The 72 Hours That Saved Malala: Doctors Reveal for the First Time How Close She Came to Death

She survived a Taliban bullet that shattered her skull's thinnest bone.

ByABC News
October 7, 2013, 7:13 AM

Oct. 7, 2013— -- Malala Yousafzai survived a Taliban bullet that shattered her skull's thinnest bone, driving fragments into her brain.

But one day later, as she lay in a medically induced coma in a Peshawar, Pakistan, hospital, her condition suddenly deteriorated, and her doctors did not know whether she would live or die.

The 15-year-old would survive to become a global icon of courage and an international ambassador for girls' education. That part of her remarkable story is widely known, but what hasn't been told before is how close she came to dying in the hospital and how a team of doctors and the most powerful man in Pakistan made sure that did not happen.

In exclusive interviews for ABC News and the BBC News on the one-year anniversary of her shooting, Malala's doctors reveal for the first time how she developed a serious infection and suffered from organ failure in the hospital, in part because of inadequate care.

They also reveal tense moments leading up to her first, crucial surgery, and how Gen. Ashfaq Parvez Kayani, the chief of army staff, was personally involved in overseeing the Pakistani army's essential role in saving her life.

And they reveal that at the center of this life-and-death drama were two previously unknown doctors from Birmingham, England, without whose intervention Malala might have died on a hospital bed in Peshawar.

Tuesday: 'He's a Hero'

On the morning of Tuesday, Oct. 9, 2012, Malala boarded her schoolbus in the northwest Pakistani district of Swat. The gunman had no doubt whom he was looking for. He asked for Malala by name, then pointed a Colt 45 and fired three shots. One bullet hit the left side of Malala's forehead, traveled under her skin the length of her face and then into her shoulder.

The news quickly filtered south 200 miles to General Headquarters, Pakistan's equivalent of the Pentagon.

Gen. Ashfaq Parvez Kayani, who had met Malala during previous visits to Swat, immediately realized this was not just another attack in a district where the Taliban still held considerable power.

"He recognized that she was a symbol," says Dr. Javid Kayani, an intensive care surgeon and deputy medical director of University Hospitals Birmingham, who happened to be in Islamabad for a meeting with the army chief that day. "He knew that if her life had been extinguished, then that would be a victory to the forces of darkness."

The army chief ordered a military helicopter to evacuate Malala to a military hospital in Peshawar, the regional capital. That order alone was unusual: Hundreds of civilians had been targeted for assassination by the Taliban, and few if any had been transported via military helicopter.

In the hospital, army neurosurgeon Col. Junaid Khan told ABC/BBC News that Malala was conscious but "restless and agitated." She seemed stable, and Khan kept a close eye on her.

Four hours later, though, her condition deteriorated. Khan realized the bullet had caused Yousafzai's brain to swell and that she needed emergency surgery to remove a portion of her skull to relieve the pressure.

But Khan had to fight for permission. According to Drs. Javid Kayani and Fiona Reynolds, a pediatric intensive care consultant from Birmingham, who was also in Islamabad that day, Yousafzai's family did not trust Khan because he looked so young. Malala's father, Ziauddin Yousafzai, wanted a civilian doctor to see her. There was also a push to evacuate her immediately to Dubai.

But by late evening, Khan told Malala's father there was no choice: Khan had to perform the surgery to relieve the pressure on her brain. The risks were high.

"The part of the brain that was involved was concerned not only with speech, not only the speech centers but also those centers which are involved in controlling or giving power to the right arm and right leg," Khan said in an interview. "So contemplating surgery in this very sensitive area can have risks in terms of ... losing the speech or losing the power in the opposite part of the body, meaning the person can be paralyzed afterward."

Khan pushed Malala's father for permission. "There are risks," Khan said, "but if you foresee that this patient warrants an operation and if you don't do an operation, she will lose her life, then you're going to take all the chances."

The craniotomy began after midnight. Khan and his team removed a portion of her skull, removed blood clots on her brain and put Malala on a ventilator.

To this day, Reynolds and Kayani say that without Khan fighting to perform that surgery, Malala would not be here.

"That first surgery saved her life. Junaid operated when the world was looking at him," Reynolds told ABC/BBC News. "Surgery's about choosing the right time to do the right operation, and Junaid did that and he did the operation and I've got no doubt that he saved her life. He's a hero."

As Kayani put it in an interview: "Malala is alive today, and two people can claim credit for that: One is the surgeon who operated on her in the early hours of Wednesday morning, and the other is the chief of army staff. If he had not been personally involved, Malala would not have survived beyond Swat."

The surgery saved her life, but she was not out of the woods. And that is where Kayani and Reynolds' portion of the story begins.