With badly fractured legs, Kawsar was rushed to the capital's National Institute of Traumatology and Orthopaedic Rehabilitation (Nitor) around 2:00am on September 15.

It had already been 13 hours since an iron rod-carrying truck run him over at Konabari in Gazipur.

As his injuries were severe, an immediate surgery was required, but he had to endure an excruciating pain for several hours since the operating theatre dedicated for emergency patients had a long queue of patients.

“They [the medical staffs] were talking about [the patients'] serial numbers. But my son was in extreme pain and was fainting,” said Kawsar's mother Majeda Begum.

Doctors amputated his left leg from above the knee around 10:00am, eight hours after he was brought in. They were able to save his right leg.

Majeda is happy that at least her son had survived, but health experts believe being the prime hospital for the country's accident victims, Nitor lacks the capacity to provide proper emergency treatment.

Each day around 120 to 180 patients rush to the Nitor emergency unit. The 500-bed hospital has only 30 beds dedicated to emergencies and those remain occupied most of the time. There are around 237 second-, third- and fourth-class staff, 292 nurses and 156 doctors there, said hospital authorities.

There are allegations that a syndicate of unscrupulous staff with the help of local brokers take advantage of patients' critical state and make a quick buck. The syndicate, in exchange for Tk 200 to Tk 300, “help” patients have priority for surgeries and make sure their medical test results are released quickly, said sources.

The brokers also get patients, most of whom are from outside the capital, admitted to different wards for money, they added.

Although the hospital authorities are well aware, they claimed they could not take action since patients seldom file complaints.

Prof Khondker Abdul Awal Rizvi, a former director of Nitor, said the waiting time for a patient at the emergency unit is a bit long. A major reason for this is the lack of discipline, he said.

Rizvi, who served as the hospital director between 2009 and 2013, said each day about 30 to 40 patients, some with critical injuries, would undergo surgeries at the emergency unit. But the number of doctors, nurses and ward boys assigned to the unit was inadequate.

The hospital was yet to meet the patients' expectations due to lack of capacity, he told The Daily Star over phone.

The environment of the unit is poor. Patients are kept waiting for surgeries in a shabby space in front of the operating theatre risking infections. And it all gets messy often. 

M Amjad Hossain, a former professor at Nitor, said lack of government policy created the inefficiency at the hospital.

He suggested that utilising existing resources and manpower, a better environment could be created at the hospital, including at the emergency unit.

Nitor Joint Director Abdur Razzaque Miah admitted that they lacked space.

He said those placed in front of the emergency operating theatre were pre-operative patients who only stayed there for a few hours until their surgeries were done.

He said some unscrupulous staff do favour patients for money but there was little he could do without written complaints.

“What action can you take if none files complaints?” he asked.

He claimed that the hospital had sufficient doctors but not enough support staff.

Wishing not to be named, a senior nurse said only two nurses are on-duty at the emergency ward to look after around 80 patients during the 12-hour graveyard shift.