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After shrapnel from a mortar shell penetrated the skull of 1-year-old Bashir Ahmed, pictured above in his mother's arms, the boy ended up in an intensive care unit in one of Afghanistan's most medically advanced hospitals.
Emergency Surgical Center for War Victims is Kabul's newest war hospital. The hospital, run and funded by the Italian non-governmental organization Emergency since 2001, changed its admission criteria to treat only "war wounds" — shell injuries, bullet wounds and stabbings — just three months ago.
The change, according to current medical coordinator Dr. Antonio Rainone, happened because the hospital has seen a dramatic increase in shell injuries and bullet wounds in the past year. A whole ward of the hospital lies empty, ready to use in case of a mass casualty incident.
"It is Afghanistan that has gone back to being a war country," said Dr. Rainone.
Emergency Hospital is proof of the growing violence and complexity of conflict happening around the capital. Patients come to the 100-bed medical facility from Logar, Wardak, Ghazni, Kapisa, Parwan and Kabul provinces, sometimes even from as far away as Baghlan or Kunduz in the North and Paktika province in the Southeast.
Their injuries, almost without exception, are severe and complicated. Thirty percent of patients are children.
The following photographs provide a look inside Emergency Hospital. (To view larger images, click here for a Flickr slideshow.)
Thirteen months ago, Apzal was shot in the chest by an AK-47-wielding tribal rival in his home district of Urgun, Paktika province. The 18 year old's spinal cord was shattered by the bullet and he is now paraplegic. In Afghanistan, treatment and care of people with serious spinal cord injuries is sparse. Apzal has spent the last several months at Emergency being treated for pressure sores, deep and potentially fatal tissue wounds that sometimes develop in bedridden patients.
Dr. Antonio Rainone examines the chest x-ray of a patient with bullet wounds.
Ruhillah, a mother of four, lives in Ghazni province in the village of Khuschi, where she said Taliban and pro-government residents live side-by-side. She was asleep at home with her family when a rocket exploded nearby. Ruhillah's arm and jaw were fractured, and now her mouth is wired shut to help her heal. Her 2-year-old son and husband were also injured.
Italian nurses, from left, Georgia Novello and Andrea Freda and anesthesiologist Federico Cafagna wheel a patient with two bullet wounds to the chest back to the operating theater. The patient had arrived earlier in the day and immediately underwent surgery to repair the damage. Steady blood loss indicated a problem, however, so surgeons prepared to open him back up.
Surgeons look for damaged tissue in a patient with bullet wounds to the chest.
Gul Bashara, 11, cries out in pain while her mother and aunt move her to a wheelchair in the children's ward. She was outside at home in Logar province with her brothers and sisters when a shell landed in the family's garden. Seven children were injured and two were killed in the explosion. Gul Bashara's spine was injured and she was paralyzed from the waist down. She also has severe flesh wounds to her arms, legs, back and chest.
Gul Bashara's 4-year-old sister Sidiqa received two badly broken legs in the explosion.
Norullah was at a relative's wedding in Wardak province when a grenade was thrown into the wedding party. He had injuries to his arms and abdomen, and lost vision in his right eye.
Minadar, a mother of nine, said she and her family huddled in their home in Sar e Pol province while fighting raged one night. A mortar detonated nearby, killing one of her sons and injuring two others. Minadar's right hand was amputated and she suffered a severe fracture and open wound to her left arm. She said she thought the situation in Afghanistan was getting worse. "I wish the war was finished," she said.
Anesthesiologists prepare 8-year-old Waris from Logar province for emergency surgery. The boy had shrapnel wounds to the chest, abdomen and skull.
Mohammad Agha, 20, was shot in the chest outside of a polling station in his home district of Archi, Kunduz province, on September 18, the day of Afghanistan's parliamentary election. The bullet damaged his spinal cord: he is now paraplegic. He got engaged shortly before his injury and now can't summon the courage to tell his fiancée that he'll likely spend the rest of his life in a wheelchair.
Khan Agha, right, 28, talks with a relative outside his hospital ward. Agha is an Afghan policeman in Takhar province, is married, and has two young sons. He said he was in a firefight with Taliban insurgents and stepped on a mine while running. His left leg was amputated as a result of his injury. When asked how he would be able to earn a living, he said, "I don't know, but God will provide."
A child sleeps at Emergency Hospital. He had shell injuries including a broken leg and shrapnel in his abdomen.
POV aired a documentary about Emergency in 2002 entitled Afghanistan: Year 1380. Learn more about this medical non-governmental agency from Italy.
Photos from Kabul: Emergency Surgical Center for War Victims »
Joao Silva: Photojournalist Wounded in Afghanistan »
Photographs from Life in Kabul »
Telling My Mom and Dad I'm Going Back to Afghanistan »