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Getting rid of hostages
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, 02 2002
The tragic story of the death of over a hundred people at ‘Nord-Ost’, after they had already been rescued from the hands of terrorists, is a story about responsibility. Tocall a spade a spade, it is a story of about the right of the politicians, who were in one way or another complicit in the crisis, to avoid responsibility.
The tragic circumstances of Russian politics, it seems, have once again plunged us into a dense jungle of disputes over dark and unexplainable medical matters. Thishas already happened before: exactly six years ago, in the autumn of 1996. Backthen the political desks of newspapers and television information services suddenly began in unison to write everything they could about coronary artery bypass grafts.

Now the ‘antidote’ has authoritatively invaded the professional lexicon of the political analyst, and the instrumentation of his analysis has been supplemented with an extensive array of information from the field of clinical anesthesiology.

Back then, as in today’s case, medicine has little to do with the matter at hand. Wecan clearly see that political intrigue remains political, even when concealed behind intricate medical terminology. Thecardiac epic of 1996that unfolded around coronary artery disease, with which the first president of Russia, Boris Yeltsin, was afflicted, and, accordingly, because of which he was temporarily unable to fulfill the duties of his office while receiving a necessary complex and relatively risky operation, was not a story about doctors and patients. Itwas actually a story about politicians who continue to struggle for power, or more precisely, to retain control over the tools, even during such a dramatic situation. Itwas a story about responsibility for a difficult decision that could, in an instant, destroy an established political structure, and, most importantly, the consequences of this decision that divided politicians.

Today’s political crisis is similar, and began to unfold even before the sleeping gas cleared and the smoke settled in the Dubrovka auditorium. Itis political, and the abundance of medical terminology in today’s chronicle should not mislead anyone.

After all, with each passing day since the ‘Nord-Ost’ tragedy, it has manifested itself ever more clearly, and we can now rest assured that we are once again talking about responsibility. Specifically, about the partitioning of responsibility, and to call a spade a spade, the right of politicians who were in one way or another complicit in this tragedy to avoid responsibility.

But, as it is known, there is but one way to avoid it: by calmly and resolutely putting it on someone else’s shoulders. Ofcourse, in such a case journalists can always be found close at hand. However, if one can almost treat an episode involving an amended law in the Parliament as a joke, you really cannot squeeze out another smile when you have retold for the hundredth time that astonishing episode, which was first described by one of the Moscow city leaders in a private conversation with a certain reporter. Thisscene has become legendary for the Moscow journalistic community: a few minutes after the storming of the ‘Nord-Ost’ building, when on the steps in front of the façade lay only the first few lifeless bodies and the evacuation of casualties had not yet begun, this same Moscow official rushed over to Vladimir Pronichev, first deputy chief of the FSB, the man in formally in charge of the crisis management headquarters, and asked: “What about the hostages?” He received the reply: “The hostages are not my problem! I’m busy with the terrorists. Gosee Kobzon about the hostages!”

This joke is not funny. First of all, because it is not a joke.

The presidential agencies, the leadership of the federal law enforcement agencies, and, behind them, the entire metropolitan power hierarchy this machine today is looking for guilty parties. Theyare looking for those who during the first hours after the assault relentlessly smeared the picture of triumph, then completely washed it away with reports of dead hostages, the number of which has gone far beyond a hundred. Pretenders to the role of these culprits are easy to determine at the very moment when needed.

Well, was there ever any doubt? Theguilty are the Moscow city government, and the doctors at several city hospitals.

