Footprints in the Dust

FOOTPRINTS IN THE DUST

Nursing, Survival, Compassion, and Hope with Refugees Around the World

ROBERTA GATELY

To Sue, Marianne and Jim with love . . .

CONTENTS

Introduction

Prologue: Iraq 2003

I AFGHANISTAN/PAKISTAN 1986–1988

First Steps

Thal

Summer 1986

Winter 1987

Summer 1987

Chitral: Fall 1988

Intervening Years

II AFRICA 2001

A War-Torn Continent

Grace’s Story

Passing Time

The Children of Kakuma

The Lost Boys

Interval

III THE BALKANS 2001–2002

A European War

A Comfortable Post

Roza and the Refugees of Kososvo

The Albanians

Waiting

IV AFGHANISTAN 2002

Bamiyan Village

The People of Bamiyan

Early Days

The Children

Hamid’s Story

Amir and the Distant Clinics

The Tragedy of Land Mines

The Women of Bamiyan

Last Days

The Time Between

V IRAQ 2003

Preparations For War

Deployment

Waiting

Nasiriyah

Karbala

The Trip to Najaf

Najaf

An Emergency

A Night of Terror

Final Days

Homecoming

VI DARFUR 2004

A Secret War

Back to Africa

Mayo

Meetings

A Place to Call Home

Hawa and the Terrors of the Janjaweed

Tawila

Disease and Disaster

Halima—Dignity and Desperation

Abu-Shok

The Continuing Genocide

Return to Darfur

Kalma Camp

The Janjaweed

The Women of Darfur

The Children of Darfur

The Truth of Darfur

Death in Darfur

A Return To Abu-Shok

Final Thoughts

Glossary

References

Acknowledgments

INTRODUCTION

Refugee—the latest buzzword, a word guaranteed to spark conversation and fuel emotion. There are more than twenty-two million refugees worldwide, and another sixty-five million who have been forcibly displaced from their homes, their villages, from everything they know.¹ But who are these people, these refugees that seem to slip into our conversations, our country, and even our lives with nary a chance for us to understand what they’re all about? The scant news we have of them filters into our homes via dramatic satellite shots of distant, barely pronounceable villages in countries as foreign to us as any images of Mars might be. We barely have time to focus on the often gut-wrenching photos before the anchor is on to the next story, leaving us less enlightened and perhaps even a little more puzzled by what we’ve seen. It is in the seeing—the firsthand, close-enough-to-touch encounters—that the real truth can be found. It is my hope that by sharing their stories, their realities, I can provide a little of that truth here.

I am a nurse, a humanitarian aid worker, and a writer, and I’ve traveled to some of the most desolate lands on earth to deliver health care to persecuted, desperate people. But lest you think that this is some soul-searching, self-aggrandizing tome, let me assure you that the refugees with whom I’ve worked have done far more for me than I ever did for them. It is in this spirit that I share their stories as well as my own.

As a young (at least from my perspective some thirty years on) ER nurse in Boston, I’d been acutely aware of the intermittent refugee crises that gripped our world. These international disasters, appearing for brief moments in the media spotlight, invariably featured stark glimpses of big-bellied babies with empty, haunting stares, who invariably caught my eye and stopped me cold. And then, as if I’d only imagined them, they simply disappeared from the spotlight and I found myself wondering how this baby or that little girl had fared. Each new story sparked my interest a little more, and finally, in 1986, after a particularly gripping news story about Afghan refugees fleeing to Pakistan, I decided it was time to do something. I called the aid organization featured in the news story, and within two months, I was on my way.

I am by nature neither courageous nor adventurous, and though drama would weave itself throughout my days and nights delivering aid, it was neither a search for adventure nor a dramatic incident that served as the catalyst that finally drew me to aid work. For me it had been the right time and the right set of circumstances, and as an inner-city ER nurse well versed in the treatment of trauma and sad-eyed patients, I was sure I could help.

