About a month after his 27th birthday, Ibrahim Mostafa al-Ezzab responded to a call.
For weeks the Egyptian Ambulance Organization had been training for the planned dispersal of major Muslim Brotherhood sit-ins in Cairo. Now, it was happening.
On August 14, police and military troops began moving to break up the Rabea al-Adaweya sit-in, where supporters of deposed President Mohamed Morsi had set up camp for more than six weeks. As security forces pushed demonstrators out with teargas and, as eyewitness reports attest, gunfire and other violent means, the paramedics tried to make their way in.
Ezzab was one of many ambulance drivers dispatched to Nasr City that day. As gunfire flew overhead, he bent over to tend to one of the injured. But it was his skull that was pierced by a bullet.
It was Ezzab on the stretcher being carried by his colleagues through the streets, because their vehicles couldn’t get through the chaos and closed roads. They took him to a small hospital nearby until they could move him downtown, where a river ambulance took him the rest of the way to the Nasser Institute Hospital in Shubra. Despite their efforts to get him better emergency care, Ezzab died the next day.
His death has sent a ripple through the community of paramedics. But after more than two years of street violence, some seem to accept that being attacked or shot are now the risks of the job.
Standing in the Egyptian Ambulance Organization (EAO) headquarters in Giza, paramedic Ramadan Fakhry Mohamed unrolls a banner with two images: A picture of a uniformed Ezzab, wearing sunglasses and sitting in his ambulance, and a much larger image of another paramedic trying to staunch the bleeding from his head.
The 38-year-old, who supervises the Heliopolis area team, says he helped carry Ezzab that day, and talks about how the young man from Gharbiya knew the meaning of teamwork and respect.
“You could say he died in my hands,” Mohamed says.
Ambulance driver Khaled Rafaat considers it fortunate that many more medics weren’t killed.
Official Health Ministry reports claim that more than 600 people lost their lives on the day of the dispersals, but the Muslim Brotherhood’s media outlets put the death toll at more than 1,000.
“When we hear someone is injured, the police are supposed to keep me safe on my way in; but that doesn’t happen,” Mohamed says. “We just run inside, not thinking about whether we will come out alive or dead, to do our jobs.”
Rafaat was a nurse before becoming a paramedic, and says that as a first responder, he now sees patients in much worse condition. Aside from coping with pushing and shoving, angry crowds and physical violence, the main problems he and his colleagues face are protesters exacerbating injuries by trying to move the wounded, and people vandalizing or stealing the ambulances, Rafaat says.
“Some of our colleagues have been sent to Germany for training, and when they came back they said we are not that different. The difference is that here people attack cars, while there they seem not to have a scratch.”
The EAO says that since January 2011, 116 ambulances have been damaged and 25 destroyed during clashes.
Dr. Ahmed al-Ansary, the organization’s vice chairman, says the strategy for handling unrest has evolved multiple times, becoming more dynamic over the past years. At first, the authority would dispatch 30 cars to a planned protest site, often to find no demonstration had materialized. Now, five cars will initially cover a hot zone, and more are sent as needed.
For their own safety, paramedics are told to obey authorities and not to clash with protesters or get in the middle of fighting, even if it means they cannot reach someone in need of care.
Ezzab was the first paramedic killed on the job from protest violence since the January 25 uprising, according to the EAO, but at least eight others have been injured — two with shots to the eye.
“Their safety as a team in the field is number one, two and three,” Ansary says. “It’s our top priority, and then comes anything else.”
Rumors circulated among the public have increased aggression toward drivers, Ansary says. Some people are suspicious of their agenda, accusing the medics of having political allegiances to one side or the other, and even refuse help, although EAO staff at all levels emphasize the organization’s very firm policy against discrimination or politics on the job.
“These political struggles — we are not part of it by any means,” he says.
“We are an autonomous organization. We took our stance from the first day of the revolution until now that we are not biased to any party.”
Even with all the new obstacles, Ansary says paramedics are still able to access and help the vast majority of patients — often with the help of protesters who retrieve the injured on the back of motorbikes and makeshift gurneys.
He names traffic as the biggest hindrance to their work, with response times in cities sometimes upward of 30 minutes.
With 2,500 cars, eight water ambulances and several helicopters across Egypt, help arrives for 65 percent of calls within 10 minutes, according to the vice chairman.
The organization is also in the process of consolidating provincial ambulance services under its umbrella, with all but four governorates, including Cairo, now centralized.
The EAO dispatches a higher density of cars to cover urban areas, holds workshops for traffic authorities and plans to propose legislation to the next parliament that would require drivers to pull over for emergency vehicles. But Ansary says efforts to improve traffic law enforcement and infrastructure, and change the public’s mentality, are slow going.
After over 25 years on the job, Rafaat wishes more people understood his work.
“Every time I ride the metro wearing my uniform people give me looks. We don’t need to be treated like doctors, but at least respected for what we do,” he says.
More importantly, he wants their sacrifices honored in a small way. “We just need the people to stand with us, and that the media would announce our injuries and deaths as people who were not part of the political fight, but instead were there to help.”
Mohamed says all crew members in Rabea al-Adaweya were affected psychologically when one of their own went down, and are coping in their own way.
At the authority, they show photos of the horrors they’ve seen — bodies so charred there is no visible skin left, a man’s bloody back draped over a paramedic’s shoulder, and body bag after unidentified body bag.
“It’s different mentally when you go treat a heart attack, and when you go to a crisis,” Mohamed says. “In a crisis, I’m mentally prepared to see a worse disaster than I expect.”
Both men agree that a positive response from a crowd can have a big impact.
“When people start to help us, it’s the most motivating thing that can make us perform better,” says Mohamed. “Even if they don’t, I have to do my job well … but when they say good luck and know what we are doing for them, that helps.”