Knife Edge: Life as a Special Forces Surgeon (38 page)

My visit to Lebanon began well before leaving the UK, when a very overladen postman arrived at my Cambridge home. He was struggling with a thick pile of large brown envelopes. X-rays, the items he was carrying, are heavy in bulk. Arabic writing stood out on the various envelopes, though I was unable to decipher a word. On each one I could see the bright red stamp of the Red Crescent, the Palestinian equivalent of our Red Cross. As I studied them, I soon realized what an enormous task lay ahead. In the various Palestinian Refugee Camps of south Lebanon, a physiotherapist had been hard at work. She had gathered together a massive collection of war-wounded injured over several years. Some young, some old. Civilians, soldiers, men and women. The X-rays, and their accompanying case histories, said all. ‘Bombed’, ‘Caught in blast’, ‘Shot’, ‘Sniped’ and assorted vivid descriptions appeared in every case report. Each X-ray showed the typical bright, white, metallic shrapnel fragments, often surrounding smashed and macerated bone. Shrapnel, named after Major-General Shrapnel, describes the pieces of metal that fly in all directions when something explodes. Some are small, some are huge. Whatever the size, the damage shrapnel creates can be immense.

The physiotherapist, Miranda, had done an impressive job. It is rare to receive such detail of likely cases before visiting locations overseas. Normally you must do the best you can when you arrive and without prior warning. To realize what lay ahead allowed me to prepare and to advise Miranda of likely treatments so she could warn the patients what might happen. Some of the surgery needed was huge, often needing more than one operation. Certain deformities created by bullet wounds, particularly high-velocity ones, can be so serious that a single operation is insufficient to correct them. You may need to operate five or six times, each time correcting the deformity a few degrees. By the final operation you leave the patient with a limb that is perfectly aligned.

Miranda wrote seven times over the succeeding weeks, on each occasion enclosing a further mound of X-rays. ‘Excellent physical training this, Doctor,’ the postman would comment as he lugged another massive weight of envelopes along the gravel drive to my front door.

I began to worry Louise would think I had struck a secret affair with a woman she had never met, so frequent were the missives from Lebanon. It is a feature of most charities that everyone is immensely cheery, amicable and supportive. By the time Miranda and I had written to each other for the seventh time we were communicating like long-lost friends, though in reality we had never met. I did my best, involving my family in all arrangements, though knowing they could not accompany me on the eventual trip. Out came the maps at the kitchen table, the Lebanese guidebooks, the histories of Palestine. I also listened carefully to Louise’s sound medical advice as to what she thought I should do with some of the children’s cases. Thus it was, by mid-September, I waved farewell to my family once more, now comprising Louise and three children, and set out for Lebanon. I cannot pretend I was relaxed. I was not.

Four of us went, two surgeons and two nurses, as I felt the work required was more than I could handle alone. Some of the operations were particularly complex and would need two operators at least. None had been to Lebanon before and each was full of anticipation, mixed with some worry, as to what lay ahead. The media does not help. Close-up shots of Palestinian youths throwing petrol bombs, or Israeli soldiers sporting Galil machine-guns appear every day. By the time your airplane has landed at a humid Beirut airport you are convinced your chances of returning home are lessening by the second. Modern warfare has never been a great respecter of the medical profession, many members of which have been kidnapped, tortured, murdered, shot and raped in various parts of the world. As a civilian, you are more exposed to these dangers than in the armed services. No longer do you have the protection of soldiers or Government behind you. Native wit and instinct are your only weapons.

We staggered from the exit doors of Beirut airport, though I noticed my surgical colleague, Fred, staggering more than most. A mammoth rucksack creaked and groaned on his back, his normally strong frame struggling to stay vertical. Had we been walking on sand rather than chipped concrete he would have disappeared to his knees. ‘What on earth have you got in that rucksack?’ I inquired.

‘Just books, Richard,’ came the reply. ‘I thought we might need to look a few things up. Didn’t know what they might have over here, so thought I would bring my own.’

Fred had, I think, brought every book to Lebanon he possessed, in case of being caught out by an unfamiliar disease or operation. It was his first time in a war zone. I laughed, having overconfidently assured him before we left England that I had seen it all before and there would be no need to worry. I would show him what was necessary. By the end of our short stay in Lebanon, I was eating humble pie. So horrendous were the cases, so insoluble the conditions, I, too, pored over Fred’s books for answers.