What happened, I’d always wondered, to people already living the hardest of hardscrabble lives when war and misery claim their land? For starters, they don’t give up. They manage to go on and sometimes even to smile no matter their own suffering, much like Fatima, a young woman I met in Iraq not long after the US invasion. We’d gone to her small village to test the drinking water, and as expected, it was filled with bacteria and would require boiling before consuming. But Fatima saw possibility in that dirty water. Tucking a stray hair under her hijab, she smiled coyly and spoke to me in perfect English so that the watchful crowd of locals wouldn’t understand her words. My husband, she whispered, is an old man and I am his second wife. My life is miserable, filled with sorrow. Her chocolate brown eyes scanned the horizon as if searching for something that was just out of sight. I want to escape this place, and God willing, the dirty water will be the end of him.

And that brings me back to the beginning—who are these people, these refugees? Are they the desperate, doe-eyed children with hungry stares, or are they more like Fatima—searching for opportunity wherever it appears? The answer, I believe, lies somewhere in the middle. They are neither all saints nor all sinners, but perhaps a little bit of each. But without their names or their stories, all we can see of them are footprints in the dust, and even those will fade in time.

It is my hope that once you’ve read these pages, those footprints will linger in your thoughts and remain there—tiny, precious pearls that help to remind us that we are all more alike than we know, that whatever separates us, we are ultimately joined by the common thread of humanity.

PROLOGUE

Iraq 2003

As I opened the door to step into the hallway, I heard a quick hush of voices and rustle of movement, and I hesitated.

Step away from the door, a harsh, unseen voice commanded me. My heart flapped furiously in my chest. This was not what I’d expected, not at all. Can I come into the hallway? I asked timidly.

Several rifles appeared, all trained on me. Other than the rifles, which seemed to glisten in the moonlight streaming in, the hallway was black, the men holding the rifles invisible. Bathed in deep shadow, their identities remained obscured, which made the moment all the more sinister. I hesitated, my breath catching in my throat, my lungs seizing up.

Show your hands! a voice demanded, and I put my now trembling hands into the air.

Motioning with their rifles, they directed me into the hallway . . .

Damn it, I thought. What the hell am I doing here, anyway?

I

AFGHANISTAN/PAKISTAN

1986–1988

First Steps

The loudspeaker crackled to life. The government of Pakistan has just announced that all foreigners must have an official entry visa for Pakistan. The stewardess cleared her throat. I felt my own throat tighten as her voice droned on. Those without visas . . . I’d stopped listening. When I’d left Boston, just twenty hours ago, a visa was not required for entry to Pakistan. I glanced through the smudged little window as the plane glided to a stop, the heat from the tarmac rising in spindly waves, almost obscuring the antiaircraft artillery that ringed the airport’s periphery and the gun-toting soldiers who lined the narrow runway. As my eyes focused on the scene below, the warnings of well-meaning friends and family rang in my ears. "Are you crazy? You’ll be killed. You’ll never make it out of the airport."

My intentions had been pure when I’d signed up to help the Afghan refugees fleeing the Soviet invasion for the relative safety of Pakistan. It had seemed a romantic notion—the perfect struggle of good against evil, and I’d wanted to be a part of it. Like most Americans, I knew little about Afghanistan or the Soviet invasion there in 1979, but the scenes of stick-thin refugees clad in rags fleeing their homes and their country had moved me to action. I’d always wanted to be involved, but until then it hadn’t been the right time, but there it was—the perfect spot for me. I’d had no doubt that I could do what was needed, and, with the images of starving children still flickering on my television screen, I’d picked up the phone and volunteered.

I’d been certain that friends and family would rally round to support me. But I was wrong. One after another chided me for what seemed, at least to them, a fool’s errand. "Do you really think you can help? I did. In fact, I was sure I could help. Finally, my aunt stepped into the verbal fray. Are you sure, she asked softy, that this is the right thing to do? I nodded in reply. And you’re sure this is not some kind of death wish? My jaw dropped. Death wish? I’d asked, perplexed. This is a life wish. I want it to matter, someday in the very distant future, that I was here. I know I can help. I’ve never been more sure of anything. And once she was convinced of that, the angst surrounding my decision melted away. I would be fine. I’m ready, I’d said confidently. I’ve done a lot of reading." But as my face hugged the plane’s window, I suddenly wasn’t so sure.

