“The building started moving, slowly, from side to side … then faster. I woke up and I called my father, and family in Kabul,” says Shokrullah, who was at his home in Gardez in Paktia province, 61km (38 miles) from the epicentre of a devastating 5.9 magnitude earthquake that hit eastern Afghanistan early on Wednesday.
“I was scared and I had this bad feeling inside me … that this was going to be very bad for Afghanistan because this is a very poor country, the people’s houses here are not strong. And then I thought we don’t have enough medicine or beds in this national army hospital.”
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Shokrullah, who asked to be identified by his first name only, is a doctor at Paktia Regional Military Hospital in one of the three disaster-hit provinces.
Wednesday’s earthquake struck at 1:30am local time near Khost, a remote province on the border with Pakistan, about 160km (100 miles) southeast of the capital, Kabul. Neighbouring provinces Paktia and Paktika were also hit.
“At 6am a call came in from doctors in Paktika province and the military hospital sent out rangers, ambulances, any vehicle we had, to the Gayan district in Paktika province,” Shokrullah says over the phone, speaking up to compete with the bustle of the hospital ward behind him. “They filled every vehicle with doctors and medical staff to go out to the district and we sent two groups of doctors in the two Russian helicopters we had to Paktika also.”
Shokrullah was called to the hospital to help prepare for the incoming patients, of which there were many, he says the staff were told.
“One group of doctors from the national police came to help at the hospital also.”
Then chaos ensued. “Helicopters, ambulances and military Ford Rangers began ferrying the injured through the hospital gates,” he says.
“I saw 200 … up to 300 injured,” he pauses – a patient has interrupted to ask him a question – “up until 10am on Thursday and just at this one hospital,” he continues.
“Others went to other hospitals in Paktia; the regional hospital in Paktika province; Khost province, Ghazni province, and also on to Kabul.
“Women, children and men came in with broken hands, broken feet, head injuries. Many patients were not stable.”
“But it was difficult to select the most critical patients for surgery and do triage because the injured people were all moving around looking through the other injured people, trying to find family members.
“Some were mourning because they already knew their family had been lost.”
Afghanistan’s three disaster-struck provinces lie on the Pakistani border in a deeply impoverished area that is prone to landslides. The worst-affected areas are in Barmal, Zerok, Nika and Gayan districts in Paktika province, and Spera district in Khost province, according to the Ministry of Disaster Management.
Tremors also rippled across Pakistan and India.
This was Afghanistan’s deadliest earthquake in decades, with an estimated 1,000 people killed and 1,500 reported injured. Afghan officials said the death toll is expected to rise as the injured are still being brought to provincial centre hospitals from more remote villages.
The United Nations Office for the Coordination of Humanitarian Affairs has put the death toll at 770 people, and said 130 injured people were transferred to hospitals as of Thursday.
The earthquake comes at a difficult time for the country, already in the throes of multiple crises. A spiraling economic crisis has plunged millions into poverty and 3.5 million children need nutritional support. The United Nations has called the situation “a food insecurity and malnutrition crisis of unparalleled proportions”; it estimated last month that almost 20 million people in the country – about half the population – are facing starvation.
The Taliban government has promised financial help for those who were killed and for the treatment of the injured. and dispatched ambulances, helicopters, medical teams and rescue teams from Kabul to the affected areas.
UN and humanitarian partners are supporting the government’s disaster management authority in assessing and responding to immediate needs, and inter-agency assessment teams have been deployed to a number of affected areas. The World Health Organization is supporting immediate health needs in the area, providing ambulances, medicines and trauma services. The Taliban government has also asked for international aid.
Hundreds have been left homeless and many are believed to still be trapped under the rubble of their homes, which are made of mud and other natural materials, particularly vulnerable to damage.
Remote areas, many constraints
For now, tracking a total death toll is as difficult as following where the injured have been taken.
Rescue teams are being met by hurdles. In Paktika on Wednesday, heavy rain carried on throughout the night and stumped search efforts. Medical staff struggled to reach the most affected areas to get a full overview of the casualties.
