by Sheri Fink
One summer day, Eric performs a needs assessment at a Serbian mental institution that doubles as a chicken farm. On the way back to Belgrade, neither the bucolic scenes rolling past the windows nor the beautiful Serbian psychiatrist sitting next to him can lift Eric’s mind from the never-ending war.
“What am I doing here in all this violence?” he asks the psychiatrist. He has asked himself the question since Vukovar.
“When people are in violent situations,” she answers, “it’s usually because they’ve been there before.”
Something in that simple statement rings true to him. As time goes on and the psychiatrist’s observation percolates through him, he begins to realize that the fight between brothers in Yugoslavia is serving as a metaphor for the conflict-ridden family of his youth. His struggle to mend the twisted, broken frame of the Yugoslav family portrait is so emotional because it is also so personal. Yugoslavia has given him a second chance in his aborted attempt to fix a family. He’s been staying here, in part, as a form of “life therapy,” attempting to find himself, heal himself, reorganize himself. Why didn’t he see this before?
Now that he realizes what he is doing, he knows that any changes he is going to make as a man must come from the inside, not the outside. His past does not condemn him to a violence-saturated future. He doesn’t need a war zone to catalyze his personal growth—he can resolve his emotional issues in other ways.
He originally joined MSF with the desire to help people who really needed help, and he can put these good intentions to use in other, equally important situations. Nonviolent situations. He begins to envision engaging in “nice and positive” international work, such as immunizing and nourishing children in need.
These thoughts grow more insistent as the war in the former Yugoslavia intensifies. The summer of 1993 brings with it the first test of the “safe area” concept. In late July, Bosnian Serb forces advance on a strategic mountain above Sarajevo, shelling the capital and pulling the trigger for NATO air strikes. But instead of firing off an air campaign, NATO leaders spend weeks in discussion with U.N. officials over the procedures and circumstances whereby NATO air strikes can take place. This time, the mere threat of force makes the Serb military back down, and eventually the United Nations and NATO settle on a “dual key” approach. It requires that both the U.N. force commander for the former Yugoslavia and NATO’s commander-in-chief of Allied Forces South agree before air strikes commence. The U.N. secretariat interprets the safe area resolutions as allowing for the use of air power in three cases: self-defense, bombardments of or incursions into the safe areas, and obstruction of the free movement of the U.N. Protection Force or humanitarian convoys.
Fighting breaks out between the formerly allied Croats and Muslims in central Bosnia, complicating the war. With international diplomacy at an apogee, Eric realizes any settlement is a long way off. He has reached the limits of what he can feel for this place, these countries. He’s had it with war, violence, hatred; had it with long waits at borders; had it with kowtowing to bored, evil men. He’s especially had it with fear, with danger, with sucked-in breath as shells arc overhead.
For a while longer he battles within himself. To abandon this place and these people would leave him with a terrible guilt. In his mind, the “right” thing to do is to stay here and see his work through to the end. But what will that end be? Death is all he can see anymore. He is close to believing that his choice is either to stay here and die with the people of the former Yugoslavia or leave and save himself.
One day in his office he notices himself reading the same line over and over again. The phone feels like it weighs a ton. He manages to lift it to call his desk officer in Brussels, telling him he’s had enough of Yugoslavia.
“I’m finished,” he says. “Send me someone else.”
Within days his replacement arrives, an optimistic young woman who Eric senses has all the energy that he now lacks. He tosses her the reins of power right away. The realization that MSF’s work will continue and the world will still revolve without him here relieves him.
In late summer, he leaves Serbia. Looking back on twenty-one months of work, Srebrenica stands out as his one success. He was able to intervene there, to interpose his medical team between the Muslims and their enemies. A small international presence has saved the town—seemingly against all odds—from the grisly destiny that awaited it. This allows Eric to escape the former Yugoslavia with an important piece of his idealism intact. He still believes that individuals, dedicated to doing good, can protect vulnerable groups. Srebrenica is his sole consolation.
He returns to Belgium and visits Belgrade a few times over the coming months for brief consultancies. Then he goes on to take MSF positions in other countries, including Haiti and the United States. He does not plan to look back.
