The official Iraqi point of view was that my team was in Baghdad in the scorching summer of 2017 to operate on military and security personnel who’d been injured in the fight to repel ISIS from its borders. Nothing more, nothing less.
I had a broader agenda. The affiliations of patients and the causes of their injuries don’t matter to me. Whatever their circumstances, they deserve the best medical treatment available. Quite simply, I wanted to extend the humanitarian mission to operate on civilians as well.
Almost as soon as we arrived at Ibn Sina Hospital, I started negotiating with the authorities to include civilians on the surgery list. But I needed to tread an extremely delicate path. I couldn’t overstate my case for fear of alienating the authorities.
As far as I was concerned, once I’d reached the target number of 48 operations on soldiers who’d been wounded in Iraq’s most recent conflict, I would be free to extend my horizons to civilians. But I wasn’t in a position to plough on without the tick of approval from the powers that be. On top of that, I didn’t have control over my theatre list. It was largely created for me by the hospital’s senior staff members, who had a specific briefing to concentrate on military, police and government patients.
The hospital’s director Dr Yasser al-Timmimi specifically—and emphatically, I might add—instructed me not to operate on anyone who wasn’t from the military. He eventually barked at me, ‘There will be no operations on civilians!’
To be honest, I couldn’t see the sense in the edict and was determined to talk around whoever it took to change the order. My purpose was to help as many Iraqis as possible—I wouldn’t be able to achieve that if I was constantly arguing with the authorities. Still, whenever the chance arose, I talked to hospital and government officials, pointing out that once we’d completed the allotted number of operations on injured soldiers, we’d fulfilled our part of the bargain. Surely that would open the way for civilians.
One of the strongest advocates for the civilian operations was Mohammed al Attar from the Prime Minister’s Department. Mohammed had met us at Baghdad International Airport when we arrived for our first visit to Iraq, and he had been our link with the department since then. He’d done a magnificent job, providing for all our needs. From his time with us, Mohammed could see the desperate need for civilians to be included in the surgical list.
He was constantly lobbying his colleagues in the Prime Minister’s Department to give me the go-ahead. He even drafted a letter for the prime minister, approving the civilian operations. But the movement of the Iraqi bureaucracy was painfully slow.
Time was ticking by—we were due to leave Baghdad on Tuesday, 29 August. As our days in Iraq were drawing to a close, civilian patients and their families were becoming more anxious by the hour, fearing they would miss out on surgery. The uncertainty was agonising for them. For us, too.
Relatives of patients would lurk in the hospital corridors, badgering my colleagues and, whenever I emerged from the theatre area, me! Local surgeons, hospital staff and even senior government officials also were cornered. The tears—sometimes wailing—and begging of the relatives were constant and deeply moving. Sadly, for most of the time, I could only empathise and tell them the decision was out of my hands.
Finally, on Sunday, 27 August, the lobbying paid off. The hospital’s director gave me the official go-ahead to operate on civilians. I’m not exactly sure who made the decision, but I think it was the result of the intense pressure on the offices of the prime minister and minister of health.
When the news came through, I was asked whether I was excited by the development. I replied, ‘No. I’m pleased, but not excited. There have been too many delays and too much bureaucracy for me to be excited. But I’m pleased.’
Among the many moving stories of the civilian patients I’ve operated on in Baghdad, two have particularly stood out for the teams I’ve taken to Iraq.
They involve a young woman and a young man, little more than kids when they suffered terrible injuries that threatened to send their lives spiralling into depression and disaster. Both of these young people were supported at the hospital by their mothers, who tirelessly campaigned for their children to have the operations they so desperately needed.
TEARS FROM HEAVEN: AMANI NASSER JABER
I first saw Amani at Ibn Sina Hospital in Baghdad in August 2017 after the Iraqi authorities had approved operations on civilians. Amani’s is a story that has touched people across the world. Since she lost her legs at the age of ten in 2009, she’s experienced the depths of despair but has recovered to become a champion para-athlete. Altogether, she’s won three gold medals in competitions across Asia. Still, she would have given away all her medals in a heartbeat to be able to walk again.
