The plan for my second visit to Baghdad, in August 2017, was to operate on as many patients as possible in ten days. But, even as we were checking in the 90 kilograms of excess baggage—surgical tools, equipment and implants—at Sydney Airport, the whole venture remained surrounded by uncertainty.
Initially, the people who were campaigning most enthusiastically for me to go to Baghdad were the surgeons who wanted to learn about osseointegration and other advanced operating techniques. But at one stage, the powers that be told me I wouldn’t be allowed to operate in Iraq. It took some delicate diplomacy and careful negotiation, but we eventually cleared that hurdle.
The prime purpose of this visit—dictated by the Iraqi Government—was to operate on fighters from the military, paramilitary, counterterrorism and police who’d been severely wounded in the battle to drive ISIS terrorists out of their country. They’d suffered huge numbers of casualties since the summer of 2014, when ISIS launched a lightning attack from its nominated capital of Raqqa in Syria.
Everyone who has taken an interest in the Middle East over the years is aware of the horrors ISIS has inflicted on the region. Not only did they adopt some of the most brutal tactics ever seen but they also celebrated their complete disdain for anyone who wasn’t part of their horrific war machine. The videos of beheadings and other atrocities they posted on social media remain notorious and among the most disturbing images of the early 21st century.
What isn’t as well known is just how close ISIS came to storming all the way to Baghdad. The writing was on the wall in December 2013 when, shortly after the authorities closed a protest camp outside the city, Sunni rebels—initially under the banner of Al-Qaeda in Iraq—took control of Fallujah, just 75 kilometres from Baghdad.
To give you some idea of how close ISIS was to taking the Iraqi capital, let’s put the capture of Fallujah into Australian terms. It’s the equivalent of ISIS being 10 kilometres south of Goulburn and headed for Canberra. For Sydneysiders, it’s like having ISIS controlling Gosford, Wollongong or the lower Blue Mountains. In Melbourne, ISIS would be approaching Geelong from the west. In Brisbane, terrorists would have taken the Gold Coast. In Adelaide, Murray Bridge would have been overrun, and the murderous Sunni forces would be advancing on the South Australian capital. In Perth, ISIS would have taken Mandurah or Morangup.
In June 2014, making the most of the growing political and social unrest in Iraq, a relatively small and vastly outnumbered ISIS unit launched a carefully coordinated offensive and quickly forced the demoralised Iraqi Army into retreat. Panic spread among the regular Iraqi soldiers and, within days, Mosul—Iraq’s second-largest city, 400 kilometres north of Baghdad—fell to the invaders. Nineveh Province, to the east of Mosul, was overrun soon after, as Iraqi soldiers deserted en masse in the face of the onslaught. Iraqi resistance collapsed.
Tikrit, 140 kilometres north of the capital and the place where Saddam Hussein was born, also came under ISIS control that month. It was the site of one of the greatest atrocities committed by the jihadists. At least 1500 air-force cadets based in the city were executed. None of them was armed.
At the height of its success, ISIS had conquered one-third of the landmass of Iraq. It went on to declare a new caliphate—which literally means succession, and follows the Islamic tradition that began with the death of the Prophet Mohammed in 632 AD. The Sunni successors to Mohammed became known as the caliph.
Abu Bakr al-Baghdadi—who claimed he was directly descended from the prophet—was named as the leader of ISIS, taking on the title of Caliph Ibrahim. He was born near Samarra, 125 kilometres north of Baghdad, in 1971 and was named Ibrahim Awwad Ibrahim Ali Muhammad al-Badri al-Samarrai.
After graduating from school, he was disqualified from joining the army because of bad eyesight. He went on to university, where he studied religion and was regarded as largely insignificant. He kept to himself during those years, but was known to openly oppose violence—in complete contrast to his later activities.
He came to prominence after rising through the ranks of Al-Qaeda in Iraq—which, at the time, was also known as the Islamic State of Iraq—and was named as its head in 2010. The terrorist group expanded into Syria on the back of the uprising against President Bashar al-Assad in 2013 and rebranded itself as the Islamic State of Iraq and the Levant.
Before long, it had raised an active army—many of them Sunni dissidents who’d previously been soldiers with the Iraqi Army but had become disillusioned after the Americans disbanded the military following the fall of Saddam Hussein. The well-equipped fighting force was backed by significant funds from taxes ISIS imposed in the areas it controlled and the sale of oil from the regions it had captured.
The situation in Iraq became so parlous that, during Friday prayers on 13 June 2014, the Grand Ayatollah of Iraq, Ali al-Husseini al-Sistani, issued a fatwa against ISIS. In effect, it was a declaration of war against the Sunni extremists and a call for all able-bodied Iraqis to join the fight against ISIS. Tens of thousands of volunteers responded and created Al-Hashd al-Shaabi—the Popular Mobilization Units, otherwise known as the paramilitary.
