The work of healing in Bosnia holds urgent lessons for us all. In the first of a two-part series, Julian Sheather meets the medics whose extraordinary work is changing lives – and our understanding of trauma and conflict
Ilijaz Pilav is a senior thoracic surgeon. We meet in the restaurant of a hotel in Sarajevo – from whose encircling hills Serbian artillery bombarded the city for 47 months, the longest siege in the history of modern warfare. Ilijaz has come to talk about his experience as a doctor during the war. He was in Srebrenica, a small mountain town just over the border in what is now Republika Srpska, a three-hour drive from here through the wooded, tightly folded Bosnian hills.
Ilijaz had qualified only two years before war broke out. From April 1993 to July 1995, Srebrenica was besieged. Before the war there were 30 doctors in the town. He was one of only five who remained – all inexperienced, none with any knowledge of battlefield medicine.
Ilijaz can speak English, but tells his story in his native Serbo-Croat: such memories do not translate easily. His friend – our tireless, huge-hearted host – Resad Trbonja, renders them into English. Despite his physical presence, Ilijaz is gentle, precise and softly spoken. As he speaks, his face, though kind, betrays his struggle for emotional restraint, his need to overcome traumatic memory.
Srebrenica was encircled and blockaded. There were no communications, no medicines and no sanitation. At night it was bombarded and the inhabitants, numbers swollen by refugees fleeing Serbian troops, were vulnerable. Ilijaz, along with his four inexperienced colleagues, had to respond. There was no operating theatre. Amputations were performed without anaesthetic. There was no time – and no antibiotics – to permit wounds to close naturally, so they had to be sutured. Chest and stomach cavities were opened, again without anaesthetic. A black-and-white picture of Ilijaz at work, hanging in the Srebrenica-Potočari Museum, shows a dark, disordered room, Ilijaz leaning over a patient on a table, others lying under rags on the floor.
Quietly, often looking down, Ilijaz describes tragedy. His father, for whose terminal cancer there were no painkillers, died in his arms. As did schoolfriends. When Srebrenica was finally overrun by the Serb forces, he separated from his brother outside the hospital – and did not see him again. He lost 17 of his 20 closest male relatives in the war. In total, the Serbs massacred 8,373 Muslim men and boys.
Yet, despite appalling conditions, Ilijaz and his colleagues in the hospital made progress. Lives were saved. During his time in Srebrenica he performed more than 4,000 operations. The five young doctors gradually started to change received wisdom about the treatment of trauma.
And there were wonderful achievements. In the winter of 1994 they admitted a 37-year-old pregnant woman with a history of four unsuccessful peacetime pregnancies. In February she went into labour, seven weeks early. They delivered her daughter, Belma, by C-section. She weighed 1.5kg. Her mother could not breastfeed and there was no incubator. They kept her warm and fed her with a naso-gastric tube. In the first three days she lost 200g; but then she turned a corner. After 10 days they knew she would live. She stayed in their hospital for six months, becoming almost a mascot. Staff would drop by to see her before their shifts. Last year, she had her own daughter.
I was in Bosnia as a guest of the UK-based charity Remembering Srebrenica, part of a medical delegation exploring the long-term health impacts of conflict. Its mission is to promote social cohesion. Drawing on the genocide in Srebrenica, it raises awareness of the risks of internecine conflict.
The UK is not the Balkans, but hate crime is rising here. Brexit has revived old xenophobias. The Government has sponsored the creation of a ‘hostile environment’. In Hungary, Poland and the Czech Republic, darker nationalisms are showing their faces. The issues are again urgent and timely.
Muslim men and boys were not the only innocent victims of the Bosnian war. The conflict resulted in the international recognition of rape as a war crime. Bosnia is also the first country in the world to grant ‘war victim’ status to survivors of sexual violence. The systematic rape of Muslim women and girls was a core Serb military strategy.
It is hard to exaggerate the impact of rape on the bonds that tie communities together. Shame, particularly in conservative, patriarchal communities, can drive trauma deep underground, where it can wreak psychological havoc, both for survivors and their families.
Sabiha Husić greets us in the upper storey of a neat, peaceful building in the foothills overlooking Zenica, one of the larger cities in Bosnia Herzegovina. She radiates an infectious warmth, aided by her bright clothes – and the full bowls of sweets awaiting us on the table. Sabiha is the director of Medica Zenica. Founded in 1993, it offers trauma-sensitive medical care, psychosocial counselling and legal advice to victims of sexual violence.
Its early days were tentative. Initially it was little more than a safe space – somewhere women and girls could come if they wanted to. They were encouraged to talk and share experiences. Little was known about how to manage trauma in a conservative Muslim culture, but they felt their way. They developed an outreach programme. They called on people and talked about the war, establishing trust, speaking with women, letting them know they were not alone.
It soon became clear that women needed medical care. Many survivors of rape had problems conceiving. There were a range of physical and psychological responses to stress. PTSD, anxiety and depression were widespread. Over half of those who had experienced sexual violence had problems with their families. But the community responded. As the majority of those raped were Muslim, religious leaders issued a fatwa calling for acceptance of women who were raped.
