On a mission

How a team of volunteer surgeons are giving fresh hope to people wounded by war.

Little Ahmad was just six months old when a rocket-propelled grenade tore through his family’s home in Syria, setting fire to his cradle and leaving him with 60 percent burns and severely damaged limbs. With no clinic nearby, Ahmad’s parents, Mustafa and Medina, walked from their home in the village of Kendal, near Kobane, to the Turkish border to get help.

Granted passage into Turkey on humanitarian grounds, they took Ahmad to a hospital, where his left hand and right foot were amputated. But a month later, the family was sent back to war-torn Syria.

Desperate to find treatment for their son’s burns, which had badly disfigured his face and fixed one of his knees at a 90 degrees angle preventing him from learning to walk, the parents set off on foot again, this time to northern Iraq, finally reaching the city of Erbil, in January 2021.

It was in Erbil that Ahmad’s casefile found its way onto the desk of surgeons from Swisscross, a new NGO providing complex reconstructive surgery for refugees, displaced families, and vulnerable communities affected by armed conflict.

Two years on, the youngster has had four surgeries, including multiple skin grafts to help him unbend his knee, and he is finally learning to walk with the aid of prosthetics.  

Ahmad is one of hundreds of people whose life has been changed by Swisscross’ team of orthopaedic, maxillofacial, and plastic surgeons, who volunteer their time to travel to Iraq to give marginalised communities access to complex treatments that would otherwise be unobtainable.

“Many of these people are quite lost,” explains Swisscross founder, Enrique Steiger, a Zurich-based plastic and reconstructive surgeon. “Often they can’t walk, or can’t move their fingers or hands, and some can't close their eyes or even bite. But because their injuries are not life threatening, they are generally overlooked by ordinary medical services.

"But it’s not about just survival, it’s about dignity and not feeling like a burden to their family and community,” says Steiger. “If we are able to correct their deformities and give these people back their dignity and allow them to have some sort of normal life and return to work to support their families, then I think we have accomplished what we are there for.”

"It’s not about just survival, it’s about dignity."

Enrique Steiger, founder and chairman, Swisscross

For nine months a year, Steiger runs a high-end aesthetic surgery clinic in Zurich performing tummy tucks, facelifts, and other enhancement for some of the world’s wealthiest people. But for decades, he has also been taking sabbaticals to join humanitarian missions for the International Committee of the Red Cross (ICRC), the United Nations, and others.

Starting out in Namibia, then South-West Africa, Steiger has also worked in Bosnia, Kosovo, Somalia, Rwanda, Sierra Leone, Liberia, Pakistan, and Afghanistan.

In early 2014, he was helping to set up a reconstructive surgery programme in Tripoli, Lebanon, for a large international NGO when Covid-19 hit, leading to the project being cancelled. Frustrated, Steiger decided to go it alone and Swisscross was born.

“All these big organisations have become too risk adverse, in my opinion. They hide behind walls and have lost touch with people on the ground,” he explains. “I had an idea to do something different. I wanted to deliver humanitarian aid for the 21st century, where we can use our expertise to help patients, yes, but also to empower and train local healthcare workers.”

Steiger also wanted to find a way to do ensure humanitarian doctors, who have become increasingly at risk in conflict zones, to deliver care off the battlefield. 

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Swisscross founder, Enrique Steiger, with seven-year-old patient, Ahmed, who was badly burned as a toddler in a gas explosion. Ahmed has had several plastic surgeries with Swisscross.

Swisscross embarked on its first medical mission in 2021, taking a small pool of volunteer doctors into Zheen International Hospital in Erbil, the capital of the Kurdish region of Iraq, to deliver complex reconstructive surgery. This is not frontline work and Swisscross doctors are not operating in war zones.

But their work is no less important as they deliver highly specialised procedures otherwise almost impossible to access in countries like Iraq, where decades of conflict and an underfunded and poorly managed health infrastructure mean this sort of tertiary care is typically either not available or only via long waiting lists that can take years for refugees and those on low incomes.

