Patients with chest injuries strengthen their lung capacity with water bottles in the physical therapy room at the Emergency hospital in Lashkar Gah, Afghanistan on March 27, 2015.
Patients with chest injuries strengthen their lung capacity with water bottles in the physical therapy room at the Emergency hospital in Lashkar Gah, Afghanistan on March 27, 2015.Paula Bronstein—Pulitzer Center on Crisis Reporting/Getty Images Reportage
Patients with chest injuries strengthen their lung capacity with water bottles in the physical therapy room at the Emergency hospital in Lashkar Gah, Afghanistan on March 27, 2015.
Sayed Malik, 25, waits to go into surgery. He lost his legs while demining, as a ANA soldier in Sangin. Lashkar Gah, Afghanistan on March 26, 2015.
Najiba, 3, suffered from a head injury from shrapnel at the Emergency hospital ward pediatric unit. Lashkar Gah, Afghanistan on March 25, 2015.
A patient is seen in the physical therapy room at the Emergency hospital. Lashkar Gah, Afghanistan on March 27, 2015.
Kharim Ahmad, 22, suffered shrapnel wounds on his face and the loss of a leg from fighting in Sangin. He was being treated at the Emergency hospital in Lashkar Gah, Afghanistan on March 25, 2015.
Razia Noorizada Didar, 30, was one of the seriously wounded victims that worked with Tolo TV for a decade. Razia has a lost sight in her left eye, and has several fractured bones. Her face is scarred from burns and shrapnel. The employees had finished a day’s work at Tolo TV, one of Afghanistan’s largest entertainment channels, when they boarded a company bus in Kabul on April 9, 2016. It was rammed by a car driven by a Taliban suicide bomber. Seven people were killed and at least 25 wounded in the attack.
Ahah Kahn, 19, is barely able to walk after a serious brain injury caused by an IED. Atah was a sheep herder from Helmand who had been at the hospital for a month recovering his strength. Lashkar Gah, Afghanistan on March 26, 2015.
Karima Mehrabi, a pediatric nurse, cares for an infant in the women and children's ward at the Emergency hospital in Kabul on March 21, 2016.
Payenda Khan gets treated for a mine injury to his face at the Emergency hospital in Kabul on March 8, 2016. Payenda was farming at his home in Gardez when he dug up a mine. The injuries to his face were so severe that he needed a complete facial reconstruction.
A bloody hand is seen in the operation room at the Emergency hospital in Lashkar Gah, Afghanistan on March 26, 2015.
Khair Mohammed, 35, a paraplegic, lays in bed outside his ward as friends and relatives—including his daughter, Madina, 6—visit him at the emergency hospital in Kabul on March 28, 2016. Mohammed had barely escaped death after taking 3 bullets to his abdomen and skull.
Abdul Kabir kisses his son, Noor Ahmad, 8, who is unconscious with a severe brain injury from an improvised explosive device (shell injury) from Mazar-E-Sharif Kabul on March 12, 2016. His father was also injured but recovered.
At the Emergency hospital, Najiba holds her nephew, Shabir, 2, who was injured from a bomb blast which killed his sister in Kabul on March 29, 2016. Najiba had to stay with the children as their mother buried her daughter.
Kabir, 5, from Faryab lays in bed at the Emergency hospital in Kabul on April 3, 2016. He is a victim of a rocket attack, lost both of his legs along with his sister and brother who were also killed.
Naser, a mine victim, suffers from a brain injury and the loss of his right hand in the sub-ICU unit in Kabul on Feb. 28, 2016.
Safiullah, 6, from Kunduz, a paraplegic rests at the Emergency hospital in Kabul on March 12, 2016. He became paralyzed from multiple bullet injuries.
Madina, 12, lost her arm, when a rocket hit her home in Paktia, Kabul on April 6, 2016. She is recovering from an operation from complications with her pancreas at the Emergency hospital.
At the Emergency hospital a Pashtun boy waits for an X-ray on his leg from a mine injury in Kabul on March 29, 2016.
Abdul Hussain Ayoobi, is seen at home with his son Ali Akbar, 3. Abdul, a carpenter was one of the seriously wounded victims for Tolo TV. The employees had finished a day’s work at Tolo TV, one of Afghanistan’s largest entertainment channels, when they boarded a company bus in Kabul on April 9, 206. It was rammed by a car driven by a Taliban suicide bomber. Seven people were killed and at least 25 wounded in the attack.
At the ICRC Orthopedic center, handicapped patients practice walking on their prosthetics in Kabul on April 2, 2016.
Patients with chest injuries strengthen their lung capacity with water bottles in the physical therapy room at the Emerg
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Paula Bronstein—Pulitzer Center on Crisis Reporting/Getty Im
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The Silent Casualties of a Forgotten War

