Hospital Madness

In Zagreb 28-11-1991

Zagreb's New Military Hospital is one of the finest in former Yugoslavia. But, as casualties pour in from the Serbo-Croat war, it lies empty because the Serbs and Croats can't decide who is entitled to use it. Even hospitals have become the casualties of nationalism. Meanwhile, a couple of miles away, there's the Rebro Hospital...

By Christopher Long

War? What War?

Don't worry. Apparently there's no war in Croatia – no casualties, no dying, no dead.

Go to the New Military Hospital near Dubrava, Zagreb, if you don't believe me, and you'll see what I mean.

You'll will see no ambulances from the front. No young men in blood-stained uniforms, no suspiciously quiet bodies on stretchers. There are very few doctors or surgeons and plenty of nurses with nothing to do.

This is one of the most modern and well-equipped hospitals in Europe. Technically it belongs to the Jugoslav National Army (now controlled by Serbia). But Croats paid $200,000,000 for it. Their banks paid another $200,000,000. The JNA contributed a further $100,000,000. And haven't we heard that the Croats had paid quite a lot towards the cost of maintaining JNA before the war?

Today Croatia is the proud owner of several kilometres of empty, clean, flat corridors and a half a billion dollars worth of operating theatres, wards, clinics, equipment and facilities. There are over one thousand beds and space in the basements for hundreds more in a crisis.

Today, I'm told, about 100 beds are in use. Ninety per cent of the investment is unused.

Since there is apparently no crisis and no war, this hospital could well host the World Bowling Championships in its long, empty corridors. Very few doctors would get in the way since nearly all of them have chosen the same time to go 'home' to Belgrade.

Indeed, there's only one full-time, fully qualified doctor of surgery there but hundreds of nurses, clinicians, technicians and general staff to set up the pins.

I visited this superb hospital last week. I was told it was JNA territory and that my colleague and I might have difficulty entering it. Not at all. No one questioned us as we entered the massive green complex, surrounded by even greener fields.

Very thoughtfully the European Commission's monitors had set up stall outside – looking like ice-cream salesmen in their smart white uniforms and smart white van. They had few customers in this cold weather.

There were a few JNA soldiers in the reception hall but no-one was carrying a gun. There were about twenty, mostly elderly, patients queuing for the psychiatric clinic and I was told they were nearly all speaking 'Serbian' – which in the space of three months is now, it seems, an entirely different language from 'Croat' or even 'Serbo-Croat'. Most of the other clinics seemed to be empty.

We took the lift up to the Casualty Department. It's situated so that it can receive casualties from helicopters on the roof or ambulances from a ramp. It's a huge department. At the centre is a reception desk. There was no one to receive us. In fact there was only one person visible in the whole department – an old woman in her '80s, sitting in a wheel-chair, waiting. She might have been waiting for a week. Perhaps she's still there today.

Where were the sounds of wailing ambulances or the clatter of helicopters bringing in casualties from Osijek, Knin or Zadar? Where were the hurrying nurses, the calls for blood, the groans of young bodies in pain?

We didn't ask the old lady in her wheel-chair. She was asleep, sitting all alone in the middle of $500,000,000 worth of space.

Then, suddenly, a charming Croat nurse seemed to understand our surprise at what we was seeing. Originally from Vojvodina, she now describes herself as a Croat. She is one of the 1,200 staff (93 per cent) who had voted for this hospital to be available to civilians who need it too – not merely the military. She is deeply sad that Croats are either too frightened to use their own hospital or that the government is either unwilling or unable to allow them to do so – simply because it was once the property of the JNA 'enemy'.

Surely no government could be so nationalistic that it would use a hospital for propaganda purposes and, in the process, deny its young soldiers the medical facilities they so desperately need?

[In a taped interview this nurse then explained her anger and frustration at 'those in power' who prevented her from treating military casualties – which was what the hospital had been built for. In the current repressive and nationalistic climate this was a brave and defiant stance.]

---

Oh, That War!

Walk into the front entrance of Zagreb's Rebro Hospital and you'll meet four young men waiting on stretchers in the corridor. Their faces are as white as the pillows and in stark contrast to the blood-stained sheets which cover them. They're too tired, in too much pain to smile. They're waiting to be taken to the operating theatres.

