Finding a safehaven for healing

A stream of patients is making its way to the Amman Palace hotel in Jordan for treatment from the warzones of Iraq

A stream of patients is making its way to the Amman Palace hotel in Jordan for treatment from the warzones of Iraq. Joshua Partlowreports.

On the third floor of the Amman Palace hotel, above a city block crowded with appliance dealers and video-game vendors, six Iraqi children form a semicircle around their therapist and practise how to breathe.

To the right of the therapist sits Abdullah, a seven-year-old boy missing his left foot and left eye. The afternoon sun slants across his face, which had once been so erased his father failed to recognise it and is now a mottled mask of flesh grafted from his back.

Two boys wear leg casts. A third has a burnt face. Three sit in wheelchairs. "The pain will be there," the therapist says. "But if we focus on it, that will only make us feel worse."

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Five years of war have disfigured the people of Iraq, hobbling and maiming thousands. There are no definitive counts, but health minister Salih al-Hasnawi says the number of wounded Iraqi civilians is "of course" higher than the estimated 151,000 who died from violence in the first three years of the war. "For any explosion, it is five to one, or seven to one, wounded to dead," Hasnawi says.

About 50 of these wounded Iraqis have been living in the Amman Palace hotel, while half that number are in the Jordan Red Crescent hospital up the hill. Dozens more, limbless and broken, arrive in Amman each month asking to be remade. They stay an average of 53 days, sometimes more than a year, attended by a team of orthopedic, plastic and maxillofacial surgeons from the Geneva-based Doctors Without Borders.

The lives these people knew in Iraq changed in a moment, with no time for them to react: the young boy standing at his grandfather's funeral when the suicide car bomb exploded; neighbourhood kids playing soccer when a mortar shell landed among them; a hotel clerk hailing a taxi when a bullet passed through his thigh. Now they have nothing but time: for the melted gums and charred skin, the hair implants and the plastic legs, septicemia and osteomyelitis, antibiotic resistance and opiate addictions.

In October 2006, the day after his grandfather was shot to death, Abdullah, then six, stood at his father's side outside the funeral tent in Baghdad's Shaab district. After a bomb exploded at a market down the street, neighbours rushed to the scene, but Abdullah's father was nervous. As a captain in the Iraqi police, he knew to expect a second explosion when people crowded around the wreckage. Abdullah and his father stayed by the house. The second attack came to them.

The driver of the Volkswagen Passat blew up his vehicle in front of their home, killing Abdullah's uncle, his great-uncle and three of his father's cousins.

Abdullah's father, Abu Hiba, was driven to a hospital with severe burns and a shattered right shin. Abdullah, a thin boy who was so excited about school that he arrived an hour early each day, was gone.

For three days, relatives canvassed Baghdad's hospitals until they found him in the sprawling Medical City complex, where he had been driven by a neighbour after the bombing. During that time, his father was recovering at another hospital, enduring daily antibacterial vinegar baths that made his wounds bubble, begging his brothers for news of Abdullah.

"They would tell me: 'Nothing's wrong with him. He has some scratches on his face,'" Abu Hiba recalls. "I couldn't stand this. I told them, 'By cane or by wheelchair, you have to take me to see Abdullah.'"

Abu Hiba, 33, is sitting on the single bed he shares with his son in the Amman Palace. He asks Abdullah to leave the room so he can finish the story. "When I entered the room, I saw he was attached to an IV," he said. "Then I saw his face, and there was no face at all. I stayed for a few minutes and I had to leave." Abdullah could not eat or speak, andphotos from those days reveal not so much a face as flayed meat and tooth, the features blasted off or melted away.

Iraq's medical system is all but incapable of caring for such patients. It was already beleaguered by the international sanctions imposed on the government of Saddam Hussein, but the problems have grown legion: specialists have fled; necessities such as bandages, saline and electricity are in short supply; and hospitals are guarded by gunmen who intimidate and sometimes kill patients of rival sectarian backgrounds.

Many of the Iraqi patients who arrive in Jordan are referred by physicians at home to Doctors Without Borders, one of the few organisations that help Iraqis wounded in the war and pay for their transportation and treatment. Since the group began treating Iraqis in Amman in August 2006, a dozen doctors have provided care to more than 340 wounded civilians in need of reconstructive surgeries. Another 140 are on the waiting list. "Sadly, we recognise that this is merely a drop in the sea of what is going on in Iraq," says spokeswoman Valerie Babize.

In December 2006, Abdullah flew to Jordan, escorted by an uncle. His father followed, in part to seek treatment himself. Until they and other patients were moved to a new hotel last week, their home was Room 213 of the Amman Palace, more of an outpatient ward than a hotel, with about 50 of the 70 rooms occupied by Iraqi patients.

The blown-up, bandaged and scarred hobble or wheel down hallways under framed portraits of Jordan's king. Amputees in wheelchairs sun themselves in front of the glass doors. Spare rooms are devoted to physiotherapy, counselling and tutoring sessions. Guests brew sugared tea and boiled rice over hot plates in their rooms. When both elevators break, as they often do, relatives carry the patients up the stairs.

The first procedure Abdullah underwent in Baghdad was a pedicle flap, affixing his face to his shoulder to regenerate the tissue. It failed because of infection and because Abdullah could not hold the awkward position for 21 days. His doctors arranged for a German specialist in cranial maxillofacial surgery to fly to Jordan to take the case.

During the first of several painstaking operations, Andre Eckardt took 12 hours to harvest skin and muscle from Abdullah's back and transfer it to his face to repair what the surgeon called the "disastrous tissue loss". Abdullah also had his missing lower left eyelid remade, a temporary prosthetic eye inserted to prevent his eye socket from shrinking, and his scar tissue manipulated.

"He's so severely injured, he will never look like a normal young boy with a normal face," Eckardt says. "You can never completely remove all his scars."

After his operation, Abdullah spent 24 hours anaesthesised in the intensive care unit before he was revived. In the weeks that followed, he could barely mumble. He drank liquids and ate soft fruit.

About three months ago, Abdullah took off his cap and is now growing accustomed to his appearance, his father says. He is still shy around strangers, although he is not in pain. More than anything, Abdullah says, he misses his mother and his two younger siblings. "I'd like to go back to school," he says. "I like it here, but Baghdad is better."

- (LA Times/Washington Post service)