I’d vaguely remembered President Carter’s boycott of the Winter Olympics in 1980 in response to the Soviet invasion, but knew little else until my planned trip had thrown me into a reading frenzy. I’d learned that Afghanistan, a nation seemingly always embroiled in conflict, offered a harsh existence in the best of times. The preinvasion population of twenty-five million lived in rural villages, where they’d subsisted on small farms, eking out a living however they could. The simple resources that we take for granted—electricity, running water, plumbing—were rarely available beyond the city limits. Health care was limited as well, resulting in maternal and infant mortality numbers that were among the highest in the world. Sixty percent of all deaths occurred before age five, and overall life expectancy hovered around forty years.¹ In the best of times, life was hard, and in those worst of times, after the invasion, life was unimaginable.

The situation across the border offered at least some hope to the millions of Afghans who poured out of their own country to the relative safety of Pakistan. But, by 1986, they continued to languish in squalid camps along the border, and though they received food, education, shelter, and health care, their host country was resentful of the attention they received. Terrorist attacks were on the rise, and the refugees were blamed. Pakistan wanted to be rid of them and the problems they brought.

To avoid the rigid structure of camp life, at least a million more Afghans chose to live outside the camps, invisible to aid and to the world. If life in the camps was hardscrabble, then life just beyond was pure misery, especially so for women, who’d never been considered of any importance beyond the sons they produced and the chores they completed. The refugees there needed everything—food, shelter, medical care. You name it—they needed it. And it was there, to that border area and those people, that I was headed.

But first, I had to get out of the airport.

Until this trip, the farthest I’d traveled was a beach resort in Mexico, and I’d never traveled alone. As the first doubts about my mission began to bubble up in my brain, I held my breath, gathered my belongings, and stepped into a world more foreign than anything I could have imagined. The heat I’d seen rising in steamy ripples wove itself into my hair and skin and even my clothes. But it was the odors—the scents of food and spices and sweating bodies, all mingling in the heat to create a musky, pungent odor—that permeated everything. It was all so exotic, I might have just landed on the moon. Still, I tried to stand a little straighter and hold my head a little higher as I was shuttled, amidst one large chaotic crowd, from one long line to the next, but my sudden burst of bravado was short-lived. As others were allowed to pass through, I stammered my way through explanations for arriving without the necessary visa, watching as eyebrows were raised and soldiers moved in. My pulse quickened when a young soldier directed me to a small room, where three disheveled young European men sat, their feet tapping nervously, their eyes darting about every time someone moved. Drug dealers, I thought. And as that reality sunk in, my mouth grew dry. Shit.

As the minutes ticked by, I began to think I really might not make it out of the airport, but I was determined to somehow stay in this country and do what I’d come for. To give up now and just go home would be to admit defeat. I wasn’t ready to do that, so instead I tried desperately to think of a way to reason with the soldiers. I’m waiting for friends, I announced to the young soldier when he reappeared and motioned one of the young men to follow him. I’d been advised to keep my aid work a secret. Pakistan is tired of the refugees, the aid recruiter had cautioned me. Better to say you’re a tourist. I’d stuck to that story though it had seemed implausible even to me. I heard the crack of a whip and shouts and another soldier returned and took a second man out. More shouts and sounds of a beating filled my ears. I could almost hear the acid churning in my stomach. Would they beat me, too?

But the young soldier had taken a shine to me and he brought me a cup of tea, smiling as he set it down. Rafiq, he said, pointing to his name tag. I nodded. Roberta, I answered with a hopeful smile. I settled in with my tea and prayed that the other members of the aid group would arrive soon and vouch for me. The third man was directed out of the room, and I sat alone. One, maybe two hours passed. Sweat pooled on the back of my neck. Surely, if they were going to beat me or arrest me, I reasoned with myself, they would’ve done it by now.

