War Hospital

by Sheri Fink

  When Eric Dachy went to MSF in 1991 it was the beginning of what cultural critic David Rieff dubbed the “era of the NGOs.” Governments and funding agencies increasingly chose non-governmental organizations to implement aid programs because of their efficiency compared with large, intergovernmental organizations such as the United Nations. More importantly, the “right to intervene” to alleviate human suffering, which MSF co-founder Dr. Bernard Kouchner dubbed droit d’ingérence, was perched to leap from operating principle of humanitarians to foreign policy of nations.

  In April 1991, MSF assigned Eric to the border of Iraq and Turkey to respond to one of the largest and fastest refugee outflows in recent history. Saddam Hussein’s forces’ brutal suppression of a Kurdish uprising in the wake of the Gulf War sent up to 2 million Iraqi Kurds fleeing northward toward Turkey and Iran. Making an unprecedented linkage, United Nations Security Council Resolution 688 labeled Iraqi “repression” a “threat to international peace and security” and insisted that Iraq allow humanitarian organizations to assist the displaced. Kouchner, who had left MSF and become a French government minister for health and humanitarian action, helped draft the historic resolution.

  A U.S.-led thirteen-nation coalition force then created a “safety zone” in northern Iraq, allowing aid workers to operate and Kurdish refugees to return home. Operation Provide Comfort erased the thick line between military and humanitarian work and so marked a new development in the discipline of humanitarian aid. Groups such as MSF, the United Nations High Commissioner for Refugees (UNHCR), and the Red Cross worked in cooperation with coalition troops. Kouchner championed state involvement in aid delivery, arguing that humanitarian intervention was inherently political and NGOs were too weak to accomplish their objectives when opposed by controlling powers. More traditional humanitarians, though, argued that states’ intentions could not be purely humanitarian and worried that involvement with the military would undermine their own neutral status.

  Eric Dachy packed his bags quite unaware of and uninterested in any philosophy of humanitarianism. He joined MSF because he wanted to do “something altruistic” for the Kurds. As a physician bored with the sprained ankles and tummyaches of suburban general practice, he was simply looking for the chance to treat and even cure patients with serious health problems. He arrived in Üzümlü, a muddy, hilly border village full of mountain views, Kurdish refugees, and cholera, and spent the next three months treating hundreds of very sick and shell-shocked patients with a combination of medicine and psychotherapy. He marveled at how instantly useful he felt as a doctor. His boredom vanished.

  Eric returned to Belgium and told MSF he wanted to do it again. He closed his medical practice and awaited his next assignment. It came quickly. Labeled an expert after just three months in the exigent world of aid work—with its ever-shifting cadre of workers, never quite enough of them, never quite as well-trained or experienced as they should be—MSF sent him to central Africa to help the government of Chad fight cholera.

  He had a disappointing three months. The government strictly prohibited him from treating patients or improving the curative programs he found inadequate, and Eric grew angry and disillusioned. He discharged his fury in a letter to MSF headquarters in Brussels, but after finishing his mission he readied himself to go out again. He wanted to help people in need. He had learned that aid work wasn’t perfect, but he still believed in MSF, and MSF, because it valued strong opinions and new ideas, still believed in him.

  The hot tropical sun still fresh on his skin, he awoke one morning in November 1991 to a call from MSF, this time to go to Yugoslavia. “For a few weeks,” the voice on the phone said. “Can you leave immediately?”

  The next morning at MSF’s Brussels headquarters, Eric was briefed on his mission. He knew almost nothing about Yugoslavia, a disintegrating, post-Communist Eastern European country. After World War II, the Partisan hero Josip Broz “Tito” had gathered six Balkan republics together into the Yugoslav Federation: Serbia, Croatia, Bosnia-Herzegovina, Slovenia, Macedonia, and Montenegro. The ethno-religious makeup of each republic was different, but this “Land of the South Slavs” was mainly populated by closely related Slavic peoples who had converted at various points in the history of empires to Orthodox Christianity (Serbs, Montenegrins, and Macedonians), Catholicism (Croats and Slovenians), and Islam (Bosnian Muslims), along with significant populations of ethnic Albanians, Hungarians, Jews, and others.