In its first 18 months, Swisscross, which is registered as a nonprofit foundation in Zurich, received more than 1,250 patient referrals and during five missions performed more than 250 complex orthopaedic, maxillofacial and plastic surgical interventions, half of which related to burns, and 70 percent involved children.

Swisscross works with several NGOs based in Iraq, including the Barzani Foundation, and Nadia’s Initiative as well as international organisations like Médecins Sans Frontières (MSF) to receive patient referrals.

It has also developed its own mobile application to help referring agencies collect and share information about prospective patients outside of Swisscross missions.

This grassroots referral system is vital to ensure the time of the visiting surgeons is used efficiently and guarantees proper post-operative follow up care for the patients.

Unlike other medical charities, Swisscross has no permanent facilities in Iraq, and instead books bed days and theatre space in local hospitals. “Building something new would be a waste of our donors’ money,” explains Steiger. “There’s no need and it’s not in the spirit of our organisation which is trying to be as flexible and nimble as possible.”

Swisscross is a lean organisation. There is CEO, Dr Ian Furst, a Canadian oral and maxillofacial surgeon and its lead surgeon is Dr Walter Kunzi, like Steiger from Switzerland, who is qualified in neurosurgery, plastic and reconstructive surgery, hand surgery, general surgery and trauma surgery.

They are supported by two field officers, Dr Sarezh Saber and Dr Lass Azad, both new graduates from the University of Hawler Medical School in Erbil, and a handful of other staff working alongside a revolving pool of international volunteers.

In addition to performing the surgeries in Iraq, Steiger also wants to pass on the group’s skills. Swisscross doctors have been working with local universities and local surgeons to do just this. “We’re not here to compete with the local medical community,” he says. “We want to share the burden and also exchange knowledge and experience.”

Most of the patients seen by Swisscross are refugees or internally displaced, many are Syrian, and there is also a sizeable number of Yazidis from the west of Iraq. Their injuries vary from third degree burns preventing limb movement and untreated or badly managed fractures that have left people immobile, to limb loss due landmines, gunshot wounds, or other explosions.

Some require corrective surgery, such as limbs being shortened, others need skin muscle flaps, or other forms of complex plastic surgery to restore their movement as well as rebuild their confidence.

CEO Furst, who is usually based at the Coronation Dental Specialty Group in Ontario, Canada, recalls one man who was hit by an Islamic State car bomb at a checkpoint. 

“His face was very severely injured in the explosion and although he had already been through two or three surgeries before we saw him, he had a bad infection in the jaw, which meant he couldn’t move his tongue. He was in a bad way.”

Two surgeries later and the man is now able to talk, eat and, crucially, is no longer in pain.

Another patient that stands out for Furst is a Syrian who was knocked down by a car in a refugee camp shortly after coming to Iraq. “He arrived in a wheelchair and had had a broken thighbone for nine years, since he was 14 years old, despite more than 20 surgeries.”

Dr Sarkhill Radha, a UK-based trauma surgeon volunteering with Swisscross operated on the young man and after three months of healing and lots of rehabilitation, he was back on his feet. “Taking his crutch away and seeing a 23-year-old walk after nine years of a being in wheelchair was just amazing,” says Furst.

Then there is the boy from Sinjar whose face was peppered with shrapnel after being caught up in an explosion. And of course, little Ahmad from Syria.

“Honestly, there are so many, and they are all so different,” he says. “It's not the type or the mechanism of injury that is important to me. People find themselves in these situations because resources are so scarce so the fact that we are there and even seeing them at all, gives them hope.

“This part of the work is very meaningful to me. I want people to experience hope and to know that the rest of the world is watching and does want to help.”

"I want people to experience that hope and to know that the rest of the world is watching and does want to help."

Ian Furst, CEO, Swisscross

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(LR) Volunteer orthopaedic surgeon Deiary Kader (left), Swisscross founder, Enrique Steiger, and Swisscross CEO, Ian Furst (right), pictured at Erbil's Zheen Hospital.