Finally, after what seemed an eternity, a handwritten sign rose above the crowd just beyond the small room, and my heart beat a little faster. Freedom Medicine, the fledgling NGO I’d be joining, had arrived to pluck me from the line, and I was free—with only a stern warning to get my documents straightened out. I nodded. I’d made it out of the airport.

As alien as the airport had seemed, the city of Peshawar in the North West Frontier Province of Pakistan was even more so. A tribal frontier town, Peshawar was the international epicenter during the Soviet invasion of neighboring Afghanistan. It had become an exciting, crowded, noisy city filled with refugees, spies, freedom fighters, foreign diplomats, aid workers, journalists, and those adventurers who had simply been drawn there, and now I was one of them. People and donkeys and dogs, and all manner of vehicles—buses, lorries, screeching taxis, tiny motorized rickshaws, horse-drawn wagons and even bicycles—filled every inch of space. Coupled with the noise of barking dogs, braying donkeys, squawking chickens, groaning motors, and the shouts of those caught in the middle, it was a place of absolute chaos, the sort of place a person might never adjust to.

For me and the others on my team—Ella, a nurse, and Tom, a medic, both from New England—Peshawar was just a quick stop, a place where we could acclimate a bit at the American Club, the brightly lit restaurant and dark, smoke-filled bar run by the American consulate, protected by security guards and hidden behind high walls. It was a place where the eclectic group of foreigners here could have a drink, flirt, begin or end an affair, and just let loose. Whether noon or midnight, it was always lively, always the place to be, but we didn’t have time for more than a quick envious peek at the goings-on there.

The next stop after the club was the local bazaar, where Ella and I would pick up our new clothes—balloonlike pants covered by long dresses, and head scarves, all to comply with local customs and hide our evil feminine wiles. Men, on the other hand, were less restricted and allowed to wear their own clothes.

With those tasks completed, we set out for Thal, the small border village where FM was in the process of setting up a clinic and a medic training for Afghan freedom fighters. Once we left the city limits of Peshawar, the road narrowed, snaking through dusty villages where you could purchase a warm bottle of Coca-Cola, a bad-tempered camel, a newly polished piece of antiaircraft artillery, or, if you were so inclined, a bit of opium, fresh from Afghanistan’s poppies.

These villages were miniatures of Peshawar—less crowded, less noisy, but still overflowing with donkeys, dogs, shrieking children, shouting men, and conspicuously absent—women. Hidden behind burqas or the mud-plastered walls of their own homes, they rarely ventured out. A sighting of any woman’s face was rare, which made Ella and me the object of great curiosity. Were we—as some probably hoped—whores, or maybe just fools in a foreign land?

Hours later, we arrived at the Freedom Medicine compound in Thal, situated on a paved stretch of road on the way to nowhere. The surrounding landscape was bare—dust and an occasional bit of scrub or a lone stray dog were all that I could see. FM, hidden behind high mud walls, was a series of one-story brick buildings with plastic sheeting for windows and doors. The living quarters, a cluster of tents, were nestled behind those buildings.

Ella and I would share a raggedy old UN tent that housed two bare cots and countless bugs, some the size of small animals. There were no amenities—no electricity, two simple outdoor showers, and two doorless side-by-side latrines (no toilets here, just simple no-nonsense holes dug deep into the ground) separated by a brick wall. A roll of toilet paper (Chinese and very scratchy, I’d later learn) lay in the dirt.

A fresh bead of sweat tracked along my forehead. Before I’d volunteered, I’d never even gone camping. My idea of roughing it had been no room service after ten, and yet, I was sure that my experience at the airport had somehow toughened me. Or so I hoped. But, in all my planning, I’d somehow never imagined what it would be like to actually be here—the scents, the noise, the desolation—and that was only here, in the FM compound. I’d only imagined myself cradling desperately ill babies or tending to fresh wounds, and so far, it wasn’t like that at all.

