Covid-19: Northern Ireland health system ‘one step from chaos’

“Bodies would start piling up” if more people do not get vaccinated, a senior doctor has warned.

Dr George Gardiner said “they would have been piling up already without the vaccine”.

“We are now facing winter pressures, Respiratory Syncytial Virus for children, the next wave of flu and Covid. We cannot do all,” he added.

BBC News NI was given exclusive access inside Belfast City Hospital’s Intensive Care Unit (ICU).

Seven Covid patients were battling the virus – six of the men and women in their 20s, 40s and early 60s were unvaccinated.

One of them was double-jabbed.

“Without the vaccine we would have been on our knees weeks ago,” Dr Gardiner said.

image caption Dr George Gardiner has spoken candidly of the challenges faced by medical staff

“We would have cancelled surgery, like we had to the last time.

“We are now facing winter pressures, Respiratory Syncytial Virus (RSV) for children, the next wave of flu and a wave of Covid. We cannot do all.

“The bodies would start piling up, and they’d be piling up already without the vaccine.”

Dr Gardiner has called for an end to “tribal politics” in Northern Ireland to allow transformation of the health service, so that cancer and coronavirus can be tackled in tandem.

The director of intensive care at Belfast City Hospital said the system was currently “one step from chaos” and warned hospitals will not cope with winter if Covid numbers continue to rise.

Northern Ireland has the highest infection rate of anywhere in the UK, but vaccine uptake is the lowest.

A total of 2,465,965 jabs have been given out in Northern Ireland, with 87.5% of people now having had a jab.

image caption Staff are already under pressure, doctors say, even before the onslaught of winter illnesses

“We need to get everyone who can take a vaccine to take it now before the winter pressures are on us,” Dr Gardiner added.

“The cancer surgery that we are doing at the minute is life saving. A few more Covid admissions, which could be prevented, will cause us to stop operating because we simply haven’t got the capacity to do both.”

During this latest surge, the hospital’s 14-bed ICU was divided in two.

On one side, doctors and nurses battled to help save the lives of those who have had serious surgery or major trauma.

Just a few meters away, on the other side of a wall, they were battling Covid and Dr Gardiner said beds were “at a premium”.

Indeed, there was just one spare ICU bed for the patient whose surgery went ahead.

Other operations were also cancelled.

image caption A number of members of staff can be involved in turning one Covid patient, to improve oxygen levels

According to Dr Gardiner, chronic staff shortages meant specialist staff could not be spread across the Belfast Trust’s three separate hospital sites.

And one-to-one nursing care, the gold standard for ICU, was no longer possible.

Dr Gardiner said they were at “the very limit with what we can achieve”.

“My biggest fear is that we won’t be able to keep going with cancer surgery; that we will be overwhelmed with Covid admissions; with routine winter admissions and that we will have to stop routine cancer surgery.

“We do not want to be faced with having to ask or decide who is going to get their operation and who is not; who is going to get an ICU bed and who is not.”

‘Atmosphere almost oppressive’

In Covid ICU – the hospital’s “red zone” – the battle to save lives is constant.

It’s hideously bright, stiflingly hot and the cacophony of hissing ventilators, beeping alarms and buzzing machinery bombard the senses.

While the atmosphere is almost oppressive, each alert is a sign that the fight is not lost.

All patients are heavily sedated and hooked up to numerous pieces of medical equipment.

None are capable of speaking.

image caption One-to-one nursing is the gold standard for intensive care treatment

At one point, it took seven staff to prone [turn] a woman in her 60s.

“That helps us to improve the oxygen level,” explained consultant Martin Duffy.

“We have been doing it very frequently during the last 18 months.”

At other beds, physiotherapists pumped chests, moved feet or arms while nurses dabbed ice lollies around the mouths of patients.

Naomi Dalzell, a specialist respiratory ICU physio, said: “These patients are often ventilated for four, five or six weeks or even more than that.

“They lose a significant amount of muscle strength while they are here. We start the rehab as early as we can [but] there’s a long road ahead.”

Janette Ancon was among dozens who have been re-deployed to ICU, having usually worked as a nurse at Musgrave Park Hospital.

“It will be scary thinking ahead if the surge will go high again,” she said, “but we will just get through with it – we are here for each other.”

‘Burnout is immense’

The onslaught of another grueling winter was also at the forefront of Emma Cody’s mind.

She had just finished another challenging 12-hour nursing night shift and described the anxiety as “immense”.

“I don’t know how we are going to keep going at this level,” she said. “It’s not sustainable. The burnout is immense.

“Everybody hits a breaking point and a lot of people have, and a lot of people will, still hit that. It is a worry.”

Meanwhile, in a high-dependency unit, cancer patient Michael McAliskey was grateful that the struggling system was still able to cope.

“I am in a lucky position where I got some treatment before I passed the point of no return,” he said.

Dr Gardiner has appealed for political unity on the contentious issue of transforming the health service.

“I don’t think there has been politics in the treatment of Covid or the way we have responded to it. Everyone has been behind that,” he said.

“But now we need to move on and accept that in order to get cancer surgery done, to treat Covid, to treat emergencies, to treat all the things that we are expected to treat we need political support.

“We need public co-operation in their behaviour, their actions and understanding of what we are actually up against.”

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Kettering drugs overdoses linked to hazardous substance

Police have warned that a “potentially dangerous batch of crack cocaine and heroin” has led to four overdoses in a town in a few days.