Hashd includes a wide variety of completely disparate militia that had been previously fighting for their own interests. It’s predominantly Shi’ite, but incorporates around 40 different groups—from Sunni tribesmen to Christians and Yazidis, a Kurdish religious minority. At its peak, Hashd could claim up to 65,000 soldiers.
Behind the scenes, the guiding hand supporting Hashd was Iraq’s overwhelmingly Shi’ite neighbour, Iran—which was supplying weapons and ammunition, and worked closely with the paramilitary. Hashd’s involvement in land battles was crucial to the success of the fight against ISIS and, along with air strikes by US planes and other Allied aircraft, they halted and then drove back the Sunni fighters. But in achieving their goal, thousands of the paramilitary—along with regular army soldiers, counterterrorism fighters and police—had suffered terrible injuries.
The Iraqi Government—mostly for pragmatic reasons, but also for humanitarian motives—was committed to providing the best possible health care for the war wounded.
This is where I fitted in. But it wasn’t as straightforward as that. For a start, I needed to know where the funding for my mission was coming from. Although I offered my surgical skills for free, there were still expenses to be covered. Various medical-device companies had provided surgical equipment and implants at cost price.
I started talking to the paramilitary about picking up the tab for the surgical equipment needed to operate on their wounded fighters. Initially, I was told there was no chance. This would have brought the project to an end before it had even started. Finally, after many long and arduous discussions, the paramilitary agreed to foot the bill for their wounded fighters.
However, at the start of our second visit to Baghdad, we still didn’t have formal approval for the operations to go ahead. I had a choice: put the project on hold while the politicking continued, or back my judgement that the issues would be resolved. I decided to take a chance. I went ahead with the first scheduled operations.
By the end of our first day of surgery, I still hadn’t been given the official go-ahead. Even into day two, the uncertainty remained. That afternoon, the hospital authorities called a halt to our activities. The theatre list was suspended. We couldn’t do anything, and unrest and tension quickly started to build among the patients and staff.
Then, an individual who was clearly a high-ranking official arrived at the hospital escorted by a small army of paramilitary soldiers. He came straight into the operating theatre.
I had no idea who he was, so I politely posed the question, ‘May I ask, who are you?’
‘I’m a humble citizen,’ he responded.
It was clear he was much more significant than he was letting on, so I decided to seek his help to get the surgical lists back on track.
‘I’ve come here to operate on counterterrorist and army soldiers, paramilitary fighters and police officers who’ve suffered terrible wounds protecting Iraq from ISIS,’ I told him. ‘I’ve already started operating on them, but I still don’t have permission to carry out these operations.’
After a brief pause, the important person, who I subsequently found out was the deputy head of Hashd, Abu Mahdi al-Muhandis, said, ‘You do now’.
‘From who?’ I asked.
‘From me,’ he responded. ‘Give me five minutes.’
He pulled a small mobile phone worth no more than US$20 out of his pocket, dialled it and issued an instruction to someone on the other end: ‘I need my patients to be treated and procedures to start.’ He hung up, left the theatre complex with his entourage and strode to the office of the hospital director, Dr Yasser al-Timmimi.
Half an hour later, I was summoned to Dr al-Timmimi’s office, where I found him sitting in front of his desk looking like a timid mouse. The same man who one hour earlier had been barking orders at me was now desperately trying to earn the favour of the paramilitary deputy leader.
Al-Muhandis turned to me and announced, ‘You’re good to go’.
The relief was massive. Until now, I’d been working clandestinely—knowing that I could be ordered to stop at a moment’s notice. Now, it was official. We could get on with the work we’d come here to complete.
On my first visit to Ibn Sina Hospital, I saw a variety of patients from all four areas of the Iraqi fighting force. But because Hashd was bankrolling the mission, when it came to my second trip, the majority of the patients were from the paramilitary.
The desperation of the patients and their families had been clear to see as soon as we arrived in August 2017. We based ourselves in a meeting room just 10 metres from the reception area and on the right of the ground-floor corridor. The throng of patients and their families spilled over from the reception area into the corridor, where they would linger—trying to corner me or my colleagues and exert pressure to gain a place at the top of the surgery list. Unfortunately, there wasn’t much I could do. The operating schedule was organised by the team at the hospital.
Through the government, Hashd and the hospital administration, I had been given the target of operating on 48 military personnel. But I also campaigned for civilians to be included. Hundreds of them had made the trek to Baghdad in the hope of undergoing osseointegration. Time and again, though, I was firmly told that no civilians could be considered until the military quota had been achieved. Until then, I would not be given permission to operate on any civilians—even though a number of them were prime candidates for very complex surgery, including osseointegration. It became clear that a decision on civilian operations would have to be referred to the prime minister.
Along with my young American colleague, Matt Weldon—who’d been working with me in Sydney as a resident for the previous five weeks—I faced a variety of challenges when we operated in Baghdad during that scorching summer of 2017. Matt, who hails from Houston in Texas, is an interesting character who always operates wearing his favourite cowboy boots! He’d never before experienced the clinical conundrums we came across in Baghdad.