Stefano Sozza, the country director at EMERGENCY, an Italian-run surgical facility in Kabul that specialises in treating war victims, told Al Jazeera, “We are open. We have beds and we are ready to ease the pressure of other facilities. We have received a total of nine patients so far with our ambulances. Not because we don’t have space, but due to the distance.”
Sozza said that on the morning of the earthquake, it was not clear what was going on at the epicentre. “Especially in these two very hard hit areas, Gayan and Barmal, they have very low capacity to count the casualties. And then there are problems of connectivity.”
The areas hardest hit by the earthquake in Paktika are accessible only by road, and although it is about 177km from Kabul, it takes a full day’s drive to get there. Roads near the epicentre have also been badly damaged. In the worst-hit zone there are 1,984 residential compounds, some housing multiple families, that are more than 5km from a good road, making the rescue effort even more challenging.
“These are very remote areas with a lot of constraints in accessibility, then there were very bad weather conditions. Not even with a four-wheel drive vehicle was it possible to reach the area because on Wednesday it was raining all day,” Sozza said.
“Wednesday morning the ministry of health sent some four-wheel drive trucks but they were not able to come back because they probably got stuck on the way on the roads. In the end they did referrals through helicopters.”
The morning of the earthquake, EMERGENCY sent staff to the Paktika hospital district and deployed seven ambulances and medical material in order to provide first aid and stabilisation to the victims.
“We tried to be as close as possible to the area that was severely hit by the earthquake to put in place a system of referrals. The area is very remote and several hours by road to Kabul. So we are working to triage and stabilise the patient and then to bring them to our hospital in Kabul,” he said.
Sozza said there is a lack of coordination and information sharing and that it is not clear where some patients have been taken or what treatment they have received prior.
“The majority of the patients are in the provincial hospitals in the nearby provinces and this is also something that we are monitoring because they could be under pressure so we are trying to help ease the load of patients.”
Sozza said that when the situation improved a bit on Wednesday, they managed to move two ambulances to the nearest health facility close to the epicentre, but added: “But then from this health facility to the epicentre itself, there are still a couple of hours of off driving.
“One of our focal points went to the hospital in Gardez, Paktia to assess the situation because we don’t know which kind of treatment they are receiving or if they are able to manage this huge number because they were talking about 50-60 patients and those facilities are sometimes not well-equipped,” he said.
Akram, a doctor in Paktika Regional Hospital who asked that only his last name be used, told Al Jazeera, “The situation was critical at the hospital. More than 40 injuries had come to Urgun District Hospital that morning, but unfortunately there were no medical supplies or equipment in the hospital to help them so all the injuries were referred to Sharn Provincial hospital.
“Many roads were destroyed, which made it difficult to evacuate the injured and many were shifted to unknown areas so it’s impossible right now to get an accurate number of those killed or injured.”
A record officer at the Daoud Khan Military Hospital in Kabul told Al Jazeera that the morning of the earthquake just one helicopter carrying five injured had arrived at the 400-bed hospital.
The same day, Dr Hares Aref, a senior surgeon at Wazir Akbar Khan Hospital, one of Kabul’s largest public hospitals, told Al Jazeera they had received no injuries from the earthquake. The majority of those injured were taken to provincial hospitals in Paktika, Paktia and Nangarhar. Though, he says, hospitals in Kabul are prepared to help with the most critical patients.
Late on Wednesday in Paktia, it is the end of a long night at the military hospital for Shokrullah and his colleagues.
The rescue operation is over but the hospital beds are still full, the doctor says.
“In some cases, 20 people from one family were killed,” he says, adding that every person affected by the earthquake is going to be worse off in what is already a difficult time for the country.
Lives and livelihoods have been lost and local residents are left without shelter, food or water.
“For now, the patients are safe and receiving treatment,” Shokrullah says. “But when they go home, they will be met by new worries, looking for missing loved ones or burying them and rebuilding homes with money that they just do not have.”