To date, no group has claimed responsibility—but the attack on a maternity ward punctuates a new chapter in the ongoing conflict in Afghanistan, with insurgent groups like the Taliban and ISIS targeting Afghan civilians with increasing frequency. More than 3,000 child casualties were documented in 2019, according to figures from the United Nations, and more than 400 children were killed or injured in the first three months of 2020. This means that pediatric surgeons now face a perverse challenge: determining the best ways to treat toddlers and newborns for war wounds.
“In other countries, people are not shooting on eight- or 11-hour-old babies,” explained Bina. With a lack of specific medical literature to fall back on, he and his colleagues face a host of unknowns when performing complex surgeries on infants.
After examining Sharifi’s daughter, the medical team discussed their relevant clinical experiences, working collectively to piece together a plan that they believed would give her the best chance at surviving. The first step was preventing her condition from deteriorating. The medical team cleaned the baby’s leg wounds and applied topical ointments and bandages. When the girl appeared stable the next morning, the team decided she was ready for a more intense surgical procedure. “We worked nearly four hours on the baby’s leg,” said Bina, “and I am pleased to say we had immediate excellent results.”
Children with such severe war injuries face a difficult future, though. Sharifi’s daughter will need regular checkups to ensure her wounds heal properly, and she may need additional surgeries. For now, the baby’s team is encouraged by small signs of progress: She has gained nearly half a pound since the surgery, and her arteries and veins have healed. “There are little injuries on the sciatic nerves, but she is a baby,” said Bina. “And babies are miracles.”
Still, operating on tiny bodies poses unique challenges. “Surgery on infants up to two years of age requires delicate, fine, and minute attention to details,” said Hamid Stanikzai, a pediatric surgeon from Kabul. As a physician resident in 2015, Stanikzai was working in the emergency room of Indira Gandhi Children’s Hospital in Kabul one night when a truck bomb detonated in the middle of a residential neighborhood.
“We received lots of children that night,” he recalled. One child had been hit in the stomach with shrapnel. Stanikzai performed a laparotomy, creating a large incision in the abdomen for diagnosis and operation. A common procedure in older patients, a laparotomy can be risky when conducted on a baby or young child. According to a trauma manual created by the Royal Children’s Hospital in Melbourne, surgeons must avoid injuring abdominal organs and ribs, which are thinner and more pliable than adults’ and provide less protection.