The stooped and withdrawn 18-year-old breathed painfully as he relived the day last month when shrapnel from a missile ripped through his lung and bowels.

Shafiq, 6, lost his eye in an IED explosion in Helmand. Three of his playmates were killed in the blast. (Photograph: Jon Boone) It was 9am and he was out collecting fruit from his family's trees in a village so small it is not included on most maps of Helmand province.

Although it was the day of the Afghan elections he, like everyone else in his neighbourhood, had no interest in voting in an area too insecure for polling stations to open. "I was just a few steps outside my front gate when about eight rockets landed," he says, sitting in a hospital in the provincial capital of Helmand, bandages around his chest. "I was hit and ran into the house where women and children were yelling because a rocket had also landed on one of the rooms."

He is convinced that it was a rocket from "foreign forces" ‑ something that the hospital cannot confirm, although they say the shrapnel was clearly from a rocket, possibly delivered from a helicopter.

With his lung filling up with blood and an equally potentially fatal wound to his lower abdomen all the village "medical worker" could do was wrap him up and begin the arduous business of moving him along roads littered with IEDs and checkpoints to a place where his life could be saved. It took more than a day for him to arrive at the Emergency Hospital in Lashkar Gah. The immaculate surgical facility run by an Italian charity, with a policy of not asking patients about how they received their injuries, does not turn away anyone. "He certainly would have died if he had not come here," says Mirco Barchetta, the hospital's head nurse, who is only allowed to travel between his nearby secure compound and the hospital in one of Afghanistan's most dangerous cities.

The hospital has received a monthly average of 183 patients in the last three months, half of them wounded from bullets, bombs, rockets and shrapnel.

The young man, who does not want his name or that of his village revealed, said the fight during which he nearly died was initiated by rebels but much of the damage was done by foreign soldiers: "The Taliban fired rockets from behind our village towards the foreign forces base and they started firing back."

That sense of hopelessness and being caught in the middle of someone else's fight came up time and again from more than 25 Helmandis interviewed last week. Civilians are being killed ‑ but just how many, and by whom, is difficult to say.

At a very rough estimate, the UN believes 1,018 civilians across the country died as a result of the conflict in the first six months of this year ‑ most of them killed by insurgents, but 30% by pro-government foreign forces.

Last Friday the issue came to the fore again when a Nato airstrike killed dozens of people, including civilians, outside Kunduz city, in the north of the country.

Such incidents do little to encourage those caught in the crossfire that their lives can be made better by a war that is causing mayhem.

To find out exactly how people are coping in Helmand, the Guardian travelled outside the usual embed arrangements laid on for visiting journalists by the Foreign Office and military.

Most of the interviewees had travelled into the relative safety of Lashkar Gah from the triangle of land north of the provincial capital which was the target of intense British activity during June and July, in an operation known as Panchai Palang or Panther's Claw.

The plan was to push the Taliban out from an area where some 80,000 people are thought to live and which had been under the control of the Taliban, and then to keep the guerrillas out of a "gated community" where non-existent government structures could start to be established.

Winning hearts and minds was the UK military's top priority, avoiding wherever possible indiscriminate air strikes, and trying to prove their presence is improving the lives of Afghans.

But that is not the way ordinary Helmandis see it. Haji Torjan, a tribal elder who looks after the affairs of 500 families in the village of Sawaki Gharbai near the Shamalan canal, which saw fierce fighting for the Welsh Guards, said foreign forces do not understand the dynamics of village life, which are too often viewed from overhead aircraft.

"We had a man in our village called Kamjan. He was an old man like me with a white beard, chosen by the village to be in charge of water distribution from the canals to our crops.

"He is an innocent man who has nothing to do with the Taliban or the government. But 11 days ago he was on his motorbike and had covered his body with his shawl, and a helicopter flying above him slowed down and started shooting and killed him."

He also said that people have been shot at for using torches at night whilst irrigating their fields or lighting lamps to prepare for the pre-dawn Ramadan meal. It's a claim made by three other people from separate villages, but is robustly denied by British officials who say that, on the contrary, they encourage people to use lights at night for their own safety.

The British also say that despite widespread claims by villagers of aerial bombardments, during the whole five-week operation, which ended in late July, they dropped fewer than 10 bombs from aircraft and the use of helicopter armaments was just over 10.

Major Jon Baxter, a senior official at the British provincial reconstruction team in Lashkar Gah, said: "We are the only people out there fighting by Queensberry rules. When people come to us they are absolutely adamant that we are responsible because they saw an Apache helicopter go overhead when they heard a Taliban mortar or IED go off. When we ask for collaborative evidence we often don't get it."

Not everyone feels able to take compensation money offered by the British.

Mohamad Salam, a landowner who spends most of his time in Lashkar Gah since fighting broke out, recently returned to a property which he said had been temporarily occupied as a British base. "Twenty days ago the British left my fort in Spin Masjid. All the windows and doors were broken but the Taliban are still in the area and they told me they would kill me if I take the money."

And there is resentment at the small annoyances of life in a counter-insurgency. "Foreign forces cannot give us security because they are too frightened about their own security for that," says Malik Shahzada, a tribal elder from Babaji. "When we go near their base they shout at us to pull our shirts up over our heads to show that we don't have suicide bombs on us."

No matter how restrained the use of force may have been, the fighting has still prompted thousands of people to flee their homes.

