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The Producer's Story:
Into Kuwait and Iraq with
Two Combat Support Hospitals
by Dimitri Doganis

Life and Death in the War Zone homepage

"Life and Death in the War Zone" was a classic documentary production: nothing we planned for actually happened, everything our research pointed to came to nothing, and just as we were writing off the film—indeed, almost the very day we decided to abandon it—a fascinating story unfolded before us.

It all began in February 2003, when cameraman Hugh Hughes and I left our homes in London to join the 10th Combat Support Hospital in Fort Carson, Colorado. A CSH is like a smaller version of a MASH, or Mobile Army Surgical Hospital. It's basically a complete hospital that soldiers unpack from steel storage containers and assemble into a tented medical facility. Erected within a short distance of the front lines, CSHs provide advanced life-saving care to wounded evac'ed from the combat zone.

The 10th was preparing to serve as the field hospital for the Fourth Infantry Division, which in the event of war was slated to attack through Turkey and Kurdish-controlled Northern Iraq. The 10th's commander, Col. John Powell, said his roughly 300-bed hospital would be the only medical facility for about 32,000 U.S. troops.

Waiting for war

At that time there was the very real fear that the Iraqi regime would fight any second Gulf War to the death with chemical, biological, and possibly nuclear weapons. It seemed a good argument to stay as far away from Iraq as possible, but it also offered a unique opportunity to make a film about combat medicine in a war zone.

We spent about a month with the 10th in Colorado, watching them pack and plan for a war that the world expected but that we all hoped might be avoided by diplomatic means. In private, the CSH doctors kept referring to intelligence briefings warning that the Iraqi command was preparing to use sulfur mustard gas, and that the 10th CSH staff had to be ready to treat mass casualties of a gas attack. Their accounts of the horrible effects of mustard gas became particularly vivid when I realized that Hugh and I were not only potential witnesses but potential victims.

Waiting is perhaps the least comfortable aspect of a project like this. As we sat in Colorado for weeks watching diplomacy run its course, my nights were plagued by dreams of filming the doctors struggling into their protective suits and suddenly realizing that I had not yet put on my own suit. It was unsettling, to say the least.

Our experience at Camp New York proved to be one of the most trying of my professional life.

As the deadline approached for compliance with Resolution 1441, the U.N. Security Council's ultimatum to Baghdad, we packed and repacked our gear, trying to lighten bags that had become swollen with gas masks, protective suits, flak vests, and decontamination kits. The U.S. Army would allow only two of us to go with the CSH, and we had to be confident that if things became hectic we'd be able to carry all our gear ourselves so as not to be a drain on the troops around us.

Then came a shock that no one had anticipated: the Turkish parliament decided to deny access to American and British forces. After weeks of waiting it seemed that the 10th CSH's mission had evaporated. Hugh and I returned to the U.K., thinking—and not for the last time—that our film was doomed.

Into the desert

Ten days later we were back in Fort Carson. The war had begun while we were across the Atlantic, and Col. Powell's men had been told they were to deploy to Kuwait, from which they'd then move north through Iraq. Within a week, on March 30, we flew to the Gulf, landing at a military base in Kuwait and heading out to Camp New York, a tented outpost in the northern part of the country.

Our experience at Camp New York proved to be one of the most trying of my professional life. We spent three weeks waiting in the desert for the 10th CSH to receive orders to go north. During this time our only link to world events was BBC World Service broadcasts from halfway around the globe, which described events occurring just 50 miles to the north of us.

For the CSH doctors the experience was even more frustrating. They had all left their lives and homes to do a job they'd spent their professional lives preparing for—treating battlefield casualties. Yet as the radio told of a humanitarian crisis unfolding not far to the north, there they sat in tents in scorching heat, their hospital still in boxes.

Dr. Dave Lounsbury—he insists on "Dr." rather than "Col."—was the second in command. I remember him talking of the terrible waste of having such an expert body of people sit idle. He spoke for many of the physicians when he described it as the most maddening experience of his life. "These aren't acolytes we've collected in the 10th," he said in one interview. "These are among the best battlefield physicians in the world. And to be sitting here doing nothing is the height of frustration."

As U.S. troops entered Baghdad, we had a series of difficult satellite phone calls with our executive producers at NOVA in Boston. They'd seen TV footage of looted local hospitals and injured Iraqis that we had no way of watching, and they were astonished that our hospital wasn't being deployed. With each passing day it seemed that our chances of making a film about combat medicine were becoming slimmer and slimmer. We'd been waiting for so long by now that my cameraman Hugh had to leave to go to another project. His entire shoot time had been eaten up without us having filmed a single patient being treated.

Joining the 21st

Just as we were preparing to head out of the desert, we heard of another CSH, the 21st, which would soon be sent north. To add insult to injury to members of the 10th CSH, who were desperate for a mission themselves, 10th CSH trucks would transport the 21st. Yet my new cameraman Neil Harvey and I realized that this was our opportunity, and that night we persuaded the executive officer of the 21st CSH to allow us to accompany her crew into Iraq.