As her athletic performances indicate, Amani is fiercely determined. ‘I won’t allow anyone to push me in my wheelchair,’ she says. ‘I have to do it for myself.’
Soon after meeting Amani, I asked her, ‘What’s your number-one wish?’
‘I want to walk,’ she told me.
Her mother added, ‘If Amani can walk, it will be an achievement for all the people of Iraq.’
The barrier to me operating on her in August had been the cost of the titanium rods and her new robotic legs. With no health insurance scheme or state subsidy to cover the bills, her family simply couldn’t afford the equipment. I decided to delay operating until our next visit four months later, hoping this would give them the opportunity to raise the necessary funds. There were tears of disappointment, of course. But I reassured Amani that the surgery would go ahead at some point.
When we returned in December, Amani was one of the first patients I saw. Neither Amani nor her mother had any idea how that consultation would unfold. To be honest, neither did I!
The crunch came quickly. If the operation was to go ahead, how would the implants and robotic legs be paid for? Amani’s mother sadly told me her family still didn’t have the money. On the spot, I made a snap decision. ‘Don’t worry. I don’t care whether you can raise the money, I’m going to operate on you in the next two weeks. If it’s necessary, I’ll pay for the implants myself,’ I told them. I felt it would be worth every last cent to give Amani the chance to make the most of her life. Again, there were floods of tears—but this time, they were tears of happiness.
Amani comes from the city of Nasariyah, which sits on the Euphrates River a little more than 350 kilometres south-east of Baghdad.
One evening when she was ten years old, a mortar shell struck a car in the street outside her family home. It erupted in a huge fireball. The strong shock waves caused by the explosion dislodged a kerosene heater that had been warming Amani’s house. It tumbled onto Amani, inflicting terrible burns to her lower legs and other parts of her body.
The day after the accident, Amani slipped into a coma. A well-connected relative arranged for a military helicopter to fly her to a US Army hospital, where she remained unconscious for three months. After a further six months, doctors saw that her wounds had become gangrenous. The following day, Amani underwent a double below-the-knee amputation.
Details of Amani’s condition were kept from her mother, who’s a primary school teacher. The reason? It wasn’t the first family tragedy she’d suffered. Some years earlier, an older daughter had died after being shot in the stomach during a US attack. She was also ten years old.
Following Amani’s operation, the family finally encouraged her mother to visit her young daughter in hospital. But they still hadn’t explained the extent of Amani’s injuries. When Amani’s mother saw her, she became hysterical. Amani tried to get out of bed to comfort her. But without the lower part of her legs, Amani fell to the floor.
For the first time, both Amani and her mother were confronted by the awful reality of her injuries. Amani was devastated and slipped deep into depression. ‘I felt incomplete,’ she explains. ‘I knew what had gone would never come back. I lost the will to live, the will to talk and to eat. I withdrew into myself. Whenever I saw any family or friends, I felt I hated them.’
Her mother also reflects on that time. ‘She was devastated. When she came home after those nine months in hospital, it was very difficult. But after about a year, I felt more in control of her situation.
‘The second year, I saw Amani being very depressed. I knew I had to do something to improve the situation. So, I enrolled her in a group with women in a similar position who were learning to cook and swim. During her time at the women’s group, a coach took Amani aside and trained her for one month in the wheelchair javelin. At the age of thirteen, she won the first competition she entered.’
That victory helped to build up Amani’s self-esteem. ‘It was a big boost,’ her mother recalls. ‘She felt good after that. At last, she understood what it meant to be happy again.’
In her mid-teens, Amani became the wheelchair javelin age-group champion of Iraq and went on to win the Asia Para Games javelin title, establishing herself as a national identity along the way.
Eventually, Amani went back to her education—taking on the challenge of studying the first years of high school with a group of considerably younger kids. She found it tough, but was determined to push through the difficulties. ‘I don’t feel completely comfortable at school, but I love studying,’ she explains. ‘There’s a problem with some of the other girls and teachers who don’t accept my situation too easily. In the south of Iraq, a female training in sport isn’t really accepted. The pressure is on that I really should stay at home and do nothing.’