Crowds of women, wearing the all-encompassing burka, sit in the shade of the trees by Lashkar Gah's main roads, begging for money. Nearly all of them are refugees of one sort or the other who either arrived recently, or up to three years previously when British troops first deployed to a province which rapidly became a byword for pitched battles between foreign soldiers and battle-hardened Talibs.

Another man and woman had been reduced to waiting for handouts from the local office of the ministry of rural rehabilitation and development. They had been there for a month from Khushal, their village in Nad Ali. "We are caught in the middle between the firing of the Taliban and the Americans. I had a big, eight-room house but it was destroyed by rockets from both sides. My plan is to go back, but just yesterday there was more fighting."

As with everyone else interviewed he appeared to dislike the Taliban at least as much as the "foreign forces", as the British are mostly known (although occasionally they are called the "Red English", apparently in part because of the resemblance of their complexion to pomegranates and partly because of memories of the Soviet Red Army in the 1980s).

"The fighters come to our village and demand to be fed. The whole village has to supply a few pieces of bread each, which is very hard on poor people like me."

On Thursday afternoon, across the road from the Emergency Hospital, the father of a six-year-old called Shafiq took his boy to sit on the manicured lawns of a park built with US money after being discharged from hospital. Surgeons were unable to save his eye, ripped out by the explosion of an IED he and seven other friends were playing with almost two weeks ago. Three were killed instantly, while the other five were badly wounded.

"The foreign forces don't come there much but recently there had been an operation in the area between foreign forces and the Taliban and it was left over from that," says the father, whose other son also lost an eye in the incident. "It looked like a ball and they were throwing stones at it."

Even a heroic group of taxi drivers who risk their lives daily operating a rag-tag ambulance service for the Red Crescent are not immune from Taliban threats. When they try to get into an area they leave their identity cards and phones behind so there is no risk of the guerrillas discovering they work for a humanitarian organisation.

"Under the Taliban, the Red Crescent was treated with respect but now they say you are paid by the foreigners, you have lost your faith," says Mohamad Qazi, a driver from Lashkar Gah with basic first aid training. "It can take so long to get anywhere that the patient often dies in the car."

They say that the run from Lashkar Gah to the town of Babaji is impossible because of landmines and checkpoints on the main bridge which the British insist is open to traffic.

"Patients have to be brought on donkey to the river where we use a car tyre tube to float people across the river to where our drivers can pick them up," says Sultan Mohamad, a Red Crescent volunteer.

Mohamad, a resident of Babaji who also drives taxis, says it has become harder to work out where the mines are buried: "Previously they left secret signs so we would know where the mine was. But that was found out by the foreign forces. Now nobody can tell where they are. Sometimes the Taliban just tell us to stay off the roads, but don't show us where they are." Another man, Mohamad Iqbal, also from the Babaji area, says some Talibs respect the pleas of villagers not to move on and not to cause trouble. But others say: "I am prepared to die, you can die too. I'm fighting and am not afraid of death and you shouldn't be either."

Panther's Claw was presented as a classic counter-insurgency operation: by clearing towns of insurgents and criminals and establishing some semblance of competent and honest local government the villagers and farmers of the agrarian communities of Babaji would firmly reject the Taliban. But if counter-insurgency theory seems obvious to foreign soldiers and western policymakers, most Afghans appear to only see yet more violence and killing.

By his own description, Haji Torjan's village has been comprehensively protected by the British effort: "The Taliban are not in our village. We are surrounded by foreign forces' bases and checkpoints. The Taliban are far away. But we don't call this protection ‑ we are being killed and injured," says Haji Torjan, who also has a son and a nephew recovering in hospital from shrapnel wounds.

It is not clear how comfortably the west's new counter-narcotics strategy is sitting with the hearts and minds strategy.

As part of the push to win hearts and minds in Helmand the poppy field eradication campaigns of the Bush administration, which often ended up targeting poor opium farmers or share croppers, have been abandoned in favour of increased assistance to help farmers grow legal crops. But the attacks on drug traffickers are just as unwelcome to the population, says Haji Torjan.

"When they do an operation against drug dealers they surround the village and an aircraft that just flies overhead. After that two or three other big aircraft land on the ground and surround the house. Then they start climbing over the walls and roofs and start killing and shooting." The British admit lives have been disrupted during Panther's Claw but they say life has begun to return to normal and that they have moved on to the second stage of operations ‑ attempting to establish the writ of the state in areas that were almost entirely under the thumb of the Taliban.

According to Gulab Mangal, the dynamic governor of Helmand who has won much praise during his year and a half in the job, there are 150 policemen and 100 Afghan soldiers in the area.

But he admits there is a problem with the behaviour of police stealing from locals and generally harassing communities.

Baxter urges patience, saying the success of the operation will be clear in the long-term: "In the fullness of time they will start to see the dividend of this. It's a slow burner and a tremendous amount of good work has been done."

Hopefully it will come right in time for the boy in the Emergency Hospital with shrapnel wounds in his chest. As the Guardian concluded a 40-minute interview with him last Wednesday, the already withdrawn and nervous teenager began to panic about what would happen if any discovered he had been talking to a British journalist.

"The Taliban are going to kill me," he mumbled to himself repeatedly.

Nothing the Italian nurse could say could convince him otherwise.