The wounded were brought in on a motorbike trailer. The sun was up and the heat and pain had thrown a sheen of sweat on their faces. One was missing a leg at the knee; the other three had suffered the wicked injuries of shrapnel to their lower limbs. Such wounds would guarantee a British soldier immediate evacuation from the war zone, followed by lengthy medical rehabilitation in Britain. But these were Afghan children — three siblings and a cousin — dull-eyed and mute with trauma. The oldest was aged 10, the youngest 4.

They had just returned to one of the areas of Helmand province in which the fighting is most intense — the very one in which they had recently been wounded, their family torn apart — in the desperate hope of receiving further treatment from British soldiers in Sangin.

The medics cut the old dressings from the children’s wounds, and were outraged. They had treated the same children nearly three weeks ago and had expected them to be recovering in an Afghan hospital, not returning with suppurating infections, including gangrene.

“This is the most disgusting thing I’ve seen here,” said Captain Rob Wise, 26, Sangin’s medical liaison officer. “The IED [roadside bomb] wounds we see are terrible, but what we expect. But this? The complete disregard for these children’s care is abhorrent.”

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The children were part of an impoverished farming family living in the fertile area along the Helmand river, just south of Sangin. On August 10 the Taleban attacked a nearby patrol base manned by Afghan and British troops. There was a brief firefight. It is uncertain who caused the explosion that tore through the yard of the family compound. The family blames the Afghan National Army.

Three small boys, none more than 4 years old, were killed instantly by the blast. Five other children and two women were seriously wounded. Without assistance from either side, survivors carried the wounded in wheelbarrows to the main British base, Forward Operating Base Jackson, in Sangin. They were given immediate treatment there, and within an hour were evacuated by helicopter to the British-run hospital in Camp Bastion for surgery.

There, one of the women, hit in the stomach by shrapnel, lost her unborn baby. The same woman’s daughter, aged 3, also died of her wounds.

At this point, owing to the pressures and confusions of the war in southern Afghanistan and the vagaries of the local health system, their care started to fall apart.

At the moment, two thirds of the beds in Camp Bastion’s military hospital are taken by Afghan civilians. The hospital excels in trauma care but has to move casualties out for subsequent treatment as soon as possible so that it can deal with the fresh numbers of incoming wounded, of whom there are many. The rate of Nato casualties last month exceeded that of any month since Western troops arrived in Afghanistan eight years ago.

Thus only two days after the survivors were operated on, the four children — three of whom require skin grafts — were moved to Kandahar where they were handed to the care of the local general hospital. Their wounded mother remained separated from them, in a military hospital in Helmand. What happened next remains unclear. Hospital records in Kandahar prove that three of the four children were admitted to the government-run Mirwais hospital on August 12. The fourth, a boy aged 4, with serious groin and leg injuries, somehow made it to Kabul, an eight-hour drive to the north.

Medical officials involved with Mirwais hospital insist that the children were seen there by doctors but that their family had them discharged against medical advice. The family denies this.

“I would rather see these children die here than get the treatment they got in Kandahar,” said Qarim Dad, 70, the children’s great-uncle, as the medics in Sangin cut the dressings from limbs. “In Kandahar hospital they lay for eight days before a doctor even looked at them. Now their wounds are all infected — worse than they were before.”

Whatever the case, by the time the children reappeared in Sangin, having been driven more than a hundred miles through the war zone in a taxi, their wounds had begun to rot. One young girl, Razia, may lose one of her legs to infection as a result.

If the family hoped that the children could be readmitted into a hospital run by Isaf (Nato) personnel they hoped in vain.

“The Isaf hospitals are full of Afghan civilians and we have to leave space for Isaf soldiers,” Captain Jennie Johnston, 30, the medical officer in Sangin, told a relative of the children as she examined their injuries. “It breaks my heart, but these are the rules — we have to get them back into the local care system.”

Had Sangin’s own development managed to progress much beyond the narrow swath of land around the British camp in the past three years then its healthcare system may have met the children’s short-term requirements.

But the Afghan Health Ministry has not staffed or equipped either of Sangin’s two clinics, one of which was refurbished with British funds. Neither of them functions. If you are poor and wounded in Sangin this summer, your options are thin.

“Who could tolerate seeing their children like this?” murmured Qarim Dad, turning away, his eyes briefly filling with tears, as the wounds were revealed. “It’s our curse that we have no money and that local doctors cannot aid us. I don’t want to take them back to a local hospital. Nothing will be done there. They will be at more risk.”

The medics did what they could. They removed the embedded skin staples and old stitches, sterilised the children’s wounds and gave them fresh dressings. They advised their uncle to take them 45 miles to Helmand’s provincial capital, Lashkar Gah, and seek treatment there at the Italian-run Emergency Hospital.

They gave him $150 (£90) — on top of the $200 handout the family were originally given from British funds to help to deal with their five dead and six seriously wounded — to cover the travel fares. They helped to load the children, who uttered barely a word throughout, back into the motorcycle cart, along with their medical documents, a supply of antibiotics and morphine. They said goodbye. They watched them drive away into the feral badlands of the Upper Sangin Valley and wondered what would become of them.

They may wonder still. By Sunday night, three days later, there was still no record of four wounded children having ever arrived at the Emergency Hospital in Lashkar Gah.