Her mother elaborates. ‘I’ve even received a threatening letter. But I care so much for Amani that I want her to do everything she can in life. In Iraq, it’s actually a very brave stand.’
The next step was for Amani to explore all the possibilities of walking again. Prompted by the director of an Iraqi feature film about her life, she went online and discovered osseointegration. And once she saw videos of other patients walking freely she was in no doubt. ‘To watch the videos gives me hope,’ Amani says. ‘When I saw them, I felt it was me who was walking again, not just the people in the videos.’
I operated on Amani on the morning of Wednesday, 20 December 2017. The four hours of surgery were complex. After I had amputated both her legs above the knee—which would give her the best chance of walking again—I inserted the titanium rods. The canals in the bones of Amani’s legs were extremely narrow, and during the operation her left femur fractured. I repaired it there and then, but it meant her recovery would take a little longer.
The fact that she hadn’t walked for almost half her life was also a significant complication. In her case, it’s not a question of learning to walk again—it’s a question of just learning to walk. At the time of the operation, I estimated it would take anything up to two years before she walked unaided. But she will.
As Amani was wheeled back into her room after the operation, her mother leaned over and kissed her on the left cheek. Then she dissolved into tears—this time, tears of joy and relief. When I saw Amani again in April 2018, her legs had healed and she was ready to begin weight-bearing ahead of being fitted with her new legs. As I sat with her on her hospital bed, Amani told me she had something for me. Leaning forward, she placed one of her gold medals around my neck. She was bestowing on me a precious possession from her past to thank me for giving her the most precious gift for her future—the ability to walk again.
There will be more tears from Amani and her mum when she does finally walk with her new legs. One of my colleagues reflected that, as Amani takes those first steps, they’ll be tears from heaven.
A MOTHER’S LOVE: GHADBAN SUBHI MAHMOOD
One of the most familiar sights in Ibn Sina Hospital in August and December 2017 was a short, middle-aged woman wearing a black abaya—the loose-fitting, full-length robe that is symbolic of piety—and a sombre brown, patterned headscarf. Her desperation bordered on obsession.
From daybreak until the early hours of the following morning, she would haunt the hospital corridors with a mournful expression. Like a ghost, she would appear from nowhere, pleading with members of the visiting surgical team to operate on her son. She often sobbed openly, and frequently wailed. She would passionately present her case in Arabic to anyone who would listen, regardless of whether they understood what she was saying or could do anything to promote her son’s cause.
The woman was Amira Najeeb Saleeh, the then 52-year-old mother of Ghadban Subhi Mahmood, who’d lost both his legs when a mortar shell exploded in front of him on 26 February 2017. No parent wants to see their child suffer, and Amira’s commitment to her son was both unshakable and admirable. ‘My life has ended,’ she said at one point. ‘I just do everything for my son.’
Time and again, I explained that I couldn’t operate on Ghadban until the necessary permission came through. Regardless, she begged again.
On that last Sunday of my August trip to Baghdad, we could finally deliver the good news to Ghadban and his mother. I asked one of the Iraqi surgeons to tell them what they’d been waiting to hear.
It was an emotional time. Everything they had saved and campaigned for was going to come true. Amira beamed, raised her hands to the heavens and repeated, ‘Happy, happy, happy!’
Ghadban’s family had been close to the centre of some of the worst excesses of ISIS, as they were living in eastern Mosul—Iraq’s second-largest city and the jewel in the caliphate crown after the ISIS advance into Iraq in the summer of 2014. The original settlement of Mosul was established on the west bank of the Tigris River and later spread to the east bank—that area was the site of the ancient Assyrian city of Nineveh, which is mentioned in the Bible’s Old Testament.
Mosul expanded rapidly in the early years of the 21st century and, at one stage, its population soared to around 1.8 million. As ISIS fighters swept across Iraq, they attacked and swiftly captured Mosul. Hundreds of thousands of refugees fled, and the population of the city shrank to around 600,000 people. Ghadban’s family had remained in the city only because they were too poor to move.