Bomb blasts and botox: a surgeon's double life

Enrique Steiger did not set out to become a humanitarian but a chance opportunity in the late 1980s changed the course of his life.

After five years of medical residency, the young doctor was bored and planning a sailing trip around the Caribbean to forget his studies for a while, when he was offered by the Swiss Army to lead a medical team of doctors and nurses with the United Nations Transition Assistance Group (UNTAG) in Namibia (then South West Africa).

“I was impatient to get on with my career, and this seemed like a good opportunity,” recalls Steiger, who is half Swiss, half-Argentinian. “I was really thrown into the deep-end but I loved the experience, the chaos, and the sense of doing things for people in need.”

After Namibia, Steiger went up to the border with Angola, and then onto Western-Sahara with the UN, and in 1994, he found himself being sent by the International Committee of the Red Cross (ICRC) to Rwanda and Burundi at the height of the genocide.

“Being there as an eyewitness to 800,000 people being slaughtered in a matter of weeks, after that I knew I could never return to the quiet of the golf course,” Steiger explains. “That experience really planted in me a kind of virus, an obligation to give back to people in need. I knew I had the capacity to work and survive in that environment and that I had something to contribute.”

From Rwanda, Steiger was sent on missions to Bosnia, Kosovo, Somalia, Rwanda, Sierra Leone. He has also worked in Pakistan, Afghanistan, and Liberia, rotating for decades between the chaos and desperation of war zones, and the serenity of his high-end clinic in Zurich performing cosmetic treatments to the global elite.

Steiger accepts it is an unusual juxtaposition - to be one day treating the world’s most vulnerable people for landmine injuries, and then doing breast implants or facelifts for some of the wealthiest - but he is also pragmatic.

“It is because of my patients in Switzerland that I have been able to fund Swisscross," he says. "Sometimes people will say to me they are embarrassed to be asking me to do their fillers, but I tell them not to be embarrassed because they are making my other work possible.”

Steiger set up Swisscross with his personal funds, supported by contributions from patients and friends. The NGO’s operations in Iraq were made possible thanks to a 2021 donation from the government of the United Arab Emirates (UAE).

This partnership with UAE Aid came about when a close friend of Steiger introduced him to Mohammed Al Shaibani, the director general of the Ruler's Court of the Government of Dubai, who then connected him to Reem al Hashimy, the UAE’s Minister of State for International Co-operation.

“HE Reem al Hashimy is very knowledgeable and engaged and she has a deep understanding of humanitarian work, so it didn’t take me long to convince her to support Swisscross," Steiger explains. "Thanks to her, we have been able to start our work in Iraq.”

The UAE Aid money has been an important springboard for Swisscross, but the organisation is keen to expand its funding pool to find support from other governments as well as philanthropic donors. Steiger said he had been encouraged by interest from several private Kurdish donors who wanted to pay to take Swisscross to other cities, including Sulaymaniyah.

“We’re trying to find people that understand the contexts we’re working in, and who see the value of addressing disability and what the long-term impact of that can be,” explains Furst.

“If we can help someone to be able to walk again, then the economic multiplier of that for their family and their community is huge. Not only can they earn their own livelihood, but their family is also relieved of the burden of caring for them. It’s a small upfront cost for a long-term benefit.”

Steiger has big plans for his model of specialised but agile care. “Erbil is the proof of concept,” he says. “But we don’t want to stop there. We want to see if we can share what we’re doing to inspire a new generation of humanitarians.”

Part of his vision includes creating a humanitarian training hub [for the MENA region] somewhere central like the UAE to bring doctors in from places like Iraq, Somalia, Afghanistan, Ethiopia, and Palestine, and give them the tools to deliver specialised healthcare in fragile environments with limited resources.

“I want to use Swisscross as a catalyst to bring together a community of organisations to exchange ideas and work out how we can all work together with organisations like ICRC, the UN, and other NGOs, to maximise our joint potential effort in an environment always stuck with limited resources and ultimately help more people.” - PA