Battle scarred: an ethnographer at Camp Bastion

What is the point of being an academic? To most scholars, the utility and inherent importance and pleasure of their profession is obvious. But not for ethnographer Mark de Rond. Not since he spent six weeks at a military field hospital in 2011.

De Rond, professor of organisational ethnography at the University of Cambridge, had previously carried out research on a disparate set of groups, including comedians and elite rowers – the latter resulting in the 2008 book The Last Amateurs: To Hell and Back with the Cambridge Boat Race Crew. The idea of doing something on military medical staff stemmed from reading a short newspaper article about a surgical team in Afghanistan. Intrigued by the prospect of observing how clinicians function in active war zones, de Rond wrote to the Surgeon-General – the senior medical officer of the British Armed Forces – and another high-ranking medical military officer enquiring about the possibility of an embedded deployment. The former said no, but the latter was more receptive. He had read The Last Amateurs and proposed a similar book telling the story of army medical teams. Within 18 months, the officer had successfully obtained permission from the Ministry of Defence for de Rond to go to Camp Bastion, the base for British and other coalition forces during the Afghanistan War.

No amount of suffering among elite rowers could have prepared him for what he encountered. The Afghanistan conflict, which officially ended in 2014 but which still lingers unofficially on, has led to an estimated 110,000 deaths, according to Brown University’s Cost of War project. That figure includes more than 3,500 fatalities among Western coalition forces, according to the website icasualties.org. Not surprisingly, then, the hospital at Bastion was the “world’s bloodiest”, according to de Rond. Between April 2006 and July 2013, it admitted about 20,000 casualties – coalition, opposition and civilians – while using more blood product than all of Scotland combined in the same period. During his first week alone, de Rond witnessed 174 casualties.

His experiences are recounted in his latest book, Doctors at War: Life and Death in a Field Hospital, published on 20 April by Cornell University Press. As early as page 10, the surgeons are assessing the wounds of a Gurkha who has been the victim of a homemade explosive. His “upper legs and buttocks” have been “ripped to sloppy twine”, with “bits of skin, flesh, and muscle left dangling spaghetti-like”, de Rond writes. Later on, a man is admitted whose face has been “stripped straight back to the skull with a fist-size hole where his nasal cavity should be”.

De Rond coped with such scenes better than he had feared. This, he tells Times Higher Education, is because “I’d had a fair bit of time to prepare myself mentally for the deployment, allowing me to shut down emotionally – presumably as a means of protecting myself.” And he was able to compile the detailed and largely dispassionate field notes that, along with conversations, interviews and email exchanges, he draws on heavily in the book.

Unlike for The Last Amateurs, de Rond keeps himself very much in the background of the narrative – and where he does show himself, it is more often to question his own academic purpose than to pass judgement on what he has seen. For all that, Doctors at War reads more like a journalistic eyewitness account than a standard academic monograph. The first piece of overt academic analysis comes at the end of chapter four, almost a third of the way through the book.

De Rond largely concentrates on detailing the lives of the surgical team: the remedies they employ, the decisions they make and their relationships with each other and with the patients. Much of this is conveyed through direct dialogue. As such, the book echoes Richard Hooker’s seminal war novel, MASH. Hooker had been a surgeon in the Korean War, and MASH drew heavily on his own experiences. One of Hooker’s principal characters is called Hawkeye, and de Rond adopts that name as a pseudonym for his own straight-talking main character, through whom he is able to convey much of what he has observed.

Unlike the soldiers, de Rond insists that he never felt in physical danger. “Without sounding cavalier,” he says, there was only ever a “small chance” of his being hit by a stray mortar. However, for all his ability to maintain a level of detachment at the time, the psychological injuries were ultimately much harder to dodge. The impact of what he saw finally hit him as he started writing the book shortly after his return to the UK. He suddenly felt what he describes in the book as a “flurry of sharply conflicting emotions”, including despondency, anger, futility and guilt. Indeed, the guilt that came to “haunt” him, he says, stemmed precisely from his lack of emotional reaction during the tour. Although he had known that he should on some level “be able to show compassion” to the afflicted, he had been unable to.

As for the anger, “I’m not a pacifist by any means, but war’s pretty horrible. Basically, you look at the collateral damage that you see so much of in the hospital; it leaves you with a really bad taste in your mouth,” he says. “It’s something to do with the unfairness: the fact that people who will never be exposed to war first-hand have a say in whether we go to war or not. It seems very callous. It’s only when you see the cost…that you realise how totally fucking horrible it is. It is so bad.”

