'A tree is the only shelter for the surgeons when they are operating'

Paul McMaster, a retired British surgeon, has been in Haiti since last Thursday, two days after the earthquake struck. He has been carrying out emergency amputations for Médecins Sans Frontières in a makeshift hospital under a tree by a roadside in the devastated capital, Port-au-Prince. Originally from Droitwich, in Worcestershire, he works as a surgical adviser for MSF and is based in Amsterdam. "We got here about 48 hours after the earthquake – I think we were one of the first emergency response teams to arrive," he said. "We flew into the Dominican Republic and drove through the night to get to Port-au-Prince. "The devastation here is on a scale I have not seen before. The hospital in Carrefour , one of the very poor areas on the west of the city that has been almost completely destroyed by the quake, was still standing, but it was empty. "The staff were trapped at home ... most had lost relatives. It was completely non-functional. "We had started to establish an emergency trauma centre for the casualties in the hospital on Friday morning when there was a major aftershock, so we had to evacuate. "We moved the surgical emergency operations to an area under a tree outside the hospital, with the patients lying on the road on mattresses. "The tree is the only shelter for the surgeons when they are operating. I don't know what kind of tree it is – it drops things on our heads while we are working. "At that stage, Friday and Saturday, we were working with roughly two surgeons and two anaesthetists on three operating tables. "I say operating tables – in fact, they are three couches next to each other. We worked continuously: we didn't stop for sleep. But that's OK. That's what we are here for. "There are a few tents on the road now where some patients can get a bit of shade. But many are lying in the open, or with just a simple shade cover to try and protect them from the sun. "Under the tree, we have been doing the more major amputations, wound operations, but we've also had to perform other kinds of surgery not related to the quake – we've done Caesarean sections, we've had women bleeding from abortions coming in. "I am not sure how many cases we have treated surgically, but of course many, many more have been seen in the triage area. Those numbers we cannot begin to count. "Unfortunately, our equipment did not make it to Port-au-Prince with us, so we have had to make do with very little. "On Friday, there was no electricity, and water was a major problem. We were very quickly running out of supplies, particularly anaesthetic. "We've run out of plaster of Paris twice in the last 24 hours, and we have now nearly run out of a ketamine drug that we use for anaesthesia. We had no bandages at all on Monday. "We were overwhelmed in the earliest days by the crowds coming for help, and we have had to try to get control. But the number of major surgical cases we are seeing now is dropping rapidly, I'm afraid, because people are dying in the rubble. I don't think many people with major injuries who have not already been seen by doctors will have survived now. "So we're moving into a quieter phase surgically – perhaps 12 to 15 major operations scheduled per day. "The next stage will be treating the open wounds, which are now contaminated. Many of them have maggots in them. I would say that we now have enough doctors and nurses to carry us through the immediate phase, but we are still very short on supplies. "And of course we have only got the emergency surgical team – there's almost no other place for people to go to with other medical emergencies. "Psychological care is now being offered to amputees and their families, and the next move will be to establish a mobile clinic to do outreach work into the surrounding community. "People are now trying to leave, to walk out of the city. They are going to the country, even though there will be little food there. "Some have relatives there, but many have not. And yet the people who can get out are leaving. This is a city which is dying." Earlier this year, McMaster spoke to the Guardian from northern Sri Lanka , where he was performing urgent surgery on victims of the Sri Lankan war.