War Hospital Read online

  War Hospital

  Sheri Fink

  In April 1992, a handful of young physicians, not one of them a surgeon, was trapped along with 50,000 men, women, and children in the embattled enclave of Srebrenica, Bosnia-Herzegovina. There the doctors faced the most intense professional, ethical, and personal predicaments of their lives.

  Drawing on extensive interviews, documents, and recorded materials she collected over four and a half years, doctor and journalist Sheri Fink tells the harrowing—and ultimately enlightening—story of these physicians and the three who try to help them: an idealistic internist from Doctors without Borders, who hopes that interposition of international aid workers will help prevent a massacre; an aspiring Bosnian surgeon willing to walk through minefields to reach the civilian wounded; and a Serb doctor on the opposite side of the front line with the army that is intent on destroying his former colleagues.

  With limited resources and a makeshift hospital overflowing with patients, how can these doctors decide who to save and who to let die? Will their duty to treat patients come into conflict with their own struggle to survive? And are there times when medical and humanitarian aid ironically prolong war and human suffering rather than helping to relieve it?

  Sheri Fink

  WAR HOSPITAL

  A True Story of Surgery and Survival

  To my parents and grandparents

  and the doctors and nurses of eastern Bosnia

  Medical ethics in time of armed conflict is identical to medical ethics in time of peace… The primary obligation of the physician is his professional duty; in performing his professional duty, the physician’s supreme guide is his conscience.

  The primary task of the medical professional is to preserve health and save life.

  —Regulations in Time of Armed Conflict, World Medical Association, 1956, 1957, 1983

  The doctor’s fundamental role is to alleviate the distress of his or her fellow men, and no motive, whether personal, collective or political shall prevail against this higher purpose.

  —The Declaration of Tokyo, World Medical Association, 1975

  Map

  CAST OF CHARACTERS

  MAIN CHARACTERS WITH AGES AT THE BEGINNING OF THE BOSNIAN WAR IN SPRING 1992

  ALÍĆ, EJUB, 32 (AH-leetch, Ey-yoob)—Physician at Srebrenica (SREBREHN-EET-SA) war hospital, separated from his wife and young son. Born in a small village and worked as an internal medicine resident in Bosnia before the war. Heavyset, with a round face, a good sense of humor, and a weakness for plum brandy.

  DACHY, ERIC, 30 (Dah-shee)—Head of the Doctors Without Borders mission in Belgrade, Serbia. Responsible for aid to eastern Bosnia. Belgian family practitioner. Passionate and outspoken. Wears a trademark black leather jacket and ponytail.

  DAUTBAŠIĆ, FATIMA, 26 (dah-UTE-bah-sheetch, fah-TEE-mah)—Physician at Srebrenica war hospital. Family practitioner before the war. Girlfriend of Dr. Ilijaz Pilav. Has long, dark hair, beautiful eyes, and a high-pitched laugh.

  LAZIĆ, BORO, 27 (LAH-zeetch, BOE-roe)—Physician with Bosnian Serb forces across the front lines from Srebrenica. Friends with several Srebrenica doctors and nurses before the war. Slender, with light brown hair, blue-green eyes, and a boyish face.

  MUNJKANOVIĆ, NEDRET, 31 (mooy-KAHN-oh-veetch, NED-reht)—Surgical resident who volunteered to walk to Srebrenica across enemy territory in August 1993. Handsome, with an athletic build, a clean-shaven face, and a highly charismatic, if temperamental, personality.

  PILAV, ILIJAZ, 28 (PEE-lahv, ILL-ee-ahz)—Physician at Srebrenica war hospital. Born in a small village near Dr. Ejub Alić. Worked as a general physician before the war. Boyfriend of Dr. Fatima Dautbašić. A tall, gaunt, and unassuming man with a scraggly beard and mustache.

  THE OTHERS

  BOSNIAN DOCTORS WORKING IN SREBRENICA:

  DŽANIĆ, NIJAZ (JAHN-eetch, NEE-yahz)—Physician at wartime clinic for civilians in Srebrenica. Internist in Srebrenica before the war.

  HASANOVIĆ, AVDO (hah-SAHN-oh-veetch, AV-doe)—Director of Srebrenica war hospital. Pediatrician before the war.