21
LIFE IN THE TOMB
FROM THE MOMENT THAT MSF brings in a large, twelve-kVA generator to replace the small one that has powered just the operating room lamp, life for Ilijaz Pilav and the other doctors in Srebrenica Hospital changes. For the first time since the war started, they can flip a light switch and see rather than feel their way blindly around the hospital, can sew up a wound or an episiotomy without a smoky makeshift candle or, at best, a flashlight. Bathed in what seems like the strongest light he’s ever seen, Ilijaz wants to stay in the hospital forever rather than go home to rooms haunted by stuttering candlelight shadows.
The hospital staff’s first impulse is to find a television and, because the signal repeaters on the hills around Srebrenica have been destroyed, a VCR. The days take on a new rhythm, with after-dinner movies almost every night in the doctor’s lounge, the “green room.” Starved for entertainment, they watch again and again the only films available—Rambo 1, Rambo 2, Rambo 3, Rocky, Vietnam War movies, and porn, varying the menu only on the rare occasions when the owner of the ad hoc movie theater in town lends them cassettes. Fatima lives next door to the hospital and spends almost every night in the green room. Joining her often are her cousin and a thin young lawyer named Smail whom she came to know and admire when he spent months caring for his injured, paralyzed brother in the hospital.
Ilijaz plays cards in the green room with his best friends and sometimes even drinks the plum brandy he usually abhors. Over the summer of 1993, he and Fatima enjoy more leisure time together, exploring the limits of the enclave by taking walks on Srebrenica’s nature trails, making picnics daringly close to Chetnik lines (where Chetniks come to picnic, too), or spending time with friends in Fatima’s aunt’s weekend house in the heights of Srebrenica.
On the other hand, Ilijaz doesn’t like the fact that his relationship with Fatima is a public secret. It bugs him when others make their relationship out to be some kind of war romance. Since everybody knows about it, everybody feels they can comment on it, and both the positive and the negative remarks grate on him. At times he feels that the relationship is more real for others than for him.
“When are you going to get married?” people ask.
“When the war’s over,” Ilijaz always answers.
“Oh, how long will it last?” they ask rhetorically. “Maybe a long time. Maybe we’ll get old here.”
“I’ll probably stay a bachelor then,” he tells them. Ilijaz can’t imagine getting married to anyone in Srebrenica. He is constantly aware that his own life is in peril, so how could he possibly take care of a family or create a new life? It seems crazy to him make plans for the future in this jail.
He convinces himself that he’s been honest and open with Fatima about all this, that she should know by now where he stands. After all, even before the war he told her that he thought their relationship would end one day. He has his reasons for feeling this way, and he doesn’t want to share them with other people, or with her. Perhaps he isn’t a very good communicator, though, or perhaps he’s sending mixed messages; he can tell that she has never stopped hoping that they have a future together.
More t
han the marriage issue divides them. Ilijaz doesn’t have the same feelings for Fatima as he once had. He finds it easier to pretend than to provoke a scandal or to try to explain the intimate details of their lives to their many friends and acquaintances. They are a famous couple in Srebrenica. He can’t figure a way out from under the “couple thousand pairs of eyes” that he feels watching him, surrounding him, imprisoning him in his relationship.
The sense of being trapped permeates his life. The ceasefire made him believe for a moment that internationals were powerful enough to flick a switch and change destiny, put an end to many, many human tragedies just by one simple move. But the ceasefire and safe-area declaration haven’t changed the fact that the Bosnian Serb advance reduced eastern Bosnia’s remaining 50,000 to 60,000 mostly displaced, non-Serb inhabitants from living on roughly 350 square miles to fifty-five here and forty-two in Žepa, maintained under siege by 1,000 to 2,000 Bosnian Serb soldiers armed with tanks, tracked armored vehicles, artillery, and mortars, paid in part by the Yugoslav government, well-organized, wellsupplied, and in control of the most strategic positions around the enclave. The Demilitarization Commission, with which Nedret has traveled a few times to Srebrenica, has frozen the situation in place, decreasing the chance of Srebrenica’s annihilation while at the same time erasing any hope of breaking its encirclement. The Chetniks drew so close to town in the days before the ceasefire that Ilijaz can now see them on the hills above Srebrenica, and seeing means being seen.