Northamptonshire Police said “lifesaving interventions” have been needed in a number of incidents in Kettering.

It believed “a very hazardous substance – possible isotonitazene or fentanyl – has been used as a cutting agent”.

Officers have asked drug users to share the warning with others.

Insp Sebastian Greschner said: “Whilst we would never advocate anyone taking drugs, the fact is that there are people in this county with drug addictions, and we want to warn them about a potentially lethal substance that may be in the drugs they are taking.

“While taking drugs always comes with danger and we absolutely do not condone their use, it is imperative for us to warn drug users about this potential threat to their lives.

“If you are a drug user in Kettering, please be mindful of this cutting agent and please share this warning with other people too.”

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Afghanistan: The pledge binding al-Qaeda to the Taliban

A key question arising from the Taliban’s return to power in Afghanistan is their relationship with their long-time ally, al-Qaeda.

Al-Qaeda is bound to the Taliban by a pledge of allegiance – or “bay’ah” – which was first offered in the 1990s by Osama Bin Laden to his Taliban counterpart Mullah Omar.

The pledge has been renewed several times since, although it has not always been publicly acknowledged by the Taliban.

Under the 2020 peace deal with the US, the Taliban agreed not to allow al-Qaeda or any other extremist group to operate in areas under their control. They reiterated this vow days after the takeover of Kabul on 15 August.

But they do not appear to have publicly rejected al-Qaeda either.

And al-Qaeda has certainly not softened its rhetoric towards the US.

image caption Al-Qaeda media outlets continue to denounce and threaten America

Significance of the pledge

The Arabic word bay’ah is a term meaning a pledge of loyalty to a Muslim leader and is the foundation of fealty between many jihadist groups and their affiliates.

It entails obligations for both parties, including obedience by the one offering bay’ah to a leader. Reneging on the pledge is considered a serious offence in Islam.

In al-Qaeda’s case, it effectively subordinates it to the Taliban, by bestowing the honorific title of “commander of the faithful” upon the Taliban leader and his successors.

image caption Bin Laden continued to deliver threats to the US from Afghanistan after 9/11

It was probably a factor in Mullah Omar’s refusal to hand Bin Laden over to the Americans after the 9/11 attacks, leading to the US-led invasion in 2001.

One famous example of the flouting of bay’ah came when al-Qaeda’s affiliate in Iraq refused to adhere to its pledge to central command, leading it to break away and later re-emerge as the Islamic State group (IS).

IS and al-Qaeda remain fierce rivals.

IS-K – Islamic State Khorasan Province – is the IS regional affiliate in Afghanistan.

image caption The IS attack on Kabul airport was a targeted at the US, the Taliban and ordinary Afghans

Al-Qaeda is not the only jihadist group to offer bay’ah to the Afghan Taliban.

The Pakistani Taliban have previously pledged loyalty and recently renewed it after the takeover of Afghanistan.

Oath to a dead man

After Bin Laden’s death in 2011, his successor, Ayman al-Zawahiri, offered his pledge of allegiance to Mullah Omar on behalf of al-Qaeda and its regional branches.

This was renewed in 2014 after IS declared its caliphate in areas of Iraq and Syria.

But in July 2015, the Taliban announced that Mullah Omar had died two years prior. Embarrassingly, al-Zawahiri had offered allegiance to a dead man.

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image caption Al-Zawahiri’s renewed pledge was declared in al-Qaeda’s newsletter al-Nafir

Al-Zawahiri renewed his pledge to the new leader, Mullah Akhtar Mohammad Mansour, on 13 August 2015, vowing to “wage jihad to liberate every inch of occupied Muslim land”.

Mullah Mansur quickly acknowledged the pledge from “the leader of the international jihadist organization”, an apparent endorsement of al-Qaeda’s global jihadist agenda.

This is starkly is at odds with the Taliban’s own messaging, which restricts the group to the implementation of Islamic rule in Afghanistan and normal relations with neighboring states.

When current leader Hibatullah Akhundzada assumed leadership of the group after Mansour’s death in a US air strike in May 2016, the Taliban did not publicly acknowledge the renewed pledge from al-Zawahiri.

Nor did they reject it.

This ambiguity over the current status of the pledge is at the heart of the ongoing uncertainty over the relationship between the two groups.

What next?

With their return to power, the Taliban are now being pulled in two directions.

Their ties to al-Qaeda lend the Taliban credibility within hardline jihadist circles, and the historic loyalty towards al-Qaeda means they may not be keen to abandon their ally now they hold power.

But the Taliban also remain bound by their obligations under the US peace deal, and the pragmatic approach to governance they have espoused.

Congratulatory messages from al-Qaeda and the group’s regional affiliates have heaped praise on the Afghan group for their “victory” and reiterated Akhundzada’s status as “commander of the faithful”.

The Taliban have not publicly acknowledged these messages, despite doing so for other groups like the Palestinian Islamist movement Hamas.

But the reported arrival in Afghanistan of Amin al-Huq – a close associate of Bin Laden – suggests that links between the two groups do remain.

And al-Qaeda reportedly maintains strong links with the Haqqani network, which is part of the Taliban.

The issue is illustrative of the essential dilemma facing the Taliban. On the one hand, they crave recognition on the international stage and the benefits that brings – but this is largely incumbent on their rejection of extremism.

On the other, they cannot easily disregard their alliance of more than 20 years with al-Qaeda.

To do so might alienate the more hardline among their militants and other extremist groups who have so fervently celebrated their takeover of Afghanistan.

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