  STANIĆ, BRANKA (STAHN-eetch, BRAHN-kah)—Physician at Srebrenica war hospital. Graduated from medical school just before start of war and went to work in Switzerland. A Catholic Croat in a mostly Muslim town.

  DOCTORS WITHOUT BORDERS DOCTORS, NURSES, AND LOGISTICIANS:

  PONTUS, THIERRY (PON-toose, TEAR-y)—Belgian surgeon. Worked in Srebrenica in 1993.

  WILLEMS, PIET (VI-lems, pete)—Belgian surgeon. Worked in Srebrenica in 1993.

  ULENS, HANS (OO-lens, hans)—Dutch logistician. Worked in Srebrenica from 1993 to 1994.

  DUONG, NEAK (dwong, neek)—French surgeon. Worked in Srebrenica in 1994.

  SCHMITZ, CHRISTINA—German nurse. Worked in Srebrenica in 1995.

  PROLOGUE

  THE SURGEON SHOWED UP wearing gym clothes. We met in the smokefilled interior of one of Bosnia’s best hotel cafés, where, gesturing, drawing, and occasionally lifting his tall, athletic frame from his seat to underline a point, he told me the story that had made him famous. It began with his hike across twenty-five miles of enemy territory to reach the besieged eastern Bosnian town of Srebrenica. There, along with a small band of village doctors, most barely out of medical school and not one a surgeon, he ministered to the medical needs of 50,000 people. Rudimentary equipment and the lack of electricity, running water, and often anesthetics were just the beginning of the hardships. These doctors and nurses were visited by nearly every imaginable affliction of modern war.

  The handsome, dark-haired doctor regaled me for two full days, interrupting our conversation only to greet well-wishers, who called him by his first name, “Dr. Nedret.” His casual dress reflected confidence and charisma befitting a man who embarks on a journey knowing that it can lead to one of only two endpoints: martyrdom or magnificence. Nedret told me a story of triumph and tragedy, heroism and human weakness, of friendship and love surviving against all odds in a climate of anger and vengeance. All this took place in the town of Srebrenica, which, attacked in the presence of U.N. soldiers, became a central testing ground for U.S.-European relations, NATO’s post–Cold War significance, and what U.S. President George Bush senior dubbed “the new world order.”

  * * *

  WHAT LED ME TO Dr. Nedret Mujkanović (and later his less hyperbolic but equally impressive fellow doctors of Srebrenica) was a conference on “Medicine, War, and Peace” that I attended my final year as a medical student. The winter conference took place in an unheated Bosnian medical school auditorium beneath blown-out windows, unrepaired two years after the war. One by one, doctors, nurses, and aid workers related wartime experiences that had pitted their personal struggle for survival against their duty to practice medicine.

  Those stories led me to reflect on my previous conception of war medicine. The popular culture depicts war as a rite of passage, a proving ground for the famous surgeon-pioneers, and a culture medium for history’s greatest medical advances. The words of a British physician from the turn of the last century epitomize this view: “How large and various is the experience of the battlefield and how fertile the blood of warriors in the rearing of good surgeons.” This cheery quotation graces the preface to NATO’s official war surgery handbook and is so well-known that it was repeated to me by a war doctor in Bosnia (who attributed it, interestingly, to a Russian).

  But even the peacetime practice of medicine in the most technically advanced country of the world sometimes crushes doctors’ personal lives and professional development. Years of rigorous, all-consuming training, unreasonable hours, sleep deprivation, pressure to be superhuman and perfectionistic, and repeated exposure to life-and-death dilemmas often dehumanize doctors and lead them to burn out and neglect their own heal
th and well-being. Having known American doctors who committed suicide, abused drugs, or made serious mistakes under the pressures of normal medical practice, I wondered whether a “fertile rearing” was really what the Bosnian war doctors had experienced. I returned to Bosnia the following year to find out.

  Those first two days I spent with the war surgeon, Dr. Nedret, offered nothing to contradict and much to support my initial, romantic notions. War had left him an optimist. It gave him plenty of chances to hone technical skills, devise ingenious adaptations to seemingly impossible situations, and perform uplifting, sustaining, purposeful work in bleak and tragic circumstances. As I probed deeper and met more doctors who’d worked in Srebrenica, though, I learned that the constant grind of not only living through war, but also treating its most severely affected victims, led some lifesavers to hopelessness, despair, and even criminal activity.

