KABUL, Afghanistan -- Zarsanga, a tiny 5-year-old with serious eyes who, like many Afghans, uses a single name, was inside her home in rural Ghazni province, playing on the floor with a 3-year-old cousin, when a firefight broke out nearby between Afghan soldiers and insurgents.
Now she’s in a war trauma hospital in Kabul run by the small international charity Emergency, the victim of a major reason that civilian casualties have jumped sharply in the first half of the year: getting caught in crossfire between insurgents and Afghan soldiers and police.
The United Nations Assistance Mission in Afghanistan reported Wednesday that the number of civilians wounded in the war here during the first half of the year rose 23 percent compared with the same period last year. The increase was even higher among women and children, up 61 percent for women and 30 percent for children.
No single reason is responsible for the full increase. In many cases, insurgents have struck targets such as police highway checkpoints, courthouses or government offices without regard to the presence of civilians or they’ve used improvised bombs indiscriminately.
However, the report says a major cause is that as the U.S.-led coalition has closed hundreds of small bases in outlying areas, insurgents have become more bold. That’s led Afghan security forces to attack, according to the report, and civilians often are caught in the ensuing fighting.
Zarsanga’s bullet entered her right hip and smashed the femur just below the joint. X-rays show that what’s left of the top of the bone sits at a 90-degree angle, and is mending that way.
"My cousin is fine. It was only me who was injured," Zarsanga said, dangling her legs in a wheelchair that was built for children but was still too large. "I can’t walk, but it doesn’t hurt right now."
It’s unclear how much she understands about how her life will be different.
The doctors are trying to partly fuse the joint, but that leg will always be shorter than the other, said Luca Radaelli, the hospital’s medical coordinator. At best, Zarsanga will walk with a slow, swinging gait.
Just inside the door of Zarsanga’s ward, a whiteboard bears the name and cause of wound for each patient.
"Bullet, bullet, shell, bullet, shell, bullet, bullet, knife, shell, bullet," Emergency’s Afghanistan program director, Emanuele Nannini, read on a recent day, hitting a rhythm as he worked down the list.
There are whiteboards like that one in all six wards of the hospital, and more in Emergency’s hospital in Lashkar Gah, in Helmand province, where the fighting has been particularly fierce. These days, those boards stay full.
Emergency admits only patients with severe trauma. Nearly all are civilians, though there also are police officers, and even Taliban. Its admissions are up 59 percent for the first half of the year, including an 89 percent increase at its hospital in the violent south.
Nannini said the spiking seemed to be in part because the fighting had moved closer to towns and villages in many areas. Also, government clinics in the most dangerous areas have been closing or seeing members of their staff flee, so Emergency is getting patients the Afghans can’t handle.
The U.N. report looks at deaths and injuries across the country, not just in the worst-hit places, where Emergency works. It says that all told there were 1,319 civilian deaths and 2,533 injuries. That reverses a decline last year.