That anger, he says, shone through in the early drafts of his book. And although he took a lot of it out again, “some of that still shows through”. For instance, the graphic descriptions of the injuries suffered by the soldiers are deliberate, designed to expose readers to the fact “that what you see in war is ugly”.

De Rond is particularly haunted by the “beautiful” child casualties he encountered: “Afghan children have lovely skin tones, long eyelashes, dark eyes. To see them completely torn to bits by explosives or all cut up and sewn back together post-surgery: it’s just sad,” he says. “You realise this isn’t normal: an eye missing, the brain bleeding into the eye. You can’t make it up. It’s then you realise this is not what humanity should be like.”

De Rond is certainly not alone in his reaction. In a paper published earlier this year in the Academy of Management Journal, coauthored with Jaco Lok of the University of New South Wales, he reports that all of the surgical team "experienced some psychological distress upon arrival back home". But the effect of his Camp Bastion experience on de Rond seems to have been particularly profound. The book describes two occasions in particular on which de Rond questioned the very foundations of the religious faith that, as a child of missionaries, had been a significant part of his upbringing.

Post-Afghanistan, “I’m probably not even agnostic any more, I’m atheist”, he says. “I think I was [already] on my way out, but I was still trying to maintain a relationship [with God], trying to pray. [After what I saw], I felt I just couldn’t. The misery you see makes you question where God is in a place like that.”

The profound effect on de Rond of his experiences at Camp Bastion is also evident in his subsequent fieldwork. In 2013, he successfully rowed the length of the Amazon River, braving pirates, river bandits, piranhas and disease in order – as he describes it on his Cambridge website – “to learn, first-hand, how collaboration unfolds, and how problems are solved, under trying conditions”. The feat gained him and his team a Guinness World Record for being the first people to row the entire 2,000-mile navigable length of the world’s second-longest river – but its impact on him barely compared with that of Afghanistan.

“Aside from the fieldwork angle, I had hoped the Amazon trip would allow me to get Afghanistan out of my head,” he says, “But I didn’t quite succeed on that front.”

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The brutal honesty of its content makes Doctors at War – unintentionally perhaps – something of a polemic, and almost led to its suppression. The officer who arranged de Rond’s deployment told him to write it “free of any fear of censorship” and gave him a written promise of confidentiality. However, as de Rond sets out in the book’s epilogue, he then leaked the first draft to the Ministry of Defence, leaving de Rond feeling “betrayed” by the officer. The Surgeon-General complained to de Rond’s vice-chancellor at Cambridge, who passed the matter on to his dean. The result was a trip to Whitehall in February 2013 for an “unpleasant meeting” at which the Surgeon-General and the ministry’s legal team told de Rond that they “opposed the book in its current form”, stating it would harm the UK’s interests internationally and could lead, among other things, to disciplinary measures against the individuals it describes.

The latter point troubled de Rond since his book does indeed depict certain Bastion staff making difficult medical decisions and describing Afghans in highly unflattering terms, for example. “Who am I to put at risk the careers of the people I write about?” he muses. “These are good people: they’re well intentioned, generous. They do good work, but they also miss their families, get tired. They’re heroes...because they are somehow able to cope in an environment that demands quite a lot from people. I had to be careful to protect people [on the] inside. It’s something I still wrestle with, so…if this ever came to haunt anyone in the book [through military censure], I would be gutted.”

Such thoughts led him to consider dropping the project entirely. A “legal read” from a libel lawyer – which he partly paid for out of his own pocket – cleared the book for publication without fear of government reprisal, and Cornell University Press was adamant it would publish. But de Rond’s doubts were compounded by a lack of institutional support from Cambridge – save from his dean, who paid the other half of the legal fee.

Eventually, however, his conviction that the public needed to hear his account of Camp Bastion stiffened his resolve – and he also “took courage” from a couple of greatly respected ethnographers, who both told him the book “must be published”.

“As academics we cannot afford to sit inside our own echo chambers as if very little outside of our own work exists,” he says. “We have a responsibility to make our work intelligible to the wider public.”

But, for all that, he still wrestles with a sense of futility. On returning from Afghanistan, he felt what he describes in the book as a “feverish desire not to fall back into a self-absorbed academic life”, for which he felt “derision and disgust”. “I would fall out with colleagues,” he says. “I wanted them to understand so badly how pointless the stuff that we do is – which didn’t go down well.”

Six years on, he says he still suffers from psychological injury, and still finds it difficult to get excited by academic work. “Whatever important purpose we academics are meant to serve,” he says, “what we do will make fuck-all difference to the world.” 

Doctors at War: Life and Death in a Field Hospital is published on 20 April by Cornell University Press.