Exclusive: Expert analysis of images from one hospital suggests severe trauma to the face, chest and genitals was caused by metal birdshot and high-calibre bullets

Tess McClure and Deepa Parent, The Guardian

Across the planes of Anahita’s* face, white dots shine like a constellation. Some gleam from inside the sockets of her eyes, others are scattered over the young woman’s chin, forehead, cheekbones. A few float over the dark expanse of her brain.

Each dot represents a metal sphere, about 2-5mm in size, fired from the barrel of a shotgun and revealed by the X-ray camera for a CT scan. Shot from a distance, the projectiles, known as “birdshot”, spray widely, losing some of their momentum. At close range, they can crack bone, blast through the soft tissue of the face, and easily pierce the eyeball’s delicate globe. Anahita, who is in her early 20s, has lost at least one eye, possibly both.

The image of Anahita’s head is one of more than 75 sets of medical images – primarily X-rays and CT scans – shared with the Guardian from one hospital in a major city in Iran, taken over the course of a single evening during the regime’s January crackdown on protesters. The plain, grayscale images tell their own story of the deadly violence inflicted on protesters and onlookers by Iran’s Islamic Revolutionary Guard Corps (IRGC).

They provide further evidence of events described by doctors and protesters across Iran, where guards switched from more traditional ‘crowd control’ to opening fire with high-calibre assault rifles and shotguns. The records present a pattern of people being shot in the face, chest and genitals, a trend also seen in the 2022 “Women, life, freedom” protests. Collectively, they help to illustrate the scale of bloodshed, showing dozens of life-threatening injuries appearing at a single hospital in a midsize city within a few hours.

Many of the images reveal catastrophic injuries that may be fatal even with immediate surgical treatment. The scan of Vahid*, a young man, shows a large-calibre bullet embedded in his neck, his trachea pushed to the right as blood pools and the damaged tissue swells. Scans of another man, middle-aged, show a bullet suspended in his brain, along with a large bubble of gas inside the skull, indicating a devastating brain injury. Medical experts describe it as “likely not survivable”. Two more young men have large-calibre bullets lodged next to their spines. The scan of a young woman shows a deformed bullet that appears to have entered the ribcage under her right arm, torn through the lung, where gas and blood have built up, and come to rest at the left of her spine.

As part of a joint investigation between the Guardian and factchecking platform Factnameh, the images have been assessed by a panel of health and ballistics experts outside Iran, including an emergency medicine doctor, a radiologist and a trauma imaging specialist. The images have also been assessed by an independent Iranian former ER doctor, who says the software used to capture them is consistent with that used in the hospital concerned and that they show no signs of tampering. Descriptions of the extent of the likely injuries are based on the doctors’ assessments, although they caution that without full medical notes and multiple sets of imaging, they cannot make definitive diagnostic statements about individual patients. Dr Rohini Haar, an emergency doctor, adjunct professor at UC Berkeley and medical adviser to Physicians for Human Rights who has reviewed the files, says the cases are “shocking” in their number and severity. “Using live ammunition and large-gauge bullets against so many individuals is … extremely unusual and notable, even globally.”

A radiologist and trauma imaging expert who has reviewed the images says that the group of patients would constitute “absolutely a mass casualty situation. Even for our large hospitals [in the US] … that would be a mass casualty alert that would overwhelm hospital resources.”

Medical experts note that the images would only reflect patients that doctors think they can save, and who have survived to the point where doctors are able to administer detailed scans. Most people shot by a high-calibre round to the head, for example, “wouldn’t have got to a CT scan”, they say. During a mass casualty event, hospitals are forced to prioritise the cases that are life-threatening but treatable without requiring extensive resources, Haar says, meaning that the scans would only represent a small subset of the injured people who presented that night.

Iran is one of a small number of states where armed forces and police use metal birdshot. While an individual birdshot pellet does not cause as much damage as a bullet, they can still be catastrophic. At long range, when the pellets spray outward, they will hit a crowd indiscriminately. Even a single pellet can cause terrible damage. The X-rays show several cases where just one or two pellets are present in the skull (indicating the person was likely hit at longer range), but they appear to have pierced the eye and come to rest in the socket. At close range, a person may be pierced by hundreds of pellets, causing the destruction of all surrounding soft tissue >>>