Surgeons using headache pills instead of anaesthetic

At Al-Kindi hospital in Baghdad yesterday, stocks of painkillers had run so low that surgeons were operating on patients anaesthetised with headache pills.

At the Medical City hospital complex, which has 650 beds, overflowing wards were without electricity or water. Of the 27 operating theatres in the four hospitals in Medical City, just six were functioning, with the help of a back-up generator that has worked non-stop for 72 hours and could fail at any time.

Aid agencies said Baghdad's casualty units were being run by a skeleton staff of doctors and nurses who had struggled to work through the fighting. Most had worked solidly for three days, snatching a few minutes' rest between emergencies.

And all the while a steady stream of civilian casualties flowed into the city's 12 main hospitals in the back of pick-ups or carried by their families.

Roland Huguenin-Benjamin, part of a team from the International Committee for the Red Cross trying to provide emergency supplies, said: "Now you have military engagements at ground level, most people are hit much more seriously. It's all the more work for the doctors.

"If street fighting becomes more widespread in the urban area, health facilities could become totally overwhelmed."

Just how large this tide of suffering had become last night was impossible to tell in a war fought by soldiers wearing civilian clothing and where civilians are shot because they might be the enemy.

The UN's World Health Organisation, which has 330 local staff in Iraq, said a conservative estimate of civilian dead and injured would be "several hundred" a day. Iain Simpson, a WHO spokesman, said: "Nobody is adding up all the numbers but there is clearly a large volume of civilian casualties."

At one point, the military and civilian toll from bombing by Allied jets and clashes with US forces along the Tigris was so heavy that one hospital saw 100 casualties arrive an hour.

Yesterday at the Kindi, in east Baghdad, 10 badly wounded patients an hour arrived during a lull in the fighting. By midday, 75 civilians had been admitted for gunshot and shrapnel injuries or burns.

Across Iraq, the number of civilians killed stands at 1,087, based on media reports of bodies seen and counted by journalists. Experts believe the true figure is far higher. The Red Cross, the only international body operating in the capital, said it had given up trying to count the numbers of injured civilians because an accurate assessment was impossible.

There are also the military wounded, taken to hospitals where reporters are not given access. The Pentagon estimated 2,000 to 4,000 Iraqi soldiers were killed in the first two days of the battle for Baghdad.

For the doctors trying to cope with this flow of the dying, the problem was the complexity and quantity of the injuries – evidence that the dull thud of battle was growing ever closer.

Dr Mohammed Kamil, a surgeon at the Kindi, said: "We're now getting not just shrapnel wounds. These are wounds from missiles and rockets. They are amputations. They require more urgent surgery."

The surgery is increasingly done in primitive circumstances. At the Kindi, doctors have been able to give only 800mg of ibuprofen for surgery – the equivalent of two headache pills. Clean towels cannot be supplied because the hospital washing machines overload the emergency generators.

Health workers elsewhere reported grave shortages of supplies, especially anaesthetics such as morphine, and antibiotics to fight infection in the growing heat of the early Iraqi summer. Specialist equipment for war injuries – blast and head wounds, burns, spinal injuries – was also in short supply.

Among the few able to help were the Iraqi Red Cross workers seeking to ferry supplies and water from their Baghdad warehouse to hospitals, including the Kindi, Medical City, Karama, Mansur and Baghdad Teaching Hospital. Where possible, they brought surgical kits in huge cardboard boxes with enough equipment and medicines for 100 operations – less than a day's supply.

The aid agencies said these were the lucky ones. Outside help has yet to reach towns south of Baghdad where the medical situation is feared to be dire, including Amarah, Najaf, Muthanna and Hillah.

Nada Doumani, an ICRC spokeswoman, said: "We get where we can but because of the fighting we are not reaching many hospitals in Baghdad, let alone anywhere beyond. In Baghdad, the hospitals have reached their limit. The medical and surgical personnel are working flat out, 24 hours a day."

Even where the fighting has abated, medics were also struggling to cope. At a British field hospital near Basra, two brothers – Abbas, 2, and Mohammed, 4 – were being treated for 40 per cent burns to their faces and arms inflicted while playing with gunpowder they had found.

Aid groups said the most pressing threat to the health of Baghdad's five million people was a lack of water. All water treatment and sewage works in the capital are working only on back-up generators, many of which had failed.In the north of the city, a fresh water pumping station at Qanat had stopped functioning while the supply to Saddam City, the sprawling suburb in the north-east of Baghdad, had been cut by half.

Iain Simpson, of the WHO, said: "Without water, everything grinds to a halt. You can deliver all the medical equipment in the world to hospitals but if you don't even have enough water to sterilise an operating theatre or instruments then it's of little use. The situation is critical."

Death toll

Combatants

American

Killed in combat: 73

Accidental and other deaths: 18

Missing: 14

Captured: 7

British

Killed in combat: 9

Accidental and other: 21

Iraqi

Killed in combat: More than 3,650

Missing: No accurate figures

Other

Killed: At least 75 Kurds

Civilians

British

Killed: 1

Iraqi

Killed: At least 1,252, according to Iraqi estimates

Other

Killed: 17 (Ukrainian cameraman, Spanish cameraman and Jordanian reporter in Baghdad yesterday; teenager killed by stray rocket in Iran yesterday; a Spanish journalist and a German journalist, both killed on Monday; a French TV journalist; an Australian cameraman; a Jordanian taxi driver; an Iranian cameraman and a Kurdish translator working for the BBC; five Syrian bus passengers; a US journalist

Missing: 9