“They know when we’re going to the toilet,” Fatima jokes.
Entire swathes of countryside, including the one where Ilijaz grew up, remain in the hands of the Serbs. Living in the tight cincture is almost unbearable to Ilijaz, who has despised enclosures and savored freedom since his childhood days roaming the hillsides around Gladovići. With his daily survival no longer in question, his struggles shift inward.
That’s when the prospect of learning surgery presents itself. Since June, a Bosnian surgeon from Tuzla, who’d been dragooned—under threat of imprisonment by Bosnian military authorities—into replacing Nedret, has repeatedly expressed his desire to return home. In early August, after he’s been in Srebrenica three months, representatives of Doctors Without Borders, UNHCR, and the International Red Cross write an appeal for his evacuation by helicopter on “humanitarian” grounds.
The surgeon, who was appalled on arrival by the lackadaisical attitude he found at the hospital and the fact that nurses accepted death to the point of failing to call a doctor when patients developed complications (reporting later that they had “died off,” using the Bosnian word izumro, which also means “go extinct”), has gone crazy lighting fires beneath the buttocks of the hospital workers. He’s earned the nickname “Mad Max,” but whereas the violent avenger in the movies loses his mind trying to restore order to a decaying, anarchic, post-apocalyptic civilization, the Bosnian surgeon instead succeeds; he has instituted medical rounds, morning meetings for doctors, a blood bank, and separate departments for internal medicine, pediatrics, obstetrics/gynecology, and surgery.
A raucous outdoor party is held to mark his departure and the summer’s first distillation of plum brandy. Aid workers and Canadian soldiers attend with the local hospital staff. The next day Mad Max flies away.
That leaves Srebrenica with one surgeon from Doctors Without Borders, Dr. Sergei Zotikov, an encyclopedic urologist from Archangel, a White Sea port city in northwest Russia not far below the Arctic Circle. A slender, cheerful man, he’s brought into Srebrenica his dentist wife and—to the bemusement of everyone, particularly Ejub, who notes its freedom of movement in comparison with his own—his big shaggy black and white dog. Sergei has the rare ability to perform almost every type of surgery, from abdominal to urological, gynecological to vascular, orthopedic to plastic. He is one of the first Russian doctors to work with MSF since the fall of the Berlin Wall.
Two mornings after Mad Max’s departure, Sergei needs an assistant to help with a hernia repair. Ilijaz, who once upon a time balked at so much as giving an injection, steps forward. A couple of hours later, he helps Sergei stabilize a broken femur. Then, in the afternoon, he assists with a Caesarian section. The following days bring Sergei and Ilijaz another hernia to repair, a birth defect that requires plastic surgery, an abdominal lipoma that needs to be removed, an anal fistula to be closed, another hernia repair, a right foot amputation, another C-section, another right-foot amputation, a fistula, more hernias, and a number of circumcisions.
Suddenly, Ilijaz is being groomed as the local surgeon, a backup in case Doctors Without Borders, for whatever reason, can’t provide an international. At first, he doesn’t believe he has the capability, nor can he imagine how he’ll quickly develop skills that surgical trainees normally spend at least four years learning.
Fatima tells him he can do it. This is a tremendous chance for him, she says. Without ever complaining about the extra hours, she adds his clinic shifts to her already crushing schedule of clinic, hospital, and emergency room work so that he has more time and energy to devote to the operating theater.
Who knows how long I’m going to be in Srebrenica? Ilijaz wonders. Who knows how long they’ll come and help us? So, I should sit down and start studying.
He requests books from the internationals, reads voraciously, takes initiative in the operating room, and learns more every day. Surgery is a galaxy for his mind to explore while his body is stuck in microscopic Srebrenica. His trepidation, his tendency to believe himself capable of less than what he can actually do, makes him a careful surgeon; he tries to envision each small step of the operation he is about to do before he even begins.
A few weeks later, he can perform simple circumcisions alone. In October, he repairs his first hernia without supervision. Dr. Sergei Zotikov leaves Srebrenica at the end of 1993. In his final report to headquarters, he predicts that an MSF surgeon will be needed for the foreseeable future. Although Ilijaz can perform a hernia operation independently, he needs about four more months of tutelage to complete his basic surgical training. Even then, he will not be ready to take full responsibility for all surgeries in Srebrenica.
