Sudan Saga: Level Four Threats

South Sudan’s recent appearance in the news prompted Dr Porter to post this series recounting his experience operating on the Nile riverbank in 2007.

After the last generator shuts off at night, animals and bugs are the only sounds. There is no through traffic. So the rumble of a truck near your tent wakes you with a startle. Between the rumble and me was a mosquito net and a bamboo fence any wolf cub could huff and puff and blow down. I couldn’t see the truck, but imagined it approaching the hospital gate.

Concerning was the second growing sound—voices in song. Song? More like chant—one of those marine corps numbers, from a brigade with uncanny ability to harmonize. It was 3 AM. I lay frozen, listening, trying to guess the nature of the chant. The language was unfamiliar, so I listened to the lilt and tone and energy, trying to count the number of vocalists (ten, at least) and judge their mood (buoyant, at best.)

The truck stops a few paces from my tent and a tailgate drops. The song stops. Boots and quiet murmurs are the only sounds for half a minute, other than my pounding heart. I listen for weapons. Do they rattle during a march? Do magazines have to be slammed into an AK-47? Hammers cocked? Chambers loaded? Probably not, it wouldn’t make for a discrete ambush. They must’ve worked out the kinks of the Automatic Kalishnakov since 1947, or it wouldn’t be the world’s best loved assault weapon.

Ten minutes later, the truck pulls away and the voices begin again. The rumble and song disappear slowly, overtaken by crickets and cats and the hee-haw of the town donkey foraging in Bor’s burning garbage piles.

During my third week, the anesthesiologist and I had finished the day’s operations and were leaving the hospital gate when I heard popping sounds behind us. I thought: firecrackers, fun! After about eight pops I wised up and looked in the direction of the gunfire. A bamboo fence obstructed my view, but I guessed the shooters to be about thirty yards away. I couldn’t tell the direction of the shots, and had no idea of the targets, the motive, the number of shooters. As we scuttled back to our compound, the frequency of ringing shots grew like popcorn in the microwave. Overhead we heard the whirring spins of ricochets.

We were chastised on arrival at the compound.

You aren’t answering your radio! You are to remain where you are when you hear gunfire!

I couldn’t hear the radio for the gunfire, and remaining under a rain of bullets seemed unsafe, I replied. What’s going on? Who is shooting? 

We don’t know anything yet, except that it’s happening very close.

That I knew. The pops were still ongoing. Worse, the gunmen were now moving in various directions. Pops could be heard in a 180-degree arc around our compound. Eighteen of us lived on the compound. Most were now huddled behind the only stone wall on the premises, as the sound moved toward both ends. A couple more were hiding across town at another aid organization.

I’d never been this scared. This put the drunk man with a stick to shame. Twenty minutes of shooting, no answers as to why. I became suddenly aware that I might feel a bullet before I heard its attendant pop. Then I wondered if I would feel a bullet at all if it traveled through insensate tissues. Was I hit already? Could a bullet enter my back, traverse my iliac vein, and exit my navel without my notice? Probably. I discretely inspected my body for blood.

One of my mates crouching next to me had a beer in hand. I reached for it as one one grabs for the banister when a stair is missed. He nodded for me to keep it. I thought of my one-year-old daughter and an ache tore through my chest. I looked again for blood. None.

Stupid. What was I thinking, coming here? I looked around at my companions who all looked calmer than I felt. None had children, I realized, except the Ivory Coast doc and the Congo logistician.

As the pops continued on, and no information was incoming, I had a growing craving I never could have imagined. I wanted a gun. I knew the lunacy of the idea, even in the moment. But the maddening uncertainty – this half a bloody hour of exposure, of waiting, of not knowing. If they stormed our compound guns ablazing, I wanted firearms, one in each hand, Butch Cassidy and Robert F*cking Redford.

Dr Chris, Dr Chris for ER! says my walkie talkie. I finish my beer in a swallow.

This is Dr Chris, go ahead.

Yes, Doctor, I am calling for you to review some patients here in ER with gunshot wounds. We have four patients. Can you come to see them please?

Pop, pop, pop. Pop. Pop…pop. Pop. Pop, pop. Whirrrrrrr. Pop, pop, pop.

I came here to help desperate people, not to drink beer and cower. But. If I am shot crossing the road, there is no surgeon in a 700-mile radius to operate on the four victims, or on me. I miss my family.

I will come when the shooting stops. Tell me about the victims. Where are their injuries? Have you started IV’s and drawn blood for cross matching? He gives me a rundown. And what do you know about the shootings? Why are they shooting?

