In a pink-painted village clinic converted into a field hospital a few miles from the Mosul front lines, there is no emergency care facility, so wounded Iraqi troops are just wheeled into the foyer for treatment.
Over the crackle of walkie-talkies, one of two men arriving with shrapnel wounds from a car bomb calls out, "Mohammad Jassim, my brother, where is he?"
He is right here, a medic reassures him. Both men are confused and in pain but expected to survive. They are federal policemen, a national force playing a key role in the fight by Iraqi forces to take Mosul back from ISIS. More federal police casualties arrive in ambulances throughout the day.
The field hospital is one of several, along with front-line points for immediate treatment of the gravely wounded, set up after the months-long Mosul operation restarted on Feb. 19.
ISIS is expected to lose Mosul. But its fighters are inflicting a terrible toll. The number of civilians and combatants killed and injured has far exceeded what was predicted, with hundreds of car bombs, land mines and booby traps adding to the danger.
The impact on the Iraqi armed forces has been colossal. Iraqi officials do not give figures, but American military officials have told reporters some divisions had casualty rates of 30 percent, without specifying whether the men were killed or injured.
Dr. Altaf Musani, the representative for the World Health Organization in Iraq, said in the first months of the offensive, many people died for lack of urgent care.
When a person is seriously wounded and in danger of bleeding to death, "there's really a window within minutes that someone should be stabilized," he said, speaking in the northern Iraqi city of Erbil.
Stabilization usually means stopping the heavy bleeding caused by bullet or shrapnel wounds and making sure patients can breathe on their own while they await more treatment.
Musani said typically in close vicinity to this kind of fighting, about 20 percent of the people in the area — civilians or fighters — sustain these kinds of wounds. But in Mosul that number has been much higher. Many civilians spoke of being deliberately targeted by ISIS as they left Mosul.
Once the patient is stabilized, Musani said there is "a golden hour" to get them more treatment — literally about 60 minutes. In the first months of the battle for Mosul, that deadline was rarely met.
Hospitals in and around the city were destroyed in the fighting and the nearest functioning medical facilities were hours away along bumpy roads.
Amid the uncertainty of war, WHO planned for mass displacement more than for mass casualties. "It wasn't anticipated that people would be stranded, caught inside East Mosul," he said. ISIS forbids anyone from leaving the city.
Now the World Health Organization, charities and Iraq's health ministry have scrambled to move medics closer to the front lines to stabilize the wounded and then provide comprehensive treatment.
"This is very difficult," he said. "You need a certain level of medical expertise, equipment and mobility to be out in front lines in order to capture cases."
One organization, Samaritan's Purse, opened a field hospital close to the east of Mosul in January in cooperation with the World Health Organization and Iraq's health ministry. They have since treated hundreds of cases and have performed multiple surgeries on a daily basis.
Throughout the operation, troops from the U.S.-led coalition backing Iraqi forces have also helped on the front lines with emergency trauma care. Col. John Dorrian, the coalition's spokesman in Baghdad, confirmed the accounts from Iraqi troops.
In the field hospital near Hammam al Alil, a federal policeman named Ali Qassem said U.S. forces patched him up after he was shot in the shoulder in a surprise attack by ISIS fighters on a group of his men.
"We were with them 10 minutes before," he said. "We took pictures with them and joked with them, and then 10 minutes later I was injured and they came quickly.
"They were very close and very helpful."
MARY LOUISE KELLY, HOST:
The fight to force ISIS from the Iraqi city of Mosul has resulted in more casualties than expected, both for combatants and civilians. That has led the Iraqi government and international aid groups to step up emergency care. NPR's Alice Fordham went to a clinic where they are trying to get medics closer to the front lines.
ALICE FORDHAM, BYLINE: In this field hospital a few miles from the Mosul front lines, there's no intensive care unit. They just wheel in casualties and start treating them right in the lobby.
FORDHAM: I get out of the way as two Iraqi troops arrive. They were hit by one of the suicide car bombs ISIS deploys every day on the battlefield.
UNIDENTIFIED MAN: (Foreign language spoken).
FORDHAM: One calls out the name of the other. Where is he, my brother? Both are conscious and expected to survive but confused and in pain, with hastily bandaged shrapnel wounds that need attention. Many such cases arrive during the day. In a tent next door, I speak with another man who took a bullet in his shoulder a few hours earlier.
ALI QASSEM: (Foreign language spoken).
FORDHAM: Ali Qassem says he was among the government forces that took the strategic airport back from ISIS and powered through into the next neighborhood. They thought they had cleared it.
QASSEM: (Foreign language spoken).
FORDHAM: But then, as a bunch of police gathered together, ISIS fighters shot them with rifles and mortars.
QASSEM: (Foreign language spoken).
FORDHAM: "There were two, three, four, several people injured. It's still going on," he says. And this is happening a lot. ISIS is expected to lose Mosul, but its fighters are inflicting a terrible toll as they fight their losing battle. The numbers of civilians and combatants killed and injured far exceeded what was predicted, with land mines and booby traps adding to the danger.
Most medical facilities are far from the fighting. And when I meet with Dr. Altaf Musani, the representative for the World Health Organization in Iraq, he says many died for lack of urgent care.
ALTAF MUSANI: There is really a window within minutes that someone should be stabilized
FORDHAM: That usually means stopping the heavy bleeding caused by bullet or shrapnel wounds and making sure the patient can breathe on their own while they await more treatment. Musani says typically in conflict situations, if they're stabilized, there's what's called a golden hour to get them more treatment.
In the first months of the battle for Mosul, that wasn't happening because the nearest functioning hospitals were hours away along bumpy roads. Musani says no one knew what would happen in the fighting, which made it hard to plan.
MUSANI: It wasn't anticipated that people would be stranded, caught inside east Mosul.
FORDHAM: The impact on the Iraqi Armed Forces has been colossal. Iraqi officials won't give figures, but American military officials have told reporters some divisions had casualty rates of 30 percent, without specifying whether the men were killed or injured. Now, Musani says the World Health Organization, charities and Iraq's health ministry have scrambled to move medics closer to the front lines to stabilize those first crucial cases.
MUSANI: And this is very difficult because you need a certain level of medical expertise, equipment and mobility to be out in front lines in order to capture cases. The other big lift that we're working on, again in support of the government, is putting down three additional field hospitals.
FORDHAM: Their services are likely to be badly needed. The battle for the densely populated west of the city is only just getting underway. Alice Fordham, NPR News, northern Iraq. Transcript provided by NPR, Copyright NPR.