MSF Trauma Center Admits 71 Gunshot Victims Over Two Weeks in Port Harcourt, Nigeria

Over the past two weeks, 71 people with gunshot wounds have been admitted to Teme Hospital in Port Harcourt, Nigeria. Doctors Without Borders/Médecins Sans Frontières (MSF) has been managing this 70-bed trauma center since October 2005. Port Harcourt is located in the heart of Nigeria's densely populated, oil-rich Niger Delta region, where the struggle to gain power and control natural resources has sparked sporadic and deadly outbreaks of violence among a fragmented network of armed groups. Michael Mills, field coordinator for MSF in Port Harcourt, and Dr. Julie Wynne, a surgeon working in Teme hospital, talk about the recent upsurge of violence.

Can you describe the level of violence in Port Harcourt that our teams have witnessed through Teme Hospital over the last week?

Michael Mills, Field Coordinator: During the first two weeks of August, we have treated 71 gunshot wounds, 27 stabbings, 16 serious beatings, and 1 rape. Seven patients have died from their injuries. We are rapidly approaching the highest numbers of gunshot wounded patients since Teme Hospital opened in October 2005. In July 2007, we treated 72 gunshot victims—the worst month on record for us.

Since the beginning of August, we had seen the usual level of violence, either two or three people arriving each day with gunshot or stab wounds. Then on Monday, August 6, we saw an influx of patients coming from all over the city. The patients all basically told us the same story. In several different locations across the city, they said that they were in the market, near the bus station, or standing alongside of the road when armed groups either in vans or on motorbikes started shooting indiscriminately into crowds of people.

That Monday, we admitted 21 gunshot wounds within about two hours. Then the next day, near the hospital, we had a similar incident. We heard sustained gun fire and explosion.  We could smell that tear gas had been used in the area, which briefly irritated the eyes and breathing of our patients and the people who had sought refuge in our compound.  Again patients poured in as soon as the shooting stopped and we received eight gunshot victims. It was a similar number on both Wednesday and Thursday. Then Friday was quiet. At around 6 o’clock in the morning on Saturday, we received 15 patients from an attack near a bus park. The wounded arrived over a two-hour period. The patients again reported that someone had opened fire into their group. Most were bystanders waiting to collect fuel. They reported having trouble getting to the hospital because of roadblocks. At the moment, we are still staffing the hospital at night in case we see additional outbreaks of violence. It is extremely dangerous for our staff to get to the hospital at night.

How accessible is emergency medical care in Port Harcourt?

The costs for medical care in Port Harcourt can be prohibitive for many patients. MSF provides medical care free of charge through Teme Hospital. There was a case last night, the 13th of August, in which two men brought their neighbor to the hospital. They said that they had been driving around Port Harcourt for two hours looking for a facility that would accept him before finally arriving at Teme Hospital. That patient died in the emergency room fifteen minutes after he arrived due to complications from blood loss.  

Beyond the financial barriers to access, roadblocks are being erected by various groups. Even those people who are aware of the medical services available through Teme Hospital are finding it increasingly difficult to access emergency care.

Can you describe some injuries you have seen in the operating room?

Dr. Julie Wynne: We have seen almost exclusively high velocity gunshot wounds. On Saturday, August 11, we had a group of people wounded from gunfire at a bus stop. One woman had a high velocity gunshot wound to her jaw. Her entire lower face was shot off. She was missing her whole lower portion of her jaw. The wound required an emergency tracheotomy. We had to have the maxillofacial surgeon work on her. It could take multiple surgeries over up to eight months to repair that injury and it will never be like her real face. In the same group, we had a man who was shot in the head and the bullet traversed both of his eye sockets. He lost one eye and the other was injured. We had two young men who were shot and both arrived to the hospital with paralysis because the bullets passed through their spine. One of the men eventually died from his injuries.

Can you talk about some of the challenges of handling such a large influx of wounded at one time?

One of the challenges is keeping enough blood on hand. The wounded get to us late because they have to organize their own transport to the hospital and most of them have lost significant amounts of blood by the time they reach us. Even if they don’t have any broken bones or wounds to chest or abdomen, these kinds of bullets create devastating soft tissue injuries. They require multiple operative debridements, long-term wound care, and even skin grafts.