Escalating violence in Rio de Janeiro has transformed the state’s health units into war zone hospitals with doctors facing a daily battle to save the lives of hundreds injured in horrific firearm and knife attacks.
The situation is so acute, a hospital based in Posse, a neighbourhood in Nova Iguacu – one of the most violent metropolitan areas in Rio – opened its doors for 24 hours at the end of last month allowing candid and harrowing access to its emergency rooms in a bid to reveal the scale of the crisis.
‘We’re operating in a war zone where there is no ceasefire and no truce,’ says Dr Lino Sieiro Netto, medical director of Nova Iguacu General Hospital (HGNI).
‘Where high velocity bullets rip people open and the number of victims from shootings and stabbings has reached record levels,’ Dr Netto adds.
A pregnant woman, shot twice by a hit man who assassinated her husband, is stretchered into the hospital
The injured pregnant woman told the film crew: ‘A gunman just entered our house… and started shooting… everything happened so quickly.’
The exclusive round-the-clock watch witnessed a weekend of bloodshed.
The 430-bed, woefully overcrowded medical centre receives around two gunshot victims a day.
But during the 24 hours it was filmed last month, HGNI registered a grim toll of six shootings in which three people died, and admitted an assault victim who had been stabbed twice.
From January to August 18, accident and emergency logged 438 people suffering from bullet wounds. The numbers are set to accelerate past last year’s total of 470.
The wider picture is equally alarming – in the first six months of this year, Rio state hospitals treated 1,275 shooting victims.
The figures are already higher than 2016’s total of 996 and experts are fearful of what the final reckoning will be.
Much of the injured are linked to drug trafficking, followed by victims of armed robberies, car jackings and assaults.
British tourist Eloise Dixon is one of the most recent victims of such attacks, and was thankfully saved from bleeding out.
Stabbing victim, Mozais dos Santos Roxa, 35, is the bloodiest casualty of them all on the night of the filming
Mozais dos Santos Roxa is given a CT scan. He has been savagely beaten up and knifed two times
The military police arrive outside the ‘war zone’ hospital with another victim
Staff come outside to help as Rio cops bring in a gunshot victim, shot six times, in an armoured tank to hospital
Instead of calling an ambulance, the 20-year-old man was brought to emergency in an armoured-plated bullet-proof cop wagon because there was no time to spare
The gunshot victim is pictured on a stretcher after being brought in an armoured tank. Doctors were unable to save him – he died before they were able to operate on him
She was shot twice by criminal gunmen earlier this month after mistakenly driving into a drug gang-controlled Rio favela with her husband and three daughters.
Her case is a stark example of just how dangerous and unpredictable the region has become and how far the iconic city has moved away from its picture postcard tourist destination.
Casualties arriving at HGNI on the weekend it was filmed included two men gunned down in a drive-by shooting and a six-month pregnant woman shot by a hit man who assassinated her husband.
In a restricted interview as she is wheeled for a CT scan, the pregnant woman says: ‘A gunman just entered our house… and started shooting… everything happened so quickly.’
The 24-hours of bloodletting starts with the admittance of an alleged mugger who has been shot twice by an off-duty cop, the target of the assault.
A nurse holds some of the bullets collected and stored by Nova Iguacu General Hospital
Luciana Carvalho, Nursing Manager, Nova Iguacu General Hospital shows the collected bullets
The huge number of bullets found in gunshot victims have been collected and stored in boxes over the years
Surgeons carry out an emergency operation on 18-year-old Gabriel Penudo Alves, to remove the slugs lodged in his chest and stomach. However, his injuries are too severe and the teen dies within the hour.
But it’s a shoot-out between criminals and police in Belford Roxo, a district just five miles from the emergency unit, that records the most startling scene in the history of the hospital.
Instead of calling an ambulance, a 20-year-old man shot six times, is brought to emergency in an armoured-plated bullet-proof cop wagon.
One of the six officers accompanying the victim’s limp bullet-riddled body, who refused to be identified, says: ‘We were patrolling the area at the time and were met with gunfire.
‘During the confrontation, this man was severely injured and we took the snap decision to try to save his life by bringing him to hospital ourselves.’
In August, British tourist Eloise Dixon was shot by gangsters in Brazil after her husband mistakenly drove their car off the main road and into a favela
One of the highways officers who helped save Mrs Dixon points out the bullet holes in the car, which the family had been driving in
It makes no difference to the physicians whether the patient is a gang member or someone in the wrong place at the wrong time, they are committed to doing their best to try to save each one.
Unfortunately, their efforts are in vain when it comes to the critically wounded victim brought in by police – he dies before he can be operated on.
But the image of the bullet battered steel-clad vehicle parked outside the hospital serves to hammer home Rio’s battlefield reality.
Shaking his head in disbelief Dr Netto says: ‘In all my 24 years of working in this hospital I’ve never witnessed anything like this.
‘The presence of the armoured truck emphasises the sense of war and is a harsh reminded that we are living during frightening times.’
As the armoured police carrier leaves, another victim of the armed conflict arrives.
Taniara de Oliveira dos Santos, 22, has been caught in crossfire after a gunman murdered her husband in front of her in a barrage of bullets. She is six months pregnant.
