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How the system failed us

Updated September 16, 2018

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Amal Umer: a precious life cut tragically short | Photos provided by Beenish Umer
Amal Umer: a precious life cut tragically short | Photos provided by Beenish Umer

August 13, 2018 was supposed to have been the dawn of a ‘Naya Pakistan.’ And it began with a positive high: celebrations at school and preparations for Independence Day were in full swing. Children were decked out in badges and flags, waiting to celebrate the oath-taking of an educated, passionate and long-awaited prime minister promising to bring about much-needed change for Pakistan. Caught in this euphoria, we decided to take our two girls to a Strings concert that was happening nearby, to get them in an even more patriotic spirit.

It was 10:05pm when we got into our car, dinner packed neatly in my little one, six-year-old Aanya’s bag-pack and my elder one, 10-year-old Amal, so excited to be going to her first real concert ever. We wanted to avoid the traffic rush and so decided to take a quicker route to the concert venue.

On the way, I handed my phone over to Amal, so she could see a recent project I had worked on while we drove to the concert. That was my last conversation with my precious little girl.

Take a look: Girl killed in crossfire during Karachi 'encounter' died due to shot fired by police, admits DIG South

While we waited at the signal, we heard a commotion. Someone was knocking on the driver-side window but, for a few moments, we couldn’t gather what was happening. My husband Umer rolled down the window to find a gun pointed at him. He handed over his phone as the dazed, crazy-eyed, panicked mugger belted out insults and asked us to hand over everything. He snatched Umer’s phone and pulled at my bag which I was already handing over to him. Then he moved towards the car behind ours.

Ten-year-old Amal Umer lost her life in the aftermath of a mugging in Karachi on the eve of Independence Day. Her mother, who watched her daughter being taken from her, recounts the terrible circumstances and makes a forceful plea for the overhaul of a desensitised policing and medical system

Before we could gather our bearings, and just when we were thinking the worst was over as we waited for the traffic signal to turn green and the cars in front of us to make way, we heard gunshots, a couple of them. I remember seeing one hit our windscreen as I was turning to tell the kids to lay low and not to panic.

Aanya was hiding behind Umer’s seat and screaming. Amal was lying on the back seat. It was dark. I thought at first she was fine and laying low like I had told both of them to. But she didn’t move. She wasn’t moving, I realised, while Aanya was still screaming.

A treasured family portrait: (Clockwise from top left) Amal, Umer, Aanya and Beenish
A treasured family portrait: (Clockwise from top left) Amal, Umer, Aanya and Beenish

Stuck in the front seat, I turned back through the gap in the car seats and touched my baby. She was bleeding. I couldn’t figure out where she was bleeding from or where she had been hit. I just remember telling my husband that Amal had been shot. I saw her breathing; she was breathing, I told him she was okay. I remember telling my six-year-old to calm down and that it was going to be okay. She told me we couldn’t go to the concert and that we had to take Amal to a doctor. I told her we would; I told my husband that the National Medical Centre (NMC) was the hospital closest to our location. He rolled down his window and drove like a maniac, screaming at people on the road to clear the way.

By then I realised my baby had been hit in the head. She was looking at me. I told Umer to hurry, told him it was her head. We coincidentally found my cousin in his car at the next intersection. We told him Amal had been shot. He followed us to NMC.

We reached the hospital, my one hand on Amal’s head and wound, the other on Aanya. Umer carried Amal out of the car. That’s when I realised she had my phone, the phone was lying in a pool of my baby’s blood. Umer put her on a stretcher and the staff rushed her inside a small room which seemed to be a part of the emergency room.

Aanya was told to wait outside on a stool, the poor kid, dripping in her sister’s blood, seeing her parents drenched in it too.

They intubated Amal and attached an ambu bag which one of the attendants was pumping manually. That’s when they told Umer we had to take Amal to either the (government-run) Jinnah Postgraduate Medical Centre (JPMC) or to the private Aga Khan University Hospital (AKUH), because time was running out and they couldn’t do anything to help our child.

At this time we had no idea where the bullet had come from, if it was still in her or if it had exited. The staff didn’t tell us anything apart from insisting we move her to another hospital. The doctor on duty just stood there, doing nothing.

We told them to arrange for an ambulance. After much insistence someone from the hospital called the Aman Foundation and handed the phone to me to tell them the details. Between one daughter critically injured and the other going through trauma, I was asked by the Aman Foundation representative on the phone to arrange for a bed and confirm if a bed was available at the JPMC or AKUH.

Amal was lying on the back seat. It was dark. I thought at first she was fine and laying low like I had told both of them to. But she didn’t move. She wasn’t moving, I realised, while Aanya was still screaming.

I told her that arrangements would be made but they needed to send an ambulance as soon as possible. She kept repeating she needed a confirmation and then said she would call back. I insisted that there was no time, my 10-year-old had been shot in the head, and they needed to send an ambulance right away. The representative on the phone told me to not worry and said she would call back in a while, after I make the necessary arrangements.

Amal and Aanya on the swing
Amal and Aanya on the swing

I held the blood-covered cell phone in my hand wondering where to call and what arrangements to make. I called my mother, told her to call her friend’s husband who was the head of the paediatrics department at AKUH, in the hope that he could make these “arrangements”.

I yelled at someone to call Aman again. My baby was still struggling, still breathing. My little one was sitting by herself on a stool, at the reception. I went to her and she asked me if Amal was going to be okay. I could only tell her to pray.

10:18pm. My cousin (who had accompanied us to the hospital) had managed to call some family members. I was still screaming for someone to call for an ambulance, my husband was being convinced by the hospital staff to take Amal to the other hospital in his car. He asked for assistance; if the wait was going to be long, he asked any of the trained staff to accompany us. They refused. He asked them to let us have the ambu bag and tube and asked for the staff to tell him how to work it. They refused.

