by Sheri Fink
Because skull bone is a thick, hard mantle that protects the fragile gellike brain within, drilling through it by hand will take elbow grease. The first time is scary. It is hard to know how far to go and when to lighten the pressure in order to avoid a novice’s worst nightmare, cracking through the last bit of bone and puncturing the brain. It takes Ilijaz a whole hour to drill the first hole. By the fifth, he has the hang of it.
He finally lifts the window of bone he has freed and finds a large collection of blood beneath it. The fractured bone has damaged an artery running along the membranes that cover the brain. The vessel is small, as arteries go, but whenever blood collects in the closed cavity of the skull, it puts pressure on the brain, slowly pushing it the only way it can go—downward into the narrow opening at the base of the skull. If there’s too much pressure, the brainstem begins to herniate through, strangling the centers for breathing, heartbeat, and consciousness and killing the patient.
Opening the skull has relieved the pressure, but now Ilijaz has to remove the clot of blood and ligate the small artery. He does so, following principles of vascular surgery that he learned in Srebrenica. Then he closes the membranes that cover the brain, puts some antibiotic on top, replaces the piece of bone he removed, inserts a drain, and stitches the scalp closed around it.
The operation takes about five and a half hours. It is nighttime again. Ilijaz, exhausted, leaves the clinic immediately, afraid to stick around and watch his patient die. He is sure the surgery has come too late to save the patient from serious brain damage.
In the middle of the night, his host, a medical technician, awakens him in a panic.
“We don’t know what to do with the black-haired guy,” he says breathlessly. “He’s yelling, jumping, wants to get up.”
Ilijaz looks back at the flustered technician.
“You should sing, Shaban,” he says. “The guy survived!”
The next morning at the clinic, the black-haired man glowers at Ilijaz.
“Are you the doctor who treated me?” he asks.
“Yes.”
“I’ll kill you when I get back on my feet!” he says. “I have a headache. I can’t stand it!” Ilijaz finds his recovery nothing short of a miracle.
* * *
TWO DAYS LATER, the bodies of the dead are transferred to Srebrenica. A funeral is held for the three doctors, and a great sadness settles over the town, particularly the hospital. The injured doctor, Dževad, is transferred to Srebrenica, where he undergoes treatment for a hip fracture and kidney contusions. Traumatized by his experiences, it will take weeks before he is able to begin work in the hospital.
Later a group of local residents investigates the crash site. They find the remains of the helicopter lying on its right side on a grassy hillside, its front crumpled like a Coke can from its impact with the nearby beech tree. They inspect the back propeller and conclude that it was hit by a .50-caliber anti-aircraft missile.
* * *
THE DAY OF THE HELICOPTER CRASH proves a fateful day for all of Bosnia. A Serb mortar round kills eleven people in a district of Sarajevo. Twice, the Bosnian UNPROFOR commander, Rupert Smith, calls for air strikes to protect the safe area, but Bernard Janvier, the Theater Force Commander for all U.N. troops in former Yugoslavia, opposes them. The command structure of UNPROFOR has recently been reorganized, and not only do air strikes depend on the turning of a “dual key,” held by the United Nations and NATO, but the U.N. Secretary-General’s decision to call in air strikes now has to be based on the agreement of three levels of U.N. command: Smith, Janvier, and the Special Representative of the Secretary-General, Yasushi Akashi, who has overall command and control.
Two weeks later, fighting intensifies around Sarajevo. Smith issues an ultimatum to both Serb and Bosnian government sides, and after the Serbs fail to meet two deadlines to remove heavy weapons from an exclusion zone, Special Representative Akashi authorizes air strikes.
On the afternoon of May 25, NATO aircraft, most of them American, attack two Serb ammunition bunkers near the capital. A thick plume of smoke billows from the direction of Pale, the Bosnian Serb headquarters.
The same evening, in Srebrenica, Fatima strolls through town with her cousin and her increasingly close friend, the lawyer Smail. Around 7:30, a loud explosion sends them into a panicked search for cover. Smail grabs Fatima’s arm and they run into the open door of a small house on the roadside. As they huddle inside catching their breath, she notices that her hand feels heavy. She realizes something is wrong, but Smail is gripping her arm.