  Tito tolerated no divisiveness between the groups, which had fought bitterly, but also had traditions of peaceful coexistence. Some believed this served to sew up a dirty wound—it left dangerous emotions festering within hearts and in families, infecting new generations at dinner tables, rather than allowing the grievances to be aired and cleared in the larger society. Others believed that covering up the past was the best way to move forward in peace for groups of people so geographically intermixed that they obviously had to coexist. For a long while it worked. The younger generations, especially city residents, ignored the past and stopped caring about what ethnicity or religion they were supposed to be.

  Tito died in 1980 without leaving a successor, and the fairly prosperous country backslid into the worldwide recession. Serb intellectuals, voicing sentiments forbidden during Tito’s rule, began complaining that Serbs, the most numerous group in Yugoslavia, lacked power commensurate with their numbers and were in some areas “endangered.”

  A Serb politician, Slobodan Milošević, found that appealing to Serb nationalist sentiment won him support and the leadership of the Serbian Communist Party. Through various tactics, he came to control half of the votes in the Yugoslav federal government, where the leaders of the six republics and two autonomous provinces now shared power. Multi-party elections in other republics brought nationalists of other ethnicities to office who opposed Serbia’s domination. After holding referendums, the republics of Croatia and Slovenia declared independence from Yugoslavia on June 25, 1991. Slovenia quickly resisted intimidation by the Yugoslav army, but Croatia had a significant Serb minority who feared they would lose power and suffer violence in a newly independent nationalist Croatian state. The Serbs’ fears were fanned by both Croat provocations and a media blitz of nationalist Serb propaganda. Croatia disintegrated into war between pro-independence Croatian forces and a combined force of Yugoslav National Army and Serb irregular units.

  “We have no dog in this fight,” said the U.S. Secretary of State, and, for the first time since World War II, the United States stepped back and left responsibility for an issue with significant security implications to the European Community, which failed to stop the fighting. In September, the United Nations imposed an arms embargo on all of Yugoslav territory. This served to favor the Serb-dominated Yugoslav army—the sixth largest in Europe—which had stockpiles of weapons and its own strong armaments industry.

  Eric’s mission was to evacuate war-injured patients who were huddled in the basement of a hospital in a Croatian city, Vukovar, that was being held under siege by the Yugoslav National Army and Serb irregulars. Several weeks earlier, in mid-October, an MSF representative based in the Croatian capital, Zagreb, had struck a deal between Yugoslav and Croatian rebel forces for evacuation of Vukovar’s injured patients. On the way out of Vukovar with the first group of 109 critically injured patients, the twelve-vehicle MSF convoy fell under a shower of mortar fire. Later a land mine exploded, maiming two MSF nurses, on a road the convoy had been directed to take by the Yugoslav National Army. MSF’s leaders had unknowingly participated in a plan that linked the organization’s access to the hospital with the safe passage of Yugoslav forces from an army barracks in Croatia. The incident shocked the MSF workers, who had never before experienced being targets. And being lied to.

  More than fifty other wounded patients were still waiting to be evacuated from the bombarded hospital, which had no running water or stable source of electricity. Eric was being dispatched to the capital of Yugoslavia—Belgrade, Serbia. Far fro
m the area of conflict, he’d be working to convince high-ranking Yugoslav Army officers to allow MSF to complete the evacuation.

  He arrived two days later and took time to familiarize himself with the warm, autumnal capital, noting the proud and handsome features of its residents. He strolled along wide boulevards flanked by ugly, socialist-style buildings and turned onto small sylvan streets lined with old square houses capped by terra-cotta tiles. He visited the city’s central park where the Sava and Danube rivers meet, overlooked by an ancient fortress, Kalemegdan, where Serbs were trapped by marauding Turks, a perpetual reminder of hundreds of years of hated Ottoman rule and the inspiration for epic poems about Serbians’ mythic suffering. The next day he awoke early and rolled out of Belgrade in an old Lada sedan, heading northwest toward Vukovar. The Russian antique belonged to the only driver Eric’s translator could find whose hunger for money surpassed his fear of driving into an artillery barrage. Confident, inexperienced, and armed only with good intentions, Eric fully expected to enter the besieged city to assess the medical situation. But, after more than fifty miles and several police checkpoints, Serb soldiers stopped the car at a sign marked “ratna zona.” War zone.

