British nurse running country's only modern hospital braces for new war

Dr Gino Strada, the Italian surgeon who succeeded against all the odds in building the only modern hospital in Afghanistan – its operating tables had to be delivered strapped to the backs of camels – shakes his head in anger. He and Kate Rowlands, the hospital administrator, from Northampton, are waiting for an influx of casualties from the new war.

"I am frightened by the Spaghetti Western rhetoric of George Bush about bringing back America's enemies dead or alive," Dr Strada says. "Politicians around the world, who could not find Afghanistan on the map, now talk about whether the country should be the target of so-called pinpoint or carpet bombing. The one certainty is that people will be killed."

Dr Strada had just returned from a five-day journey by four-wheel-drive and horse through the mountains of Pakistan to his 120-bed Emergency Surgical Centre for War Victims, which opened three years ago near the village of Anaba, in the isolated Panjshir valley.

The hospital, a cluster of pretty white buildings with red doors and window frames, is an extraordinary achievement. A former police college, it was rebuilt partly from abandoned Russian military equipment. Wood from old ammunition boxes was used in the ceilings and pipes from tanks in the sewage system.

Medical equipment must be brought across the front line through the mountains on the backs of pack animals. Some of it was transported in a convoy of 40 donkeys. These animals abound in the Panjshir valley. The hospital, paid for by the Italian charity Emergency is primarily for war victims.

Ms Rowlands is an intensely energetic former nurse and a chain-smoker – she has a large notice on her office door reading "smoking allowed".

"Some 70 per cent of our patients have war-related injuries," she says.

But because there are no other fully equipped hospitals, the five surgeons and 24 nurses never turn anybody away. Dr Strada says: "If you have a simple eye cataract, here you go blind because there is no eye surgeon in the whole of northern Afghanistan, though we should have one soon. We are the only hospital in this area which has oxygen."

Most beds in the wards are occupied by soldiers and civilians wounded in the latest fighting.

In one room, a physiotherapist was exercising Hoja Sharif, a 40-year-old unemployed man from Charicar, which is north of the capital, Kabul. His left leg was torn off by a Taliban rocket.

In another bed,a tough-looking man called Shir Aka had his leg covered in plaster. He had been commander of a section of the front until 18 days ago.

"I was hit by shrapnel when the Taliban attacked and captured part of our line," he says. Nearby was a captured Taliban soldier who had been sent to the hospital from a prison camp when his wound became infected.

Not all of those injured as a result of the war are soldiers.

Ms Rowlands pointed to a 15-year-old boy named Sardarkhan, saying: "He has been in here twice. Both times after ammunition he was playing with blew up."

Some patients have travelled a long way to get to the hospital. Dr Strada showed an X-ray of the head of a young man brought by helicopter from Dari Souf, a besieged opposition enclave. "There is quite a piece of metal inside here," he says. "Normally a sort of capsule forms around it. We won't touch it unless we have to."

Almost all of Dr Strada's patients come from areas controlled by the opposition Northern Alliance. But he has been trying to open a hospital in Kabul, and for three weeks earlier this year he thought he had succeeded.

He says that, of the 14 hospitals in the Afghan capital, only one, a 400-bed military hospital, really deserves the name of hospital.

His new hospital in Kabul had 120 beds, soon to be expanded to 300, and a staff of 250. But soon after it was opened it was raided by the religious police, or maroof, which has the task of "combating vice".

Ms Rowlands says: "They beat the staff and threw three of them in jail for 10 days. They said we had allowed men and women to eat together, but it wasn't true. There was a screen between them."

Dr Strada has decided to close the hospital, and says he will not reopen it until he has a guarantee for its security from the Taliban authorities.

Dr Strada is still negotiating with them.

Last week, a deputy minister in Kabul told him there were only two weeks' supplies of drugs left in Afghanistan. Ms Rowlands had asked her staff in the hospital to see what drugs were in short supply. "We'll ask our usual smugglers what they can do," she says breezily.

When he was asked if obtaining medical supplies was difficult, Dr Strada replied: "Difficult? It's a nightmare."

But he is grimly humorous about the problems of running a hospital in Afghanistan. His rage is reserved for the hypocrisy of those whom he believes are about to inflict fresh suffering on the Afghans.

He blames the US and Pakistan for sending the first religious fanatics to Afghanistan to fight the Cold War by proxy, and thereby starting a process that eventually produced the Taliban. "After 1979, you could go to any Pakistani embassy in the world and, if you said you wanted to fight in Afghanistan, they would give you a free ticket paid for by the CIA," Dr Strada says. "It is they who created Osama bin Laden."