Tragically, as well as slaughtering thousands of Iraqi Army soldiers and civilians, ISIS went on a rampage that destroyed priceless buildings. Some of them dated back more than several thousand years and were reputed to contain the tombs of Old Testament identities such as Jonah. They also set fire to the university library, burning treasured and irreplaceable books and artefacts. In addition, it was from inside the historic Great Mosque of al-Nuri in Mosul that ISIS leader Abu Bakr al-Baghdadi declared the establishment of the new caliphate.
With ISIS controlling the city, Ghadban’s family spent most of the time in their house. ‘We felt sad. We felt as though we were prisoners in our own home,’ Ghadban explains.
The Iraqi counterattack didn’t materialise until the autumn of 2016, but when the offensive finally came, it was decisive. Allied planes bombed ISIS from the air, while Iraqi counterterrorism forces, regular army, paramilitary and police led the ground assault. While the terrorist group retreated from other regional cities it had captured, Mosul remained one of the last jihadist strongholds. However, by mid-2017, the last few hundred defenders of the caliphate were fighting a desperate rearguard action in the narrow streets and alleyways of the old city on the western banks of the Tigris, using civilians as human shields to cover their escape.
Of those civilians who remained in Mosul, around 150,000 were trapped in the city’s west, facing shortages of food and water and living in desperate conditions. Close to the end of the battle for Mosul, increasingly desperate ISIS fighters were reported by the United Nations to have killed more than 150 fleeing Iraqis—including women and children—close to an ice-cream factory in the city. Then, in an act of mindless defiance before they abandoned the city and retreated to their final stronghold of Raqqa in Syria, ISIS destroyed the very mosque where the Islamic State had been proclaimed.
Ghadban was 22 years of age when I met him, the oldest of three children and the family’s only son. His sisters were aged nineteen and thirteen.
Around nine o’clock in the morning on 26 February, Ghadban had walked out of the front door of the family home on his way to school—and straight into the path of a mortar shell that exploded in the street immediately ahead of him. This tall, solidly built young man took the full blast on the lower part of his legs.
Amira rushed out of the house and immediately applied first aid, quite possibly saving her son’s life. She has stayed at his side ever since, taking every opportunity to passionately advocate for him.
Ghadban was rushed in a neighbour’s car to the nearest American hospital. He spent five days there, undergoing surgery to amputate both legs—the right leg above the knee, and the left below the knee. He was then transferred to the hospital in Erbil, the capital of the Kurdish region of Iraq, where he remained for the next two months.
As he recovered, Ghadban tried to walk with socket prostheses, but he couldn’t master them. As a result, he was confined to a wheelchair. Still, the family was determined Ghadban would walk again, and they researched every possible surgical alternative. Finally, through Iraqi friends in Australia, they were alerted to the potential of osseointegration.
Ghadban emailed me, and I suggested that he should come to Baghdad when I was there in August. Once she knew I was going to Iraq, Amira set about raising the A$80,000–$100,000 for her son’s operation and his new robotic legs. She sold her house, car and the little gold she possessed; she cashed in the back pay she was owed from her job as a teacher—schools had been suspended in Mosul after ISIS had taken control—and borrowed money from family and friends. She was also in touch with an overseas charity that was offering financial assistance.
Then the two of them embarked on a nine-hour taxi journey from Mosul to the Ibn Sina Hospital in Baghdad. They had to contend with traffic jams and long stops at military checkpoints along the way.
I operated on Ghadban the day after I’d been given the go-ahead to treat civilian patients. He came into the operating theatre late on the Monday evening, the day before we were leaving Baghdad. It was an instant of sheer joy for Ghadban and his mother. ‘I’m very excited. I’ve spent three months waiting for this moment,’ Ghadban said in the minutes before he was wheeled into the theatre. ‘I’ve spent those three months exercising so I was ready for this day.’
Amira couldn’t keep the smile from her face. ‘It’s like his life will change considerably when he can walk again and lead his life as a normal person,’ she beamed. ‘It’s a dream come true.’
The operation went smoothly and his news legs were fitted when we returned in December.
Everything went well for the first few hours. Ghadban started moving enthusiastically and felt particularly comfortable on his left leg. He told me that it felt like the limb he’d been born with. He could feel the surface he was walking on through his artificial feet and legs.