The first, of course, was the condition of the patients. Their injuries were some of the most complex any of us had ever seen. The devastation inflicted by bullets, IEDs, rockets, shells and mortars was far worse than anything we routinely see in Australia. Added to this was the fact that many of these patients had previously undergone surgical procedures that we wouldn’t regard as ideal. And, often, infection had set in, damaging tissue and bones.
Then there were the conditions in the hospital. Some equipment and surgical fixtures and fittings that are the norm in Australia simply weren’t available. And although the doctors and physiotherapists mostly appeared knowledgeable, eager to learn, well prepared and enthusiastic, some of the nurses didn’t seem to be familiar with the latest procedures. For a handful, even basic hygiene and sterilisation methods were either a mystery or an unnecessary detail—replaced with a shrug of the shoulders when standards slipped.
Then there were the cultural and language difficulties. I speak fluent Arabic, so it was okay for me. But other surgeons and staff who came with me weren’t in the same position. Plenty of details seemed to be literally lost in translation for patients as well as some of the medical staff.
For example, one of the patients who was scheduled for afternoon surgery was instructed in the morning not to eat anything before his operation. I understand that at lunchtime, Sophie McNeill—who was covering our visit for ABC TV’s Foreign Correspondent program—saw the patient disappearing into a cupboard with a plate of food. When he was challenged, the patient simply said, ‘I know I’m supposed to be fasting. I’m taking the plate of food into the cupboard so no one can see me eating. It’ll be okay if no one sees me. They won’t know I’ve eaten anything!’ Fortunately for the patient and the operating team—both of them facing a potential disaster in the theatre if the patient had food in his stomach—the beans were spilled. His operation was delayed for 24 hours.
Our days at the hospital started around eight o’clock each morning. We continued operating, with only a brief break for lunch and dinner on the run, until the operating list had been completed. The earliest we finished in the theatres was 11.30 p.m., and on many days it wasn’t until after 1 a.m. that the final patient was wheeled back to the ward. We took only one Friday off, because it’s the Muslim holy day. Most hospital staff members weren’t available, leaving us with only minimal support.
Many of the military men I operated on had been through hell in the months and years before I met them. In the end, around 50 per cent of the patients I recommended for osseointegration decided not to have the operation. Fear of the unknown, I guess.
Every single one of the patients we treated had a story to tell—many of them reflecting key aspects of life in Iraq.
THE DANCING MAN: HAITHEM JABBAR RAHEEL
The first person in Iraq to walk on a new robotic leg after undergoing osseointegration was 29-year-old Haithem—a short, slim man with a shock of dark hair, a beard, eyes that constantly smiled and a broad, cheeky grin. His relentlessly cheerful attitude was a tribute to his resilience, particularly considering his ordeal of the previous three years.
Despite the history of bitter and bloody conflicts between Iraq and Iran, by the second decade of the 21st century, large numbers of wounded Iraqi soldiers were being sent to Iran for treatment. Haithem, who’s single and from Kirkuk—about 250 kilometres north of Baghdad—was one of them.
He’d suffered terrible injuries fighting with the paramilitary against ISIS in the autumn of 2014 near the town of Baiji, 200 kilometres north of the capital. Like so many of the wounded Iraqis, he stood on an IED while on patrol. His right leg was blown off above the knee.
Haithem lay wounded on the ground for around half an hour, receiving rudimentary medical care, before being rushed to hospital in an ambulance. He remained in hospital for the next year, being pumped full of antibiotics to ward off the life-threatening danger of infection, before being transferred to a medical facility in the Iranian capital, Tehran. For the first six months there, he was confined to a wheelchair. Eventually, he was fitted with a socket prosthesis—but he never mastered walking with it. In the end, he gave up and, in mid-2016, went back to the certainty of his wheelchair.
Haithem’s X-rays clearly indicated that osseointegration would work well. He enthusiastically accepted the idea and underwent surgery the next day. No more than 24 hours later, he was discharged from hospital with only paracetamol—he was one of the lucky few to get paracetamol—and a big grin, declaring, ‘I feel as though a new life is opening up for me.’
The next chapter in that new life began when we returned in December 2017 and Haithem was fitted with his robotic leg. He took to it quickly, and within a day he was walking short distances using a frame, under the supervision of Romanian prosthetist Bogdan Dimitriu, who we flew to Baghdad especially to work with our patients.
By day two, Haithem was walking with the aid of two crutches along the ground-floor corridor close to the physiotherapy department. Bogdan was adjusting the fitting of his new leg so it would force Haithem to develop the strength of different muscles—a crucial part of helping him walk virtually normally.