“Let me see!” she screams. “Let me see! Move your hand!”
“I can’t move my hand while yours is on top of it!” he says. They lift their hands to find blood welling from a hole in her forearm. They bandage it quickly and inspect themselves for other injuries. Her cousin’s shirtsleeve, which has a hole where the shrapnel that hit Fatima passed through, appears to be the only other casualty. When the shelling subsides, they head for the hospital, leaving what they realize, only then, is an ancient, rickety structure that has provided them little more than psychological protection.
It has been a light day in the operating room for Ilijaz, who performed just one surgery, a circumcision, early in the morning. He is in his apartment during the attacks, and someone comes to fetch him with MSF’s car. Several casualties are brought to the hospital at once. The MSF surgeon currently rotating in Srebrenica takes a thirteen-year-old girl to the operating room to reposition her fractured arm bone.
Ilijaz takes care of Fatima, his face tight, probing at the gashes on either side of her forearm where a piece of shrapnel has sliced clean through. Her hand is swelling up, suggesting that a bone is broken. At least nothing appears to be displaced. He cleans the wound, cuts away some damaged tissue, and wraps plaster-coated strips around her arm to make a cast. In the morning, he’ll x-ray her arm with Srebrenica’s sometimes-functional machine and then decide whether there is more to do. He gives her painkillers and antibiotics and tells her to rest tonight in the hospital.
Fatima’s cousin and her friend Smail stay in her room.
“You can go,” she tells them. “I’m OK.” Smail refuses to leave her. He remains by her side all night, his presence comforting her.
An x-ray is taken the next day. The shrapnel glanced one arm bone, the ulna, and fractured it, but avoided, by what seems to have been a hair’s breadth, the bundle of nerves and vessels that run between it and the other arm bone, the radius. Fatima has to keep the cast on, take antibiotics, and eventually do exercises to get her strength back.
What is harder is the emotional impact. The helicopter crash and now this. More than two years after the death of Dr. Nijaz Džanić, it again comes as a shock to think that something could happen to the tight hospital clan. Fatima is alive, she’ll be OK, but she and everyone else are shaken.
The same day as Fatima’s injury and the NATO air strikes, the Serbs vent their wrath at four of the other five “safe areas.” An artillery and mortar attack on the center of relatively peaceful Tuzla exacts the highest death toll. It kills roughly seventy people, mostly teenagers gathered at a café.
As Fatima recuperates at Srebrenica Hospital the day after her injury, Serb forces continue to fire on the capital, Sarajevo. NATO launches further air strikes against six Serb ammunitions bunkers. Then the Serbs strike back against the internationals, taking several hundred U.N. personnel hostage around the country and chaining them to strategically important engineering structures as human shields against NATO targets. NATO halts the air strikes. The hostages remain captive. Over the following days, Bosnian Serb forces with shoulder-launched missiles and anti-aircraft batteries fire at NATO surveillance aircraft monitoring the no-fly zone, shooting down an American F-16 with a radar-guided surface-to-air missile. Although its pilot, Captain Scott O’Grady, successfully ejects and is ultimately rescued from Serb-held territory by American marines, the incident shows that the Bosnian Serbs can see NATO aircraft on the rad
ar screens of the integrated Air Defense System they inherited from the former Yugoslavia. They are willing to put their anti-aircraft batteries to use against NATO. NATO requests permission to take out the Bosnian Serb air defense systems, and when the United Nations says no, NATO halts monitoring flights over Bosnia.
The next weeks of recovery give Fatima time to think hard about her life. She realizes that she has spent so much time obsessing about her onagain, off-again relationship with Ilijaz—who still hasn’t ended his affair with the operating room nurse—that she has neglected her own needs. While she encouraged Ilijaz and helped him to become a surgeon, she forgot to think about her own career. She wants to make changes. She wants to take advantage of the presence of the MSF and Dutch surgeons and develop her own skills in surgery, particularly gynecologic surgery, rather than leaving all the operating room experience to Ilijaz. She also wants to develop her personal life. Over the next days and weeks, she begins to walk with friends more often on her own, without Ilijaz. She also notices, though she doesn’t say a word and neither does he, that she is beginning to feel something more for Smail than friendship.