But, just a few weeks later, that is exactly what Ilijaz must somehow do. The surgeon who follows Sergei departs in mid-January and his replacement, a Frenchman waiting for a “visa” from Bosnian Serb authorities, fails to arrive. Ilijaz isn’t a typical surgical trainee hotshot who relishes the challenge of being in over his head. The thought of having 50,000 people depend on him frightens him.
On the other hand, he doesn’t shrink from his responsibilities. The morning after the surgeon departs, Ilijaz performs a regularly scheduled hernia repair on a fifty-seven-year-old man. In the afternoon, he faces his first urgent case, a patient with an infected appendix that he removes successfully in an hour. Over the next eight days, Ilijaz performs a dozen surgeries, nine of them operations under general anesthesia, including hernia repairs, appendectomies, the setting of a femoral fracture, and the removal of an ovarian cyst. He is also constantly on call, visits all of the recovering surgical patients, sees patients in the clinic, and handles all emergencies. With each successful operation he surprises himself and grows more confident. The entire operating room staff, from the newly trained anesthetists to the instrument technicians, seem sure of him, trust his judgment and respect his authority. It isn’t Ilijaz’s style to yell at them or, as a surgeon, to set himself apart; in the operating room, he treats them as colleagues, outside, as friends. They coalesce into a closeknit team. Naim Salkić, the dark-haired medical technician Ilijaz worked with in the field at the start of the war, has moved to Srebrenica with the fall of Gladovići, and is rapidly becoming Ilijaz’s best friend.
On the afternoon of Ilijaz’s ninth day without a surgeon supervisor, a man rushes into the hospital holding his right index finger—all of it—in his left hand. The man, in his late twenties, has been chopping wood nearby with an ax. Ilijaz has seen plenty of limbs amputated, but never reattached.
Nevertheless, knowing the simple anatomy of the finger, he does what makes sense to him, pinning bone to bone, stitching together the ends of a tiny artery, and joining what look like nerves and tendons. He is fairly certain the finger won’t take, and when he finishes his work, he writes the man’s name on tomorrow’s operating schedule for an amputation.
Meanwhile, Fatima has an emergency in the obstetrics department. Several months ago, a pregnant woman in her mid-thirties came to the hospital with cramps, spotty bleeding, and a history of three previous miscarriages. It looked as if she was about to have another. With a lack of birth control methods such as condoms or IUDs in Srebrenica, Fatima is used to seeing women desperate to terminate their pregnancies. This woman was desperate to keep hers.
Fatima used a common asthma medication to stop the woman’s labor and has kept her convalescing in the hospital for the better part of the last four months, rather than sending her back to the dark basement where she and the rest of her displaced family live. Now, two months shy of her due date, the woman is starting to hemorrhage.
Fatima took charge of obstetrics and gynecology much as Ilijaz came to run surgery—because somebody had to do it. Although one of her most memorable experiences in medical school was observing a delivery (she can still remember watching the live baby girl emerge from her mother; it made her cry), she never considered becoming an obstetrician. Before the war, cutting an umbilical cord was the sum of her practical experience. When the war started, she didn’t know when, during a difficult labor, to refer a woman for a C-section, and some women didn’t reach the operating room in time to avoid the catastrophic rupture of their uteruses and the distress or death of their babies.
She studied diligently to improve her knowledge, using an American textbook from 1961 as one of her guides. Now Fatima oversees a delivery department with five trained nurses and a midwife and treats outpatients for gynecological problems in the clinic twice a week. Obstetrics does a booming business—seventy to eighty deliveries per month, of which seven to eight are referred to the surgery department for C-sections. Fatima thinks that perhaps an equal number of women have their babies at home. The gynecological and obstetrics ward, a single room down the hall from the operating suite, has only nine beds for patients in various stages of labor, gynecological illness, or recovery from surgery or delivery. Because space is so tight, healthy women are checked and discharged two hours after delivery, instead of the pre-war standard of a weeklong hospital maternity stay.