Haithem was discharged from hospital and scheduled to return one month later for further checks and potential alterations to the robotic leg. His prospects are outstanding. ‘I am so happy,’ he says. ‘It feels very comfortable. I have wanted to walk for so long. It won’t be long before I make you dance with me! I will dance first, then think about what else afterwards!’
What does the future hold for Haithem? Well, there’s every chance he’ll be able to dance again. It all depends on him. I know that before the operation he declared he’s from the paramilitary and intends to return to their ranks once he’s able to walk again. I want him to concentrate on his dancing.
A FATHER AND SON: ALI BASIM JABBAR SHAREEF
People with a physical disability face a tough life in Iraq. There’s no anti-discrimination policy, and there are few social-support networks. Instead, the future holds the prospect of prolonged unemployment, financial hardship and constant struggle—even open hostility in public places.
Ali, who’s stockily built with dark hair and a pencil-thin beard running down the centre of his chin, was wounded in the fight against ISIS in 2014, also at Baiji. ‘We were surrounded by ISIS for two days, and we’d used nearly all our bullets and grenades,’ he remembers. ‘I was injured when they attacked us with guns and seven car bombs.’
Looking back, he had been fortunate to survive the battlefield. More than 70 of his fellow paramilitary fighters were killed that day. He was shot in the lower right leg, suffering severe damage to the arteries and nerves. After a week in hospital, doctors delivered the news that his leg would have to be amputated below the knee. ‘If we don’t amputate it today, gangrene might set in tomorrow and you could die,’ they told him.
‘From that point of view, it was the best choice,’ he reflects. ‘I thank God I only lost one leg.’
At the time, he was married with a four-year-old son, Hussein. Soon after he was injured, things changed. Ali’s wife left him and their child. He became a single father with little means of support, other than his parents. Hussein found it difficult to come to terms with his dad’s injuries. ‘Early on, he refused to come near me,’ Ali recalls. ‘Slowly, slowly, he understood and accepted it.
‘This is what happens in Iraq. This is quite common. Disabled people don’t have rights. They don’t look after you. They treat you like garbage in the street.’
Ali, who lives with his parents and Hussein on the northern outskirts of Baghdad, was the first patient to undergo osseointegration in Iraq. The next morning, his father and son visited him in the ward. He showed them his leg and celebrated with them, teasing Hussein with the words, ‘I’m the first person who’s had this surgery in Iraq. Maybe I will be a famous man! ‘This is one of my best mornings. I will not forget this morning. It will change my life for the better.’
When we returned four months later, Ali was the second Iraqi to be fitted with his new leg. That day, he walked out of the hospital using one crutch, hand in hand with Hussein, saying, ‘I have a good relationship with my son. But I hope this will help him look at me in a new kind of way. I want to be able to do all the things we used to do together before I was wounded. I want to take him to the zoo and on lots of outings. Spend time together.’
TWO NEW LIVES: AHMED ABD ALRAHMAN YOSIF
Happily, not every wounded Iraqi soldier experiences the collapse of his family and personal life. Ahmed was engaged to his cousin, Safa, when he was horribly injured near Fallujah in May 2015.
She never wavered in her support for him, and they were married in 2016. In August 2017, two days before I operated on him, their first son was born. Ahmed was in hospital at the time and still hadn’t seen his son when he underwent surgery to amputate his right leg above the knee and clean the infection from his badly damaged right shoulder. These were only some of the injuries he had suffered. He had also lost most of the fingers on his right hand and is blind in his right eye.
His injuries were sustained when, along with his paramilitary colleague Uday, Ahmed approached a factory entrance. An IED erupted, instantly killing Uday. ‘I didn’t hear anything,’ Ahmed recalls. ‘It felt as though someone had pushed me from a long way off. I couldn’t see anything with my right eye and had blurred vision in my left eye. I still do. But I remember noticing blood and parts of my right hand and fingers falling off.’
Ahmed lay bleeding profusely from his wounds for half an hour, calling for help, while the rest of the patrol checked the surrounding area for more bombs. Once the all clear was given, he was lifted into an ambulance and lost consciousness on the way to hospital in Fallujah, before being transferred to Baghdad.
Ahmed was completely disorientated for the next couple of months. ‘I didn’t know where I was or who I was,’ he says. Over the next two years, he underwent more than 40 operations in Iraq and Iran. But he was never free of pain or infection.
In December 2017, I inserted a rod in his right leg, ready to attach a new robotic leg on our next visit. Later, I performed what’s known as reverse shoulder replacement surgery on his right arm. It’s called that because, instead of the normal configuration of a ball on the top of the arm and a socket on the shoulder itself, the operation places a socket on the top of the arm and a ball on the shoulder. It’s a relatively new technique that isn’t widely used. But it works well and is becoming more popular.
Five months later, I performed osseointegration on his right wrist, inserting a rod as the base for a prosthesis that will allow him to grip items, even though it won’t look like a normal hand. Two reconstructive surgeons from London’s Royal Free Hospital—Dr Norbert Kang and Dr Alex Woollard—also travelled to Baghdad at the same time as part of my team and operated on Ahmed.
