LONDON, Oct 19: The British hospital treating Malala Yousufzai raised hopes for her recovery on Friday when doctors said she was able to stand with some help and to write.

She was unable to talk because a breathing tube had been inserted into her windpipe but she was communicating by writing, said Dave Rosser, the medical director at the Queen Elizabeth Hospital in Birmingham.

The teenager escaped certain death by a matter of centimetres, with the bullet grazing the edge of her brain, he said. The hospital released first pictures of Malala, in her hospital bed, clutching a teddy bear.

Despite the news of Malala’s progress, Mr Rosser warned that she was “not out of the woods yet”, her doctors’ chief concern being an infection in the bullet track through her head.

“Malala is still showing some signs of infection which is probably related to the bullet track, some infection in the bullet track which is our key source of concern,” he told reporters outside the hospital.

“It’s clear that she is not out of the woods yet. Having said that, she is doing very well. In fact, she was standing with some help for the first time this morning when I went in to see her.

“She is communicating very freely — she is writing.”

He explained that Malala’s airway was swollen by the bullet passing through, so doctors inserted a tracheostomy tube to protect it.

The tube means she cannot speak but there is no reason to believe she would be unable to talk once it is removed, which may happen in the coming days.

Rosser explained how the bullet went through the face of the girl, who the hospital now says is 15 although she has previously been described as 14.

“She was struck just above the back of the left eye,” he said. “The bullet went down through the side of her jaw, damaging the skull, the jaw joint on the left hand side, went through the neck and lodged in the tissues above the scapula — the shoulder blade — on the left.

“The bullet was removed in Pakistan pretty much straight after the event.”

He said specialists thought she would need a few weeks to rehabilitate, to make sure that the infection has cleared up before she could undergo surgery.

“Then her skull will need reconstructing either by reinserting the piece of bone that was removed initially or with a titanium plate,” Mr Rosser said.

“Her jaw joint may need further work down the line but that remains to be assessed in a couple of weeks’ time.”

Mr Rosser said she was shot at point-blank range. Shock waves from the shot shattered the thinnest bone of her skull and fragments were driven into her brain.

He said there was certainly physical damage to the brain but it was too early to tell whether that would affect any brain functions.

“She seems to be able to understand, she has some memory,” he said. “She’s able to stand, she’s got motor control ... (but) whether there are any subtle intellectual or memory deficits down the line, it’s too early to say.”

The hospital is expert in dealing with complex trauma cases and has treated hundreds of soldiers wounded in Afghanistan.

It has the world’s largest single-floor critical care unit for patients with gunshot wounds, burns, spinal damage and major head injuries.—Agencies