Navy corpsman Andrew Sieber leaned over the injured Afghan policeman, who had a gunshot wound to his right shoulder.
Sieber, 24, inspected the policeman's bandages and then helped load him onto a vehicle for the short but bumpy ride to a landing zone ringed by mountains.
Within moments, the policeman was whisked away by an American helicopter that had squeezed over a steep mountain range and landed in a blast of dust.
"He'll be fine," Sieber said, removing his rubber gloves. "We haven't lost anybody yet." He said they get three or four wounded Afghans a week.
The war in Afghanistan has changed. The Afghan forces are doing most of the fighting and taking a larger share of the casualties, as U.S. forces withdraw. But Afghanistan's military remains dependent on Americans for medical evacuation helicopters, surveillance and equipment to counter roadside bombs. Afghan commanders worry the withdrawal of American forces will leave them vulnerable.
The Taliban remain weakened, but still capable of attacks. They are increasingly targeting Afghan forces. The latest reminder came early Sunday, when Taliban suicide bombers attacked a joint U.S.-Afghan air base in eastern Afghanistan, leaving at least five Afghans dead.
Afghan Maj. Gen. Sayed Malouk, who commands the 215th Corps here in Helmand province, said morale in the Afghan army is high despite the daily casualties they take. In a recent meeting, Malouk told Marine Lt. Gen. Robert Neller, who was visiting from the U.S., that he appreciated the help the Americans have provided.
"But we should be honest with each other," Malouk said. Without the medevac support, many of his troops will die where they are injured and that would hurt morale, he said.
The coalition strategy is to strengthen the Afghan military and police, and weaken the Taliban before most U.S. troops leave in two years.
"Our job is not to be here until you get a Taliban surrender," said Marine Maj. Gen. Charles "Mark" Gurganus, commander of Regional Command Southwest.
It's not yet clear how much support the United States and its allies will provide after 2014. U.S. and Afghan officials this month began negotiating over the terms that would allow a residual force to remain in Afghanistan after 2014. It would probably be a smaller force that would be capable of providing support, such as medevac helicopters and surveillance assets, and launching targeted raids against terrorists.
U.S. officers cannot make any promises yet. "Those negotiations between our governments are taking place now, and I have no idea what that will be," Neller told Malouk.
The number of U.S. Marines here in Helmand province, once a Taliban stronghold, went from a peak of about 21,000 last year to 6,500 today. Overall in Afghanistan, the number of U.S. forces has declined to about 68,000 from a peak of nearly 100,000.
Meanwhile, the number of Afghan forces has increased. "The Afghan security forces are moving into the lead," Marine Gen. John Allen, the top commander in Afghanistan, told a gathering of U.S. troops at Camp Leatherneck in Helmand.
The 215th Corps, based in Helmand province, has been boosted to about 16,000 and is getting larger as the Afghans take over the fight from the Americans. Nationwide, the number of Afghan security forces is projected to reach 352,000.
They have also gotten better, according to NATO statistics. Nearly one-third of the Afghan battalions in the Helmand region are considered capable of independent operations coupled with U.S. advisers, the top NATO rating. At the beginning of this year, no battalions held that rating.
"These guys will fight," Gurganus said. "They keep going back into the fight."
Now American commanders are faced with the challenge of keeping them in the fight as U.S. troops withdraw and take with them key support functions.
"They're going to get a bloody nose once in a while," said Marine Col. Tim Fitzgerald, chief of staff for the 1st Marine Expeditionary Force here. "We just don't want them to get knocked out."
That means pushing the Afghans to be more independent without jeopardizing the momentum of the past couple years.
"Over the course of 11 years, some of the Afghans have become very dependent on some of the Marines and coalition forces," Gurganus said. "It's really hard for us to say no in some areas, but we have."
For Western troops, that means staying on their bases more, which can be a frustrating role for Western officers trained to aggressively pursue the enemy.
In a briefing, British Royal Marine Maj. Mike Scanlon, a company commander, expressed some frustration that the Western forces were doing less as the Afghans did more.
"It's called success," Neller shot back.
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