After the osseointegration and shoulder surgery, Ahmed could feel hopeful about his future. ‘My wife and I have been waiting for this operation for four months—so we’re very happy. But I’ll be even happier when my shoulder has recovered,’ he explains. ‘Previously, I couldn’t move much because my leg was very uncomfortable. Now, it’s more comfortable. And it will be wonderful when I can get more movement in my shoulder. It will make my life easier. This is one of the few good things that has happened to me since I was injured. It will help me find a new life.’
After the shoulder surgery, Ahmed’s main complaint was that he was bored staying in hospital. He’s now walking smoothly and confidently on his new leg and has a broad smile on his face. He’s come a long way in a short time.
‘I MAKE BOMBS, NOT CAKES’: MOHAMMED HUSSEIN ABD ASADA
Plenty of people in Iraq don’t know their birth date—especially older people and families from remote areas. Traditionally, there was no registration of births in regional parts. The records simply weren’t kept.
Instead, a convention emerged that Iraqis who didn’t know their exact birthday adopted 1 July as the day they came into the world, rather like 1 August being the birth date ascribed to all racehorses in Australia. You’d be amazed, even now, by how many Iraqis will tell you 1 July when they’re asked for their date of birth. There’s also a superstition among some Iraqis that it’s unlucky to reveal your birth date. I don’t know why.
When I first met Mohammed—a handsome, cheeky and wiry 25-year-old taxi driver, who’s married with two children—he either didn’t know or wasn’t willing to reveal his birthday. Routinely, we ask all patients for their date of birth. Baghdad-based Mohammed wasn’t impressed. ‘I don’t care about celebrating birthdays,’ he responded.
‘Isn’t there a day when you have a birthday cake?’
‘I make bombs, not cakes,’ he replied, with a defiant grin. In truth, his comment probably wasn’t far from the mark.
Mohammed had been serving with the paramilitary to the west of Mosul in late 2016 when a shell exploded a few metres away from him. One of his fellow patrol members was killed in the blast. Mohammed turned his left side towards the impact to protect himself.
He suffered shrapnel wounds to his left eye, left arm and left leg, and was unconscious when he was taken to hospital in Mosul. He emerged from the coma only after he’d been transferred to Baghdad. Regaining consciousness brought home the grim reality of his injuries. ‘I was in a dark place. I didn’t want to talk to anyone,’ he recounts.
Over time, he started to recover. The shrapnel was removed from his eye. ‘I was good looking again,’ he quips. But there were still significant problems with the rest of his recovery. Mohammed’s left leg was badly infected, and our first job was to debride the wound, removing dead or damaged tissue to allow the healthy tissue to survive and thrive.
On my second visit, we addressed the injuries to his left arm—he still couldn’t fully extend his elbow. In this case, the solution was an elbow replacement. But, with no implants on hand, it meant ordering one from overseas.
We operated on Mohammed in December 2017, implanting a new elbow. The operation should eventually restore full movement of the arm, which will help him return to the workforce. ‘Taxi driving is about all I can do,’ Mohammed explains. ‘I wasn’t fully educated. I only went through the first two years of primary school. I didn’t work at it. I didn’t do anything. I wasn’t any good at school. I just stayed home. Since then, I don’t feel my life has been terribly fulfilling.’
So what about his life would he change? Mohammed looks confused and confronted. There’s a long pause. ‘That’s the first time anyone has asked me that. I’m shocked by the question.’ He pauses again. ‘I guess I wish I was born outside Iraq. It has been my wish for a few years. Because of the politics and the security issues.’
THE MAN FROM THE MARSHES: JWAD PACHAY JABER
In Western nations, adult illiteracy is relatively rare. In Australia, compulsory education to Year 10 means most adults can read and write. There are, of course, significant pockets where that’s not the case—especially in remote Indigenous communities. In addition, some migrant groups cling on to their culture and language rather than learning to read and write English.
It’s different in Iraq. Even now, plenty of kids barely go to school. Either they get bored or they’re more important to their family as a source of income. In Iraq, 20 per cent of the population is illiterate. UNESCO figures from 2015 indicate that around 86 per cent of Iraqi men are literate, but less than 74 per cent of women.
When I met Jwad in September 2017, he was 37 years old and couldn’t read or write. He was originally from the wetlands close to the Iranian border in the south-east of Iraq, and was one of the Marsh Arabs who were absolutely despised by Saddam Hussein. Of all the ethnic and cultural groups in Iraq, they suffered more than most under his regime.
The Marsh Arabs were poor, ill-educated people. They eked out a living raising water buffalo, some sheep and cattle, or growing rice, barley, wheat and millet. By the 1990s, the marshes also had become the most important source of fish in Iraq.