Ella, a seasoned aid worker who’d most recently volunteered at a Cambodian refugee camp in Thailand, unpacked quickly, as she filled me in on her work there, regaling me with her memories of the work she’d done. Mostly in the morgue, she announced matter-of-factly. I was in charge of public health, and when the rains came and the camp flooded, there was a big problem with what to do with the bodies, so I worked on that. I sighed and hoped that the work here would be different. Ella barely noticed my chagrin. She pulled out a blue nylon nightgown before plopping herself down on her cot. So, tell me about yourself, she said, a quick smile draping her lips.

There wasn’t much to tell. Until a few hours ago, I’d been an opinionated, maybe slightly overconfident ER nurse, but now, I wasn’t even sure of that. Ella sensed my unease, and she literally took my hand as she walked me to the latrine and the shower and demonstrated the basics of third world life.

By the time I fell onto my cot (still in my clothes, since I’d inexplicably decided that bringing a nightgown might be seen as too prissy), I was certain sleep would come quickly. And it did. For Ella.

For me, it was a different story. I lay awake, my mind still racing—so much to learn, so little time, my confidence ebbing away with each passing minute. Just as I felt myself start to drift off, I was startled by the sudden rumble and whistle of distant artillery. I sat bolt upright, my eyes wide open. What the hell is that? I whispered. Ella’s only reply was the soft snoring that punctuated her sleep. I wanted to shake her awake, to make her sit with me, but she remained blissfully wrapped in her dreams. I curled up, covered my head with my pillow, and tried to sleep. And, as the artillery rounds tapered off and the sun began to poke through the tent’s flap, I finally drifted off.

Not much later, I woke to find Ella, already dressed, swiping a line of blue eye shadow across her eyelids. I sat up straighter. Ella, makeup? I sighed. "I am so impressed."

Oh honey, she replied, finger-combing her tousled curls, you’ve got to look good, you never know who you’re going to meet.

My pencil eyeliner and lipstick had already melted in the sticky heat, but I was learning. After that, I never left home without sturdy lipstick, not to mention real sleep-wear. Ella was right; even if you are without water and haven’t washed your face in days, a swipe of color across your lips and you feel better, renewed somehow.

Lipstick, even in Afghanistan, or perhaps especially in Afghanistan, makes a world of difference.

Thal

Summer 1986

Our first days were spent organizing the medicines supplied by the UN, and writing protocols and procedures for the medic training program. There were still no babies to soothe, no wounds to tend. We didn’t even have a clinic yet. We watched as Mike, an American construction worker, and his crew quickly crafted a rustic structure—a mud-and-grass roof, a floor of swept dirt, and walls made of canvas sheeting strung from ropes laced throughout the clinic. The furniture consisted of old army cots for patients and simple metal tables where we could write.

It wasn’t until the second week that we were able to see patients, and the work, once we began, was challenging. The refugees were a bedraggled group dressed in tattered, threadbare clothes, many of them gaunt and hollow-eyed and desperate for help. It is one thing to see refugees on television, but it was heart-wrenching to see them in person, and I wondered if I could really make a difference here. I had been so sure that I would know what to do, how to help, but in those first days, I lost that cocky confidence and sometimes felt paralyzed by what I was seeing. And who was I anyway, to think that I could really help? Those sad-eyed babies with big bloated bellies that had so moved me already had worried mothers to soothe them. But, I was there. I had to do something.

FM had only one physician, a Brit named Daniel, a thin, quick-witted man who guided the rest of the medical team through the assessment of so many foreign diseases—malaria, typhoid, malnutrition, dysentery. Within days, we were doing what had seemed unimaginable only days before—diagnosing dysentery and worms and occasionally malaria—each of us clutching our handbooks as we plowed through the list of waiting patients. As each day passed, my confidence grew. It would be okay. I would be okay.