  Medicine and the war in Bosnia, I discovered, were intricately intertwined. In Bosnia, doctors, aid workers, and patients, in spite of their “protected” status under international law, became the earliest and among the most regular targets of war. Conversely, several physicians instigated and led the war’s campaigns of “ethnic cleansing” and genocide. And finally, at times aid efforts paradoxically stood in the way of more decisive actions to bring peace and were used as shameful cover for international failure and inaction on diplomatic and military fronts. It took the killing of most of Srebrenica’s adult male population, the largest massacre on European soil in nearly half a century, to move the powerful nations of the world to action.

  * * *

  THE STORY OF SREBRENICA AND ITS DOCTORS so impressed me that I spent the next four and a half years pursuing its details. What happened when doctors—community leaders used to having the power to fix things—realized that bandaging patients’ wounds did nothing to address the root causes of their suffering? Were the ethics of medicine in wartime truly identical to the ethics established for peacetime? Did the international conventions protecting and governing the practice of medicine and delivery of aid need updating in this post–Cold War–type conflict? These were some of the questions I set out to answer. Because enemy forces had overtaken the town, including the hospital, dispersing or killing all of its medical workers and patients, my work involved combing Bosnia and the world for survivors and sneaking around Srebrenica’s abandoned hospital in pursuit of a story that gripped me ever more tightly.

  What I found in Bosnia was a story of individual doctors that highlighted, clarified, and personalized a war so many people outside found confusing and that offered insights into larger questions about how “regular people” with no conscious desire to fight (with, in fact, a sacred pledge to sustain life) were caught up and participated in war. I chose to reconstruct a narrative from the perspective of several doctors—Bosnian Muslim, Bosnian Serb, and international from Doctors Without Borders—whose individual backgrounds, personalities, and beliefs led them into and out of the war zone at various times, responding in very different ways to the challenges that faced them. What linked them, besides the three-story Srebrenica Hospital building, was their confrontation, at least once, with that ultimate doctors’ dilemma—whether to serve their patients or save themselves.

  These individuals offered hundreds of hours of their time, recalling in great detail the most difficult days of their lives. I was most surprised by the extent to which their work influenced the war itself. Doctors mixed medicine with advocacy, community organizing, and politics. Some—with the painful conviction that they could save more lives by taking lives—shook off their white coats, picked up guns, and turned themselves into fighters. Here is their story.

  PART ONE

  BROTHERHOOD AND UNITY

  There was a time when meadow, grove, and stream,

  The earth, and every common sight,

  To me did seem

  Apparell’d in celestial light,

  The glory and the freshness of a dream.

  It is not now as it hath been of yore;—

  Turn wheresoe’er I may,

  By night or day,

  The things which I have seen I now can see no more.

  —William Wordsworth (1770–1850) Ode, Intimations of Immortality from Recollections of Early Childhood

  For men to plunge headlong into an undertaking of vast change, they must be intensely discontented yet not destitute, and they must have the feeling that by the possession of some potent doctrine, infallible leader or some new technique they have access to a source of irresistible power.

  —Eric Hoffer, The True Believer

  1

  FIRST DO NO HARM

  THE NURSE’S HANDS FLUTTER AROUND THE PATIENT, but the doctor just stands and stares. He squeezes his right fist around the white cloth he used to dry his hands, crushing it, and then opens his hand, finger by finger. Squeezes. Then opens.

  A technician bending over the patient straightens, wiping his bare hands on his white coat. Another leans over to fillet the patient’s blue jeans with a pair of scissors.

  Summer sunlight floods through the large, wood-trimmed window and pools on the patient’s right leg. The knee looks normal. But the swollen, blotchy skin below it leads to a foot mummified in layers of bloodstained, torn bed sheets. The medical technicians begin unwinding the improvised bandage.