The Marsh Arabs lived in small reed huts either at the side of a waterway or on artificially created reed islands. Their lifestyle reflected their ancient origins. Some were nomadic, following the seasons to provide the best feed for their animals. Many of their social traditions were based on the customs of the desert tribes. Altogether, it was a bleak and sparse existence.
Jwad didn’t have a great start in life. Both of his parents were blind, and he had completed only the first year of primary school by the time of the First Gulf War. During and after the Shi’ite uprising in the region in 1991, Saddam ordered the waters of the Tigris and Euphrates rivers to be diverted from the marshes. This was carried out for two reasons: to cut off food supplies to the Marsh Arabs, and to eliminate hiding places for dissident soldiers.
The marshes were turned into virtual deserts. Saddam’s troops attacked marsh villages, burning down houses and, according to some reports, poisoning water supplies. The population of 500,000 Marsh Arabs in the 1950s shrank to around 20,000. Many fled to refugee camps in Iraq or over the nearby border into Iran.
Along with the majority of their people, Jwad and his family—his parents, six brothers and two sisters—were forced to escape and took refuge on a conventional farm at nearby Al-Ahwar. They survived on a diet of milk, bread and yoghurt, but Saddam’s soldiers would routinely steal their supplies.
To help his family’s circumstances, Jwad carried bags for people who were shopping and, occasionally, drove cabs. ‘I hated Saddam so much,’ Jwad says. ‘All the bad things that happened to me—leaving school, no education—that’s all down to him. I’ve had a very hard, bad life because he didn’t want my family to live where we were.’
Ironically, when he turned eighteen, Jwad was conscripted into Saddam’s army—the same force that had driven his family from the marshes. He lasted only eighteen months in the military before he escaped, hiding in a van carrying fruit and vegetables to Baghdad.
To evade detection, he obtained forged documents, changing his first name to Abdullah. Being a fugitive was terrifying. ‘I was arrested several times,’ he remembers. ‘I had a fake ID, and sometimes I had to give the guards at the checkpoints money to let me go through.’ He couldn’t return home, and eventually he found work on a fishing boat on the Shatt al-Arab waterway between Iraq and Kuwait.
Following the call in 2014 by the Grand Ayatollah of Iraq, Ali al-Husseini al-Sistani, for all Iraqi men to fight against ISIS, he joined the paramilitary. Around seven months into the fighting, near Samarra, 125 kilometres north of Baghdad, he stumbled across a group of soldiers clambering into an Iraqi military ute equipped with a machine gun on the rear tray, which was used primarily to attack helicopters. He assumed they were Iraqi soldiers, but quickly realised his mistake when the ISIS fighters who’d seized the vehicle opened fire. Jwad took bullets in the front and back of his left arm. Shrapnel from a grenade struck him in the back.
He remained conscious and remembers seeing muscles protruding from the wounds and fragments of his bone scattered on the ground around him. He also felt excruciating pain. A paramilitary colleague bundled him into a car and drove him to the nearest hospital, where they once again ran into ISIS. Jihadists had surrounded the facility, and unleashed round after round as the car approached.
Jwad’s colleague turned the vehicle around and sped out of range. Before long, they stopped a truck carrying a consignment of chickens destined for the hospital. Jwad climbed in with the chickens. In the tense moment as the truck approached the hospital, the ISIS terrorists paused. Then they waved it through.
Once his condition had been stabilised, Jwad was transferred to hospitals in Baghdad and Basra—and then Iran. With his medical problems still unresolved, he borrowed money to travel to India for surgery. It didn’t go well. He contracted an infection that required another three months of treatment.
Jwad had been through a lot by the time I saw him. His arm was still carrying significant damage from the bullet wounds. Matt Weldon operated and shortened his arm before attaching an Ilizarov frame that would help lengthen the arm in the subsequent months.
The marshlands that were once Jwad’s home have also made a recovery. After Saddam was overthrown, the remaining marsh inhabitants broke down the artificial dykes and allowed water back into the wetlands. The water only covers around half the area that once made up the marshes, and the relatively small number of people who have returned to their old way of life face major problems with basics such as clean drinking water and effective sewerage. But it’s a start for them.
ONE FOOT IN THE GRAVE: MOHAMMED SALAH SALMAN
There’s a belief among some Middle Eastern religions and communities that the whole of a person’s body must be buried in one place. Of course, this poses a challenge for patients who’ve had part of a limb amputated.
When I first saw 35-year-old Mohammed in August 2017, he told me that he had been a vegetable farmer with a smallholding near Basra. He had regularly taken his produce to the city’s markets, providing an adequate living for his wife and four children—three young boys and a daughter.
His life changed in 2014, with the Grand Ayatollah of Iraq’s declaration of a fatwa against ISIS. Supported by his wife, Mohammed joined the paramilitary forces serving in Saladin Province, south-west of the terrorist stronghold of Mosul. He served as a driver and, over the next two years, saw many friends killed and wounded.
