A near death in the unforgiving desert

Scotsman journalist Emma Cowing almost lost her life in the searing heat of Afghanistan. Her ordeal exposed an unwritten danger facing our troops. Here she tells her story

THE ground was stony, uneven. I kept my eyes on the Royal Irish soldier ahead of me and walked carefully in his footsteps, mindful of the high risk of improvised explosive devices (IEDs) in the area. The atmosphere among the US Marines, Royal Irish troops and Afghan National policemen was tense.

Around us, wary Afghan eyes watched our progress through the small-town bazaar, the odd child running forward with a smile and a shout of "salaam". Ahead of us, a truck started driving towards our patrol. Soldiers immediately dropped to their knees and aimed their rifles. The truck kept coming and the soldiers – aware of the high suicide bomber threat in the town – readied their weapons. Just before they took aim to shoot, the truck stopped, and the soldiers lowered their guns.

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In the 54C heat, encased in my Kevlar body armour and helmet, I was beginning to stagger and sway. I had never felt so hot or disorientated. We reached a halfway safehouse and I fell to the ground, trying to take my helmet off in a desperate attempt to cool down. I remember telling a soldier I couldn't go on, I remember trying desperately to breathe, and then everything went black.

It was the afternoon of Sunday, 6 July and I was out on patrol with the US Marines in Musa Qala in Afghanistan's Helmand province.

The notorious former Taleban stronghold was retaken by British and Afghan forces in December and I had been told that, since then, the situation had improved considerably for those living here. The school – for boys only, although girls were being considered for next year's classes – had reopened. A health clinic had started seeing patients. The once- deserted bazaar was now a busy hotbed of trade.

The US Marines were mentoring the Afghan National Police Force, and Royal Irish troops were mentoring the Afghan National Army.

Meanwhile, the "hearts and minds" operation of the British Army and the Foreign Office was in full swing, with a radio station beaming out positive community messages and a poster campaign radiating anti-Taleban propaganda.

I was desperate to see it, particularly as a high number of Scottish troops – including several companies from both 2 and 5 Scots Battalions – were based in Musa Qala District Centre, the camp next to the town.

Despite the good-news stories, I had heard grumblings of hostility towards British troops in the bazaar and a growing discontent among the townspeople with Mullah Salaam, the coalition forces-installed governor who was a former Taleban commander.

So when the opportunity came to go on a foot patrol through the town and into the bazaar, I said yes.

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The Scotsman's photographer, Ian Rutherford, did not have that luxury. Having suffered badly in the intense desert heat, where the temperatures regularly soared past 50C, he had been ruled out of the trip by the camp medic. I, on the other hand, felt OK.

We had been in Helmand eight days at this point and, although I had felt slow and sluggish at points, I thought I had acclimatised well. I was fairly fit, and had worked out with a personal trainer before travelling to Afghanistan. Knowing water was key I drank an average of nine litres a day.

Out on patrol, at first anyway, I was fine. I kept the (admittedly slow) pace of the troops, marvelling at their constant alertness for any trouble, and looked on as some soldiers went to check on a new water construction project for the town. But by the time we hit the bazaar, having walked around 1km in body armour and helmet under that 54C sun, I was suffering from severe heat- stroke. Soon after, I collapsed.

Heatstroke is one of the most common causes of military casualties in Helmand. In the desert surrounding areas such as Musa Qala, it can reach 56C in the heat of the day, and soldiers – many of them carrying at least 50lb of body armour and kit – are at serious risk of injury as a result of being exposed to such temperatures. Fitness is not necessarily a defence, only true acclimatisation, which – according to one officer – often takes the Scottish soldiers out there seven to eight weeks.

What happened to me that day was a unique insight into the treatment a soldier injured in the field by Afghanistan's intense heat receives, and a testament to the highly precise medical evacuation procedures of the British Army.

After I collapsed, I was put in the back of an armoured vehicle and driven back to camp, the soldiers looking after me so concerned about my condition that they bypassed normal rules to check for roadside bombs to get me to safety.

Once in the Musa Qala camp medic tent, my clothes and boots were cut off and I was covered in cooling packs by Captain Cooper, head of the medic team, and hooked up to an IV drip. Meanwhile, as my temperature soared to a life-threatening 43C, a Medical Emergency Response Team (MERT) Chinook was called in from Camp Bastion. These are highly trained medical teams, equipped to deal with any field emergency, from a roadside bomb to a heat-exhaustion victim, in the most hostile of situations.

The Chinook landed and I was driven to the landing pad under the protection of armed soldiers.

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It rose into the air and I lay unconscious on a stretcher while the MERT team of Lieutenant-Colonel Duncan Parkhouse, Flight Sergeant Mark White and Flight Nurse Maggie Carter got to work on me amid the noise, dust and heat. A drip was inserted.