* * *
THE FIRST OF JUNE 1995, less than a week after Fatima’s injury, a Serb raiding party ambushes and kills several civilians in the southwest corner of the enclave. The same day, the Bosnian Serb army instructs the U.N. Protection Forces in Srebrenica to move one of their observation posts, Echo, north in order to provide the Serbs with better access to a road just south of the enclave. The U.N. commander refuses. Two days later the Serbs surround the post and fire at it with rifles, mortars, and anti-tank weapons. The U.N. commander calls for NATO close air support, but higher authorities deny the request, presumably because it might jeopardize the lives of the hundreds of U.N. personnel still being held hostage by the Serbs. The U.N. soldiers abandon the position, regroup, and establish new observation posts nearby. Their backing down infuriates the Srebrenicans.
The current contingent of U.N. soldiers in Srebrenica is Dutch. U.N. leaders had to scramble to find troops to replace the 140-odd Canadian soldiers who came into the enclave when the safe area was declared back in the spring of 1993. Most countries that voted in favor of resolutions creating the safe areas, such as the United States, refused to allow their troops to be deployed in them. Offers from Muslim countries were rejected. The U.N. force commander directed elements of a Nordic battalion to replace the Canadian battalion in Srebrenica, but the government of Sweden instructed it to refuse.
The Dutch were asked next and they accepted the assignment, eager to contribute to the international humanitarian effort in Bosnia and failing to put much consideration into the feasibility of the mission. They dispatched a Dutch Air Mobile Battalion to the enclave around the time of Dr. Neak’s arrival, in the early winter months of 1994. The soldiers were met with a less than enthusiastic welcome in Srebrenica. A frenzied crowd of women and children blocked the exits of the Canadians’ compound and tried, as if their lives depended upon it, to prevent them from leaving. Neak, who was inside visiting, watched a Dutch officer grow furious at the reception his troops were receiving.
Despite their inauspicious arrival, the Dutch U.N. Protection Force, Dutchbat, quickly became a boon to the hospital, particularly the surgical ward. The size of the Dutch medical team and the quantity of equipment in their complete surgical hospital suggested they were expecting all-out war here. Although their duty was to treat the Dutch troops, one day, about a week or two after the troops’ arrival, Dutch military doctors showed up at Srebrenica Hospital. They had nothing to do, they said, and wanted to volunteer their assistance.
That was just the beginning. Soon providing health care to the local population became the Dutch medical officers’ major activity. At first, the work violated a U.N. directive that specified a strict division between military and humanitarian tasks, the latter being left to the U.N. refugee agency. A year later, the military doctors laughed when a Dutch army medical officer in the Netherlands called them on the satellite phone to announce that the directive had changed. They were now officially allowed to engage in the humanitarian activities they had performed for so long.
The first Dutch surgeon to rotate in Srebrenica saw patients once a week in clinic and then operated on them either in Srebrenica or at the U.N. headquarters compound, a converted battery factory in the nearby village of Potočari. To Ilijaz it seems that with each successive Dutch force rotation, which occurs every few months, the cooperation between the Dutch army surgeons, MSF, and the local doctors grows greater. He relies on the Dutch surgeons for many things, from technical advice to material assistance, and the population, particularly those who live close to Potočari, go freely to the Dutchbat medical hospital in case of emergency.