Mass Evacuation

“We’re sitting, sitting and waiting, and waiting It’s eight in the morning already Onthe television is this footage, which they would later be showing all day long. Welook, and there is this bus. They’re dragging, dragging people out. Theystuff one in, then another Welook, and there’s this guy you can see him through the glass. He’s sitting like this like this and his head is like this Well, we’re like a chorus: your mother! He’s not breathing! We look: what are they doing out there? There’s somebody with an oxygen mask. Welook, and he pokes the mask. Butwhat good’s a mask? He’s not breathing Wellthat’s how we were sitting, we’re sitting and watching, we look and there’s another of the same, and another They’re not breathing! Wecan see they’re not breathing. They’re not breathing”

Four young physicians: the anesthesiology-resuscitation department of a major Moscow clinic at almost full strength. Itis two days after the hostage rescue operation, and they are talking with a correspondent of from ‘Daily Journal’ on how they met that morning. Onthe eve of the assault, during the day on Friday, the clinic discharged every patient possible, and released a maximum of beds. Theycanceled elective surgeries, checked their supplies of medicines and blood, and called in doctors who were not on duty. Theyheld a briefing: expect gunshot wounds, burns, grenade-blast injuries, and amputated limbs. Anesthesiologists, of course, were prepared to work with the surgeons, but then, hour after hour they sat in front of the television and watched as people were first dumped on the sidewalk, like firewood, and then dragged onto the buses, and how these people were dying simply because they were not breathing, while no one around them knew that to do with them in such a situation. Ifthey had seen it live, they could have rushed over there and maybe helped, but it was a recording on the air, already more than an hour old, and it was already all over.

Exactly the same thing was said by doctors from the famous Scientific Surgical Center, from the Botkin Hospital, and from most of the ‘numbered’ city clinics. There the surgeons and anesthesiologists were ready to receive a huge number of wounded and maimed from Dubrovka, but at some point much too late it turned out that they were not needed, that the hostages were not killed by bullets, but from the effects of a gas attack, and what was lacking were completely different specialists and completely different medicines in a completely different place.

Here is the testimony of Dr. IgorSharipov, a leading specialist on disaster issues at the Sklifosovsky Institute: “Somewhere between 8:20 and 8:30 am a bus drove up, but all seven people who were there, were already dead. Andit probably makes sense to speak in general about this problem, why it occurred. Thencame ambulances, there the patients were casualties of varying severities, but again, because the secrecy, it was unclear as to how to treat them”

And here is the terrible record from the public diary that Stepan Kravchenko of radio ‘Echo of Moscow’ keeps on Live Journal, dated that Saturday: “This morning Ihappened to arrive at the 13th municipal hospital simultaneously with the buses of hostages. There weren’t any other journalists. Thedoctors didn’t have enough stretchers or hands, despite the official declarations about how all medical facilities were ready to receive hostages there weren’t any hospitals ready, and they had to drag the injured and the dead by their arms, and the floors of the buses were covered with corpses bluish corpses, but no signs of gunshot wounds. Distinguishing the living from the dead was practically impossible, and the people couldn’t walk, they were nauseous and they almost puked out their insides together with the poison. Whenwe were carrying the last living person to intensive care, on the buses were at least 50or 60corpses. Andit was at 7:40 am when the government reported only 10killed. People were already on the buses. Several times Imade a mistake of dragging a dead body, they pointed it out and Ihad to drop the body halfway and come running back to look for the living. Andthe impression Igot was that the people were also blind, in any case, all those Icarried into the ward were constantly asking: ‘Where am I, what’s happening?’ They couldn’t see anything. Wemust give the doctors their due: they acted extremely swiftly, though there weren’t enough stretchers, but over the last 15or 20minutes we 100or 150people into intensive care. Somegot first aid right on the bus. Theydid artificial respiration and heart stimulation”

To give the doctors their due particularly those that received the first, most frightening, and most significant wave of casualties from the hostages evacuated from Dubrovka is everyone who observed their work during the first hours and days after the assault. Themaximum load not only arrived at the previously mentioned 13th city hospital, but first and foremost, a hospital situated just a few hundred meters from the theatrical center.

City veterans’ hospital number 1is the “hospital of the great wars.” Concentrated here was a large group of doctors, from this facility, as well as from the Sklifosovsky Institute and other city hospitals. There, also on their own initiative, gathered more than a hundred nurses and paramedics, including many who had long been at the hospital, and though their shifts were over, they decided that they “might come in handy.”