It is difficult to know what to bring as a surgeon to such places. Do you take every hi-tech item known to man, or do you do the best you can with what is available? I have always chosen the latter course. Hi-tech equipment usually has to return home again, and cannot be left behind. It seems unfair to raise local hopes for the short period you are there, only to dash them once you leave. On one occasion I was visiting a Third World country in company with several surgeons, in order to demonstrate certain modern surgical procedures. One of my companions, a charming fellow and with the interests of our hosts at heart, took with him in his suitcases every item of equipment needed for major surgery. They rattled and clunked furiously through each security check, and were a guaranteed manual search whenever stopped. His luggage weighed tons. He could barely carry it and had left himself room for only a single pair of underpants as a personal item. By the end of our two-week stay, not only did he smell overripe, but he had not had an opportunity to use any of the instruments. Due to various reasons, the locals had cancelled our operation schedule. The mass of equipment returned to England unused and, by then, much hated.

The medical lot of a Palestinian in Lebanon is not a happy one. Money is unavailable for private care, while Government-run hospitals do not always offer the full spectrum of possible treatments. As a result, diseases, wounds and children’s deformities can remain untreated for years. This was the country into which we stepped. Like Northern Ireland, every eye that stared was a potential kidnapper, every backfiring car a terrorist assault. Though it was early evening, I felt the cold trail of sweat run an isolated course down my back as I searched the mass of unfamiliar faces crowding the passenger reception area. Were we expected? God knows. Please come and meet us, somebody, I silently cried.

‘You must be Richard Villar,’ I heard a gentle voice say to my left, interrupting my incipient panic. I turned to see who it was and was glad to see a woman of European appearance, tanned, well-dressed and smiling in welcome. A gentle hand was extended as greeting. ‘Hi,’ she added. ‘I’m Miranda.’

It is always a shock to meet someone for the first time to whom you have previously written on numerous occasions. So it was outside Beirut airport that evening. The occasion was slightly awkward, but we both had work to do, so there was little time for discussion. With the briefest of handshakes I was ushered into her dilapidated, certifiable, though much-loved car and driven south along the coastal road towards the town of Sidon. My colleagues were squeezed into a more modern version of the same, following close behind.

Miranda was a remarkable person. As a physiotherapist she spent much of her time dealing with bone and muscle problems, many of which had been caused by the ravages of war. A bullet through a child’s spine, for example, can cause paralysis of everything below the point of injury and spasticity of the muscles. Spasticity makes the arms and legs rigid and tight, so the patient can barely move them. A physiotherapist can work wonders, loosening them up, eliminating the inevitable deformities prolonged spasticity creates. This is one tiny example of the many conditions they can treat, but however much physiotherapy you offer, some deformities will not correct without surgery to allow treatment to start. Once tight tissues have been released, the physiotherapist steps in once more. Miranda largely masterminded our visit as a result. Scheduled to leave the country shortly, after a long tour of duty with MAP, she wanted to be sure she had done as much for her patients as possible.

As we thumped our way along the cratered and potholed road in her rattly car, Miranda explained in her mild New Zealand accent what was involved. I was feeling uneasy. I always feel uneasy in war zones. Though Lebanon was reported to be quiet, such terms are relative. I now realize I was being unnecessarily alarmist, but my mental image of Lebanon then was one of bombs and kidnappers round every corner. Miranda, meanwhile, was completely relaxed, continuing her briefing as if she was driving down the centre of England’s safest motorway.

‘You’ll be working from Hamsharry Hospital. It’s in Sidon, next to one of the refugee camps,’ she explained, it is the main Palestinian hospital in Lebanon. You are badly needed.’

As she spoke I felt the car slow. We were approaching a haphazard arrangement of oil drums on the road. I had heard of Lebanese roadblocks, the second most common point of kidnapping after Airport Road. The isolated trickle of sweat on my back was fast becoming a torrent. Miranda was unfazed, oblivious of the unnecessary worries continually flashing through my mind. She must have been through hundreds of the things. Road blocks were two-a-penny. I never did learn who controlled them though I believe the majority were run by the Syrian Army. On this occasion a good-looking young man, no more than twenty years old, put his head through the driver’s window and smiled. On his shoulder was a gleaming Kalashnikov, oiled perfectly. I could tell from the way it lay against his shoulder the magazine was full. Most so-called armed guards in the UK carry a rifle loaded with thirty rounds of fresh air. The bullets either have to be kept in a tunic pocket or in the guardroom nearby. Whoever thought that rule up had never been in a real-life contact with an enemy. The opposition is hardly going to wait while you run to retrieve your bullets so you can return fire. This young man had a fully loaded, and cocked, weapon. Arguing with him was not an alternative.