  The soldiers refused to let them proceed.

  “Impossible. Far too dangerous,” they said, which struck Eric as ironic because, after all, the danger came from the soldiers themselves. He stepped out of his car and listened to the boom of heavy guns, feeling each detonation shake the ground and echo in his belly.

  Having failed to break the siege lines, he visited a few nearby health clinics and rode back to Belgrade in the dark. That night he couldn’t sleep. He sat in an old armchair by the window of his room, facing the moonlit garden. He closed his eyes and thought of Vukovar, thoughts he would record in a chronicle of his experiences:

  What if chance had led me to be born there? Would I have had the wherewithal to escape in time? I’m not sure. I can easily imagine having chosen to remain, having refused to believe that everything was going to hell. Now, I, too, would be a prisoner, trapped under bombardment with thousands of others.

  Damn it, he would get them out. He’d do everything in his power to get them out, like a fireman carrying people out of a burning house. This, he decided, would be his mission. His only mission. MSF’s mission, too. This was a cause that would be worth any trouble, any difficulty he’d have to bear.

  He no longer considered himself a humanitarian as he had in Iraq and Chad. Here, in this place of extreme violence and sophisticated hospitals full of experienced surgeons and nurses, there was no space for a goodwilled doctor with basic medical knowledge. No space at all. Here, he would have to become an activist.

  His anxiety evaporated, replaced by a calm serenity. He believed his life had just changed. It had taken a direction.

  Over the following weeks, the sun disappeared from the Belgrade sky and the temperature sank. Every day Eric and an MSF administrator tried to gain official access papers to Vukovar, hoping to negotiate a ceasefire, bring medical supplies to the hospital, and carry out the planned evacuation. They chased from one government office to another where Communist-style apparatchiks happily clinked glasses of the plum brandy they kept in their cabinets, but refused to so much as direct them to those in charge of access to the ratna zona. At last a functionary offered the name of a top general, but they never made it past his secretary. After numerous office visits and phone calls, they garnered only a threat: Call once again and I’ll toss you in prison. Delegates of the International Committee of the Red Cross (ICRC) faced similar frustrations in their negotiations for access to Vukovar.

  In late October, as conflict had broadened throughout the Republic of Croatia, the U.N. secretary-general again designated the United Nations High Commissioner for Refugees, UNHCR, as the “lead agency” to coordinate humanitarian assistance in an internal conflict zone. Because the UNHCR had managed the large aid effort in northern Iraq earlier in the year, it was the obvious agency to task with the difficult and unfamiliar job of providing aid to besieged or displaced people who, because they hadn’t crossed international borders, lacked the official status of refugees.

  Eric Dachy, though, had already realized that aid was a secondary concern to the people in Vukovar. Radio news reported intense shelling of civilian areas. Even the hospital had been hit. Noncombatants were suffering and dying because they were being targeted.

  When UNHCR Belgrade convened a meeting of aid workers from the principal international organizations, Eric led the charge. He was a doctor, not a politician or a top-ranking U.N. official. But, like his MSF forebears who had witnessed the failed aid operations in Biafra, he burned to take control of the situation and make it right. And he believed that through MSF he could.

  “This massacre should be stopped!” he cried out at the meeting, sure that his colleagues would agree.

  But a representative from the ICRC blithely pointed out that the granddaddy of humanitarianism, the founder of the Red Cross himself, Henri Dunant, had done his good deeds for the wounded on the battlefield of Solferino, Italy, after the battle was over.

  The others concurred. Perhaps they had been around the block once too often and grown accustomed to war’s outrages. As humanitarians, international law gave them the duty and right to improve the lot of civilians and other noncombatants in conflicts. They were doing their best to achieve this. They could not stop the war or enforce the international laws that prohibit the disproportionate targeting of civilians during wartime. That was a task for states, not aid workers.