It took Ghadban a little more time to get used to the longer artificial right leg. But he was progressing well when he left the hospital at the end of his first day of walking. Unfortunately, on the second day, he lost his balance as he was trying to stand from his wheelchair. Subsequent X-rays revealed that he’d fractured the head of his right femur. I operated straight away to repair the damage. It was a setback, and he needed to keep his weight off the fractured leg for three months. After that, he began walking again using the parallel bars to take the early steps.
Of course, this young man who suffered such horrific injuries dreams about more than simply walking again. Before he was wounded, Ghadban wanted to join the military—to become an officer in the Iraqi Army. Clearly that aim was shattered at the same time as his legs. Now, he wants nothing more than to live like a normal person. ‘I don’t want people to think of me as disabled,’ he says. ‘I hate this wheelchair. When I stand and walk, I want to complete my studies and hang out with my friends.’
Losing his legs has also cost him an important relationship in his young life. Before he was injured, Ghadban had been planning to marry his fiancée. But as soon as he was injured, her family broke off the relationship, believing a disabled man wouldn’t be able to provide a stable lifestyle for his wife and family.
Despite that, Ghadban kept in touch with his girlfriend, hoping that once he could walk, her family would relent. Sadly, it didn’t happen. In November 2017, she told him her family didn’t want her talking to him any longer. Even with his new legs, they didn’t believe he would be able to provide her with a normal life. She would always have to support him. It was an emotional chapter for him, but every cloud has a silver lining.
Along with his mum, Ghadban came to Baghdad for a check-up in August 2018. They were no longer the desperate mother and son I had first seen a year earlier. Their lives have been transformed. Ghadban is walking smoothly and naturally, with just a single crutch. In time, he may be able to get rid of that. On the other hand, he may find that he wants to keep it because of the sense of security it provides.
Ghadban has finished school with excellent results in his final exams and will be going on to university. But the biggest change is that he’s confident and smiling. Constantly.
And his mum? The woman who used to be dressed all in black with a dark headscarf as she haunted the corridors of Ibn Sina Hospital now wears a head covering of bright green and red, with flashes of gold and black. After those tense days of sobbing and pleading for her son to undergo osseointegration, it’s now almost impossible to wipe the smile off her face. She’s truly happy, happy, happy.
‘LIKE A BIRD SET FREE FROM A CAGE’: MOHAMMED KHAREEM
The brutality of life in Iraq after the Second Gulf War is hard to imagine for anyone who didn’t live through it. Mohammed saw it from close quarters. In 2007, terrorists kidnapped his father, a university cleaner. To this day, his family has no idea why. He wasn’t an important figure and wasn’t wealthy. There was no likelihood of a large ransom payout.
For four long weeks, no one knew his fate. Then came the awful news—his body had been discovered in a Baghdad street. His head and arms had been hacked off. No one has ever been convicted of his murder.
Mohammed, who was born in 1985, joined the Iraqi police force and was serving in Mosul in 2011. He was fighting ISIS terrorists in the street when an IED detonated, smashing his right leg. The injuries were so serious, he realised straight away that it would need to be amputated. The operation was carried out one week later, leaving only a short stump.
Mohammed struggled for a year afterwards.
‘I hated feeling that I needed the help of other people to do things,’ he explains. ‘It affected me so much. My work. Even my family and friends. I thought no one would accept me or want to marry me.’
Happily, his worries were unfounded. In 2014, Mohammed married his cousin, Lina, and they now have two young sons.
Living at home with his wife, mother and brothers, he was afraid that he was letting down his children. ‘My hardest moment was when my eighteen-month-old son dragged my crutches over to me and asked me to pick him up and carry him. I couldn’t do it. I went to my room crying,’ he remembers, choking back tears.
Even though he was wounded during the fighting against ISIS, he came to me as a private civilian patient during our second visit to Baghdad in the Iraqi summer of 2017. He was absolutely determined to undergo osseointegration. In pursuit of that goal, Mohammed sold his house and his wife’s gold jewellery to help pay for his new robotic leg. But he doesn’t regret the sacrifices.
