Unsung Heroes of Srebrenica

Small band of doctors treated horrendous injuries without anaesthetics in besieged town.

Unsung Heroes of Srebrenica

Small band of doctors treated horrendous injuries without anaesthetics in besieged town.

Srebrenica war surgeon Dr Ilijaz Pilav at the ceremony in Potocari commemorating the victims of the 1995 massacre. July 11, 2013. (Photo: IWPR)
Srebrenica war surgeon Dr Ilijaz Pilav at the ceremony in Potocari commemorating the victims of the 1995 massacre. July 11, 2013. (Photo: IWPR)
Friday, 12 July, 2013

Merdijana Sadovic

Merdijana Sadović
IWPR's Regional Director for Western Balkans

Two months ago, I was lying on the operating table in a Sarajevo hospital trying not to faint as a tall, stern-looking surgeon probed between my ribs with latex-gloved fingers. He was looking for the right place to make an incision and insert a small tube with which to re-inflate my collapsed lung.

I put on a brave face, but I was really, really scared.

Just minutes earlier, I had come into the surgical ward with pneumothorax – a condition that caused my lung to collapse and required an urgent, albeit small surgical procedure.

But as any patient will tell you, no procedure is ever small if it is being performed on them.

The surgeon was called Ilijaz Pilav. The name sounded vaguely familiar to me, but I could not remember where I had heard it before. As I searched my memory, Dr Pilav announced that he had found the right spot and was ready to make the incision.

“But… but, you will give me a local anaesthetic first, right?”, I stammered in a feeble attempt to conceal the panic in my voice. The prospect of having an incision between my ribs without anaesthesia did not exactly thrill me.

Dr Pilav laughed out loud and said, “Of course I will – this isn’t 1992 any more!”

At first I didn’t understand why he was referring to the year the war in Bosnia began. But then the male nurse proudly informed me who my doctor was – a famed surgeon from the Srebrenica hospital who performed thousands of operations there during the war, many of them with no anaesthetics.

I realised my fear of a simple surgical procedure must have looked very silly to a man with such a background. But if it did, he did not show it, and I was very grateful in my deep embarrassment.

As Dr Pilav used a needle to inject the anaesthetic between my ribs, it suddenly dawned on me why his name was so familiar to me. He was one of the main protagonists in a book I had read several years earlier while covering the Hague trial of Naser Oric, the wartime commander of Bosnian government forces in Srebrenica.

"War Hospital: A True Story of Surgery and Survival", written by American physician and Pulitzer Prize-winning journalist Sheri Fink and published in 2003, was one of the best books I had read about Srebrenica. I remember not being able to put it down until I had finished it. I was amazed at the bravery and resilience of a handful of young local doctors – none of them a trained surgeon – who were trapped along with 50,000 men, women, and children besieged by Bosnian Serb forces in the eastern Bosnian enclave between the spring of 1992 and the summer of 1995.

One of these doctors was Ilijaz Pilav, who was a 28-year old general practitioner at the outset of the war, and became a surgeon and a key figure at Srebrenica’s hospital in summer 1993.

He stayed in Srebrenica throughout the siege, and during that time performed around 3,500 operations.

Unlike other books about Srebrenica, which mainly focused on the massacre of more than 7,000 Bosniak men and boys that occurred when Bosnian Serb forces overran the enclave in July 1995, Fink’s book told the story of Srebrenica from the perspective of the doctors who faced the most intense professional, ethical and personal challenges of their lives during the siege.

Most of Srebrenica’s medical staff fled at the start of the war. Out of its original 45 doctors, pharmacologists and dentists, only four remained in the town when the war broke out. They were later joined by one physician from nearby Bratunac, and another doctor fresh out of medical school.

In the summer of 1992, one of the staff, Dr Nijaz Dzanic, was killed. The five doctors who remained – Ilijaz Pilav, Avdo Hasanovic, Fatima Dautbasic, Branka Stanic and Ejub Alic – had to bear the burden providing care to the 50,000 people in the besieged town.

The challenges these physicians faced were not just a consequence of the medieval conditions at the Srebrenica hospital – no medicine or sanitary supplies, operations carried out without anaesthetic or basic surgical instruments – but also stemmed from their lack of experience and formal surgical training.

They had to cope with huge numbers of people injured by shelling, landmines and bullets. Particularly after heavy shelling from Serb positions around the town, the influx of patients sometimes got so large that the hospital could not accommodate them all. Patients lay in corridors as hospital staff worked for days on end without sleeping, showering, shaving or changing their clothes.

These doctors were also haunted by the fact that in performing surgery without anaesthetics – which the hospital lacked in the first months of the war – they were effectively committing torture, even though they had no other choice and were doing so with their patients’ consent.

“If I would have to single out the worst experience I had during that time, it would be the operations performed without anaesthesia”, Dr Pilav told me in a recent interview.

“I had to talk to the wounded people I was operating on and encourage them to endure the pain for just a little longer, while at the same time I was aware that I myself would not be able to withstand such pain.”