After two months getting to know the 10th, setting up our characters and planning storylines we'd follow with them, we had to start all over with a new unit.

It was like trying to sleep in driving mud.

We left for Iraq on April 24. By that time, most of the fighting was over. Ambushes and skirmishes still occurred every day, but it felt safer than other war zones I'd filmed in. Our only hairy moment came when we made the same wrong turn that Jessica Lynch's maintenance crew had made earlier in the war. One of the trucks became stuck in mud as we tried to backtrack. Just over the brow of a nearby hill I could see tracers and flares of a firefight, while behind me I became painfully aware that many of the soldiers I was with were holding weapons for the first time since basic training. I remember thinking how I'd have felt safer being embedded in a combat unit.

Three days after leaving Kuwait we reached a captured air base near the Iraqi town of Balad. Here we would set up the hospital. It was fascinating watching the soldiers build the 21st CSH, but sleeping arrangements were pretty uncomfortable. In Kuwait we'd slept on the floor, but we'd had tents over our heads. Here the soldiers would erect the sleeping tents only after they'd finished with the hospital tents. At night we were kept awake by sandstorms alternating with driving rain. It was like trying to sleep in driving mud. All the waterproof and sandproof cover we had went first on the camera equipment, for trying to repair a Digital Betacam in the middle of a devastated Iraq would not have been fun.

A new focus

As soon as Col. James Bruckhart, commander of the 21st, declared the hospital open, the first casualties started to arrive. In those early days there were limited numbers of U.S. casualties day to day—fewer, in fact, than there are as I write this in January 2004. But local Iraqis were in dire need of decent health care. The commanding officers were unclear about whether they should be treating the locals who arrived at their gates. All the doctors were keen to practice medicine, but the army guidelines indicated that the CSH could admit only those who were in immediate danger of losing life, limb, or eyesight.

Initially this was a curious sideline to our filming. But as the filming progressed, this issue—who the doctors could and should treat—became the central issue for the hospital, and the central theme of our film. (For more on the ethics of battlefield care, see Tug of War.)

What had started as a film with the 10th CSH about the science of treating combat casualties had changed almost beyond recognition. We were now filming with another unit, in another part of the country, and the film's subtext had become medical ethics in a war zone. The finished film is one that I couldn't have imagined at the start of the project but which is more interesting and complex than anything I'd predicted.

The end of something

On the first of May, my 32nd birthday, President Bush declared an end to hostilities. For me it was also an ending of sorts: I spent the day hitching rides on Blackhawk helicopters out of Iraq. My time was up; I'd signed up for a four- to six-week shoot, and three months later the rest of my life could wait no longer. Callum McCrae, a talented documentary filmmaker also from the U.K., would handle the last two and a half weeks of filming.

In the end, "Life and Death in the War Zone" presents only part of the story of the 21st CSH, for life at the hospital—which, as I write this in early February 2004, remains fully operational in Iraq—has changed radically. In the months after we finished filming last May, young American men and women began filling beds that were empty when we were there, and the CSH itself has come under frequent attack. Let us hope that the coming year brings better news not only for the doctors and nurses of the 21st CSH (and of the 31st CSH, which has just replaced it in Iraq), but also for all those who need their care.

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Dimitri and Hugh filming

Dimitri Doganis, right, and cameraman Hugh Hughes filming at Camp New York in northern Kuwait.

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Powell briefs the 10th

Col. John Powell, commander of the 10th CSH, briefs his team before its departure for Kuwait.

The 10th packs to go home

After waiting four frustrating months in the Kuwaiti desert with their hospital in boxes, the 10th CSH packs to return home to Colorado.

CSH in container

Hospital in a crate: One of the storage containers containing the 21st CSH about to be unloaded at Camp Anaconda in Iraq.

Dimitri's bed in Iraq

Doganis (foreground) gets some shut-eye in his "room" at Camp Anaconda.

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Life and Death in the War Zone
Tug of War

Tug of War
How do combat doctors decide whom to treat?

The Producer's Story

The Producer's Story
Go behind the scenes with filmmaker Dimitri Doganis.

Personnel Profiles

Personnel Profiles
Five doctors and nurses on life in Iraq since filming ended in May 2003.

Images From the Field

Images From
the Field

View a gallery of production stills shot in Colorado, Kuwait, and Iraq.

Military Medicine Through Time

Military Medicine
Through Time

Identify what you're seeing in photos from the Civil War to the Iraq War.

Dimitri Doganis Dimitri Doganis, producer of "Life and Death in the War Zone," runs a London-based television production company called Raw TV. He has made numerous documentaries for the BBC, Channel 4, and Channel 5 in the U.K. as well as for U.S. broadcasters, including Frontline's "The Siege of Bethlehem," about the 2002 standoff between Israeli forces and the Palestinian militants who stormed Bethlehem's Church of the Nativity.

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