Kabul, Afghanistan - The sound of the heart monitor beeped quickly and steadily as the doctors and nurses worked to clean out and stitch up the rest of the gaping wounds to Nadia's legs and to check on injuries to her abdomen they had stitched up a few days before. Pins were screwed in to stabilise her leg where shrapnel from a mortar had shattered the bones of the 35-year-old mother of five while she worked at her home in the remote village of Charkh in Afghanistan's restive Logar province.
After finishing with Nadia, Dr. Abdul Shukur Sardar opened up Hajji Mohammad Gul and removed infected pieces of liver from a gunshot wound the man sustained while walking to the polls. His fourth out of six operations on Thursday was on Nadia's sister-in-law, who was also heavily wounded in the mortar attack on election day - a day many hailed as " peaceful ". Every day since the April 5 presidential vote, Sardar has been working to clean up the human wreckage left in the wake of Afghanistan's vote.
Although Kabul seemed to heave a collective sigh of relief when polls closed at the end of the day with no attack on the capital, the situation in the countryside was somewhat different. In general, security was much better than observers had anticipated, but dozens were still wounded and killed around the country in hundreds of attacks. "The main fighting, the real fighting, is going on in the rural areas," said Luca Radaelli, the medical coordinator at Kabul's Emergency Hospital. Contrary to many reports, for Nadia and others, the "historic" day was marked by violence and death.
The election was a dangerous thing - especially because the government doesn't control these places.
"She was brought in six hours after she was wounded after being taken to a clinic by the Afghan National Army," said Sardar, a surgeon since 2002 at the Emergency Surgical Center for War Victims in Kabul. "I don't know how she survived the journey. She and her sister-in-law were brought in at the same time, from the same house. Their husbands, two brothers, were wounded in the attack and four others were killed."
Stepping back from the operating table to take a break while nurses bandaged the massive hole in the woman's lower leg, Sardar said they had received 15 patients at its Kabul hospital. "This was more than normal," he said. "We had one policeman who was shot when there was an assault on his convoy when they were bringing ballot boxes from the provinces to Kabul to be counted. Insurgents stood in front of the convoy and shot at them. We had to amputate his finger because of a bullet wound. Two police were killed."
'The war is not finished'
Although the number of victims across Afghanistan on election day remains unclear at this point, Emergency's hospital in Kabul is one of the few places in this country of grinding, small-scale, low-grade violence where the human toll of the war is distinct, has a face, and is countable. "It was not unusual, but it was a very active day in terms of attacks around Afghanistan," said Radaelli. "The war is not finished. It is still going on," he said, adding, "even now for us it is clear that we need to be ready for the busy season coming."
Indeed, with campaigning and the vote held in late March and the first week of April, the busy season came early. Just on election day, Emergency's hospitals in Kabul and in Lashkar Gah, the provincial capital of violence-plagued Helmand province in the country's south, together admitted 32 patients. "Starting from May we admit between 200 and 300 people per month," said Radaelli, noting the uptick in violence usually seen when the weather warms up in the country. This means that the hospitals took in around three times more casualties on election day than they would normally see on a single day during the peak of the fighting season.
While it is still too early to get a specific number of attacks, Afghan security forces initially reported about 160 attacks across the country on election day, while the Taliban said they initiated over a thousand assaults. In the past days however, the Ministry of Defense has moved its original number up to 690 . Across seven provinces in the country's southeast, the Afghan Army faced 347 attacks by insurgents on election day, Stars and Stripes reported, compared to an average of 30 to 40 incidents per day the rest of the year. The Afghan public affairs officer for the army's 203 Corps later told Al Jazeera there had been 188 attacks.
Still, the government sees the vote as a success. "The election was more peaceful than 2009. Election day was more peaceful than a normal day in Afghanistan," said Sifatullah Sahaf Safi, media and information director at the Presidential Palace. "Insurgents tried their best to disturb the election, but Afghan security forces managed to disrupt the attacks."
But at Emergency, the experience of some who were wounded while voting seems to go against this narrative. "I decided to go vote. The polling station was at a mosque. Near the mosque there is a big tree. I think someone attached explosives to it near the line of people waiting to vote," said Jamaluddin, a taxi driver in Charikar district of Parwan province. "When it exploded, there were about eleven people injured. I was one of them," he said, moaning, and pointing to his legs. A fragment broke the femur in one leg and pierced an artery in the other.
"The election was a dangerous thing - especially because the government doesn't control these places. Next election, I won't go," he said. "There were a lot of police and military. But they are useless because they could not secure the elections." Given that Parwan is a relatively peaceful province just 60km north of Kabul, reports of violence in more dangerous areas becomes more believable. "We never had anything like this happen in our village. This is the first time. The security was fine where I live," he said. "I might go to another election, but only if there is good security."
With US and NATO forces set to withdraw a majority of their troops at the end of the year, prospects are not good. The UN's Annual Report on Protection of Civilians in Armed Conflict said that the number of civilians killed or injured in Afghanistan increased by 14 percent in 2013, documenting 2,959 civilian deaths and 5,656 injured. The figures mark a seven percent increase in deaths and a 17 percent increase in injuries as compared to 2012.
"There is a constant increase in fighting in [the provinces] around Kabul. There was an intensive moment here one week before the election and on election day, but we expected that. But, generally speaking, around the country, from January to March, there was a constant increase in victims. According to our statistics, there was a 30 percent increase in victims compared to last year," said Emergency's Radaelli.