I spoke to the Aman representative and told her arrangements had been made, I asked her to send the ambulance and asked her how long it could possibly take. She told me not to worry, she told me it would be there in some time, she didn’t say how much time. I kept asking her, she kept repeating her statement.

I went back to that small room where Amal was, her eyes were open, she was bleeding, still breathing. Umer and I stood there for a second, wishing we could take away her pain, wishing we could rewind and undo, apologising to her for letting this happen. That’s when we witnessed her take her last fleeting breath.

Amal’s first oilpainting
Amal’s first oilpainting

She was gone forever.

We had failed, everything had failed, everyone had failed. This whole system had failed in every way possible.

From there, I was sent home. Umer took Amal to the JPMC for medico-legal formalities. At the JPMC, they placed the mugger who had been shot by the police next to my daughter. Everyone belted out insults at him. The media started probing Umer for a response even before we could take our Amal to the morgue. I was asked to go over to give her a ghusl [final bath]. My little baby was no more and this was my last chance to touch her.

I had never imagined this day and I could have never imagined what it could feel like. The love, the heartbreak, the guilt and the amount of faith that one needs to believe that she was now in much better hands and in a much better place; a place that would not fail her like we had so badly.

My father and my uncle went to the police station later that night. That’s when we started to see that something wasn’t fitting into the equation. The mugger had already looted us, there was no point in him shooting at our car. We had no clue what had happened, but messages and concerns about the event had started pouring in.

Over the next two days, August 14 and August 15, among other visitors we were also visited by a bunch of police officials, including Senior Superintendent of Police (SSP) Omer Shahid Hamid of District South. On meeting Umer, the SSP said the bullet seemed to be that of the bandit. That was the police’s stance for the first two days.

On August 16, the Inspector General of Sindh Police, Amir Sheikh, also paid us a condolence visit along with SSP Hamid, Deputy Inspector General (South) Javed Odho, and some other high-ranking police officials. In a discussion with them, Umer’s main concern was why had there been a crossfire at such a busy and crowded signal in the first place — that, too, targeting our car when the dacoit had already mugged us and moved on to other cars behind us. During the meeting, another SSP named Munir Sheikh, looking at the car photographs, felt that the impact and bullet holes seemed to be from a heavier assault weapon than the one carried by the dacoit.

That night, the security and health departments did everything in their power to make sure our child would not make it back home ...

It was decided that day that another inquiry into the incident would be carried out. Odho was appointed to conduct the inquiry. The order stated that a detailed report of the incident, along with recommendations, would be provided within the next three working days.

Odho reverted on the inquiry, accepting that the CCTV footage they had acquired showed clearly that the bullet was from a police assault rifle used by the officer on duty. Odho explained that it seemed that the bullet had ricocheted from the road and entered from the boot of the car, piercing the boot and the backseat, hitting my child and then the front windscreen of the car. A statement was issued by the police to the media and the state subsequently lodged a First Information Report (FIR) against the officers.

A smile that made the world go round for us
A smile that made the world go round for us

In another meeting with Odho on August 27, the use of assault rifles for countering street crimes was discussed. He explained how, after the Afghan war, the country had been exposed to such weapons and how the police had to defend themselves with equally lethal weapons. He also explained that such heavy weapons are not used by police forces anywhere in the world and that the police department in Pakistan used leftover weapons discarded by the army. He said that the police department had a remarkable average of fighting crime and killing criminals and mentioned how “only” two out of 10 people killed by the police were “collateral damage.”

As parents of a 10-year-old, who was unfortunately one out of the two people killed in police encounters on the streets of Pakistan as ‘collateral damage’, our concerns with the police department are many.

The two departments which form the backbone of any country failed us immensely on the night of August 13, 2018. We question the systems which have made us so regressive that we are fighting street crime on the streets of an independent country with assault rifles, where seven bullets from an AK-47 are fired by a constable to kill one bandit at point-blank range. But he fired, and fired so aimlessly that he managed to kill an innocent child who was sitting inside her car, celebrating Independence Day that was to dawn the very next morning.

Now a month later, the trigger-happy officers have been suspended and are apparently at home. Our lives, meanwhile, are in ruin. Our car stands destroyed and devalued at the cleaners after a long wait for clearance from the thana, while the police reverted with accurate information on the paperwork, with no guilt-filled offers of any kind of compensation either.

When taken to the NMC emergency, Amal was denied first aid. No blood was given, no measures taken to facilitate her transfer to the recommended hospitals. When medical staff (who have all taken an oath to save lives) were asked to accompany the child, they denied help. When we requested the hospital to let us borrow the ambu bag, that too was denied to a 10-year-old child. The Aman Foundation denied us an ambulance and it seemed like everyone just watched our precious Amal struggle to breathe and then they stood by, waiting for her to die.

That night, the security and health departments did everything in their power to make sure our child would not make it back home, that she would never see Independence Day, another birthday, laugh or sing, or be able to hug her sister ever again. Our little one struggles to understand the loss of an elder sibling and hopelessly attempts to black out the trauma, while we struggle to assess how to get on with life, get back into a car, get back on the road, get back to work and get through each day without our Amal.

The police department and the hospital both killed our daughter. And while Amal was taken away from us, the police, the hospital and the state indifferently move on. But as parents of another daughter and of the millions of children of this nation, we need to make sure this never happens again. We ask parents and concerned citizens to stand together and demand reforms. We demand accountability and we demand empathy and humanity from these desensitised departments. We demand justice and betterment of the systems and this society. And we demand it right now.

The writer is Amal Umer’s mother. She is a film-maker by profession.

Published in Dawn, EOS, September 16th, 2018


CRITICAL QUESTIONS AND RESPONSES

Eos Report

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