How plastic surgeons in Iraq help bomb victims feel accepted in society

It was a mother’s nightmare. Rawneq al-Tai begged doctors at the Wasseti Plastic Surgery Hospital to help her daughter. “I want her to be happy and find a husband one day,” she said, holding up three-year-old Tabarek.

The child’s head was bandaged with gauze, hiding a partially severed ear after insurgents blew up her nursery school four days ago.

Plastic surgeons have become a vital part of the response to political violence in Iraq. Long after hospital staff have wiped away the last bloodstains from the floor of the accident and emergency department, the much-maligned surgeons will attempt to give the maimed a life worth living.

“For women especially, any injury to the face is disastrous. They have no hope of living well if they are disfigured, no marriage, no children,” Mahdi Hameed Abood said. The 25-year-old doctor has a collection of before and after pictures on his computer.

It has been a busy week for surgeons in Baghdad. Two car bombs exploded on Sunday in one of the worst attacks in the Iraqi capital since the start of the insurgency. More than 1,000 people were wounded and at least 155 killed. This has resulted in a rise in demand for cosmetic and reconstructive surgery.

“There is a big increase in cases this week but also generally,” Dr Abood said. Surgeons are so busy that they work day shifts in public hospitals and night shifts in private clinics. Despite being used to the bombing, many feel overwhelmed by the countless wounds and burns.

Thamer Wisam, a doctor at the Wasseti specialist hospital, said: “It doesn’t start immediately after an explosion ... But within a week we’re overflowing.”

To cope with demand, a record number of medical students are graduating from Iraqi universities, according to the Health Ministry, and every week private clinics are set up. Demand still outstrips supply.

Dhirar Hassan, another Wasseti doctor, said: “We will be busy with this explosion for weeks and months to come.” Yesterday he examined Tabarek. She will be given an operation that will cost her parents 50p, and is expected to make a full recovery. Her mother found her in the day care centre of the Justice Ministry minutes after it was destroyed. “I grabbed her and ran to the hospital,” she said.

Children wanted to look like other children or their psychological development could be affected, Dr Hassan said. “And adults too. They need to be happy with the way they look. That’s why plastic surgery is important. Many patients are so disfigured even their own family won’t accept them, and they will never have a job again without an operation.”

Rasha Khalid, 24, was in the lobby of the Justice Ministry when the bomb exploded. She has shrapnel lodged in her head, neck and breast. Ms Khalid received plastic surgery within two days but will be visiting more doctors. “I need this so I can forget,” she said. “People think plastic surgery is for those who want to be special. But I just want to be normal again.”

The politics of plastic surgery can be treacherous in Iraq. Political parties fighting an election are trying to win favour by offering treatment abroad. Shia politicians send patients to clinics in Iran free of charge. Sunni rivals offer the same in Jordan and Syria. Wealthy patients travel to Britain and the US if they can get a visa.

Yet they may be better off staying at home. When it comes to repairing bomb damage, Iraqi plastic surgeons have more experience than most. Dr Wisam said: “The skills of Iraqi plastic surgeons are vastly improved as a result of the violence. Some are world experts now. No wonder, we sometimes get 300 patients a day. A Western doctor might get that in a month.”

Iraqi surgeons said that they were constantly improving techniques. They watch the work of foreign colleagues in academic journals on the internet and try to replicate the operations. Experimentation is a big part of emergency plastic surgery.

“There is a lot of opportunity for that,” Dr Wisam said. “In some cases we have developed techniques to fold two difficult operations into one. Of course, the facilities in Iraq are still bad. We don’t have enough operating rooms. We need more of everything.”

Many also wish for a break from the relentless misery. They said that the injuries to torture victims were worse than those of bomb patients. Often their noses and jaws have been broken, their ears have been cut and their cheeks slashed. Some were held for days, others for months. Every time the patients looked in the mirror, unless operated upon, they saw a reminder of the darkness they experienced.

Oliver August, The Times 29-10-2009

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