Up there, ten surgeons and teams of exhausted nurses and clinicians maintain a factory production line, working round the clock in teams to clear the corridors downstairs and feed the Intensive Care Unit with more desperately sick post-operative casualties.

In the Intensive Care Unit the equally exhausted staff have been on duty for 36-48 hours with only an occasional hour or two of sleep. Four of the 18 Intensive Care Unit beds have become vacant, still stained with the blood and urine of the previous occupants.

There's a problem. Which of the dozens of young bodies coming out of the operating theatres should be given one of the four precious beds? Which should take their chances in one of the hospital's 240 ordinary beds?

They have another worry too: the hospital has five heart/lung machines (ECCs) but only one of them is in the Intensive Care Unit. It's already being used by an elderly civilian waiting for a left-heart by-pass operation. So, Zagreb, tonight is not a good time to choose to have serious heart failure.

In just one small room of 'ordinary' beds are six young men. They are all packed together with no curtains, no privacy and nowhere to be alone with their visiting wives or girl-friends. They recovering from operations to shrapnel wounds to arms, legs, chests and necks.

They are some of the pretty ones. Their faces are intact. In other rooms are the less pretty ones – not suitable viewing for journalists, it seems. I ask the nurses how young men are expected to break the news about their amputations and disfigurements to devastated girlfriends in such crowded circumstances and with no psychiatrists or counsellors on the wards.

"This is war, you know," she replies stiffly. "The men can help each other."

Downstairs no one knows what will come in through the front doors next. They're prepared for anything and everything, as they have been for the last four months. And still the hospital trolleys weave their way through corridors packed with the grey, anxious faces of fearful and equally exhausted families and visitors. The scene can be little different from the final days of the First World War when this surgical clinic was founded.

A year ago Zagreb's Rebro Clinic was like almost any hospital in Britain, France or Italy – an old building with never enough staff, equipment and facilities to serve a growing civilian population.

Today eight out of every ten patients – in corridors, the casualty department, the operating theatres, the ICU – is a young soldier from Vinkovci, Vukovar, Nustar, Knin...

Suddenly there has been a 300 per cent increase in demand on a hospital that was fully stretched before the war started.

Yet, somehow, miraculously, the white-gowned and green-gowned nurses and doctors still have time to be courteous and welcoming as the steady stream of misery, ruined bodies and scarred minds demand their attention.

In charge of the Medical Faculty is Professor Soculic, formerly a naval officer in the JRM and for seven years a colonel in the Military Hospital in Belgrade. For nine years he has led his team in Zagreb to achieve 15 heart transplants, the development of advanced specialities in cardiac, abdominal, plastic, traumatology and paediatric surgery – and a successful medical school.

But what, I wondered, did he think of the almost empty New Military Hospital across town?

"That is a very modern, very nice hospital," he says guardedly. "But they have no doctors and no patients. Here we do have doctors and patients!"

So, where have the doctors gone, I ask.

"I don't know," replies the Chief of the Medical Faculty.

But, thank God, one man does seem to know where they've gone:

"If I can say something, I think a lot of them left the hospital to go to Belgrade," says Ervin Serverdija.

There is an uneasy tension in the air. Professor Soculic is one of the 'old guard' who prefers silence to anything that might result in trouble. Ervin Serverdija is a straight-forward clinician who sees no need to obscure ugly truths when he's surrounded by so much that is uglier still.

Dear Mr Serverdija! If ever I suffer from heart failure I hope you'll be there.

He's small, thin, gentle, pale, tired and endlessly patient. Maybe he is pale from giving blood – the supplies are so bad that the already anaemic staff are constantly giving more blood for the patients.

Ervin had to leave his wife and children in Belgrade when he decided that he must offer his rare skills to Croatia. He hasn't seen them for months and worries all the time about his son who is hiding from the JNA somewhere in Belgrade.

He is horrified by the extent of the injuries he is seeing now:

" I have never seen anything like this before," he says. "I find it very difficult. We had no idea of what shrapnel can do – the speed of the shrapnel and the damage it does to the tissues is fantastic. For example, in injuries to the lower abdomen we have seen the blast effects causing contusions of the heart and lungs which means the shock waves are travelling 35 centimetres from the lower abdomen to the upper chest although there is no anatomical connection between the two."

