off at a right angle. They need to dissect the nerves so that they are not extending into the scar tissue. If that happens, the soldier will feel pain and discomfort forever, whenever he rubs the stump. And the doctors in the field don’t seem to know that if they have an amputation that’s only a few inches below the knee, that it’s actually better to make the cut above the knee.

“You try to tell them this and their response is, ‘Oh, so now you’re going to teach me about being a doctor?’ ” Khan said. “I remember making a presentation on this and one doctor remarked that Pakistan was still a country with tuberculosis and that rehabilitation of these soldiers was a fancy dream.”

Khan said officers have asked the army to insist that its 150-plus doctors receive training at the Rawalpindi institute, which, in 2009, fitted 67 soldiers with prosthetics, up from 48 in 2008 and just 20 soldiers in 2006.

Ayesha Siddiqa, a strategic analyst who wrote a book on the Pakistan military, said it’s possible that health care is less of a priority within the military nowadays. Pakistan’s economy has been battered in recent months by rising inflation, skyrocketing fuel prices and falling foreign investment. Pakistan has told Western allies that it doesn’t have the troop strength, or the money, to add to its operations against the Taliban.

The Pakistan army was recently forced to scale back its operations in South Waziristan because it was having trouble with the expense associated with helicopter gunships, The Express Tribune, an English newspaper in Pakistan, reported recently in a front-page story.

“I think there’s a sense that they aren’t getting everything they want,” said Siddiqa, who added that the military gobbles up as much as 5 per cent of Pakistan’s expenditures. “That could affect the funding for health care.”

Aftab Hussain, 34, was injured on Nov. 26, 2009 in South Waziristan where, contrary to public perception, the Pakistan army has a presence of some 12,000 troops who carry out “intelligence-based operations,” according to a senior army officer.

Hussain stepped on a land mine as he walked to an outpost.

He wasn’t admitted to the rehabilitation institute in Rawalpindi, however, for more than a year, checking in on Dec. 30, 2010.

“Most of us feel that we’ve done something bad and are being punished,” Hussain said quietly, preparing to eat a lunch of mutton stew and lentils.

Sitting on a blue bench in a doctor’s office, Ali sighed and began to tell his own story.

It was dark and quiet in the pre-dawn hours of Aug. 22, 2004, and Ali’s battalion had an early-morning mission.

Stationed at a base 11,000 feet above sea level, Ali was assigned to leave at 5 a.m. to neutralize a group of Taliban fighters bunkered down in a cave. His commanding officer was confident the enemy would still be sleeping.

“He told me we would meet for tea by 11,” Ali recalled.

There was one kilometre between Ali’s base and the Taliban lair. Ali remembered adjusting his night-vision goggles, checking his AK-47, and running towards the enemy.

He got to within 200 metres when disaster struck.

“I didn’t even feel the landmine underneath me, it just blew me in the air,” Ali said in a measured voice. “When I came to, I looked down and my foot was gone.”

After he emptied the magazine of his machine gun, yelling at his soldiers to attack, Ali blacked out from the pain.

Ali showed a visitor a new, $700 silicone sheath that he slides over his stump, reducing irritation. Ali said the sheath would last for six months before he had to throw it out, and that few soldiers were given the expensive sheaths. Ali had one because priority was given to officers, he explained.
“We need to show the people of our country the price we are paying in this war on terror,” Ali said.

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