Sarajevo airport stands outside the city itself. No APC, ‘armoured personnel carrier’, was available to take us to the United Nations Headquarters at the post and telecommunications building, the PTT, so a routine minibus it had to be. Largely unprotected, I could see the bullet holes crazing the driver’s window. Despite their white colour, and blue UN flag, minibuses were fair targets in this crazy Balkan war.
As we drove towards the PTT, the true horror of a city under siege became apparent. Everything was destroyed. Not one window intact, not one wall spared the irregular pitting of shrapnel damage. Every building was gutted, roofs in tatters, their bare and charred beams in full view. It was a depressing sight, as if a huge tornado had passed by, destroying everything in its path. Occasionally there was an oddity. A bright orange Volkswagen Beetle, completely untouched, parked close beside the ruins of a house. Perhaps the pride and joy of its owner, I have no idea how it had escaped. There was no petrol to run it, but why a bored Serb gunner had decided to spare it was a mystery. Our minibus driver remained silent throughout the journey. I learned later he had been wounded three times since the conflict began, and had lost every member of his family. His sister had been raped before she was murdered. When he eventually told me this, I was struck by the impassive way he described events. War does suppress emotions — for both hunter and hunted.
The PTT was a busy place, people and vehicles coming and going continuously. When we arrived, our driver exited the minibus without saying a word, leaving us where we sat. No one had said where the Serb front line was positioned, so I had no idea whether or not we were in a firing line with a sniper at the other end. Consequently, I felt the only safe place was tucked away in the parking area between two large APCs. We crept from the minibus and cowered there until I noticed the strange looks from passing UN staff. One eventually beckoned me forcibly. ‘Come on!’ he said. ‘There’s no problem at the moment. You don’t need to hide there.’
Walking into the PTT itself I could see a complete mixture of people. Long-haired, ragged aid workers worked alongside immaculate UN soldiers. Meanwhile many well-known television journalists flitted to and fro the various offices, gleaning what little information they could. No office had curtains, or very few, and every exterior window was criss-crossed with sticky tape. The PTT fared well during the siege, though came under attack occasionally. Communication with the outside world was difficult, as fighting had destroyed most telephone landlines. However, there was one satellite fax, running night and day, and a telephone in the office of the United Nations High Commission for Refugees, the UNHCR. They guarded it for their own needs closely, as it was one of the few ways of communicating elsewhere. To use it without being caught or challenged was one of the only ways of having fun in Sarajevo.
Our contact at the PTT was a charming Scandinavian, working on behalf of the World Health Organization. He had seen most of the war through its various stages and knew everything about the conflict and its warring sides. He greeted me as if we had known each other for ages when, in fact, we had never met. After an initial, warm handshake and the only smile I had so far seen in Sarajevo, he looked at me seriously.
‘We were going to cancel you,’ he said, his voice quiet and low.
‘Cancel us? Why?’ I asked.
‘There didn’t seem any point in you coming. All electricity is off, there’s no water and gas is non-existent. We didn’t think you could do very much without basic power.’
‘I’m sure we can do something to help. Prepare an appreciation if nothing else. Perhaps it would be best for us to find out what Sarajevo is lacking and set the scene for later visits.’ After so much anxiety and emotion to come this far, we were not giving up at such an early stage.
The Scandinavian appeared to agree. ‘Yes, I thought that too. We decided to let you come and do the best you can. I understand you’ve done this sort of thing before.’
I nodded and avoided saying I had never before entered a city under siege. ‘Where will we be going?’ I asked.
‘The State Hospital. It’s where little Irma came from. No teams have been there before. At least no team has stayed there before. But I’m afraid it’s a little close to the front line.’
‘How close?’
‘A hundred, maybe a hundred and fifty metres.’
‘Shit.’
The drive to the State Hospital was an adventure in itself, directly through the heart of Sarajevo. To get there, our sad little minibus had to negotiate the lethal Sniper’s Alley, so-called because of its proximity to Serb snipers. The Alley was the front line. Snipers would sit, or lie, in buildings only fifty metres from the Alley. You survived a journey down that road from the goodness of their hearts, what little remained. It was impossible for even a one-eyed beginner to miss. Naturally it was important not to draw attention to yourself. You did not drive the route with headlights blazing or sirens wailing. You drove fast, steadily and looked neither left nor right. Unless, of course, your name was Beverley.