Then there were the children born from rape. Sabiha explains how she worked for three years with one young woman to prepare her to talk to her mother about her rapist father. She then worked with the mother. Finally, she brought them together.
Since its inception Medica Zenica has offered a safe house to 2,000 women, counselled 16,000 and supported over 50,000 in total. It also trains other health professionals in trauma-sensitive counselling. A key challenge is interrupting the generational transmission of trauma – the children of survivors are also vulnerable.
In nearby Tuzla we meet Branka Antić-Štauber, a GP and director of Snaga Žene (Strength of a Woman), an NGO set up in 1999 for women refugees living in the Tuzla enclave. It is not easy to imagine the trauma suffered by these women: turned out of their homes, many of them raped, some having witnessed the slaughter of family members, they were suffering from complex psychological trauma. One woman had lost 37 close relatives.
Through experience, Snaga Žene has developed an ‘ecological’ model of healing. In addition to medical, psychological and social help, it offers legal support that helps women secure basic rights – to pensions, education and stolen property. It also offers ‘horticultural therapy’.
Before they were torn from their homes, these traumatised and displaced women were accustomed to working hard. Driving through Bosnia, you realise how close many people are to the land. Almost every house has a large, cultivated vegetable plot. Our trip was in spring and women were everywhere in the fields, hoeing between the lines of fresh green crops. The land is rich, alluvial, almost miraculously verdant.
Snaga Žene set aside 15 acres of land for women to cultivate as a physic garden. The therapeutic benefits were extraordinary – recorded rates of depression fell from 72 to 28 per cent. And because they grew so much, they started to sell herbal teas, both in Bosnia and internationally. Increasingly self-supporting, the project has returned self-respect to the women, helping them back into ordinary life.
Throughout the trip, we repeatedly hear that justice is the midwife to healing. Without it there can be no reconciliation, no letting go of the past. And for many Bosnians, the first step was to find their missing dead.
Dragana Vučetić is a forensic anthropologist. She works for the International Committee on Missing Persons’ Podrinje identification project in Tuzla. Her job is to identify the dead. We park outside a cluster of weathered pre-fabricated offices on the outskirts of the town. Dragana meets us at the door.
We talk briefly in the hall, then she ushers us into the morgue. It is as big as a warehouse. The cold air smells, if not of death then deathly. The rows of ceiling-high shelves hold long stainless-steel trays, three hundred of them. On each are bagged the remains – sometimes only a few fragments – of the unidentified dead.
After the killings, the bodies were buried in mass graves. With the end of the war approaching, the killers panicked. Using bulldozers and mechanical diggers they moved the bodies to secondary, even tertiary, graves, tearing the remains apart and mixing fragments of bodies together. In 2007 they found the remains of one person spread across five burial sites.
Dragana leads us into her work room. On a silver tray lies a nearly complete skeleton, peat-brown from the earth it has lain in. It has been arranged with anatomical correctness. Not buried in a mass grave, it had been spared further violation.
A section of the left femur has been neatly removed. It will be sent for DNA testing then checked against samples of blood taken from those with missing relatives. With luck they will find a match and somebody else will know where their loved one rests. It is slow, painstaking but necessary work.
Somewhere in the region of 6,700 victims have been identified to date. Dragana thinks there is one, possibly two, mass graves still to be found.
Justice involves more than recovering the dead. Bakira Hasečić and her team work from a ground floor office in Sarajevo.
Their NGO, the Association of Women Victims of War, seeks not only to strengthen the rights of women war victims but to identify the perpetrators. Bakira was born in Višegrad, in Eastern Bosnia. In 1992 Serbian troops knocked on her door. They repeatedly raped her and her daughter, then forced the family to flee their farm.
Bakira is plainly spoken. Her face is lined, her blue eyes fearless. The smell of cigarette smoke prickles in the air.
At first, all she wanted was revenge. But with time this changed, hardening into the fixed pursuit of justice. The team holds a database of 25,000 women who were raped. On one night alone, 54 girls were raped. There was Almira, raped at 11 then thrown from the sixth floor of a building. After a trial, a Serbian major was sentenced to 22 years for the crime. Bakira has coached women to testify at the Hague and the International Criminal Tribunal for the former Yugoslavia.
She was among the first to return to Eastern Bosnia, escorted by international troops and local police. Among her protectors, she identified those who had raped and murdered. Those who returned were taunted at first, but things have changed.
‘I am stubborn,’ she says. ‘I am not afraid of anything anymore. And they are afraid of that. I know who they are and what they did. Now criminals run away from me.’
After a group photo I stand outside waiting for my colleagues. It has been an extraordinary trip. Sarajevo’s encircling hills are dark green under the high blue sky, free now of artillery. It is not easy to square the beauty of this country with such savagery. The work we have seen, the commitment and courage of the people we have met, has never seemed more vital. So too is the warning it relentlessly transmits about the terrible dangers of inflamed nationalism, and the price that divided communities can pay.
Bakira is leaving with us, heading back to her beloved farm on the Drina river. Under her arm is an old fruit crate full of young potted plants. As she steps out of the shadows their fresh leaves are suddenly translucent – glowing a hopeful green in the spring sunshine.
Julian Sheather is specialist adviser, ethics and human rights at the BMA