Mohammed can’t wait for the day when he can walk and carry his children. ‘That would be one of the best things,’ he says. ‘I only went to school until I was ten, and I made money by carrying bags at the airport and train station and driving taxis. I will do anything to get work and earn money for my family.’ Mohammed’s osseointegration went smoothly, and he was fitted with his new leg in December 2017. It’ll be a lengthy rehabilitation for him to learn to walk because his amputation is so high. But he understands the process and is determined to go through it, literally step by step. ‘It will feel so good. I will be like a bird set free from a cage,’ he smiles.
Mohammed took his new leg home with him the evening after it was fitted. Of course, his family demanded a demonstration. His oldest son helped him fit the leg before Mohammed walked two or three steps in front of the gathered audience. They were only a few small steps for a man, but a giant leap for Mohammed’s whole family.
‘It was a wonderful moment. The whole family shed tears of happiness,’ Mohammed explains. ‘I couldn’t believe my dream had come true. I’m very relieved, but I’m particularly happy for my son. He used to bring me one shoe. Now he brings me two shoes.’
‘I DON’T WANT TO BE A BURDEN ON MY COMMUNITY’: AETHAM ABDUL HUSSEIN MOHAMMED
A badly injured person’s desire to walk again is a normal human emotion. But in Aetham’s case, there were other motivations as well. He felt a responsibility to society to make a useful contribution.
After being released from hospital following the amputation of his right leg close to the hip and his right arm below the elbow, he spent three months at home, sitting in a wheelchair and rarely plucking up the courage to emerge into the wider world. ‘I was very sad, but I was thinking about how I would continue with my life,’ he explains. ‘I don’t want to be a burden on my community.’
Aetham—who’s tall, sports a moustache and lives in Babylon, about 125 kilometres south of Baghdad—joined the Iraqi police force in 2002 at the age of 25. He was wounded while fighting ISIS in a field in rural Anbar Province on 19 August 2016, when a small missile landed a few metres away from him. His body armour protected his torso and saved his life. But one of the twelve people fighting alongside him was killed.
‘It was horrific. My uniform caught fire and the whole of my right side was in flames,’ he remembers. ‘I rolled in the sand to put out the flames. I saw my wounds and my blood. I felt like I was going to die.
‘There were some rocks and small trees nearby, but, because of my injuries, I couldn’t move to take shelter. I was waiting for someone to come and rescue me—or for ISIS to kill me.
I thought a sniper could take a pot shot at me at any moment.’ There was a lengthy exchange of gunfire, and Aetham was left lying in the open for half an hour or more before paramilitary soldiers and police came to rescue the wounded. Aetham was rolled onto a blanket and dragged through the dirt and dust to a forward station. It took another six hours to transfer him to a field hospital for emergency treatment. Soon after, in a Baghdad hospital, surgeons amputated his right leg and his right arm.
He faced fresh challenges when he was given a dated socket prosthesis in December 2016. ‘To start with, it was very difficult to walk,’ he explains. ‘But gradually, somehow I got used to walking with it.’
Within a month, he was given an artificial arm, which stretched his horizons. ‘Before I had the artificial arm, I was very shy about leaving the house,’ he says. ‘I was worried about the way people looked at me. But afterwards, I began to build up my confidence.’
His confidence received another boost when, during our second visit to Baghdad, I operated on him as a civilian patient and inserted a titanium rod in his right femur, ready to attach a new robotic leg. His reaction, before he returned home to his eleven-year-old son and twelve-day-old daughter, was favourable. ‘I’m optimistic my life will be changed in a very dramatic way,’ he says.
I saw Aetham again during my fifth visit to Baghdad in August 2018. He was walking well on his new leg and was so enthusiastic about his improved lifestyle that he persuaded me to perform further osseointegration surgery on his right forearm.
‘IF MY CONDITION STAYS LIKE THIS, I HAVE NO FUTURE’: YASSER NABEEL
Osseointegration isn’t the only surgery we’ve carried out to help civilians in Iraq. My colleague and friend Dr Kevin Tetsworth—an American-born, Brisbane-based orthopaedic surgeon who joined us in Iraq in December 2017 and again in April and August 2018—operated on seventeen-year-old Yasser Nabeel from Najaf, about 150 kilometres south of Baghdad.