Beverley, Bev, is one of the best operating theatre sisters in the trade. In a moment of weakness, her weakness, I had persuaded her to join the Sarajevo project. Keen for adventure, she had agreed. It is astonishing what some will do to escape the National Health Service. Despite what were undoubted worries for her, she never once expressed those concerns to me. Bev had not been to a war zone before and had come armed with her tiny camera, poised to take photographs for what I assume will one day be her memoirs. The camera was one of those automatic affairs that decides for you whether or not to use its flash. As we drove down the middle of Sniper’s Alley, each minibus occupant looking steadfastly forwards, I suddenly realized not everyone was trying to remain inconspicuous. There was a whirr, a click and a rustle from my left. Then, as bright as sunlight on this overcast evening, Bev’s flash went off. Every one of us jumped out of our skins. I was convinced I had just been shot. ‘Oh bugger it! I’m sorry!’ she said. Worse still, the picture never came out.
How we survived the Alley, I do not know, but the Serbs were feeling kind that day. At one end, though a little beyond, stood the State Hospital. As we rounded a final corner I could see it to our front. It was a mess, its high-rise structure completely shell-blasted and destroyed. The hospital was also a military hospital and, as such, fair game for Serb gunners in the early days of the war. The Geneva Convention was not widely honoured in the Balkans. Such things are excellent ideas, but practice is so different from theory. No wonder its local name was the Swiss Cheese Hospital. Full of holes, it was a dangerous place to be.
By the time we arrived, the war had been running for eighteen months. The once-attractive Sarajevo had been reduced to a barren hulk. From a pre-war population of over 500,000, only 350,000 remained. Sixty-four thousand Sarajevans had been killed or wounded, of whom 16,000 were children. Of those who died, most had perished from explosive blast; but bayoneting, strangulation, rape, cold and starvation had killed many more. Of the 38,000 women, and girls, raped in Bosnia, 3000 had been assaulted within Sarajevo itself. More than 9000 pregnancies, 200 of which were Sarajevan, had been the result. This was ethnic cleansing, etnicko ciscenje, in all its horror.
No establishment is more exposed to the realities of war than a hospital. The Swiss Cheese Hospital was a classic example. For most of the war it dealt with up to thirty operations every day, week in, week out, month in, month out. It had to do this without an external electricity supply, limited fuel and a maximum of two hours’ running water each day. So extensive was the damage that all hospital activity above the fourth floor had been abandoned. Most clinical work took place on the lower four floors, and as much as possible on the first two. Red still stained the hospital forecourt where, at times of enormous casualties, buckets of scarce water were used to wash the blood away. Large concrete paving slabs rested against ground-floor windows as protection against blast, while a damaged, non-functional ambulance stood uselessly to one side.
The hospital’s orthopaedic surgeon
was waiting at the front door, greeting us with open arms. ‘Welcome to Sarajevo,’ he said, an impressive smile across his otherwise pale, drawn face. ‘We have tried to make your visit as safe as possible, but I am afraid it is going to be difficult.’
Staying outside, in the exposed, open air of Sarajevo made us feel naturally insecure. We were delighted to be taken indoors, breathing a sigh of relief as we entered the moderate protection of the hospital building. Our host led us through the gloomy maze of hospital corridors. Every window was either shattered, or contained several bullet holes. Even internal walls had been fragmented and destroyed. As we passed the kitchen, he indicated a sequence of large, irregular, gaping cavities extending through several walls, from street outside to kitchen itself. ‘Tank round,’ he said. ‘It went through five walls and killed our cook. He was a good man.’ He spoke without emotion, devoid of feeling, as if it was an everyday occurrence that an innocent cook should die. I looked at the surgeon’s face. It was an expression I got to know well. I saw it on every face in Sarajevo. Passive eyes, expecting nothing from life or the world, pale sallow skin and slumped shoulders.