Ammo is lodged in her shoulder and a pellet passed straight through her left wrist. Mercifully no bones have been damaged and the baby is fine.
The young mum-to-be is in a state of shock and lies on the trolley staring into space as physicians examine her injuries.
She sheds no tears, just yet, and speaks hesitantly to reveal what happened.
Mrs dos Santos recalls: ‘A gunman just entered our house and shouted at my husband, “Get up your time has come”.
‘Then he just started shooting. My husband had no time to run or hide. He was shot down where he stood.
The hospital is based in Posse, a neighbourhood in Nova Iguacu – one of the most violent metropolitan areas in Rio
Nova Iguacu hospital is overcrowded and serves a population of over three million
In just 24 hours, the 430-bed woefully overcrowded medical centre saw a toll of six shootings in which three people died and admitted an assault victim who had been stabbed
‘Seconds before this my two-year-old nephew was sitting on my lap. He climbed off and went into another room just before the man entered. It was lucky that he did because he would have been shot too.
‘Everything happened so quickly. All I could think about at the time was trying to protect my nephew and protect my unborn child. I didn’t even have any time to worry about my husband. Now I don’t know what I’m going to do without him.’
According to detectives her partner was involved in trafficking drugs. She was collateral damage.
Accident and emergency shift medical manager, Fernanda Sahione says: ‘Taniara was fortunate.
‘The bullet entered just under her collar bone, missing important vessels and coming to rest in her shoulder blade. The baby wasn’t hit and is doing okay.
‘Doctors decided the bullet didn’t immediately pose a threat to her life so it hasn’t been removed.
‘This was a difficult case because we couldn’t do many scans and internal exams because we didn’t want to risk the life of the baby.’
A&E Shift Manager, Fernanda Sahione (left) and Medical Director, Dr Lino Sieiro Netto (right)
A police car and ambulance are seen outside the hospital. Nursing manager, Luciana de Carvalho said: ‘Over the years we have seen a difference in the type of ballistics being used. Before the projectiles were .38 calibre and the injuries were simpler. Now we are seeing high velocity impact bullets from rifles and machine guns.’
Mrs dos Santos was discharged two days later.
Stabbing victim, Mozais dos Santos Roxa, 35, is the bloodiest casualty of them all on the night of the filming.
He has been savagely beaten up and knifed two times. His clothes are soaked red, and he is disorientated and unable to respond coherently to the doctor’s questions.
Emergency general medical surgeon Dr Julia Schlinz says: ‘Mozais is suffering from extensive internal bruising. He has been stabbed in his hand and in his back.
‘However, from the CT scan and our examinations we are satisfied that he will not need an operation. But he will be kept in for observation.’
Roberto Pereira Thiago was killed in a drive by shooting as the killings escalate in Rio
After 24-hours monitoring HGNI’s trauma unit, the session ends with a bloodbath from a drive by shooting.
Two men reportedly sped along a residential road in Posse unleashing a hail of bullets on innocent diners outside a roadside bar.
The murderous attack instantly killed Roberto Pereira Thiago, 43, as he sat with his wife and children.
Leandro Silveira, 44, was struck in the abdomen and Nelson Nascimento, 31, was hit in the left leg which was so badly shattered it had to be amputated.
Both men are still in hospital. Mr Silveira remains in intensive care and his health is reported to be stable.
Neither were prepared to talk for fear of reprisals.
The bullets extracted from their bodies were deposited with hundreds of others collected and stored in boxes kept by the hospital since 2005.
Nursing manager, Luciana de Carvalho says of the incident: ‘Over the years we have seen a difference in the type of ballistics being used. Before the projectiles were .38 calibre and the injuries were simpler.
‘Now we are seeing high velocity impact bullets from rifles and machine guns which are responsible for some of the most devastating injuries that more than often kills the patient.’
HNGI is the only accident and emergency centre in an area covering a population of over three million inhabitants.
Rogerio Lisboa, Mayor of Nova Iguacu says: ‘The situation in the hospital is very difficult. We are operating in a volatile and increasingly demanding patch.
‘But we only receive enough money from the federal government to cover 800,000 inhabitants in Nova Iguacu. In actual fact, we serve an area of over three million inhabitants.
‘At the moment, we receive six million reais but we need double the amount of between 12 to 14 million reais.’
But Brazil is in the midst of an economic downturn and the state of Rio de Janeiro is strapped for cash as it suffers from a serious financial crisis.
Medical surgeon and A&E director, Dr Christian Ferreira, says the pressure on the hospital and staff is immense. Practitioners are being trained in how to operate as if in a state of war.
But no one can prepare for the moment a revolver is pointed at them by an agitated gunman.
Which is what happened to Dr Ferreira, who has worked at the hospital since qualifying over 20 years ago as a neurosurgeon.
He said: ‘The man wanted his daughter treated first, ahead of more seriously ill patients. He pulled out a gun and held it to my head and threatened to kill me if I didn’t do what he said.
‘My life flashed before my eyes and I froze. I managed to explain that his child had leg injuries which were not life-threatening. Fortunately, I got him to calm down and we carried on working.
‘Despite the scare it will not stop us from doing our jobs and continuing our fight to save lives,’ he said resolutely as he left to attend to yet another casualty of Rio’s violence.