And then, somewhere over the Helmand desert, my heart stopped. For three minutes the team worked to resuscitate me, giving me two bouts of CPR as the helicopter clattered on.

Against all the odds, it worked. My heart started, the Chinook landed and the MERT team handed me over to the intensive care unit at Camp Bastion hospital.

I woke up the next morning covered in wires and tubes. The doctors told me that, at one point, I had no blood pressure. I was on a ventilator as I was unable to breathe on my own and, at its worst, my core temperature had been 43C. Reaching 44C, apparently, would have meant instant death. The MERT team, through precision and assurance in intolerable conditions, had saved my life.

As I lay on that bed, breathing shakily through my oxygen mask and listening to these statistics, all I could feel was lucky. I had survived because I had received the best medical treatment in the world, under some of the most extreme conditions on Earth. I felt – and still feel – incredibly humbled by the treatment I received that day, and by the dedication to duty of the people who cared for me.

The army moved heaven and earth to fly me out of Afghanistan that night. I was placed on a Hercules which flew me to Kandahar, where I was stretchered on to an RAF TriStar.

Here, a separate area was created on the plane for me so the medical team could constantly care for me – changing my drips, giving me morphine, and holding up cups of water with straws that I could sip at.

The TriStar landed in Birmingham and I was taken to Selly Oak hospital, where all evacuated British casualties are treated.

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Again, the care was exemplary and I was discharged four days later. A welfare team representative came to see if there was anything I needed. I asked for names and addresses. I had a lot of thank-you cards to write.

When I got home to Scotland, I unpacked my kitbag. Inside, placed right on the top, was one boot. There was no sign of the other one. It was covered in dust. There was a spot of blood on the toe. The laces had been cut down to the quick.

I've placed it in a corner of my living room – it is a permanent reminder not just of the fragility of life, but of the professionalism of the British Army and its medical teams as they continue to fight, and save lives, in one of the harshest environments on Earth.

'Every bit as dangerous as the enemy'…heat is the silent killer that keeps claiming more victims


THE document is known in the Armed Forces as JSP 539 – Climatic Injuries in the Armed Forces: Prevention and Treatment. It is available to everyone, from the novice soldier to experienced officers. Yet still, the heat continues to claim its victims.

The guidelines on heat-related illness are constantly under review. Gruelling training is carried out by armed forces personnel before tours of harsh environments like Afghanistan and Iraq, and numerous regulations are in place to ensure that, once there, harm is minimised.

Ultimately though, no amount of forward planning can eliminate the risk posed by extreme and changeable weather conditions.

Recent statistics showing the number of troops to have succumbed to heat illness are unavailable, but between September 2004 and July 2006, some 284 service personnel suffered heat- related injuries in Iraq: cramps, fatigue, or heatstroke. Of them, 80 had to be bedded down or admitted to a field hospital. In Afghanistan, 33 personnel suffered heat illness between April and July 2006, with nearly half requiring bedding down.

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Clive Fairweather, the former SAS deputy commander, said last night: "The conditions of extreme heat are every bit as dangerous as the enemy. An injury such as heatstroke can be fatal, and it's vital to get into a routine of acclimatisation. The most important thing is to have a basic level of fitness, but not every man or woman is the same with regard to the water they need, or work they can do. TA soldiers, for instance, may not have the same level of fitness, so it's vital to keep an eye on everyone."

Under Ministry of Defence (MoD) procedures, personnel embarking on six-month-long tours of such regions – where temperatures can break the 50C barrier – do so after around ten days of physical training in environments like the Kenyan desert, arriving for their tours in March to April, or September to October. Known as the "rip" – short for "replacement in place" – the changeover allows soldiers a few months to acclimatise.

Once on the ground, regular checks exist for soldiers' water requirements – they can often drink up to 15 litres a day – and for the most part, there are cooling kits with breeze panels, special rations and isotonic drinks on hand to regulate body temperatures. Commanders, meanwhile, try to schedule their operations around daily temperature and humidity forecasts. There is also a Heat Stress Index, a model which gauges how much work a soldier can carry out, and how much rest they need, although so fierce is the heat in Iraq, it often falls outside of the indices.

There are many checks and balances, but they are not always sufficient. Last year, a Board of Inquiry (BOI) report brought scathing conclusions following an examination of the death of Private Jason George Smith, 32, of Hawick. He died in 2003 in southern Iraq as daytime temperatures soared above 50C.

The report said the death of Pte Smith, a TA member with the 1st Battalion King's Own Scottish Borderers, was caused by heat exhaustion after a heart attack. It noted that he had a body mass index of 34, but the incident has brought the introduction of lengthier acclimatisation periods.

The report also noted that his accommodation did not have air conditioning.

The MoD's goal is to provide air-con in housing for its personnel, but there have been repeated complaints of tents and housing blocks without such units.

There has also been resentment over the lack of air con in some light armoured vehicles.

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