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Don't close your eyes. Stay awake!" the anti-militant Syrian fighter yelled at his injured comrade as a Humvee whisked them across Daesh's former stronghold Raqqa.
With the battle drawing closer to the city centre, the distance to the nearest medical facilities is lengthening, making it increasingly difficult to keep injured fighters and civilians alive.
The military vehicle carrying the wounded Syrian Democratic Forces (SDF) fighter whipped around a pile of rubble in Raqqa's battered northeast as the man bled heavily from a gunshot wound in his ribs.
His lolling head was supported by his comrade throughout the bumpy 20-minute ride along destroyed streets to the nearest stabilisation point, in the eastern Al Meshleb district.
Medics there rushed to stop the bleeding, stitch the wound, and quickly pack the fighter into an ambulance headed north.
Ahead of him was a journey of two hours through desolate terrain to the nearest proper hospital, in the city of Tal Abyad on the border with Turkey. The fighter's survival would depend on the initial treatment during what medics call "the golden hour", said Farhad Delli, a nurse with the Kurdish Red Crescent.
"Those wounded with a gunshot or blast wound from a mine are bleeding heavily. Medics should stop the bleeding before they arrive," said Delli, who provides urgent care at a stabilisation point in Hawi Al Hawa, on Raqqa's western edges.
The Kurdish Red Crescent has established various stabilisation points around the city to respond, and treats between 80 to 100 people a day, Delli said. But the task of keeping people alive long enough for them to reach proper hospitals has become increasingly difficult.
In the early phases of the Raqqa battle in June, the journey from the front lines on the city edge to the Tal Abyad hospital took 90 minutes. As battlefronts have drawn deep into the heart of Raqqa, and checkpoints along poorly maintained roads have multiplied, the trip has doubled in length, said Vanessa Cramond, medical coordinator for Doctors Without Borders (MSF), which supports the Tal Abyad hospital.
There is also no cellphone service on the road out of Raqqa, so Red Crescent medics provide as much information as possible to their counterparts in the hospital before they set out.
"We write everything down on a card and send a picture of the patient to the Tal Abyad hospital to explain his condition," said Delli.
"That way, when he arrives, they're prepared to treat him." Cramond says those messages are vital. "Every minute counts in trauma care," she said outside the Tal Abyad emergency room, where a nurse examined a young child with a bandaged foot.
"We're able to exchange photos of the injuries to give some advice and prepare ourselves on this end so we know how many patients are coming, how we will respond, who's going to (surgery) first," Cramond said.
War wounded from Raqqa make up majority of patients in the sparsely equipped Tal Abyad hospital. Patients, relatives and doctors zigzagged across the chaotic waiting area outside the emergency room, as children's cries echoed through the corridors.
Labels hand-written in red marker identified various beds in an urgent care ward, where four middle-aged men were being treated for blast wounds to their legs and arms. In an air-conditioned room nearby, a young girl with severe burns tossed and turned.
Just a few pockets of militant-held territory remain in Raqqa, but the hospital staff are bracing for a new influx of wounded because Daesh is believed to be holding civilians as human shields.
"The way the conflict is evolving at this point, there are more at-risk civilians," Cramond said. "We want to be ready to support the civilian response."
For the SDF fighter with the rib wounds, the efforts were in vain. His comrades reported that medics had been unable to save his life.
AFP
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