In the immediate vicinity of the tragedy were still huge numbers of city ambulance crews. Information on the number of ambulances massed near the Melnikov Street varies: representatives of the Moscow city government argue that there were about 400, while experts from the Parliament believe there were less than 80, but in any case, it turned out that there were, according to the paramedics and nurses, at least 200physicians.

Yet at the crucial moment crucially decisive for the lives of those who were just rescued from the hands of terrorists the hostages, who were poisoned with the narcotic gas, were left without assistance from people who were more or less qualified, or at least informed of the simple rules for handling of such victims.

“They didn’t really need anything special there,” explains a doctor from a Moscow hospital that received the most crowded buses. “Free up an area of about twenty by twenty meters, and put a dozen paramedics there who can check pulses and know that if someone is unconscious, so that they don’t lay him on his back, but sideways, you need to make sure that he doesn’t drown in his own vomit or choke on his own tongue and that’s it! Andbecause of this we could have had half as many die. Butif they had put on this site another five intensive care specialists, who could in severe cases intubate (put a tube with an inflatable ‘cuff’ through the entrance of the larynx to allow effective artificial respiration ‘Journal’) and determine who can breathe on their own and who cannot, and half could be separated. It’s simple to intubate one after the other and ‘breathe’ for them. Notfor a long time. Alittle while, until the ambulance picks them up, and that’s all!”

In front of ‘Nord-Ost’, however, there was no “and that’s all”.

Many doctors, who during those days had an opportunity to talk to correspondents from ‘Journal’, admitted that when they saw that terrible picture of a “mass evacuation” of victims from the building, they remembered back to their student days and half-forgotten training sessions in military field medicine. “There’s a whole science on the organization and tactics of field medical service,” said one of our interlocutors, the department deputy director of a large Moscow hospital. “Pirogov formulated these rules for the first time, and ever since they’ve been considered immutable: when a doctor has to deal with mass casualties, the main thing is sorting. Thisone’s still walking send him to the bus. Thisone slap his cheeks and he recovers. Thatone requires chest compressions. Thisone can’t make it without serious resuscitative measure: the first few minutes on the spot, then later on the ambulance. Andthat one nothing can be done, leave him, don’t waste time, save the living”

Another doctor, the chief resuscitator of another well-known metropolitan hospital, believes that things are not that simple: “This is, you see, one of the most important issues in medicine who needs to go to whom: the patient to the doctor, or the doctor to the patient.” Still, he is convinced: “But in any case it’s impossible that, at such a moment, nobody thought about this, and nobody tried to direct these ‘streams’ head on.”

Another of our consultants, an experienced surgeon, wrinkled his brow while recalling those same truths of field military medicine: “You know, in military medicine there is an almost fundamental principle: ‘away’. Thedoctor must as soon as possible transfer the patient from the company sick tent to the battalion aid station, then to the regimental medical unit, then to frontal hospital and beyond, to the rear, to the rear, away, away Butthere everything is clear: we’re talking about wounded who need to as soon as possible to be evacuated from the zone of active combat operations. Butwhat is this here? Where did they bring them? Whydid they pack them all into buses, without any distinction between the living and the dead? Noone is obliged to arrange this crowding, this blind removal”

But here it would be good to wait a moment: “no one is obliged”? There are some considerations.

Operation ‘Away’

The organizers of the assault, high-ranking members of the Interior Ministry and Federal Security Service, together with important Kremlin persona, are all ready to dismiss any criticism, any doubts that they themselves planned the assault, or that its implementation was anything but absolutely brilliant. Thisis related to but two universal arguments.