These patients are not from the shootings you hear, says the ER assistant. I think I hear him suppress a chuckle, as only a Lost Boy has the right to do in this situation.

My companions huddle around as we listen in pure puzzlement.

These four patients have been shot while traveling the road to Juba many hours ago. They just arrived as the shootings began here. We don’t have information about the shootings happening now.

Attacks on the only road out of town, and gunfire in town. To me, this adds up to generalized armed pandemonium. War has enveloped us.

The popping ceases. I wait five minutes.

Dr Chris, Dr Chris for ER.

Yes, yes, I am coming.

Dr Chris, I am just calling to inform you that we have a new patient. This one has been shot just now, and…

I am coming.

Arriving in the ER I found three gunshot victims on gurneys and two on the floor. I performed mass casualty triage for the first time in my life. The scene was a bloodbath, the decisions urgent, and my own fear of being shot substantial. The volley of gunfire yards away ended just minutes prior. The best available explanation of the recent incident came from one of the victims, a drunk 23-yr-old minus a proximal tibia, searching in vain for a comfortable position on the concrete floor. Local police were the shooters. A crowded street were the victims (including drunk boy on floor and a 14-yr-old riding a bicycle, now dead.) The inciting incident (note my herculean efforts to be impartial) involved boys told not to perform a weekly ritualistic dance (because fights always ensued), the confiscation of drums, a successful mob reconquest of said drums from the police station, warning shots into the air, mob response, and so on.

The other four victims had been shot in a crowded minibus which had tried to outrun a gauntlet of bandits on the only road out of town. We operated on four of the five. The urgent one had five gunshot entry wounds in his back.

A few nights later, more gunshots. In the pitch dark. 3AM. By sound they are further away – two city blocks, if there were such a thing. I hear rustling on our compound, searching for cover or information, I presume.

Do I get on the ground? If so, why? I’m diagramming geometry in my head. Why is a body lying on the ground any safer than one standing, or trying to get back to sleep on a cot? That rule applies to grenades tossed your way, I decide, not random gunfire in the neighborhood. ZZZZZ.

I was getting used to local shootouts. Paralyzing as they were in the moment, great relief came in later learning the motives. However unsettling the circumstances of the gunfights, no violence seemed to be directed at our group or the other humanitarian aid groups. [Yet. See later episode.]

Then they stormed our compound.

By they I mean heavily armed, angry and determined warriors.

I was on my way to make rounds when they kicked in our only door. I caught my first view between buildings. The front guy held his AK ready to fire, swinging it in a wide arc pointing at everyone present. He moved like a wolverine, breaking from the pack, for our warehouse.

I’d gotten accustomed to seeing the AK’s everywhere: Slung on backs, checked at the hospital gate. I’d not yet had one pointed at me by a fast-moving soldier.

Behind the wolverine, came a grimacing soldier carrying – in fire position – an RPG launcher, which also took its turn pointing at my chest. My eyes made an Alfred Hitchcock pan-zoom onto the rocket-powered grenade. The point of the missile had lost its paint and seemed rubbed shiny, as if long-overdue for a target. I wondered if it was sharp enough to enter my chest before exploding. Would it bounce off and spin around my feet like a ground-bloom flower? Would it pass through me and the water-sanitation engineer and continue on to Somalia before its report?

Then I saw the scariest thing yet: the leader. Leather-faced and wiry, talking to none of the pleading people from our compound, he barked short grunts at his men, who feared him as much as I did. A pistol hung from his hand as if connected, with a nonchalance telling twenty-two years of war stories. He looked old enough to have been a child soldier in the first civil war. His body moved with athletic grace while his eyes, liquid fury, moved with urgency. I could not have imagined the discomposure he struck in me by his mere appearance. I’d never seen, up close, a man who’d fought war his whole life.

His gang was still filing through our only door. I was vacillating between the cover of our stone building and proximity to the blocked exit. Were they here to loot? We had fuel, medical supplies, radios, trucks, cash, food, beer, and whiskey – everything an army could want. What was their mission? Would they kill unarmed men and rape the women, as per the habit of soldiers since the dawn of time? The stories I’d heard from our patients opened my eyes to vicious possibilities I’d never dreamed. I trembled, and my heart ached for my wife and child.

I had previously considered myself a soft-core adrenaline junky. Part of the reason I’d come here was to enjoy some fear. But presently I was learning the difference between the kind of fear I enjoyed (class IV whitewater) and pants-pissing terror.

Chris Porter MD

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