  Eric wondered whether he lived in the same world as these fatalists who shrugged and asked, “What more can we do?” How could they be so unconcerned? He left the meeting feeling alone in the urgency of his worry for the estimated 15,000 to 20,000 civilians trapped in Vukovar.

  On November 5, 1991, the presidents of Yugoslavia’s six republics signed the Hague Statement on Respect of Humanitarian Principles. In it, the leaders agreed that “wounded and ill persons must be helped and protected in all circumstances, all arrested persons, and notably combatants who have surrendered, must be treated with humanity,” and they promised “unconditional support for the action of the ICRC in favour of the victims.”

  The shelling and bombardment of Vukovar’s civilians, however, continued. Neither MSF nor the ICRC gained permission to aid the wounded. Less than two weeks after the humanitarian declaration, on November 18, 1991, Vukovar fell to the Yugoslav National Army and to local Serb nationalist soldiers. Eric Dachy raced to get there, and not only to deliver the needed medical supplies. The spirited director of Vukovar’s hospital had become a hero of the Croatian resistance. Journalists broadcast her descriptions of suffering at the hospital as it was repeatedly targeted by heavy artillery and critical supplies such as anesthetics ran dry. Eric had an inkling that as an international, his presence might protect her and her colleagues from attacks of vengeance.

  Despite his efforts, soldiers stymied him for an additional two days before promising to let him through on the morning of November 20. He left at dawn for Vukovar with a colleague and a translator. At the last military checkpoint before the city, he came across a frantic International Red Cross worker, arriving after the battle, like his predecessor, Henri Dunant, but looking mightily distressed. Gesturing wildly as he spoke to a group of soldiers at the checkpoint, he barely seemed to notice Eric. After a delay, soldiers permitted the MSF and Red Cross teams to cross the checkpoint and drive toward the city. In a few miles, a tapestry of destruction that rivaled Guernica unfolded.

  Eric peered out at the city around him. It looked like the moon. So desolate. Even the air seemed to be afraid of what had happened.

  He bumped along the pitted road, sandwiched between ruined buildings perforated by thousands of bullets, ripped by shells. Empty window frames jutted at strange angles, an occasional curl of smoke the only movement inside, an occasional red glow of fire the only color. Gray, broken trees leaned over the road, branches splayed a
t odd angles, their few dead leaves unsettled by the breeze. Dog and pig carcasses littered the ground next to cars flattened by tanks.

  It seemed surreal to Eric. This, he thought, was a city in the middle of civilization, in the middle of Europe! It was completely destroyed.

  They drove slowly in silence. Eric noticed the body of a small man wearing a cap, curled up on the side of the road as if he was asleep. For a moment, he allowed himself to imagine the man’s fight for life under siege, to wonder who he was, how he died, and why he put on his hat today. Eric wished they could stop, wake him up, and tell him that his suffering was over.

  At the hospital, Serb militiamen stood outside wearing long beards in the style—Eric was informed—of Chetniks, World War II anti-Croat, anti-Communist fighters loyal to the Serb king, themselves emulating Serb warriors who fought against the Ottomans. Eric noticed shell craters on the exterior of the hospital, and when he went inside, he found its upper floors deserted. Patients huddled in the basement and several anti-atomic shelters, for two months the only usable parts of a hospital constantly under fire. In spite of the conditions, the medical staff had somehow managed to keep the patients’ bandages clean.

  The ICRC had reached agreement with the Yugoslav National Army and Croatian authorities to “neutralize” the hospital—take control of it as a protected object under international law—and undertake an evacuation. But the previous evening, soldiers had removed the aid workers from the hospital and begun to evacuate the patients themselves. Eric looked around for doctors and nurses, but saw none. Someone told him Serb soldiers had arrested the medical workers after accusing them of experimenting on Serb patients. Eric sent his translator to ask the patients what they had seen and heard. The translator returned and whispered that soldiers had earlier arrested and taken away dozens of those sheltering in the hospital.