The observance of strict secrecy in the preparation for the operation this is the first of them. Direct participants in the events on Dubrovka unanimously confirm that there was not just one headquarters with differentiated groups under it responsible for this or that direction of the crisis, but two headquarters that were completely isolated from each other’s governance structures. Representatives of law enforcement agencies and experts in terrorism were focused in the first and certainly the primary “forces center”, with absolutely no connection with to it was a second “little headquarters” nestled nearby. Thisone was responsible for “the administrative side and housekeeping portions.” The Moscow leadership was decisively packed into this auxiliary command center. Itmust be said that many city officials had no doubt that this was “discrimination”. “Well you can just imagine,” said one of them. “You couldn’t get away from the crowd that was raging around you day and night. Everybody came in who could: some Moscow Chechens, and members of parliament, and some of the hostages’ relatives got in, and journalists and just some wise guys, and nobody had any idea why they were there, they would wander in, day or night Fromtime to time outsiders were rounded up and kicked out, but they’d be back again, and more of them. Itwas clear that you couldn’t just come out and say that the assault’s going to be at a certain hour and we’re going to use this gas Herewe were doing important things, but not critical things. Weprepared packs of medicines for the hostages. Wearranged the headquarters for working with the relatives and the victims who managed to escape. Wereadied the negotiators for (leader of the terrorists) Barayev, so that they could try to get the kids out. Forthem we got stocks of water and juices. Food in fact twice we collected eight hundred rations, the first time we had everything, several big thermos with hot water in which instant soup can be made, but those bastards didn’t take anything Andthe rest, this was in that headquarters, or the other” For the loss of the first one, well, that was really upsetting, but that was not the crux of the matter.

That they needed to keep the operational plan to free the hostages a secret is not subject to argument. Thetask itself was important. Butthere is another matter that we amateurs also feel is not a negligible one, namely: keeping the rescued hostages alive. Hereis where the problem of coordinating the activities of the two headquarters suddenly cropped up: after all, the “housekeeping” side needed to take over the task of removing the hostages from the “frontline”, and no one was ever led to believe that this problem did not have a reasonable solution. Ifonly both sides had understood the importance of this, and both sides were willing to exert the same effort in making this coordination happen. Inthe end, however, these difficult problems could be addressed, if there was the desire.
But what if there is no desire? Whatif it is: who cares? Whatif the top commanders made the cold-blooded calculation that every corpse that remained in the theater auditorium or somewhere nearby within the zone of combat operations is OUR body, but if this body is found somewhere in the process of evacuation, especially at the end of it then it is YOUR body. Andonce it is yours, you take the rap for it all by yourself. Butour side of it was clean, and our hands, too just look at them here they are Andour operation is unprecedented, a jewel, breathtaking.

It was this kind of logic that was accepted by the leadership of the “forces” headquarters. Theplan for storming the theater center took into account the actions of all forces at every stage of the operation, from entering the terrorist-controlled zone and “to the doors” of the captured building. Everything that was to happen next was described with an uncertain gesture, a sluggish movement of the fingers, and the phrase: “Well, then Moscow picks them up.” None of us ever saw this gesture, of course, nor did we hear the phrase, but we can easily imagine one or the other by looking at how this approach was put into practice.

The gas attack as a key element of the forthcoming operation was proposed during an early planning stage. FSBofficers readily explained this part, but they prefer to remain silent as to just how deeply and thoroughly they analyzed the effects of the narcotic gas under such nontrivial circumstances. Whatcan help us to determine how deeply they did, however, is the fact that during the last hours before the assault a team (one!) of anesthesiologists was summoned from the Sklifosovsky Institute to discuss the finished plan. Eventhough it was located in the same hospital building as the headquarters, the huge medical team, in which there were certainly enough resuscitators and anesthesiologists, never received any special directions or instructions, nor the slightest hint of what was to come. Didthey need to keep it secret? Ofcourse, but mobilizing physicians to rescue victims from real, not imaginary threats, this also needed to be done.