Only rarely did anyone venture outside. Lack of daylight, for months on end, living like rabbits in a burrow, made the Sarajevans look terrible. Yet staff would walk the hospital corridors, heads silhouetted against shattered, uncovered windows for any sniper to see. At night it was common to sit in uncurtained rooms, by the light of a candle or single electric bulb, for all outside to view you. It was as if the Sarajevans had now seen so much, endured such hell, that they had become acceptant of their fate. Each one had a tale to tell, of near misses, or woundings, or families lost and killed. ‘Every day is a black day,’ one surgeon said to me.
Unlike Sarajevo airport, the air around the Swiss Cheese Hospital was full of continuous noise. Crack! Crack! Boom! Sniper putsa - ‘Sniper shooting’ - could be said over two hundred times each day. High-velocity bullets cracked everywhere. Due to the urban environment it was impossible to say from where the round was fired. In open areas it is easier. First you hear the ‘crack’ as the bullet flies past - you naturally do not hear it if it hits you - then the ‘thump’ as the metal breech of the rifle moves to and fro. It is the ‘thump’ you listen for, not the ‘crack’. It gives you the location of the sniper. The time and interval between ‘crack’ and ‘thump’ tells you the distance. ‘Crack-thump’ demonstrations are commonplace in the Army, where rounds are intentionally fired over your head in training to teach you this direction-finding skill. In Sarajevo, using crack-thump was difficult due to noise deflection and echo off the buildings. Any thump you might hear was normally the bullet hitting a body or brickwork, not the metal breech of a rifle. It was safer to assume that snipers were everywhere and take precautions accordingly.
When you first visit such a place, where to go in safety, if there is such a thing, and how to do it, is confusing. No one briefed us where the Serbs were to be found, nor on how to stay alive should we venture on to the streets of Sarajevo. I had given the team a short talk in Ancona, before our ordeal with Maybe Airlines, explaining the basic principles of avoiding death during war. Cross intersections at a sprint, peer round corners at ground level rather than standing up, vary your speed of travel to make it difficult for a sniper to hold his aim. Do not wear bright clothes, and use dead ground - areas the enemy cannot see — as liberally as you can. Though such advice is better than nothing, there is no substitute for experience. Unfortunately, for most team members, war experience was something they lacked. A skeet shoot was an unfamiliar event, let alone life under genuine fire.
The locals did their best to make life difficult for snipers. Ropes were attached to the first floor of buildings each side of the narrow streets and blankets suspended from them to disrupt the sniper’s view. Certain no-go areas were commonly known. It was sometimes safe to walk down one side of a street, but lethal to walk on the other. Bev nearly died one day, returning from another city hospital after completing her assessment of operating-theatre facilities. She had been fortunate to beg a lift in an APC, a rare occurrence for aid workers, even with ODA blessing. The APC driver had refused to go near the Swiss Cheese Hospital, claiming it was too dangerous. Bev was left, 300 metres from the hospital, dressed in a bright yellow T-shirt. She could not have offered a better target if she had tried. I should have warned her to wear dark, inconspicuous clothing. Off she set on foot, only days into her first visit to her first war zone, in full view of every Serb sniper for miles around. I have no idea why she was not shot. Perhaps it was the opposition being kind to the fair sex - many snipers were themselves female - perhaps it was simple good luck. It took her several minutes to realize everyone else was walking on the opposite pavement to herself and that the old lady on the other side of the road was wildly gesticulating at her for a reason. Bev sprinted hastily to safety. I imagine several dozen telescopic sights were trained on her by then. She now gives an excellent description of what it sounds and feels like when a high-velocity bullet passes by, millimetres from your left ear. APCs were a dirty word that day.
Added to snipers, Sarajevans were regularly bombed. Not by aircraft, but from mortars. As many as 600 mortar bombs could land in a day, though this had reduced to about thirty during our time there. Firing a mortar is now an accurate art, so I could not understand how bread queues, schoolchildren or marketplaces could be hit without absolute intent to do so. As a surgeon in Sarajevo you rarely dealt with wounded soldiers. The majority of patients were unarmed civilians. My first ward round with our host was an education in this respect. Virtually all the hospital’s 250 beds were full. Patients lay in curtainless wards, each window again shattered by blast or gunshot. Even a patient in bed was fair game for a sniper. Women, children and the elderly, lay motionless, many paralysed and dozens without an arm or leg. People like Mika, a beautiful twelve-year-old Bosnian girl, the victim of rape on two occasions, who lay stranded without legs in her ward. Her parents had been murdered months earlier. For many of the patients I saw, perhaps even her, death would have been a blessing.