In August 1992, the Srebrenica doctors received much-needed help. An aspiring young surgeon, Dr Nedret Mujkanovic from Tuzla, made it into Srebrenica. In order to aid his trapped colleagues, he spent a week walking on foot through minefields and enemy lines carrying a backpack with basic surgical equipment and medical supplies.

He soon acquired hero status. In just eight months that he spent in the besieged town, Dr Mujkanovic reportedly performed more than 1,300 operations. He was later awarded the Golden Lily, the Bosnian army’s highest honour.

Several months after the war started, the first volunteers from the international group Doctors Without Borders, MSF, came to Srebrenica, bringing urgently-needed medical supplies, but no anaesthetics. According to Dr Pilav, these arrived only months later, in another convoy.

The MSF representatives were shocked when they saw the conditions the local doctors were working in and they did what they could to improve things, from bringing in more supplies and equipment to training local staff including Dr Pilav.

Over time, conditions at the Srebrenica hospital considerably improved.

“We still didn’t have electricity and very often we had to improvise, but at least the situation became bearable”, Dr Pilav told me. “At the beginning of the war, we didn’t have anything, and thanks to MSF, we now at least had some supplies, some medicines, even anaesthetics.”

In the summer of 1995, however, Serb attacks on Srebrenica intensified and the hospital itself became a target. But by then, the doctors had become so used to the shelling that they did not even pay much attention to it while they were at work.

On one occasion, Dr Pilav operated on a patient with explosives injuries to his arms and face and a rupture to his upper arm’s main artery. Just then, a mighty shell blast shook the operating room and shattered the windows. But the surgeon did not move, his hands in the wound still holding a hypodermic needle. As soon as the dust settled, he continued with the operation as if nothing had happened.

When it became obvious that Serb forces were about to take Srebrenica, Dr Pilav and other local doctors and medical staff decided to join thousands of Bosniak men from Srebrenica attempting to break through enemy lines and reach Bosnian government-held territory, some 110 kilometres away.

With just a few hundred weapons, and weakened by three years under siege, the men in the column fought their way over densely wooded hills for five days in grueling heat. They faced artillery barrages, ambushes, and hallucinogenic gas shells, and had to walk through minefields at night.

Dr Pilav will never forget walking through a minefield and hearing the moans of the injured in the dark around him, and not being able to help them.

Bosnian government estimates of the number of men and boys who tried to make it through the enemy lines vary from 12,000 to 15,000, but the exact figure may never be known.

In the end, of the thousands who set off from Srebrenica on July 11, 1995, only 3,500 made it through Serb lines to reach safety on July 16. The rest were either swiftly captured and killed, or were left trapped in the woods after Srebrenica fell. Some of the latter found the way to Tuzla weeks later, others were captured by Serb forces and the rest surrendered.

Dr Pilav and most of his colleagues from the hospital who went with him on this journey – which they later called the Death March – were among those who arrived in Tuzla safely.

After the war ended, Dr Pilav wanted to do something to commemorate friends and relatives who died trying to reach Tuzla, so in 2005 he initiated the March of Peace.

Every July, thousands of people from all over Bosnia and from abroad walk for three days from Tuzla to Srebrenica, using the same route as the men of Srebrenica did in 1995. On July 11, they all gather in Potocari to attend the burial of Bosniak victims massacred by Serb forces after the takeover of Srebrenica.

In 2013, the remains of 409 people including a newborn baby and 44 underage boys will be buried in Potocari, joining 5,657 others who have been interred there in previous years.

Pilav, 49, has been on the March of Peace three times, but he can no longer do so for health reasons.

But as he does every year, he will be in Potocari this week to pay tribute to the victims of the Srebrenica massacre.

“Like most people who survived this genocide, I measure time as running from July 11 one year to July 11 the next year. There is no place on earth where I could be on that day other than in Potocari,” he told me.

Pilav is now head of the surgical department at the thoracic surgery clinic in Sarajevo’s main hospital, and respected by fellow-doctors and patients alike.

While I was his patient, I discovered that behind the stern façade there was a gentle man with quiet good manners and a great sense of humour.

If I had not read “War Hospital”, I would never have guessed that he has seen more human pain and suffering than any person I know. The only giveaway is his facial expression, which changes every time Srebrenica is mentioned – it becomes serious and his eyes become darker.

Although he now lives in Sarajevo, he says that in spirit he has never left Srebrenica.

“War Hospital” ends with a letter Dr Pilav sent to its author Sheri Fink in 2002, in which he said that “although the war is over, I still carry it in me and live with its consequences. The war is over, but the time has not eased the pain.”

I asked him whether anything had changed since he wrote that – whether he had found some peace over the last 11 years.

“The only difference between then and now is that I have learned to live with this pain,” he replied. “I have established some sort of balance between the past that I carry within me and the life I live now. It’s as if I exist in some surreal space between these two worlds, which can never be joined together but cannot be separated from each other, either. And both these worlds are equally mine.”

Merdijana Sadovic is IWPR’s regional director for Western Balkans.

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