Next: “Moscow” did not receive any information about the actual content and technical features of the forthcoming operation, and, accordingly, all preparations for the evacuation were carried out in the dark. Moscow administrators were forced to disperse resources equipment, transport, staff, physicians, and support staff in order to provide a solution for every scenario. Onemember of the Moscow city government, working in the “small” headquarters, points fingers: “We were provided and prepared for a scenario of a ‘simple evacuation’, where everyone was in one piece. There was a scenario in case of panic and a mass exodus of hostages, whom the terrorists would follow and shoot at. There was one in case of heavy fighting and large numbers of wounded. There was also the worst one the Disaster Relief Ministry scenario with the need to clear away a collapsed building and rescue victims from under the rubble. Wewere supposed to be prepared for any development in the situation, and we were ready, but we only discovered the essence of the operation from the facts (after it was over).”

Now back to the headquarters’ universal arguments. There is still the second and last of them, one that the organizers of the assault use to explain their demand for an immediate, at any price and the fact of the matter is that it was at any price evacuation of the casualties from the scene. Their argument is simple and apparently convincing: the threat of an explosion.

To be sure, you could wait for the already famous “summary of events” press conference, held on Thursday by representatives of law enforcement agencies. Atthe moment when the first of the victims was brought to the square in front of the theater center, this threat no longer existed. Thiswas known by the command of the forces carrying out the assault: the explosive devices that the terrorists had set up could not be detonated, because their control panels simply had no batteries. Thecommandos, and those whose orders the commandos were carrying out, even before the attack they could see it with their own eyes with their video surveillance and hear it from their own inside informant. Itturns out that the bomb threat seemed real only to those who organized the barbaric evacuation of victims after the assault, and it was on them that the barbarity acted against their will. “It was a horror, a wild general hysteria,” now recalls one of the Moscow ambulance physicians who was directly involved in transporting the hostages. “There was one continuous cry: ‘Take them away! Takethem away quickly! Hurry up! Hurry up!’”

By the way, you did not even need to wait for the aforementioned press conference, and you could even do without it: simply compare the timeline of that night’s events, and there can be no doubt that by the time the evacuation took place the commandos were already with the hostages for ninety minutes. After all, the beginning the assault was recorded with absolute certainty: at half past five in the morning, live on the air of ‘Echo of Moscow’ a call was broadcast from Natalia Skoptsova and Anna Andrianova, and this call was transmitted rebroadcast on every television station in the world. During the call the first shots were heard, but the first of the hostages were not taken out of the building until just before seven. Thistime was logged on many cameras working the scene. Between these two moments there was room for everything and more: the first attack by the commandos, a fierce firefight, the “control shots” to the heads of the sleeping female suicide bombers, the hunt for the last surviving terrorists and, what is for us especially important, the work of the combat engineers who burst into the hall already “on the shoulders” of the first wave of commandos and since then went through the whole building, freeing it of explosive devices. Again, it turns out that only those who were dumping the bodies of suffocating hostages into buses continued to fear an explosion, while those who knew what really was to be feared and what was not, did not want to stop the madness.

And the explanation for this mystery is really very simple, and once again it is the same: the organizers of the assault on ‘Nord-Ost’ were not as worried about how many victims their operation would incur as much as they were worried about WHOSE victims these would be, and on whom they would “hang” them, as the bureaucrats like to put it. Theywere quite satisfied with a situation that allowed them the ask a question that, by their own admission, we have heard more than once, a question put to many officials from the Moscow mayoral staff and to the physicians at the Moscow clinics: “What’s this? Wesaved them all and now that you have them they’re all dying?”

Remember that phrase, so wonderful in its frankness: “The hostages are not my problem”? Well, you cannot really doubt that it was said seriously. President Putin’s subordinates have interpreted his words, that the most important thing in the tragic situation was the hostages’ lives, quite differently. Atthe time, while some were busy rescuing hostages, others, in fact, had before them a much more pragmatic and achievable goal: to get rid of them. Getthem off their hands, in any way possible. Justhurry up, hurry up.

By Sergei Parkhomenko
November 1st, 2002in ‘Yezhdnevniy Zhurnal’ (‘Daily Journal’)

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