By Fiona Govan
A British medical team is treating the injured, rebuilding clinics and training health workers, reports Fiona Govan
Sekineh stumbled over the white-shrouded corpses that lined the roadside as she tried to find her way to the hospital. Minutes later, her wanderings vain, she lay down in the rubble and gave birth, her cries indistinguishable from the wails of those mourning their dead.
Eleven months later, seated on the floor of her tent, the 32-year-old tickles the chin of her giggling baby as she recollects the circumstances of his birth, 11 hours after an earthquake measuring 6.7 on the Richter scale levelled the city of Bam in south-eastern Iran, killing 32,000 people and leaving thousands more injured.
"I realised that the baby was coming and I was trying to find the hospital but I couldn't recognise anything - all the streets had changed, there were no buildings standing, only ruins everywhere and people calling for help," she said.
"I thought that he would be born dead because the house had fallen on us, and even when he was born and cried out, I couldn't believe that he would live for long. He was six weeks early and I was all alone. My husband had broken both his legs and my parents were dead. For the first three days I had no shelter, no milk for the baby and the health clinic was gone."
She named her son Mohammad Ali, after the grandfather he lost in the earthquake. He is now a healthy, chubby child, a fact that Sekineh attributes directly to the help she received from foreign aid workers in the days and weeks that followed the earthquake.
"They stitched me up and they gave him injections to stop infection. They gave me a sterilisation kit and milk so that I could feed him and they set up a new clinic so I had somewhere to take him when he was sick." Mohammed Ali is one of 44 babies born since the earthquake who are regular visitors to the temporary clinic in Poshtrood, a village on the outskirts of Bam.
Since the collapse of the brick structure that served as a health house to a rural community of 3,000 people, Fatima, a 45-year-old nurse, has been running a women's clinic from an air-conditioned portable hut.
It is one of the emergency clinics provided by Merlin, a British charity, which is working closely with other international NGOs and the local health ministry in the effort to rebuild Bam.
Sean Keogh, a consultant in emergency medicine for the NHS and a member of Merlin's rapid-response assessment team, arrived in Bam on the December 29, 2003, three days after the earthquake struck.
"Apart from supplying emergency medical services to those injured, the real challenge lies in the weeks and months that follow a disaster such as this," he explains.
Dr Keogh and his team arrived from Baghdad with two lorries full of essential medical supplies including, hygiene packs, cholera kits, antibiotics and intravenous fluid.
"We found that more than half of the rural health clinics in the Bam area had suffered damage during the earthquake, killing many of the doctors and nurses and leaving communities without access to essential primary healthcare. Our priorities were to rebuild sanitation systems, provide temporary health clinics, while rebuilding the damaged ones, and train healthcare workers to replace those who had died."
Long after the search and rescue teams had given up all hope of digging further survivors from the rubble and the field hospitals had packed away their emergency operating theatres, Merlin is still in Bam providing refresher training for almost 150 healthcare workers and rebuilding 29 of the worst-hit health clinics.
This has proved a lifeline to the 75,000 people left homeless after the earthquake, the majority of whom are still living in tents among the rubble of their former homes.
With extreme temperatures of minus 10C at night in winter soaring to 50C (122F) on summer days, the clinics have to treat many patients suffering from dehydration and exposure in addition to those with the usual health problems prevalent in any community.
The nurses also find themselves acting as counsellors to those who now have no one left to rely on. Each morning, Nabat hobbles out of her tent, and, using two walking sticks to support her frail frame, she cautiously negotiates the path through the debris to her local clinic.
The short but arduous journey has been a daily necessity for the 98-year-old since the ceiling of the home she shared with her daughter and grandchildren collapsed in the earthquake leaving her the sole survivor. She attends the clinic to receive the eye drops and tablets that until December 26 last year were administered by her daughter each morning at breakfast.
Almost blind, and deaf to all but the loudest shouts, Nabat's face crinkled into a toothless smile as the nurse deftly rubbed soothing cream into her arthritic joints.
"It's not too busy today so I am giving her the extra special treatment," explained the nurse in charge of the clinic. "She's one of my favourite patients and spends a lot of time here. If the clinic wasn't here, I don't know what would become of her."
Another frequent visitor to one of the clinics rebuilt by Merlin is eight-year-old Zahra, who lost her left leg when she was crushed beneath a heavy cabinet as she slept. Sitting in the tent that serves as a waiting room while the clinic is fully rebuilt, she put aside her doll and timidly tugged up her trouser leg to reveal a stump criss-crossed with scars.
"It's much more beautiful now than when they first took the bandages off." She sighed. "Then it was all black and blue and had stitches poking out everywhere. I couldn't look at it and cried all the time."
Before the clinic was rebuilt by Merlin, Zahra had to travel to the main hospital in the centre of Bam for treatment. With no car of their own and no public transport, Zahra and her mother found the 14-mile round trip on crutches too much to do regularly, and her wound became infected.
It is only now, months after her leg was amputated, that Zahra has recovered enough to be fitted with a prosthetic limb by a rehabilitation worker who has travelled out to Merlin's clinic specially.
"Today I'm getting a new leg," she beams. "It's as beautiful as a doll's."