And Ervin confirmed the opinion of another doctor, Tomislav Skalamera, a Croat army doctor I met in October in the retreat from Cavtat to Dubrovnik. He said he had never seen a wound caused directly by a bullet."

"Shrapnel causes 95 per cent of all the wounds we see," Ervin says, "and we must remember that more civilians than military are wounded or killed."

[It should be said that owing to the lethal capabilities of modern high velocity weapons, most of those hit by rifles were likely to have been killed in the field or to die long before they could be hospitalised. A hit to even one of the long bones of the arms or legs transfers shock waves through the skeleton which are frequently sufficient to kill. Blast, burns and shrapnel were the most common injuries among those hospitalised until the widespread establishment of mine fields in 1992-94. Also, most of the fighting took place in areas far from hospital facilities while the ill-disciplined and disorganised militias seldom had medical teams among their units. However, vast numbers were killed in car accidents as a consequence of being shot at, hitting road mines, driving at high speed over shell-damage or from reckless driving on treacherous roads. These casualties usually died at the scene owing to the lack of emergency services, the risks involved in reaching them and an increasingly callous attitude to 'victims' of any sort.]

"I find that I am always sad these days. When you are working all day you have some successes with the patients. But the war situation and what we see every day on TV news and what we see here makes me very unhappy. We are not responsible for this war. And we can't do as much as we want to be able to do. This makes all of us disappointed. We are not going to fight – we don't want to fight – but here we can only fight with our scalpels."

Is he angry at the people who have allowed this war to damage so many young men? Does he blame Milosevic or Tudjman, for example? The question is unfair because we both know the price of truth these days.

"I was in the military and I lived in Serbia for 30 years. I know the people there. But this war is not the solution. We have waited 800 years for independence and we had no idea that this could be the result. The people decided to leave Yugoslavia because it was a prison – not just for Croats but for everybody. So we cannot blame anyone here except perhaps for some small details, points of politics. For that reason I'm not angry."

But it distresses him that because military casualties (80 per cent) are given medical priority at the Rebro this means that he can only treat the most urgent civilian cases from Zagreb. Hundreds, perhaps thousands of civilians are not getting the routine treatment they need – just one category among the many hidden casualties of war.

"We need help. Germany has promised DM10 million and a further DM100 million as a credit. Humanitarian help is most important but it is not enough because I think there are probably more than 10,000 wounded Croats in our country. You can imagine what that means."

So, could he make good use of medical and nursing staff from West European countries, I wondered as I looked at his exhausted face and tried to wipe from my mind pictures of the vast, wasted skills and resources of the Military Hospital.

"Yes. But we have unemployed nurses in Croatia. We need more nurses but we cannot afford to pay for them."

And what about the skills of doctors, surgeons and specialist nurses who have gained years of experience in Northern Ireland, the Falklands' War and the Gulf War?

"For sure, for sure! Here in Croatia we have no such expertise. This is the first experience of war for a whole generation of Croat doctors. Particularly useful would be those with expertise in shrapnel, blast, massive trauma, plastic surgery, etc.."

I couldn't help wondering what he felt about his old colleagues in Belgrade and those who had left the Military Hospital in Zagreb:

"We have no communication with our old colleagues – not even by telephone. Only a few of my neighbours show a little interest in what I am doing. I find that interesting. I was in what we called the Yugoslav Popular Army and then it was genuinely 'popular'. But when this army started to fight its own countrymen I couldn't support it."

And so it was that he left the JNA in October 1990, tired of colleagues who talked politics and war all the time; heartbroken at leaving his wife and children behind. They are almost prisoners, he says. She is accused of being 'Ustache', despite having lived there for 30 years. She cannot work, he cannot send her money, he knows she is suffering and he fears for his 25 year-old son who is on the run from the JNA – a young man no different from the hundreds whose broken bodies lie in the corridors of Rebro Hospital this week.

This article was refused publication by Globus (Zagreb). Dissenting or critical items had by this time become unwelcome. Instead the taped interviews for this story were filed to BBC Radio News by a colleague, Cathy Jenkins.