Letter: Tragic lessons of the Sarajevo siege

Sir: I have just returned from a second working trip to Sarajevo, helping my surgical colleagues there in the enormous task of reconstruction of limbs damaged and disfigured by war. The differences in the town since the ceasefire are dramatic and the streets throng with people out walking just for the enjoyment of their relative freedom.

In the town's two main hospitals the emergency rooms that for two years rang to the screams of the injured and the wailing of bereaved relatives, are now quiet and almost empty. Instead, the orthopaedic and fracture clinics are filled with patient crowds of citizens whose bodies bear lifelong reminders of the vicious nature of shrapnel and bullets. Up to 100 patients are seen every morning at the state hospital, and although the majority can be helped by appropriate surgical reconstruction, the hospital can operate on only two or three major orthopaedic cases a day.

Many non-governmental organisations (NGOs) are already heavily involved in helping the local surgical and anaesthetic staff, but there is a deplorable lack of communication between NGOs. Plastic surgical skills for example are urgently needed and the difficult task of addressing this need is being undertaken by a large international NGO. Another NGO, with financial support from the British government, has recently arrived, also with the aim of assessing and meeting the plastic surgical need. Sadly, no communication between the NGOs was made, and neither knows what the other is doing. The result is an inevitable doubling up of resources, embarrassment to well-meaning visiting specialists, and confusion to local health planners.

Surely the time has come for there to be a mandatory central co- ordinating authority that is consulted by, and in turn directs the work of, every healthcare NGO. The World Health Organisation has tried to co-ordinate the many healthcare groups in Sarajevo with a weekly meeting, but not every NGO attends, some sadly preferring high-profile independence to the relative anonymity that comes from teamwork.

History will judge the West severely for its prevarication and lack of co-ordination over military involvement in the early stages of this war. It is not too late to avoid the same judgement being applied to our efforts to help with medical care of the wounded.

Yours sincerely,

CHRISTOPHER LAVY

Consultant Orthopaedic

Surgeon

University College Hospital and The Middlesex Hospital

London, W1

11 June