2 days ago
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By 8 January, Iran’s anti-regime protests that began in late December had spread across the country with reports of at least 45 people killed by security forces. Over the next three days the regime appears to have instigated a brutal crackdown on protesters that is now estimated to have led to the deaths of more than 5,000 people.
By the time I reached the hospital in Tehran on Thursday (8 January) night, the sound of the city had already changed.
Up until a few hours earlier, doctors and patients were still sending me photos on WhatsApp; pellet wounds to the back, the hands, the head. Painful injuries, frightening injuries – but survivable. The kinds of wounds that could be treated, that suggested the violence still had limits. Then, at eight o’clock, everything went dark. Internet, mobile phones, messages, maps – all gone.
Minutes later, the gunfire started. From about 8.10pm or 8.20pm, I could hear shots echoing through the streets, along with screaming and the sound of explosions. I was called into the hospital. By the time I arrived, it was immediately clear that we were no longer dealing with the same situation.
The patients coming in now were not hit by pellets – they had been shot with live ammunition. War bullets. These were not warning shots. These were bullets designed to pass through the body. Bullets that entered on one side and exited from the other.
I am a surgeon who deals mostly with torso injuries, and that night the operating rooms filled with wounds to the chest, abdomen and pelvis. I did not see arms or legs, others dealt with those, but I saw the injuries that decide whether someone lives or dies within minutes. The injuries where there is no margin for delay, no room for error. Many of the shots had been fired from close range. The damage they caused was severe. In some cases, catastrophic.
Very quickly, the hospital became a mass casualty zone. We did not have enough of anything: not enough surgeons, not enough nurses, not enough anaesthesiologists, not enough operating rooms, not enough blood products. Not enough time. Patients kept arriving faster than we could treat them. Stretchers lined up. Operating rooms turned over again and again.
In a hospital that would normally perform two emergency surgeries in a night, we carried out about 18 operations between 9pm and 6am. When morning came, some patients from that night were still on the operating table.
There was no pause. No moment to step back and assess. You moved from one patient to the next, from one operating room to another. I have worked through earthquakes and seen mass casualties after major accidents. I have never experienced anything like this. Even in disasters, you might receive 20 or 30 injured patients over several hours. That night, and the night after, it was hundreds: gunshot wounds; severe trauma. One after another.
The exhaustion was total. Physical exhaustion, yes, but more than that, mental. As surgeons, our job is to save lives. That night we were saving people who had been shot by their own government. That contradiction stays with you. You keep operating because you have no choice, because people are still arriving, because stopping is not an option; but part of you is breaking.
While in the operating room, I heard weapons that do not belong on city streets. I heard the sound of DShK [Soviet designed] machine guns. Later, I saw them mounted on the backs of pickup trucks moving through the city. I am describing what I heard and what I saw, not what caused specific injuries, but the atmosphere was unmistakable. This was not policing. This was something else.
As the night went on, it became impossible to even think about counting the dead. There was no way to collect accurate numbers. The volume of casualties far exceeded the capacity of the hospitals, the staff and the infrastructure.
People were afraid to come to the hospital. They knew what happens afterwards. From experience, once the situation is considered “under control”, hospitals receive official letters from security institutions demanding patient information – names, details, injuries. If administrators refuse, they face serious consequences. This system existed long before these protests.
During those days, many injured people chose not to come at all. Instead, they called me. My phone rang constantly whenever there was even a brief signal. People spoke in code, terrified the calls were being monitored.
The calls were not only about young adult protesters. They were about a 16-year-old child, about a man in his 70s, about people who had simply been in the street. You did not need to be demonstrating to be shot. You only needed to be there.
By Friday morning, I was still in the operating room. Some patients from the night before were still undergoing surgery. Later that day, I had to travel to a city in central Iran. The city I drove through looked wounded. Metro stations were burned or shattered, their slanted glass structures destroyed. A route that would normally take less than 10 minutes took nearly two hours.
When I arrived in the city, the situation was the same: friends working in hospitals there told me the night had been catastrophic. One colleague said the on-call surgeon could not cope and that several doctors had to operate continuously. In one hospital, 13 abdominal and chest surgeries were performed in a single night.
Even private hospitals, where gunshot victims are usually nonexistent, were overwhelmed.
I do not have official numbers – no one does yet. But I know the hospital capacity. When a small hospital that normally sees one death in 24 hours receives eight bodies in one night, when medium hospitals receive 20 – people who likely died before reaching the hospital – you understand what is happening. When you know how many hospitals a city has, and what their capacities are, you can estimate.
In a city of about 2 million people, I believe more than 1,000 may have been killed in a single night; [across Iran] I would estimate more than 20,000. These are purely estimates, based on my experience and bed capacity, not official statistics.
In one street, I saw blood pooled in a gutter, nearly a litre, with a trail stretching several metres along the ground. Someone who loses that much blood does not survive long enough to reach a hospital.
As time passed, the violence escalated step by step. On Thursday night, I heard mostly individual shots. On Friday night, I heard automatic fire.
The level of violence did not resemble policing, it felt like wartime rules applied to civilians.
Families continued to call. Many were terrified not only of their injuries, but of what would happen if they sought care. The hospital, which should be a place of safety, had become a place of fear.
The scale of what happened in those days cannot be fully conveyed: the destruction, the volume of injuries, the silence imposed by communication blackouts, the exhaustion of medical staff. The sense that something fundamental had broken.
My words are not enough to describe what happened. But I know this: what took place was far beyond anything the public has been told. And most of it happened in the dark.
Based on testimony given to the Guardian’s Deepa Parent and the Center for Human Rights in Iran
While there have been no formal or official death toll figures, the US-based Human Rights Activists News Agency estimated 5,002 have been killed – comprising 4,716 demonstrators, 203 government-affiliated people, 43 children and 40 civilians not taking part in the protests.
