The Face Of War

By Jonathan Margolis/Manchester

Thursday, April 29, of last year, a rainy day in Kosovo, should really have been the last of Besim Kadriu's life. That morning, in the Albanian sector of the town of Mitrovica, Serb paramilitaries torched the house the 21-year-old economics student shared with his pregnant wife Valbona. Watching the inferno from a distance, Kadriu was confident Valbona had escaped but was unsure where she had fled. He set off on foot for the village of Zaza, a few miles away, on a hunch she would be there with her two brothers. She wasn't, but a large number of Serb militiamen were. Thugs in balaclavas surrounded the village in three rings, moving inward to trap the inhabitants. Knowing they were targets, Kadriu and a few other men tried to escape. They managed to pass the two inner cordons undetected.

But as the men attempted to cross the third, they were spotted. One of Kadriu's brothers-in-law was shot dead on the spot. Kadriu and the other brother-in-law ran for the woods. The brother-in-law was shot in the leg, but kept running and survived. Kadriu felt a bullet sting his face, fell to the ground and played dead. Much of one side of his previously handsome face, including his entire nose and an eye, had been removed by the shot.

A strong-minded, pragmatic man, Kadriu resolved to avoid glimpsing any reflection of himself in puddles left by the rain, even though he needed them to drink from. For his psychological survival, this was probably a good tactic. So grotesque were his injuries that when he finally judged it safe to return to Zaza, he went unrecognized. People scurried from him in horror until he produced a photo he happened to have in the back pocket of his jeans. It showed him and Valbona smiling for the camera a few months before, at Christmas 1998, days after they had married.

Besim Kadriu still keeps that photo in his wallet as a lucky charm, for while some people would opt for death rather than disfigurement, he considers himself a fortunate man. For one thing, a couple of centimeters farther back and that Serb bullet would have hit his brain. For another, he was reunited with Valbona and survived for three months in the care of relatives. He was still avoiding mirrors when the Kosovo Force peacekeepers arrived. But luckiest of all--and thanks to the efforts of an American doctor and a British military medic with a bag full of electronic gizmos and an Internet connection--Kadriu's face has been rebuilt by surgeons in Manchester, England.

Before the technology, however, came philanthropy. In June 1999, Dan Clay, a California emergency-room physician, set up a charity clinic on the outskirts of Mitrovica. Kadriu soon heard about it and went to see "Dr. Dan." Like every other doctor who was later to meet the young man, Clay was shocked. He also recognized that the injury was far beyond his expertise to treat. "I've spent half my career in ERs in some of the most violent cities in America, seen all kinds of mangled human beings, but I've never come across anyone still alive carrying such a horrific injury as Besim." Local surgeons could do nothing. "I knew," says Clay, now back at the rural St. Helena Hospital in Deer Park, Calif., "that I had become his only hope."

Working with a Royal Army Medical Corps doctor who had an unsophisticated telemedicine link to the outside world--nothing more than a couple of standard digital cameras, a laptop, a satellite phone and an AOL account--Clay was able to put details of Besim's case and photos of his face on the Internet. The photos were copied and recopied in e-mail to surgeons across Britain who had responded to a British Medical Journal article appealing for help for Kosovo victims. The complexities of coordinating surgeons' timetables meant that plans for Kadriu's operation began to coalesce around Manchester, where the necessary team of specialists could be assembled most swiftly.

The operation was finally performed in December--a week before Kadriu's daughter was born. It took 15 hours and involved details that sound more like makeshift engineering than surgery. First, doctors removed the remains of Kadriu's damaged eye and retrieved its surrounding membrane, which was reinserted after being filled with a piece of fat from Kadriu's buttock to create an eye-shaped mass with the remaining ocular muscles attached to it. It will later form a mobile platform for a false eye resembling a giant contact lens. Doctors then re-created an upper eyelid using cartilage from the back of an ear and a lower eyelid with skin from the forehead. Next, doctors exposed the remaining parts of Kadriu's cheek area and screwed in a set of titanium plates. The missing midface soft tissue and skin were replaced with a graft. Finally, a titanium nasal bone was fixed to Kadriu's face--a foundation for a new nose. Fortunately, the nasal passages and linings were still present in residual form and worked normally after the operation.

The successful operation left Kadriu looking something like himself again, albeit with a pale flap across his face. For the moment, living in an apartment block in Manchester occupied entirely by Kosovar refugees, Kadriu seems a happy man. Valbona tends their new baby and has a support network of other young ethnic Albanian women around her.

It is clearly not easy for Kadriu to relate the details of his shooting through an Albanian interpreter, but he is measured and phlegmatic. Emotional reaction overcomes him only at moments. When taking a wedding photo from its frame, a key falls out from behind the print. "This is key to house in Kosovo," he says tearfully in his newly acquired English. "Now the key is all we have. House gone."

Digital pictures of Besim Kadriu continue to flash across the Internet, keeping the band of doctors following his case informed of his progress. In California, Dan Clay has been especially thrilled to see the images. "I think I will always rate downloading those photos from Manchester as one of the greatest moments of my medical career," he says. "He looks beautiful."