The teenager is the oldest of six children—he has three sisters, and his two youngest siblings are boys. Yasser was born with two club feet, which severely restricted his ability to walk—to the extent that he regarded 50 metres as a long journey. Clearly, that’s a huge limit on the lifestyle of a ninth-grade schoolboy, and it has led him to have feelings of hopelessness and depression. His father says, ‘My son has been very depressed about his condition. And so am I. Like any family, we wanted many things for our oldest son that we haven’t been able to achieve.’
They considered selling their house to raise the US$12,000 they needed to pay for Yasser to undergo surgery with a Russian specialist. As it was, the surgeon charged them US$50 to examine Yasser and write a report about his condition and the surgical options. But even US$50 was a lot of money for them, his father points out.
Yasser’s policeman father is a keen sportsman and, at the age of 42, was still playing football in a competition in Najaf. Like many young men, Yasser is also keen on sport—in his case, he plays wheelchair volleyball. And, in the two years since he’d taken up the game, he’d become part of a hugely successful team that had won, among other trophies, an Iraqi national title.
He’s a strongly built young man with a wide range of friends—including some overseas mates he’s made through sport. But, at his age, he was obviously becoming extremely conscious of the impact of his difficulties in getting around.
He and his family had decided the time was right to address the issue. ‘I am very happy and excited to get rid of my problem,’ Yasser said before his surgery. ‘It’s God’s will. As soon as the operation is over, I want to continue my life like normal people.
‘If my condition stays like this, I have no future. I wouldn’t be able to work. I am optimistic that the operation will change that. I would like to be a taxi driver.’
Kevin and I examined the X-rays of Yasser’s lower legs and came up with a course of action—a procedure known as an Ilizarov frame. Kevin operated on Yasser’s feet and attached the frames, which allowed gradual adjustment of the joints over the coming months to change the angle of the feet. After that time, his feet will sit flat on the ground.
The morning after the operation, Yasser and his father had high hopes for the future. Yasser’s father said, ‘I am hoping for the best. I hope my son will be able to walk the same as the other kids. Like any father, I would be happy if that happens. Our whole family is excited about this. It would be a great thing to watch my son play with other people.’
The prognosis is excellent. While Yasser won’t be able to walk completely normally or over marathon distances, he’ll certainly have much greater mobility and a more normal gait. For a sports-mad teenager, it’ll change his life.
‘ARE YOU AN AMERICAN SPY?’: ABU MAHDI AL-MUHANDIS
Abu Mahdi al-Muhandis is the deputy leader of Hashd, the Iraqi paramilitary force.
I had met and spoken to him a number of times to finalise details of the operating schedule for the wounded soldiers. In April 2018, however, he came to the hospital late one night on a civilian matter. He suffers from arthritis of the knee and wanted me to give him a pain-relieving injection. It’s a completely routine procedure that I was happy to carry out.
Everything seemed remarkably straightforward until, in the early hours of the morning, I received an urgent call from the chief doctor of Hashd. ‘He’s in agony,’ the medico stressed. ‘He’s in so much pain he can’t sleep. What the hell did you inject him with?’ Then, comparing my actions to the poisoning of Russian double agent Sergei Skripal and his daughter Yulia in the United Kingdom a month earlier, he asked, ‘Are you spying for the Americans? Did you try to kill him?’
There was a sense of fun about his question, but it was underscored by a more sinister note of concern about the events that had unfolded. He instructed me to stand by for another phone call and to be ready to attend the patient’s house at short notice.
The order filled me with foreboding. I suspect al-Muhandis is actually the leader of Hashd in everything but name and is an enormously powerful figure in Iraq. He is on the list of designated terrorists in the US and was sentenced to death in his absence after being convicted of masterminding the bombings of the US and French embassies in Kuwait in 1983. Definitely not someone to upset.
