ISLAMABAD, Pakistan — When the time came to choose medical treatment for Malala Yousafzai, the 14-year-old Pakistani schoolgirl who defied the Taliban
and then was gunned down by them, her family and doctors faced a world
of possibilities after a global outpouring of advice and offers of
assistance.
Whatever they chose, a medical jet from the United Arab Emirates was
waiting to take her to hospitals abroad. Pakistani and American
officials had talked about arranging treatment for her at the giant
American military hospital at Landstuhl, Germany.
A well-developed offer came from former Representative Gabrielle
Giffords and her husband, Mark E. Kelly, who had gone through their own
treatment ordeal after she was shot in the head last year. They had gone
as far as to line up a noted neurosurgeon and had even arranged a
transportation option of their own to the United States — with a
television celebrity offering to quietly foot the fuel bill.
Those were among dozens of offers from across the world. But when the
time came to fly the wounded schoolgirl out of Pakistan, in the early
hours of Monday, a deal from Britain to accept Malala at a specialized hospital in Birmingham proved hard to beat.
But first, to get her there.
Out of worry that the Taliban would fulfill their promise to take a
second shot at the teenage activist, the dawn run from the military
hospital in Rawalpindi, Pakistan, to the airport was shrouded in
secrecy, said Rehman Malik, Pakistan’s interior minister.
“I directed the airport staff to remain incognito, because there was an
alert, threats from the Taliban that they would kill her,” he said. “We
were very careful.”
Yet there was little doubt that each of the possibilities, especially
given the diplomatic tensions between Pakistan and America, carried its
own political risk.
Initially, Pakistani officials had approached the American Embassy for help, officials from both countries said. Two options were discussed, Interior Minister Malik said: the possible
use of an American military facility in Oman, and evacuation to the
Landstuhl Regional Medical Center in Germany. “We scrambled like hell,”
one American official said. “We were standing by, ready to do anything.
There were also private American offers — from Ms. Giffords and Mr.
Kelly, plus at least three other “serious” parties, the American
official added. One came from an American businessman with ties to
senior figures in the Pakistan government; another came from a
constituent of Senator John Kerry, who has longstanding political ties
to the country.
Meanwhile Ms. Giffords’s doctor, Dr. Dong Kim, the head of neurosurgery at the Memorial Hermann-Texas Medical Center,
got ready to travel to Pakistan. Mr. Kelly, a former astronaut, said he
had recruited an American celebrity, whom he declined to name, to
finance the fuel costs of an emergency plane trip from Peshawar to
Houston.
“We were just trying to offer the best help available, as we understand it from being down this road,” Mr. Kelly said.
Mr. Kelly also pressed political contacts in the White House, State
Department and Pakistan to help push the offer through. He said that
Johns Hopkins University made a similar offer. But over the weekend, Mr. Kelly was told by a senior State Department
official that “Pakistan has decided to solve this domestically.”
The British connection, however, had already been well established at
that point through two doctors, both experts in trauma injuries and one
of whom was of Pakistani descent, who happened to be visiting Pakistan
at the time of the shooting last week
The medics were quickly drafted into the effort to save Ms. Yousafzai’s
life. They were flown to Peshawar to help with the initial diagnosis and
then on to the hospital in Rawalpindi. They shared in decisions about
how long to keep the patient in Pakistan, officials from Britain and
Pakistan said, declining to name the two.
Early Monday morning, the medics accompanied a Pakistani brigadier in
watching over Ms. Yousafzai during the flight to Britain. The air
ambulance that ferried them had been offered by the United Arab
Emirates, a country with close political ties to President Asif Ali
Zardari.
By several accounts there were sound medical reasons why the American
offers of help to Ms. Yousafzai were not accepted, including the
lengthier flight to the United States.
But Britain may also have held other attractions. While the United
States and Pakistan have engaged in diplomatic warfare in recent years —
over the Osama bin Laden raid, drone strikes and the controversy
surrounding a Central Intelligence Agency contractor, Raymond Davis —
Britain has carefully cultivated a less adversarial relationship. Britain has been a major aid donor to Pakistan for decades, and many
high-ranking Pakistanis, in political life and in the country’s armed
forces, have been educated or trained in Britain.
“If we had an offer of British help and American help, all things being
equal we would go with the British,” one senior Pakistani official said.
“It makes more sense.”
Exact details of Ms. Yousafzai’s condition remain hazy. Doctors say she
requires treatment for a serious skull fracture, caused by a bullet that
passed through her head. Later, she may require long-term neurological
rehabilitation.