Jun 29, 2016

Five-year-old Kabir was in a seemingly safe place—his own house in the remote district of Faryab—when the rocket-propelled grenade struck on an early April day.

His brother and sister were declared dead before he was driven more than 500 miles to the nearest emergency hospital in Kabul. There, his shrapnel wounds were treated and both of his legs were amputated. This wide-eyed boy, quietly staring up, has not even begun to grasp the effect that the previous 24 hours will have on the rest of his life. "This is what happens in Afghanistan," says photojournalist Paula Bronstein . "It's what happens in war zones. It's nonstop carnage, these people are the collateral damage, and they're barely making the news."

Now in its 15th year, the Afghan conflict is America's longest foreign war yet. Despite nearly $800 billion appropriated by Congress for military operations in the country—and with the continuing withdrawal of U.S. and NATO forces—the Afghan government has struggled to maintain control of the country. As factions fight for influence and power, warlordism infiltrates nearly every part of the system: American diplomats only travel by helicopter; car bombs and land mines have become an everyday occurrence; and Afghans rarely socialize in public spaces. Too many have been caught in the crossfire.

Last year, more than 11,000 Afghan civilians were killed and wounded, the deadliest on record for civilians in Afghanistan since the U.S.-led invasion 15 years ago, according to a latest UN report. Thousands are fleeing to neighboring countries including in Europe, but for those unable to leave, the horrors of war are right at their doorstep.

Since the denouement of the post-9/11 U.S. bombing campaign in 2001, Bronstein has returned each year to photograph the victims of a forgotten war. Her latest work, funded thanks to a Pulitzer Center Grant, documents the survivors of suicide bombs, mines and gunshot wounds at various wards at the Orthopedic Center and the Emergency hospital, an Italian-run surgical center in Kabul. “It oscillates between quiet moments walking around a hospital, talking to the troops, photographing recovering children in evening lighting—to a mass casualty situation, where they’re coming into the emergency room screaming and crying after a bombing, a dozen at a time with traumatic amputations and bullet wounds," she says. "I have to say okay, Paula, focus. Focus in and just try to work and don't get in people's way.”

During the first quarter of 2016, the Emergency hospital reported a 30% increase in patient numbers compared to the year before. Patients are coming from much further distances now especially since the bombing of the Doctors Without Borders hospital in Kunduz last year .

Bronstein's images show the faces of the people behind the statistics: a women cradles an injured young boy while his mother is away burying his sister; a man recovering from brain trauma attempts movement again with a walker; a young journalist grasps her chest in pain from facial burns after a car bomb targeted by the Taliban. "I'm constantly amazed by their response to decades of war,” she says. “There's a strength and resilience in these people beyond what I think we could imagine. It can’t get any easier, but they deal with it because it's all they have known."

Paula Bronstein is a Reportage by Getty Images photographer based in Bangkok, Thailand. You can follow her on Facebook, Instagram and Twitter. Her book "Afghanistan: Between Hope and Fear," will be published by University of Texas Press.

Alice Gabriner, who edited this photo essay, is TIME’s International Photo Editor.

Rachel Lowry is a writer and contributor for TIME LightBox. Follow her on Twitter and Instagram.

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