His own tour of duty came to a shuddering end in April 2017 when an IED exploded in the street directly under his car. Mohammed took the full brunt of the blast, which badly damaged both feet and the lower parts of his legs. Two others in the vehicle suffered only minor sprains and small fractures.
Mohammed regained consciousness when he was being treated in a field hospital. He was then transferred to Baghdad, where he underwent four hours of surgery. Less than a week later, he was moved back to Basra.
It was clear as soon as I looked at Mohammed’s X-rays that the previous surgery hadn’t been completely successful. His left leg could be saved with a further operation, but the bone in his right ankle was already dead. The lower part of the leg would have to be amputated before an osseointegration operation.
Mohammed was philosophical about the blast and the prospects for his future. ‘It happened,’ he mused. ‘It’s a common thing. I had been involved in three previous explosions when I wasn’t injured. If the explosion had been 50 metres away, we wouldn’t have been wounded. Now, I think I’m in good hands. I feel comfortable with it.’
Even so, he decided not to tell his wife about the operation before it was carried out. ‘She would only worry,’ he declared matter-of-factly.
The surgery went smoothly, but there was a twist. Mohammed insisted that we keep his amputated foot and lower leg in a plastic bag after it had been removed. It was placed to one side of the operating theatre as we completed the procedure and was nearly overlooked by the theatre orderlies as Mohammed was wheeled into the recovery area. After being alerted to the omission, the orderlies returned to the theatre to recover the severed leg, which was placed overnight in a hospital refrigerator.
Mohammed was discharged the next day and was driven, with the amputated lower leg in its plastic bag, to Najaf, Iraq’s most holy city, to bury it in a grave in the world’s largest cemetery, Wadi Al-Salam. The journey took more than two hours and was completed in the height of the Iraqi summer, when daytime temperatures regularly soar to 48 degrees Celsius! Let’s just say I was pleased to be back in the relative comfort of the operating theatre at Ibn Sina Hospital rather than in the cab with Mohammed and his amputated lower leg
All the same, the ritual was very much a part of Mohammed’s religious beliefs. When he eventually dies, the rest of his body will be buried in the same grave—reunited with the amputated foot.
Mohammed made an excellent recovery and was fitted with his new leg in December 2017. Within a short time, he was walking freely and was delighted with the outcome. ‘It has been very good—much better than before, absolutely.’
‘THERE IS NO LOVE STORY’: ABBAS JASIM HUMOOD
Even in the early part of the 21st century, arranged marriages are common in the Middle East. If they’re not directly organised by the families of the couple involved, there’s often considerable pressure from parents for particular relationships to form.
Abbas is 25 years old and lives in Najaf. He signed on as a soldier in the Iraqi Army just after his 21st birthday. Two years later, he was severely wounded in an advance against ISIS through the centre of Anbar Province in the west of Iraq. He lost his right arm above the elbow and suffered shrapnel wounds to his chest, lower abdomen and face.
Despite his injuries, Abbas married his twenty-year-old cousin, Hawraa, in 2016. ‘There is no love story,’ he explains. ‘My family knew her, I didn’t. They suggested she would be a suitable wife. So I met her and asked her to marry me.’ Now they have a son, Mahdi, who was born in October 2017.
Abbas is content and says his wife is, too. ‘My wife has a similar personality to me,’ he says. ‘I want a woman to be a housewife. All her time is for her family. She’s not a student and she doesn’t work. She’s happy doing that.’
Abbas remembers every vivid detail of the day he was injured. He was the machine gunner on the back of an army ute advancing through the streets when an ISIS rocket struck his right arm, slicing it off in an instant. ‘I didn’t see the rocket coming,’ he says. ‘There are no words to describe how I felt when I saw I had lost my arm. I thought I was going to die.’
The impact knocked him off the ute and onto the road. Immediately he saw that he was losing an enormous amount of blood, and he knew he needed urgent medical assistance. He scrambled to his feet and started sprinting towards the medical centre at the nearest military post. Abbas ran for around five minutes before his legs weakened and collapsed beneath him because of the massive blood loss.
No one else on the ute suffered substantial injuries, and they soon caught up with Abbas as he lay on the road. His colleagues dragged him onto the vehicle and raced to the closest hospital, where doctors debrided the tissue surrounding his wounds and sutured his arm.
Days later in a Baghdad hospital, infection set in and he underwent further procedures to clean and dress the wound before being transferred to a hospital in Najaf. Within five days, he was sent home to his parents, five brothers and two sisters.
Abbas remains in the army, but he is only required to turn up for a couple of days a month to collect his salary. ‘I do nothing,’ he says. ‘I just show myself at the army base. They told me to do that. But they won’t ever find me anything to do. The rest of the time I just spend at home with my family. I’m very proud of my son. He looks just like me. But there’s nothing else to do.’
He hopes that will change when he’s learned to master his new arm. ‘I think the future looks good for me,’ he predicts. ‘When I have my new arm, I will go back to the military and see if there’s a job I can do there.’