‘We are travelling to Sidon,
al-Hamdu lillah,’
Miranda announced in excellent Arabic. ‘This man is a surgeon who has agreed to work there.’ She pointed towards me disdainfully, as if I was a piece of baggage. I felt exactly like one at that moment - a very sweaty mess.

The young man smiled further, revealing a sparkling gold filling in a lower tooth. Looking at me carefully, he inspected me in detail. Then, with a brief closing of his eyes, a mild facial sneer and a casual wave of his right hand, we were ushered past.

Hamsharry Hospital is a dominant building, standing immediately beside a Palestinian Refugee Camp in the city of Sidon. Of 1960s design, square and ugly, it is for most Palestinians their only real medical hope. Pockmarked by shrapnel, it houses several wards and two operating theatres. All around is evidence of rebuilding and reconstruction, an attempt to eliminate any trace of war. In some areas of Lebanon, particularly the Israeli Occupied Zones, this is a forlorn struggle. As fast as rebuilding progresses, another assault knocks it down.

In the cellar, now a storehouse, sit the remains of an old courtroom. Now untidy and neglected, one can imagine the earlier scenes of judgements made and punishments issued. Many would have been terrified to enter that room. Outside the hospital perimeter, day and night, gunfire can be heard. Normally intermittent, it can occasionally be continuous and severe. Stand on the hills that surround Sidon and you would be forgiven for thinking full-scale conflict was still in progress. Admittedly there are no major explosions, but rifle fire is persistent, the sound of either skirmishes or sniping. Southern Lebanon is unquestionably a paradox. It really is a land where you can sit outside in the evening with your ice-cold drink, looking at a sunset in one direction, but murder being committed in the other. Peace and war can take place at the same time in the same street. After a long day in the operating theatre, we would occasionally play games, trying to identify a weapon by the noise it made. As there was no way of confirming our various opinions, I imagine we were always hopelessly wrong.

Hospital staff were a hard, motivated crowd. They welcomed us with open arms, particularly as our way had been paved by Miranda. Most were very fit and very tough. Many had been fighters at some stage. Firm handshakes, and incredible courtesy, were the order of the day. You would always look a man in the eyes when you spoke to him. The slightest hint of an Israeli assault on a refugee camp or village, and the hospital would empty immediately. Staff of all grades would disappear to the area under threat to help. For most, an attack on any Palestinian was the same as an attack on themselves.

I never understood the various groups - Sunnis, Amal, Hezbollah, Palestine Liberation Organization, Popular Front for the Liberation of Palestine and many others - it was best not to ask as it would mean entering a political conversation that I wished to avoid. The uniting factor for all groupings was their universal dislike of the other side. Being a fighter, for whatever Palestinian cause, was respected. Those I met were astonishing people and had led a precarious existence for years. In certain of the camp wars, when the refugee camps had come under direct attack, irrespective of the vast number of defenceless civilians within them, the Palestinian fighters could spend weeks defending a tiny area no more than 200 metres square. Pinned down from all sides, and shot at if they showed themselves for more than a second, it was little wonder these people were tough. If it had not been for my Army experience I would have been daunted.

As well as the Palestinians, there are certain doctors who have upheld the best name of the profession under the most arduous of conditions. None more so, I believe, than Pauline Cutting in Lebanon. I had, of course, heard of her. Working as a surgeon during Beirut’s Bourj al-Barajneh Camp siege, she continued supporting sick and injured Palestinians under the most deprived and stressful conditions imaginable. To read her book
Children of the Siege
is to see war surgery in its true perspective. Quiet-spoken, charming, I have never before met a doctor so admired by her former patients. Mutual danger and discomfort bonds mankind tightly - I had experienced that with the SAS. The same applied to Pauline and the Palestinians. They love, cherish and admire her. I know she would be too modest to admit it. It was certainly my privilege to meet her. One cannot underestimate the enormous stresses placed on someone under the terrible conditions she was forced to endure. Scars can remain for life.