May 2037 – Tehran, Republic of Iran

The early summer heat had arrived too soon. By mid-morning, the air in central Tehran shimmered with dry warmth, thick with the scent of diesel and dust. From her office window on the fourth floor of Arad General Hospital, Leila Ahmadi could see the slow crawl of traffic around Valiasr Square and the distant smudge of Alborz Mountains under a haze of smog.

Leila Ahmadi handed me a porcelain cup of steaming chai and sat across from me, the hem of her dark-blue headscarf tucked neatly under her collar. Her office was small but orderly, with a narrow window that overlooked a patch of rooftop gardens planted by interns.

"Drink before it gets cold," she said, her voice low and kind, with a faint rasp from too many long nights. The ER shifts here were a different world compared to the nearly two years she'd spent with the Iranian Red Crescent in France.

"They stabilized the wounded right at the front lines. Small, regimental-run medical posts—nothing more than holes dug into the ground, really, with one or two medics doing what they could. Once a soldier was stable enough, they'd send them to us, a few kilometers behind the lines.

There were dozens of these camps scattered along the French and Belgian fronts—everything from massive military tent setups to whatever we could throw together in an abandoned church or barn. Honestly, all we could really do was handle the immediate danger—stop the bleeding, prevent shock—before sending them farther south, where the proper hospitals were. We had surgeons, yes, but not enough. Never enough. And supplies? Some days we were lucky to have clean bandages, let alone proper anesthesia. The worst days were after a major push. They came in waves, sometimes dozens in an hour. Mud still caked on their boots, faces grey from shock. Missing limbs, burns, internal bleedings. Others couldn't speak, just shell shocked.

"There was never enough light, never enough heat. The most critically injured—those we still had a chance of saving—were brought into the large military tents. I never liked walking in there. Just rows and rows of makeshift beds, lined with broken men and women. Some barely looked human anymore. Tubes running in and out of their bodies, bandages long overdue for changing. Nurses, nuns, even high school kids moving from one bed to the next, doing what they could.

They gave medals to the men who jumped out of aircraft or held the line until the end. Those got none. It was in those stolen minutes when the caregivers stepped outside, cigarette in hand as the injured inside didn't stop the gurgling, crying, making noises that could make a dog go crazy. Staring blankly at the mud caked around their boots, you could see it in their faces: no medal was ever going to bring back what they'd lost.

"No warmth. Just freezing wind slipping through the tent seams. Flies in the summer. Rats—always. You wouldn't believe how much energy we poured into keeping the flies away, especially during the hotter months. It was relentless. Mosquito nets draped everywhere, waste management treated as seriously as the surgical ward. We sprayed gallons of insecticide and larvicide—sometimes it felt like we were the ones being gassed at the front.

And still, it was never enough.

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I wouldn't wish the sight of maggots on a patient's wound on my worst enemy."

"We had everything from surgeons from prestigious universities like Harvard Medical School or Johns hopkins to guys and gals who learned how to clamp an artery in a Sudanese refugee camp. Red cross, crescent, doctors without borders, Catholic Relief Services, Lutheran World Relief. Or just folks with medical degrees from Peru to Bangkok who showed up to help. Wasn't always easy but we got a system in place.

"You learn to triage quickly in those conditions. Who might make it. Who probably wouldn't. When those ambulances arrived from the front lines, we had minutes—just minutes—to decide where to send our attention. Those choices stayed with you. They still do.

But the worst... it wasn't the wounds. It was when we ran out of morphine. You haven't really heard pain until you've heard a young man or a girl screaming while you try to clean a wound with nothing but Betadine and a piece of cloth for them to bite down on. God help you if you had to clap an artery or had to take care of a fracture. You'd secretly pray they'd faint fast enough just to make the job easier. Those medical camps were as bad as the frontline for the wounded. Even more traumatic in some cases.

She paused then, her fingers loosely cradling the cup of tea she'd long since forgotten to sip. Her eyes weren't on me anymore. They were somewhere else, somewhere far more brutal.

"Sometimes," Leila continued, her voice quiet but steady, "you had to get creative with what you had. There wasn't always a scalpel when you needed one. A broken bone? You might have to use a splint made from a rifle stock or even a broken chair leg. And there were no fancy sterile tools—just dirty hands and whatever you could find around you. If you were lucky, there was a piece of cloth to act as a tourniquet. But most of the time, it was torn-up uniform fabric.

I remember one time, a soldier came in—his leg had been nearly torn off by shrapnel. We had nothing but gauze and some iodine. I had to pull what was left of the bone back together. I still can't get the sound of it out of my head, the crack when I had to reposition the femur. He was awake the whole time, of course. No morphine. I'll never forget the look in his eyes—like he was already somewhere else, trying to escape the pain. I think we all were."

Leila's fingers trembled slightly as she traced the rim of her cup, and for a moment, the weight of her words seemed to fill the space between us. Then she went on, her voice growing softer, but the horror still thick in her tone.

"We used anything we could. If a patient had an open chest wound, you'd pack it with what you had—sometimes with a clean shirt, or even a towel if that's all we could find. And then we'd tie it down with strips of bandage or—hell—if we ran out of bandages, anything that could hold. Leather straps, belts, you name it. You'd have to be quick, because every second counted. And if they stopped breathing, well… you had to do what you could to get them going. Sometimes that meant manually forcing air into their lungs—pressing down on the chest like you were trying to push the life back into them."

She looked up at me now, her eyes hard and steady, as if daring me to ask more, daring me to understand.

"And the worst part?" she said, almost a whisper. "It wasn't the blood. It was the helplessness. That feeling when you knew there was nothing more you could do. When you had to choose who to save, and who to let go. Every day was like that. And you couldn't save them all."

Leila set the cup down with a soft clink and leaned back in her chair. The quiet after that was unbearable.

"When the allies landed in northern Germany and Poland, the crabs grew more desperate. My husband was an air force pilot, told me the fighting in the north had been surprisingly calm. Not for nothing, the crabs and their heavy equipment were all desperately crawling south. They didn't care for Berlin, Hamburg or Szczecin. Everyday fighting in the south got harder. When we weren't taking care of the wounded we were wondering when that day would come, when the crabs would break the frontlines and come pouring south. How many wounded we could evacuate before they came crawling here or before we got nuked."

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