‘I FEEL GOD HAS GIVEN ME A SECOND LIFE’: FITYAN HUSSEIN ALI
Baghdad was one of the most dangerous places on earth in 2009. Thousands of people were being killed. Every day there were bombings, shooting and kidnappings. People were being thrown from rooftops by various terrorist groups and street gangs that ruled the Iraqi capital.
Fityan is married with two young children—a ten-year-old daughter and a nine-year-old son—and was a major in the Iraqi police force in those dark days. Even he admits that the authorities were incapable of keeping up with the whirlwind of violence engulfing the Iraqi capital at the time. ‘It was terrifying to be in Baghdad,’ he remembers. ‘Everyone was frightened. The police couldn’t keep control. Even the American soldiers couldn’t stop the killing.’
Around 7 p.m. on 18 March 2009, Fityan was driving home after work with his daughter, headed along the main road through the northern Baghdad suburb of Al Shaab. Without warning, an explosion erupted under the driver’s side of the vehicle, sending the car skywards before it crashed back to the ground. To this day, Fityan doesn’t know whether the bomb was on the road or attached beneath the car.
He checked on his daughter. She was uninjured. He looked down at his left leg and knew it was badly damaged, but he still had control of his right leg. He wrestled with the driver’s side door, which had been jammed shut in the explosion. Using all his power, he forced it open and stepped out. But his left leg couldn’t support his weight, so he tumbled onto the road. ‘I was in severe pain. I thought I was dying,’ he recalls. In fact, his left leg was suffering complex injuries, including compound fractures, extensive tissue loss and vascular damage.
Police colleagues drove him to hospital. Within hours, his left leg had been amputated above the knee. Amid fears of gangrene setting in, his right leg was amputated below the knee nine days later. The next year was a long battle to achieve a level of mobility. He acquired two socket prostheses, which allowed him to walk with crutches.
Fityan underwent further surgery on his left leg in Germany in 2014, which allowed him to wear a more modern Genium X3 prosthetic leg. It’s fitted with a robotic microprocessor knee, a significant advance. This meant he could throw away the crutches and walk with just one stick. After undergoing osseointegration, Fityan—who was 46 at the time—was aiming to dispose of the walking stick as well.
He’s been promoted to the rank of general and expects to continue advancing his career and his family life after he’s learned to walk on his new legs.
‘I accept what happened to me,’ he says. ‘I feel God has given me a second life. God willing, I will be like a normal person. It will change my life, the way people look at me. My family has been very supportive, and I believe every day will be better.’
These are just some of the military cases I’ve dealt with in Iraq. There are thousands more like these. Most of the fighters I operated on in Iraq were members of the paramilitary, but that doesn’t mean I’m particularly supportive of Hashd. I don’t support any organisation that relies, at least in part, on violence and counts among its numbers religious fanatics and street gangs. And I don’t sympathise with the paramilitary’s strong association with Iran. The fact is I’ve operated on a large proportion of their fighters because Hashd is by far the most efficient of the defence forces in accessing my humanitarian project. Hashd arranges for its wounded fighters to come to the hospital, often with X-rays, allowing them rapid access to my clinics.
It also helps that one of the senior doctors at Ibn Sina is the brother of Hashd’s medical director.
My role in forming the surgical lists is limited. Usually, it’s the hospital staff who dictate the order of patients, although I have more influence on the civilian cases I take on.
As I’m sure you can imagine, my work there is particularly rewarding. It’s hard for me to explain the joy I feel. Many of these patients were wheelchair-bound. Now, they’re recovering much of their previous mobility.
Despite—or because of—the ordeals they’d been through, our patients are remarkably resilient. In Australia or the United States, it’s not unheard of for patients who’ve undergone osseointegration or other complex trauma operations to complain about the pain 24 hours after surgery. In Iraq, the patients take far fewer painkillers—mostly nothing stronger than paracetamol. And no one in Iraq moans or whinges. I guess it’s because they’re used to a tough way of life.
An example of this Iraqi fortitude came to light when one of my osseointegration patients phoned my mobile a few weeks after being fitted with his new leg. ‘Dr Munjed, can you tell me what’s wrong? My leg is bleeding a little bit.’
‘Is there any pain?’ I asked.
‘No. No pain. But there’s a little bit of blood where the leg’s attached.’
‘What have you been doing?’ I inquired.
‘I’ve just come back to Baghdad from a pilgrimage to Najaf.’ The city is the focus of an annual pilgrimage by Shi’ite faithful—a journey of about 150 kilometres from Baghdad.
‘How did you get to Najaf?’
‘I walked,’ he told me—to my absolute horror.
‘And you used your crutches, didn’t you?’
‘Crutches, Dr Munjed? I threw those away as soon as I walked out of the hospital.’
The good news is that as long as there’s no pain, he’s fine. But I did recommend that he curb his enthusiasm for long-distance walking!