And I proved that to myself one bright morning when I was summoned for an emergency. Miss! Come here, miss! One of the Afghan medic students frantically waved his arms and motioned for me to follow him. I adjusted my head scarf and hurried after him to the entrance. Already, I could see a crowd hovering there. A baby’s cry rose above the din, and as I approached, a sudden hush fell over the scene. I moved closer and the group parted, revealing a young man holding a baby out to me. The baby, from what I could see as I quickly cradled him, had a large, gaping head wound, with blood and gray matter that seemed to be spilling out from his skull. The father was speaking quickly, the student trying to keep up. He fell, the father cried as we rushed to the back of the clinic.

As I stopped and leaned down to place the baby on the cot for a better look, the lump of gray matter fell to the dirt floor. My heart stopped. The baby cried, and his father reached for the tissue in the dirt.

No, I shouted. Leave it. I knew we couldn’t replace it in the baby’s skull. I didn’t want this distraught father to try. He seemed not to have heard or understood me. Gripping the gray squishy lump in his hand, he reached for the baby’s head. Still holding the baby, I turned away. The baby screeched and flailed about. It was then I saw a long gash in his scalp that surely needed stitches, but there was no evidence of a more serious injury, and no sign that his brains had leaked out. The wound was superficial. I rocked the baby and turned questioningly to the medic, who was laughing.

"Che ast?" ‘What is it?’ I asked.

The father held the gray hunk out for me. It is the liver of a goat. We put that on a wound to keep it clean and to stop the blood. Famidi? Understand?" the medic asked.

I didn’t really, but in a way, it made sense. The blood’s clotting factors are produced in the liver. The animal liver may have helped stem the bleeding, and at least protected the wound from the dirt that was all around us. We irrigated, cleaned, and sutured the wound the only way I knew—with saline and stitches and bandages.

"Tashakore," the father said as he lifted the baby into his arms. He slipped the little envelope of antibiotics we’d prescribed into his shirt pocket and turned to leave.

Come back, I cautioned, if there are any signs of infection, and in seven days, we want to take those stitches out. Understand?

The father ignored me. I had done what was needed, and now I was just a female again. The Afghan medic repeated my instructions, and the father nodded. The baby squealed, delighted to be done with us, and I heard his laughter as father and son were on their way back home, but home was a worn and dingy tent with a dirt floor. We had yet to develop a record-keeping system, so we never got the family’s name, and I knew it was likely we’d never see them again. This baby and his father were blunt lessons in understanding the realities and limits of delivering health care amidst chaos, especially as a woman in a land where women were not to be heard or seen.

Our days were full. Refugees and locals walked for hours just for the hope of medical care. For others, who really weren’t sick, a visit to the clinic provided a break from the hellish monotony of life in the camps. For the women, each day was filled with reminders of all they had lost—their homes, their husbands, sometimes their children. Once surrounded by large, extended families in thriving villages, they were now forced to live in small tents or mud houses with their remaining family members. A visit to our clinic allowed them a glimpse of foreigners and provided gossip for days to come. I could see the women, hidden by their veils, their shoulders shaking with laughter, as I fumbled with my head scarf or the baggy pants I wore under my dress.

Asma was among them, an older woman who’d walked to our clinic one day, not because she was sick but rather because she’d heard about the foreigners in Thal and wanted to see us for herself. She wore a threadbare dress, a grimy head scarf, and plastic sandals. She took a number, and when I called her in, she rose, leaning her thin frame on a crooked wooden stick. She followed me into the clinic and sat heavily on the old cot.

"Salaam-aleikum, chetore asti? Khoob asti? Jon ‘a jurast?" I greeted her. ‘Hello, how are you? Are you well?’ I’d been learning Dari, enough that I could sometimes get by on my own.

She nodded and shrugged her shoulders. "Waleikum-salaam. Khoob astam."

"Che taklif em rosa?" ‘What is your problem today?’ I asked, reaching for my stethoscope.

I have no problems, she said haltingly in a mix of English and Dari.

You speak English?

"Kam, kam, a little. She swiped the end of her head scarf across her brow. I am Asma, she said. I am from Afghanistan, a beautiful place. Not like this, she added, casting a scornful eye around the clinic. I am here for a short time. You understand?"

I nodded and set my stethoscope