  Dressed in a white gown, round face and brown sideburns capped by a blue paper hat, thirty-two-year-old Dr. Ejub Alić stands back from the table. A man taping the operation with a camera powered by a car battery softly begins to narrate. It is July 17, 1992, at 2:50 P.M. The hospital in Srebrenica, Bosnia, closed for the first three months of war, reopened only five days ago. And Ejub, a pediatrics resident accustomed to treating kids’ sore throats and earaches, is being asked to amputate a young man’s leg. He watches the nurse pull off the last cloth strip, baring the full, damning evidence of the injury to everyone’s eyes and nostrils. An exploding mine has bitten off the bottom of the foot and left two flaps of skin yawning around the patient’s missing heel. During the time it took for the patient’s family to get him here, arranging for a horse and cart and driving through a dozen miles of mountainous territory partly held by the enemy, bacteria have digested the remains into a tangle of blackened sinews.

  There is no monitor here, but Ejub doesn’t need one to tell him that the heart of this patient—not much more than a boy, really, twenty years old, lying on the orange cot still in his jeans and beige T-shirt—is beating quickly. Blood loss, fever, raw fear. The patient’s well-defined muscles evince the three months he’s spent hefting a rifle and ammunition around the hilly, forested, some would say backward, border country of eastern Bosnia. When war exploded on the eve of Bosnia’s independence from Yugoslavia and Serb nationalist forces quickly took control of two-thirds of the republic’s territory, this young Muslim man picked up a hunting rifle and fought to protect his family’s village east of Srebrenica. So far he has helped save its citizens from the fate suffered by thousands of Muslims throughout Bosnia—deportations, imprisonment in concentration camps, executions, and massacres.

  The young man’s pallor gives him a weakly appearance. He has curled his left arm to his chest, as if bracing himself, and on his wrist, a large, steel-colored watch ticks away the time. Someone has draped a small towel over his eyes, shielding him from the sight of what will come.

  A nurse bends over the leg and shaves it with bare hands and a serious expression, ignoring the putrid smell. A tendril of dark hair escapes her blue cloth cap and curls beneath the birthmark on her left cheek. When she finishes, Ejub repeats her work, picking up the razor and inching it up from the blue, livid ankle to the pink, healthy thigh, postponing the inevitable moment when his scalpel will meet skin. Neither he nor any of the handful of doctors who have, over the past few days, made their way from islands of neighboring “free” Bosnian territory to the town of Srebrenica has experience as a surgeon. Ejub cannot recall surgery ever having been performed in this small, Spartan
hospital, where women used to come to give birth before the war. No, Ejub is no surgeon, has never aspired to be a surgeon. Although he has talent for fine manual work—he practices woodcarving—his short, chubby fingers make performing even some non-surgical medical procedures difficult. But now he has war experience, having worked as the sole doctor in a nearby Muslim village that was isolated for the war’s first three months. Here, there is no one any better qualified than he, and if he doesn’t try to do something, this young man will most certainly die.

  Ejub drops the razor into a beaker full of hydrogen peroxide. Used in the production of rockets and torpedoes, paper, chemicals, and car batteries, here in the operating room it serves as a sterilizer. Some townspeople found a cache of the liquid treasure at the abandoned battery factory up the road. Others diluted it with water purified in fifty-liter vats used, in better times, for distilling plum brandy. War is full of such small, absurd ironies. A 3 percent solution oxidizes bacteria to death without harming human tissue. If Ejub didn’t have it, he’d be stuck in American Civil War–like conditions. One out of three amputation patients used to die from infection or blood loss. Sterile technique, shown to prevent infection by Joseph Lister in 1865, catapulted survival rates and stood as one of two great surgical advances of the century. Ejub calls hydrogen peroxide “Bosnia’s greatest war hero.” Little jokes like this keep him going.

  At the moment, Ejub isn’t smiling. The ability to sterilize equipment and apply an antiseptic puts him only one foot into the nineteenth century. The century’s other great discovery—general anesthesia—is not something Ejub has to offer his patients. All he has are two syringes of precious local anesthetic swiped from the town’s abandoned dental clinic. They lie in a silver pan before him. Ejub knows how to use the anesthetic to numb the skin, but not to prevent pain in deep structures such as bone. When he thinks of the fact that the injured foot connects to a conscious human being, he wonders whether it would be better, in some cosmic sense, not to operate. Not long ago, when faced with his first amputation, he felt so powerless that he prayed to God for the suffering patient to die before he began. And—regardless of the fact that he’s trapped in what some people are calling a “religious” war—Ejub does not even believe in God.