When the earthquake struck Haiti last Tuesday Melene Samedi was shopping for shoes in downtown Port-au-Prince. As the ground began to shake, she froze. A piece of concrete, ripped off a building by the force of the quake, struck her leg, fracturing the bone and wrenching it through her skin. Bystanders rushed the 29-year-old to Port-au-Prince's Hôpital de l'Université but it was too late. The following day surgeons were forced to amputate, just below the knee.
"I don't have a job and I don't have the house. And now this," lamented her husband Schiller Polycarpe, 27, standing by his wife's tatty bed in an improvised ward in the hospital car park. "There is no help from the government.
As Port-au-Prince's largest hospital, the Hôpital de l'Université, or HUEH, has borne the brunt of casualties from the earthquake and doctors are struggling to cope with the seemingly endless stream of new arrivals.
More than a week after the earthquake the HUEH is at the centre of a health catastrophe that many surgeons believe will leave as many as 200,000 Haitians without at least one of their limbs. Aid agency Médecins Sans Frontières this week claimed that the last time surgeons carried out so many amputations was during the Crimean war.
"We are in big trouble," admitted Dr Philip Guilleu, a volunteer surgeon from New York, who said he had personally performed 30 amputations during the last few days. "It is overwhelming."
Even before passing through the hospital's green iron gates, it is easy to sense what lies ahead. In the street outside, hundreds of Haitians cluster around fresh-faced US soldiers clutching M16 assault rifles. The men beg for their families to be admitted to the hospital. The women clutch pieces of orange peel to their noses to mask the stench of the decomposing bodies that have been abandoned on the cracked pavement or are still buried in the rubble of surrounding buildings.
Move through the gates and the true extent of the crisis becomes clear. Hundreds of seriously injured patients and their relatives pack into the hospital's narrow car park. In the scorching midday sun, they lie on battered school desks, filthy mattresses and ageing hospital beds. Many have lost one or more limbs. Others have been badly deformed by falling rubble. Nearly all await surgery in one of HUEH's five operating theatres.
On Wednesday the queue was more than 1,000 patients long. Among them was an unidentified female patient whose lips had been almost completely shorn off by falling debris. "She's got an infection and she's got maggots in there," said Daniel Wiersma, a 24-year-old nurse from Michigan, as he peeled back her bandages.
"I call this war surgery," said Dr George Bouttin, a 73-year-old surgeon from Fort Lauderdale, Florida, who estimates that 95% of those coming in with crushing injuries were having to undergo amputations, partly as a result of infections. "It is guillotine-type amputation." Another of HUEH's emergency recruits, Jean-Paul Bonnet, an American GP, said the US government urgently needed to intervene to help Haiti's new generation of amputees. "There will have to be rehabilitation centres. We will have to train these people to walk again. We will have to train these people to survive again," he said.
"Ironically, if we can find any good out of the war in Iraq perhaps it is the advances in helping amputees … Hopefully those nine years of education will have trained us enough to help this poor country.
"Bring us the technology. Bring us the prostheses. Bring us those people who know how to train these people to function and walk again."
As if the appalling injuries on display were not enough, doctors say they are now having to contend with looting. Following Wednesday's aftershocks, which struck at around 6am, the hospital's guards fled, fearing another big earthquake. Immediately the crowds outside poured through the unguarded gates towards the main building.
"They came into our operating rooms and stole whatever they found," said Bouttin. "The oxygen tanks were gone. Everything was gone. I understand why they steal … but they steal useless things for them. I mean, what are they going to do with an oxygen tank? What are they going to do with intravenous antibiotics?"
With surgeons continuing to perform amputation upon amputation, Samedi and her family were left to reflect on their future in "section four", where the only privacy comes in the shape of a black tarpaulin draped over her bed and where the stench of putrefying flesh hangs in the air.
What would the family do now? "Now we will wait," Polycarpe, who had spent the previous eight days sleeping on the concrete floor next to his wife, said bluntly.
His father-in-law, 56-year-old Neider Samedi, was more reflective. "God gives and God takes," he said of his daughter's injuries.
And what had he said to his God since the earthquake? He shrugged. "Merci."
