MOCOA — Doctors have the power to save lives. Their decisions are especially important when natural disasters strike, as they determine procedures aimed at ensuring that as many lives as possible are ultimately saved. Julián Ramírez, who got his medical training at the Santiago University in Cali, was at home in the southern Colombian city of Mocoa when torrential rains arrived provoking an avalanche of mud that has left at least 290 dead and many more missing.

A group chat message sent out by a deputy-head of the city's José María Hernández hospital declared an emergency and ordered him to the disaster site. He recounts an experience that began rather uneventfully — with the 7 a.m. start of his shift last Friday — but then took a turn he says he'll never forget.

I was sent to surgery. Afterward, as I changed, I felt a light breeze and said, "It's going to rain and it's cool. Lovely." Then I left to go home not far from the hospital, and ate while waiting for my girlfriend. Around 11 p.m. it began raining hard. An hour and a half later the lights went out and that's when people began talking.

I went onto the balcony of my room and saw people scooping water out of their homes with buckets. The streets looked like lakes. On Saturday at 12:07 a.m., Ruby Alexandra Jajoi, the hospital's deputy-head of science, sent out a Whatsapp message to the medics' group, declaring a hospital emergency and asking for help at the hospital. That's when I something was up and that the situation seemed serious. Yet I had no idea then of the scale of the disaster.

I got ready, went out, took out my phone and used it to light up the streets to reach the hospital. I saw a lot of chaos from San Francisco Street onwards leading to the hospital, ambulances and lots of people walking around. When I entered, I saw people immersed in mud, crying and naked. The emergency ward was full right at the entrance. The number of injured people made it look like a scene from a horror movie.

There was an injured woman with her eyes full of mud. She could not see anything and was vomiting mud. It was appalling. I asked myself, "what is going on? Why are people like this?" The pre-consultations nurse then told me to go help with patients at the pediatrics ward.

The session got worse. Every two minutes an ambulance arrived with more wounded.

My first patient was a little girl who arrived at the hospital without relatives, and since nobody knew anything about her, she was categorized as NN. She was about nine years old. I said, "hello princess, how are you? What happened? Where's it hurting? Is something bothering you, are you injured somewhere? Can you breathe? Do you feel anything?" She said, "no" and the only thing hurting were her feet and back. I checked them and found multiple cuts on her legs, a swelling on her right ankle and she was badly hit and traumatized. I washed out her eyes and told a nurse to give her medicines. I had no idea then that patients in worse shape would arrive: the ones the landslide had dragged but who managed to hang onto something.

Loads of people began to arrive. The maximum time I could spend with anyone was five or 10 minutes at the most, and one of our priorities was the children who were in really bad shape. My next patient was another girl who was 12. I checked her, and she had a wound on her forehead and multiple injuries on her body. When I asked what had happened, she said her mom was holding her at the moment the landslide happened, but lost her suddenly. I gave her antibiotics and followed with another. I went through a lot of patients: adults with open wounds, body fractures, naked children covered in mud, women with broken parts all over. It was really shocking. I was particularly struck by a woman who had fallen and broken an arm trying to escape the avalanche. I kept her still as best I could.

The session got worse. Every two minutes an ambulance arrived with more wounded. The patients were assessed, we bathed them if necessary and lay them out to be seen. There were critical patients needing reanimation, like a woman who arrived without vital signs.

Looking for survivors in Mocoa on April 3 — Photo: Juan Zarama Perini/Xinhua/ZUMA

We tried to revive her for 15 minutes, but she did not respond. Like me, other doctors had to deal with difficult patients who did not survive, whom we tried to save but who wouldn't react in spite of what we did. It was like this all night, and we didn't have a moment's rest. We were just seeing patients, seeing what they needed.

At 6:30 Saturday morning, I was exhausted by my shift as I had already worked all day Friday. I had to sleep since I'd have to return to work that night. I left the service head a list of patients who urgently needed surgical cleansing, which he said he would check. Leaving the service, I saw another horrible spectacle. There was no room for people. The corridors were full and I could barely move. The morning doctors arrived and I went to rest, so I could return and resume saving lives that evening.