Damage limitation

One of the most pitiful sights in conflict areas is the local prosthetics store, with its rows of artificial limbs, sized from adult down to tiny child. A poignant reminder that, whether fleeing a war or injured in one, the human body and mind are subjected to extreme damage.

Imagine triggering an improvised explosive device (IED) that shreds your leg and sends shrapnel, soil and debris deep into your body. Would you be able to apply a tourniquet to your injured leg, to prevent bleeding out from severed arteries? Soldiers are trained to do this. Some wear tourniquets in position, ready to wind tight should the worst happen.

Your village is shelled and every member of your family killed. You escape the bombs and run for months across the Middle East, see others drown in the Mediterranean, then walk overland to arrive in a temporary camp with inhuman conditions. Alone among thousands, you find neither sympathy nor asylum. Do you risk electrocution, or being crushed in the Channel Tunnel, or freezing or suffocation smuggled in the back of a lorry, in the hope of reaching a distant relative you believe lives somewhere in Manchester? How do you cope?

The military medical historian, Emily Mayhew, details extraordinary progress in blast injury medicine. In around 2008, Afghan insurgents learned from the landmine manual that wounded soldiers consume more of the enemy’s resources than dead ones: they began to ‘improve’ their IEDs to inflict maximum damage. Her book chronicles consequent improvements to the military medical response that now keep soldiers alive despite injuries that would previously have killed them.

Mayhew weaves the stories of two blast victims into a riveting description of the journey from the battlefield through every stage of resuscitation to recovery back home. By the end of the book we have seen soldiers who have lost three limbs emerge from ‘surround and sustain’ care, fitted with computerised prostheses and living full lives.

Specialised teams include plastic surgeons, who can ‘read the wreckage of the human beings brought to them like no one else’, and orthopaedic surgeons, who brought a new approach to amputees in the first world war, but were overtaken by general surgeons in peacetime, and have now come back into their own.