I slept little that night and around 5 am I woke Claudia and we went down to an early breakfast and then onto Ibn Sina. Around 7.30 am I called the paramilitary doctor I’d spoken to the previous night to catch up on the latest developments. Al-Muhandis had drifted off to sleep. I would receive another call as soon as he woke up.
Around 9 am, the call came through. ‘A car is on its way to pick you up from the hospital in five minutes.’
When we arrived at the home of the paramilitary deputy leader, I was relieved to see him sitting up at a table eating breakfast.
‘What’s the matter?’ I asked and then added a phrase Claudia uses. ‘Are you a sooky-sooky la-la?’
He smiled. ‘I thought you’d be taking me to hospital this morning for osseointegration,’ he responded. As he was speaking, he pointed to his mid-thigh, saying, ‘You can amputate at this level.’
He then invited me to join him for breakfast. But it wasn’t long before the tension mounted again. We started talking about the number of paramilitary soldiers who’d lost their limbs fighting ISIS—more than 1000 amputees and several thousand more with musculo-skeletal injuries. Al-Muhandis looked at me and said, ‘Your task is to treat all of these patients before the end of the year.’
Without thinking, I replied with some verses from the Koran: ‘I will do my best but there are limitations on what can be done in that timeframe.’
Al-Muhandis smiled. ‘So you know the Koran.’
‘I memorised the Koran when I was 12 years old,’ I told him, before stupidly adding, ‘but then I saw the light.’
The room immediately fell silent and stayed that way for at least two minutes. It seemed an age. I thought, ‘What have I done? This could be my equivalent of the Last Supper.’
The Hashd deputy leader finally spoke and changed the subject, resuming the conversation by talking about Persian rugs. I hoped that meant he’d misheard me. But of course he hadn’t.
After breakfast, Al-Muhandis escorted me downstairs, held my hand and took me into a room lined with photographs of dead people. ‘You mentioned seeing the light. All these people died in the name of God, striving to see the light of their faith,’ he told me.
My heart sank, but I tried to ease the tension with a flippant remark. ‘Are you going to kill me?’ I inquired.
With a peaceful smile, he responded, ‘Your time has not yet come. We still need you.’ With that, he accompanied me to the waiting car and left me with the reassuring words ‘I can walk better now.’
TABLES TURNED: ZHIDA AL SAADI
I hadn’t seen Zhida for the best part of 30 years. But as soon as I set eyes on her in April 2018 I knew exactly who she was. Zhida, who’s now in her seventies, had been one of my lecturers when I was at medical school in Baghdad.
Our interaction hadn’t been extensive, and it wasn’t among the finer moments of my academic career. Zhida was a lecturer in gynaecology and obstetrics. I distinctly recall attending only one of her lectures—and being thrown out of it because I’d fallen asleep!
This time, it was me who put Zhida to sleep. Well, not exactly me, but the anaesthetist who prepared her for the operating theatre, where I performed a revision hip replacement. It went well. Zhida and I later reflected on our previous meeting with a grin.
Our first four operating visits to Iraq in 2017 and 2018 were all frantic. We saw 90 potential patients during the fifteen hours of clinical examination in May 2017. Our first surgical trip in August involved 58 operations on 51 patients—43 of them from the paramilitary, three from the federal police and five civilians. We carried out a total of 23 osseointegrations on 21 patients—two of them bilateral amputees. In addition, there were 34 complex trauma patients and one total hip replacement. During our 17-day stay in Baghdad leading up to Christmas 2017, we carried out 190 operations including 62 osseointegrations. And in April 2018, we performed dozens more operations.
Remarkably, when we returned from our second operating mission to Baghdad, Iraq was ranked fifth in the world for the number of patients who had undergone osseointegration. Australia led the way with 476 osseointegration operations. Sweden was second, with less than half that number—230 operations. Germany and the Netherlands were equal third on 130 each. Iraq was next on 85—the only developing nation in the top five. Sadly, this reflects the number of amputees in the country as a result of the conflicts that have raged there over the last four decades.
As well as improving the lives of individuals, I hope my contributions in the Middle East can help make people less nationalistic and more passionate about forging a peaceful future across the region.