Sami Mustafa, principal of The CAS School where Amal Umer was a student, raised some critical questions about healthcare and policing systems in a letter to Eos. The same queries are being repeated by a number of concerned parents and ordinary citizens in other circles. We reached out to Sindh Police SSP (South) Omer Shahid Hamid, the National Medical Centre’s (NMC) Administrator of Medical Services, Dr Omer Jung, and Aman Foundation’s ambulance service for answers.
CITIZENS VS POLICE DEPARTMENT
Is it merely a coincidence that the mugging and tragic death of a 10-year old girl happened next door to police station? If one is not safe in the close vicinity of a police station, then where else would one be safe?
Omar Shahid Hamid: The presence of police constables in the area suggests that the police are well aware that this area was a crime hotspot, and therefore, had posted personnel for patrolling purposes. What I will say, however, is that the police officers’ response to the situation was accurate.
Why was the police repeating the same story of Amal being murdered by a bullet by bandits?
OSH: There was nothing malafide from our side, it was a matter of more clarity being reached as more evidence came out. There was confusion at the beginning because even the officers who shot at the bandit did not know that an innocent citizen had also been hit. Of course, in Beenish and Umer’s situation, they would have rushed to the hospital. And that’s what happened, they waited for the traffic lights to turn green and sped to the hospital. Our constables did not know of this. Second, because the incident took place on August 13, and the next day was a public holiday, we could not get hold of CCTV footage for two days. Forensic evidence was inconclusive. Once more evidence came to light, we had more clarity, too.
Are there any SOPs or any rules of engagement for policemen? How faithfully are those rules being implemented?
For this kind of incident which was happening live, you can’t have any SOPs. It depends entirely on the officer’s judgment, for which he has less than a second to make a call. Shooting is incidentally not a norm.
Were the policemen who arrived at the scene to ‘nab’ the bandits trained enough to be trusted with heavy weaponry with instructions to ‘shoot to kill’? Is the use of heavy weaponry in a crowded public place a wise strategy?
OSH: It’s a fair debate to have regarding the use of heavy weapons. The constables were trained, of course, but shooting at a criminal in a live situation depends on the snap judgment of an officer. If the officer makes the call that the criminal is going to shoot to kill, he can respond by opening fire as well. That said, this is a fair debate to have. Keep in mind the operating environment for the police. Over the past two decades, Karachi police have been outnumbered and outgunned by various kinds of criminals. Officers were first handed heavy weapons in the 1990s in response to the threat that they faced. That has continued. And today, it isn’t just terrorists who use heavy weapons but also street criminals. The issue goes beyond terrorism. As the police, you have to match whatever [weaponry] your opponent has.
A tragedy has happened, a 10-year old child is dead, could this tragedy have been avoided had the police operated more responsibly? And can tragedies of this nature be avoided in future? If so, then how?
We met with Amal’s parents when we went to their house to offer our condolences. Based on these discussions, we have launched a pilot project in [Karachi’s] District South, where we have handed pistols to the patrol squad. Let’s see how it works out in practice.
Who is the real culprit of this tragedy? The two policemen who have been suspended, or the police system which armed untrained, unprofessional and trigger-happy policemen in the name of ‘curbing street crime’?
This was a tremendous tragedy on two counts. As a parent, I feel the pain that Beenish and Umer must be going through at this time. But also, I feel sympathy for the constable who shot the bandit. He took action as he saw fit. I can’t pass judgment unless I was in his shoes.
CITIZENS VS NATIONAL MEDICAL CENTRE
What are the NMC’s standard operating procedures (SOPs) for critical injury cases?
Dr Omer Jung: We follow best practices that are followed across the world. Any patient that is brought in is taken to the Emergency Room, where they are stabilised first and given first aid. Once that happens, if patients need to be operated upon, they are sent to the operating theatre. If they need to be sent the ICU, then they are sent there. In the case of bullet injuries to parts of the body that are not critical, we administer first aid and then transfer patients to a hospital where medico-legal procedures exist. But as in this case, or for that matter when the Karsaz blast happened upon Benazir Bhutto’s return to the country, we treat first. No patient is held back on that count. What we do, however, is to inform the Defence police station. They have all records of such cases and you can check with them as well.
Why was Amal not given due first aid and shifted immediately to the ICU?
DOJ: When Amal came in, about 10 to 15 minutes after the incident, she had an oxygen saturation of 20 to 30 percent. The minimum required for survival is 85 percent. On the basis of this, an endotracheal tube was passed which was manually ventilated. Her heart had stopped, she had no breathing other than that aided by mechanical ventilation, and she had no blood pressure. Bear in mind that this is a child we are talking about. The bullet entered from the back of her skull and exited from her forehead. And had an autopsy been conducted, you could have verified that half the brain wouldn’t be there.
I’d respectfully disagree with the claim that we didn’t do anything to save Amal’s life. In fact, our staff was at the ready when she was being brought in because the family had made a call to the hospital director beforehand. He had informed hospital staff that an acquaintance was coming in, in an emergency situation, and to provide the best-possible care that we could. The doctor-on-duty in the emergency room was actually a pediatrics specialist. He dealt with the case and tried to stabilise Amal. But because it was a brain injury and she had lost so much blood, we were fighting a losing battle. We still did our best to save her.
What doctors do in such situations is to administer a medicine called Epinephrine which is essential for CPR. This is to resuscitate the heart. If you see her EKG, you can confirm that Epinephrine was administered. Even after someone is clinically dead, peaks show up on the EKG. Amal’s EKG shows the same thing.
Why did the admin and medical staff not facilitate the move to another hospital?
DOJ: The child was clinically dead. We couldn’t help after that.
CITIZENS VS AMAN FOUNDATION
What is their SOP for dispatching an ambulance and responding to a critical case of a bullet wound? Are they not supposed to attend to the emergency and help transport the patient to a nearby hospital? Are they supposed to wait for a “booking” at a hospital before sending help?
Despite repeated attempts, the officer concerned at Aman Foundation did not respond until our going to print, after assurances that he would.
Published in Dawn, EOS, September 16th, 2018