Ali gets ready to face the world

A shell attack has left Ali Hussein disfigured. Now two British surgeons are donating their skills to help give the Iraqi boy a normal life

Yesterday in the Craniofacial Unit at the Chelsea and Westminster Hospital, a team of leading medics carried out an operation that will change the life of a little boy. You may already have heard of Ali Hussein. He was featured in the Cutting Edge documentary "A Tale of Two Alis", which told the stories of two children called Ali who were both gravely injured in the Iraq war.

One child, Ali Abbas, aged 13, lost his arms. He was flown to the US for treatment and became one of the iconic images of the conflict. The other boy, Ali Hussein, then aged seven, suffered severe facial injuries that left him unrecognisable even to his own brothers. He spent two months in hospital in Kuwait, and was then sent back to his parents' farm outside Baghdad.

There was no medical or psychological support available for his family, and the story might have ended there. But a crusading new charity, Facing the World, stepped in. Facing the World supplies the most advanced and expert reconstruction surgery to children who would otherwise have no hope of a normal life. The founders of the charity, Martin Kelly and Norman Waterhouse, two of the world's leading craniofacial surgeons, along with a full medical team, are giving their time and skills for free to rebuild Ali's face.

Despite his ordeal, Ali Hussein is a remarkably perky, charming little boy with a ready smile and infectious giggle. Like any other eight-year-old, he loves toys, especially anything with wheels. From certain angles, last week, his face looked almost normal. But in the shell attack that killed several members of his family, he lost his left eye and the majority of his nose. Face-on, the extent to which he was disfigured is all too obvious.

Ali's father, Hussein Mohammad Jaloub, an austerely handsome farmer whose face shows the strain of the past few years, accompanied his son to London. A man of few words, he told the family's story via an interpreter. "At midday on April 3 the coalition troops started shelling in the village. In the afternoon we thought we should take shelter in the fields. We left home around 6pm, and at around 7pm the military started targeting us. They probably thought we were soldiers. We scattered and Ali was with his aunt. She was killed, Ali was badly hurt."

Seven members of the family died; Ali's father lost his mother, two sisters, two uncles and two cousins in the mis-targeted raid. The US army flew an unconscious Ali to hospital in Kuwait, where he spent two months, with no contact with his family. His father, already grief-stricken for his other relatives, feared they would never see him again. When he finally came home, he had been patched up and was very much alive. But he was so badly disfigured, he was unrecognisable. "At first his friends feared him," says Hussein Mohammad Jaloub.

Ali's trip to London was not easy to organise. Even the simplest task, like getting a photo for his passport, was a struggle in the shattered country. The American and British armies helped, along with sympathetic journalists, and British Airways donated flights for Ali and his father.

Yesterday, Martin Kelly and Norman Waterhouse began the task of reconstructing Ali's face, using his own bone, cartilage and skin. "We leave it to the will of God, but hopefully his face will look as normal as possible," says his father. "He is always asking 'What time will they be fixing my face?'"

Ali himself is extraordinarily cheerful. He has taken the culture shock of his first ever trip abroad in his stride, though he misses his mother Rasmiya and his little brothers Mohammad, three, Ahmed, one, and four-month-old Athir. He loves double-decker buses and feeding the ducks in St James's Park while he waits for his operation. Facing the World has found an Iraqi family in central London to host him and his father, so they hear their own language and eat familiar food. And Ali has retained a sharp sense of humour. Basel Hafez, the interpreter, has a very short haircut. "I know that when I have the operation they will cut my hair, and I'm going to collect it and give it to Basel," he said last week.

Amazing as it may seem, Ali's case is by no means the most complicated that Facing the World has tackled. Groups of doctors regularly visit the developing world to perform straightforward surgery on defects such as cleft lips and palates, but Facing the World takes on cases that cannot be treated in their home countries because medical resources are inadequate. Severe birth defects and injuries that require major reconstruction work need the skills of a craniofacial specialist. Craniofacial surgery is a relatively new medical discipline; it was pioneered by a French surgeon, Paul Tessier, in the 1960s. Tessier has remained at the forefront of the field, and Kelly, 38, trained with him. The techniques of craniofacial surgery involve working not only with soft tissue, but with the underlying structure. "A facial plastic surgeon reaches the limit when they hit bone," explains Kelly. "We are working with the foundations of the face; the carpentry below. We move the bones, and put the face back."

The bulk of Kelly and Waterhouse's work is carried out for the NHS in this country. Facial birth defects, where, for example, a baby's bones don't knit together properly before birth, or knit too soon, are almost as common in the west as in the developing world. All Kelly and Waterhouse's Facing the World cases are operated on strictly in their own time. And for the children who reach them, it is a life-transforming experience. These are children whose deformities would lead them to be utterly excluded.

It's hard not to recoil at a photo of Kalyani before her surgery, for example. Kalyani was born with a huge facial cleft that stretched through her nose and split her forehead into three sections. Had she been born in the West she would automatically have received attention early, but in India the techniques needed were unheard of. Her father, a baker with no hope of raising the funds for an operation himself, travelled over India looking for help, and laboriously wrote 400 letters which he sent out all over the world before Facing the World took a hand. Kalyani turned five in the UK just weeks after surgery. She asked for a new name for her birthday. "Kalyani was a girl with a strange face. Now that I have a new face, I need a new name," she said.

"We are hard-wired to reject an abnormal facial pattern," says Kelly. "It's a knee-jerk reaction, though the person inside is just like anyone else, with no mental incapacity. Craniofacial surgery can reduce this terrible in-built capacity for rejection and get a child back into normal social relationships."

He is not exaggerating about the seriousness of the problem. When he was working on a humanitarian project in 1997 in Kabul, a father brought his baby daughter, Hadisa, to the clinic. He would not remove the blanket over her head till he was alone with Kelly - because he was afraid his little girl would be stoned in the street. Hadisa was missing most of the bones in one side of her face, and Kelly could do nothing on the spot; but she was the first child to be treated by Facing the World, which launched last year.

Over the last 15 years craniofacial surgery has become increasingly sophisticated; though what can be achieved still depends on the seriousness of the child's original condition. Sometimes the surgery is so successful that there is no indication that anything was ever amiss. But at the least, the child goes back into their community looking socially acceptable, with the chance of a normal life.

Facing the World is about multi-skilling and teamwork, says Waterhouse, 49. "The days of the single surgeon with the big ego have to go. It's a great learning experience." The charity draws on all kinds of skilled professionals, including ophthalmic, dental and psychological specialists. At the moment, says Waterhouse, Facing the World is still small and can deal with maybe half a dozen cases a year. The charity is a very tight ship, with just one paid co-ordinator to bring the volunteers together.

"Our eventual vision is not that we will treat 500 or 600 cases a year ourselves," he explains. "With research and training we would like to establish a worldwide network, so that if someone calls from, say, Bolivia, we can refer them to a facility in Mexico or Chile."

Both men are fathers. Kelly has two sons, Theodore, three, and Otis, 10 months, with his partner, the actress Natasha McElhone. Waterhouse has four children, Suki, 12, Imogen, nine, and four-year-old twins Charlie and Madeleine. They both say that fatherhood has sharpened their instinct to help other children. And they both say their medical skills have never been tested more rewardingly than when they are helping children like Ali or Kalyani. "Work like this brings it sharply into focus that you have a skill that can transform a life," Waterhouse says.

Facing the World is a registered charity that relies on donations. For more information, contact 020-7352 0052; www.facingtheworld.co.uk