The fifth rotation of Dutch soldiers, beginning in February 1995 for what was supposed to be a three-month period, has had it tough. Upon their arrival, while their attention was occupied with the handover, Serb forces to the west of Srebrenica established new positions that encroached on the enclave. Naser Orić instructed the new Dutch commander to keep off the Srebrenicans’ turf. When he failed to comply, a local Srebrenica commander held about 100 soldiers of the new Dutchbat rotation hostage for four days. This could not have endeared the Srebrenicans to the new Dutch commander. Beginning in February, Serb forces increased restrictions on humanitarian and UNPROFOR supply convoys, denying the soldiers their supply of diesel. They have had to borrow fuel from the U.N. refugee agency, resort to foot patrols of the enclave’s borders, and hire locals to carry their supplies on horseback. Since late April, the Serbs have refused to allow Dutchbat personnel to enter or leave the enclave, effectively shrinking their forces from 600 to 400, after those who went on leave were prevented from returning. In the town, rumors abound that the Dutch want their soldiers to be replaced after the current battalion’s rotation ends. In fact, since May there have been debates among U.N. Security Council members and U.N. commanders about whether to withdraw UNPROFOR from the entire country, leaving the Bosnians to fend for themselves. This is exactly what some Bosnians pray for. If UNPROFOR was gone, and with it the threat of hostage-taking by the Serbs, one of the main excuses against lifting Bosnia’s arms embargo and using NATO air power would be moot. But the United States—unwilling to contribute the 20,000 troops it is bound to commit in a NATO plan to support the U.N. pullout, and loath to threaten the NATO military alliance by refusing to deploy its troops—opposes the withdrawal.
In the spring of 1995, a woman from Srebrenica is treated at the Dutch military hospital for a severe blood infection after a self-induced abortion. She ends up in the ICU with multi-organ failure. A ventilator fills her lungs with oxygen, a tangle of intravenous lines drips antibiotics, diuretics, and heart regulators into her blood, and a pharmacologist crushes vitamins into a homemade milkshake to feed her through a tube that runs from her nose to her stomach. Serb authorities refuse to permit her evacuation, and as the weeks go by, in the process of her treatment, supplies and medicines such as nasogastric tubes, the cardiac drug dopamine, stomach acid blockers, and certain IV antibiotics run low. Every week, Dutch soldiers and medical personnel meet to discuss her care and decide whether to continue it. Some oppose it, arguing, among other things, that supplies that might be needed for the soldiers are being used up on a comatose woman. Others insist that now that they’ve provided her care, it would be unethical to terminate it. After seven weeks of twenty-four-hour treatment, she begins to emerge from her coma and speak and move again. Then she contracts a severe gastrointestinal infection and dies within forty-eight hours.
The normal elective operating program at the Dutchbat hospital was stopped because of the comatose woman and now it cannot be restarted. There is not enough gasoline to fuel the generator that lights the windowless room and runs the anesthesia and monitoring equipment. The Dutch surgeon has stopped seeing patients in Srebrenica’s surgical clinic, too, in sympathy with MSF, which went on strike after municipal authorities
conscripted their local driver. Srebrenica authorities have long insisted that MSF, whose local staffers are practically the only workers in Srebrenica to receive salaries, rotate their local staff members. MSF expatriates, believing that municipal meddling violated their organization’s fundamental principle of independence, stayed in the enclave, but halted all non-lifesaving activities.
The strike makes more work for Srebrenica’s local doctors and reduces the number of elective surgeries that Ilijaz can offer. Over the past few months, the Bosnian Serbs have not only cut off U.N. military supplies, but also severely restricted humanitarian aid for the Srebrenica population. By spring 1995, the food warehouses are reportedly almost empty, and normal smuggling routes and front-line bartering have become too dangerous for most to attempt. People living on the outskirts of town move closer to the city. After the Serbs’ attempts to encroach on the enclave, Dutch soldiers begin allowing Srebrenica soldiers to carry weapons openly, in violation of the demilitarization agreement, and to take shadow positions near U.N. observation posts.
People in Srebrenica are painfully aware of a growing rumor that control of Srebrenica and Žepa might be ceded to the Serbs in a new peace plan. The Serbs have objected to multiple peace plans in part because Srebrenica and Žepa would remain Muslim-controlled areas. The two enclaves are a perceived obstacle to the larger goal of peace in Bosnia. Every day, Srebrenicans flock to the center of town where news pours out of a loudspeaker rigged up to a radio. They listen for hours, trying desperately to discern whether rumors of Srebrenica’s impending demise could be true.
23
EGRESS
DR. EJUB ALIć HAS COME TO BELIEVE that the groups in Bosnia are mired in a state of conflict as sticky and intransigent as any in the world. He still views war as something comparable to an out-of-control marital spat. In some ways, the fighting has gone too far—there is no easy way back to the halcyon days of Brotherhood and Unity. In other ways the fight has not gone far enough. Nobody is yet willing to compromise.