War has a habit of creating multiple injuries, rather than damaging one part of the body at a time. This can sometimes cause immense problems for medical staff. Take Viktor as an example. It was nine o’clock in the morning and had been a busy night. More than twenty major explosions near the hospital had kept the operating theatres permanently active.
A few minutes after breakfast a massive blast shook the hospital to its core, jolting free the few remaining shards of glass that hung loosely in the multitudinous, damaged window frames. Seconds later came the sound of frantic shouts from outside the casualty entrance. It was Viktor, caught within several metres of a mortar blast, again an innocent civilian. His two children, lovely twin girls aged no more than eight years, were hanging desperately to the bleeding body of their father as two burly friends dragged him to the entrance. Long, bloody smears on the chipped pavement tracked their course as they manhandled their colleague to the hospital. Viktor’s crime had been to accompany his children to a makeshift school. ‘For their protection,’ he muttered through a blood-soaked mouth. ‘Their mother was shot last week.’
The blast had created terrible damage. His right leg was a bloody stump below the knee - a traumatic amputation - though reasonably clean. Strangely, he was not bleeding badly from the injured area as the blood vessels had constricted tightly to control the blood loss. It is one of Nature’s miracles that arteries contain muscle in their walls. Cut one and the muscle will immediately clamp down to prevent excessive bleeding. Viktor’s other leg was also a bloody mess - mangled bone, dead muscle, tendons flapping uselessly through destroyed skin. Small particles of grit, or perhaps shrapnel, peppered the area, a large piece of jagged metal protruding visibly from the depths of the wound. It was tempting to remove it. You could easily grasp it between finger and thumb and pull, but if you did so there was real danger bleeding could increase. Remove a foreign body and the arteries have nothin
g to clamp down upon. I have seen patients nearly die as a result. Never remove such things, however tempting it may be, until the patient is safely inside the operating theatre and an intravenous drip is running fast to allow instant blood transfusion.
Added to his leg injuries, small pieces of shrapnel had peppered Viktor from neck to groin, though his face had largely been spared. Some of the wounds were deep, some superficial, but there must have been thirty separate wounds in all. You could see it was going to take some time to save Viktor, if he could be saved at all.
Apart from his visible injuries, it was difficult to be certain whether or not the blast had damaged internal organs, such as liver, kidney or spleen. Viktor was therefore treated by ‘peritoneal lavage’, sterile fluid being injected through his abdominal wall and allowed to circulate before being removed again. The normally clear fluid was tinged red. ‘Damn!’ That meant he was bleeding into his belly. Not only would surgery have to deal with his legs, and the multiple shrapnel wounds, his abdomen would have to be opened as well. Two macerated legs, thirty shrapnel wounds, and an abdominal operation were injuries only the strongest could survive.
Viktor was taken immediately to the operating theatre, his two children crying inconsolably as they saw their father being wheeled down the hospital corridor away from them. It was a heart-rending sight. There was no one to help, no one to cuddle or console them. Medical staff were too busy struggling to keep Viktor alive. Large iodine-soaked dressings were slapped firmly in place by the casualty staff, heavy pressure being applied to control any bleeding. Arterial spasm does not last forever. Two drips were set up, one in each forearm, to allow rapid transfusion, though whether enough blood existed in Sarajevo for Viktor’s needs was in doubt. His problems did not end there. No one was available to operate on him. Everyone was busy dealing with other casualties, and all surgical staff were operating in theatre. Viktor had to be left on his trolley in the theatre reception area, unaccompanied, without painkilling medication as supplies had been exhausted long ago. His pain was immense, soon overwhelming his initial self-control. He screamed, and he screamed - a horrible penetrating cry. You could not avoid it, it struck to the core. ‘Please God,’ you prayed, trying hard to concentrate on the patient before you, ‘Somehow, anyhow, please release Viktor from his agony.’ But release did not come, nor death. Viktor was a strong man, an agricultural worker in more normal times. He lay on the trolley, eyes tightly closed, uninjured hands gripping the side of the battered mattress and continued his incessant cry.
Knife Edge: Life as a Special Forces Surgeon Page 33