Australian trauma surgeon Craig Jurisevic headed to a battle zone to treat the wounded, but ended up taking lives, Shane Gilchrist reports

Craig Jurisevic has received a few death threats lately. Yet death is something to which he is not unaccustomed.

The Australian trauma surgeon has travelled to Israel, East Timor, Afghanistan and elsewhere, utilising his skills in what he viscerally describes as "wet mechanics", the delicate, bloody job of putting back together people who have been shot, bombed, burned, stabbed or otherwise mutilated.

In conflict, much is mangled, including morality.

Jurisevic knows this full well.

In 1999, prompted by television broadcasts depicting streams of refugees, figures behind barbed wire fences and bodies heaped in ditches, the victims of Serbian leader Slobodan Milosevic's campaign of "ethnic cleansing", he headed to the Balkans to treat the injured.

Within seven weeks, Jurisevic had taken up arms and taken aim, fighting with guerrilla group the Kosovo Liberation Army.

Jurisevic is on the phone from Adelaide, where he works as a senior cardiothoracic surgeon at Royal Adelaide Hospital and in private practice. He is married (to a doctor) and has three children.

He has just released a book on his experiences in Albania and Kosovo in 1999. Blood on My Hands: A Surgeon At War has been on the best-seller list in Australia for the past four weeks and has elicited a range of responses for its candid and controversial narrative.

"I have had quite a vehement response from Serbian groups in Australia, to the point of receiving several death threats and being indicted by some Serbian war crimes group run by several Serbian nationalist parties. I haven't heard the charges yet," Jurisevic says, his laconic tone not hiding the fact that such threats are to be taken seriously.

Among other sectors, the reaction has been "overwhelmingly positive but also controversial", he says.

One issue to the fore is euthanasia. In a sobering and highly moving chapter, Jurisevic describes his discovery of a mortally wounded woman in a hut. On the floor was her husband; cradled in her arms, her 5-year-old son. Both had been killed by Serbian forces.

The woman had been partially disembowelled and shot in both legs, injuries Jurisevic thought were designed to inflict extreme pain, to prompt cries of anguish that might have led others to the booby-trapped abode; she asked him to kill her; he did so, using a pistol.

"That lady I had to euthanase ..." Jurisevic pauses. "That is where the medical profession have identified themselves as either supporting that action or not. Overwhelmingly, they have said they would have done what I did in that situation. I actually thought there would be much more resistance or negative feedback."

Perhaps more contentious is the issue of a doctor taking up arms and intentionally harming others.

Asked whether such actions could compromise the safety of medical staff operating in theatres of war, Jurisevic offers an honest answer: "I don't know," though he concedes the subject is a hot topic in international humanitarian law.

"Wearing the Red Cross and carrying arms and using them would put other medical staff wearing the Red Cross at risk. But by not wearing the Red Cross and just acting as a combatant, I don't think that would put other medical staff at risk," says Jurisevic, who is a member of the International Humanitarian Law Committee of the Australian Red Cross.

"In the Australia and New Zealand defence forces, when we deploy overseas, you only wear the Red Cross within base. Outside base, you don't. You aren't allowed to carry arms and wear the Red Cross. In Australia and New Zealand we have an understanding that medical personnel in defence forces carry weapons and have to defend themselves and their patients."

Jurisevic may have found himself negotiating some murky moral ground in the mountains near the borders of Albania and Kosovo, but his reasons for going there were straightforward enough.

The son of a Slovenian mother and Australian father, grandson of a man who survived Nazi concentration camps only to be later imprisoned by the Yugoslavs for whom he fought, Jurisevic has always had "a hatred of injustice".

"Seeing what was happening on the TV screen, I thought it was terrible, but also I figured a few months out of my comfortable life in Adelaide to help out was not too much of a burden. I went there to offer my services because I thought I could do some good in a short amount of time and it wouldn't be too taxing on my life," the 45-year-old explains.

Thus he headed to Albania to work for the International Medical Corps, co-ordinating surgery for a refugee population of 100,000. Sent to the town of Kukes, north of the Albanian capital Tirana, Jurisevic discovered the hospital there was run by a corrupt director who, in connection with local mafia, extorted money from patients.

An unsuccessful attempt to bring the situation to the attention of the United Nations prompted him to disclose the corruption to the United States military newspaper Stars and Stripes, which on May 24, 1999, ran a front-page lead titled "Refugee death trap".

A colleague, who turned out to be a local KLA officer, urged him to leave and find safety amid the guerrilla group. Jurisevic did, but not before resigning from the International Medical Corps.

"I realised that I would be a great asset to them [KLA], but by the same token I realised I didn't have a choice. I had to blend in with the KLA so that I could treat the victims at the frontline. Most of them were refugees who had armed themselves. It was a difficult choice, but not that difficult."

In Blood on My Hands, Jurisevic details what he experienced in those ensuing weeks, from rooms stained with blood to a mountain cave stacked with putrefying bodies; from witnessing the slaughter of villagers to himself shooting Serbian soldiers and paramilitaries.

He even mapped the positions of Serbian forces, his co-ordinates leading to NATO air strikes believed to have killed up to 600 people, some of whom, he admits, might not have been soldiers.

"The patrols I went on with the KLA were what we call retrieval patrols. We went into villages to pick up injured. We weren't combat patrols, but if we met opposition we might have to fight or run.

"I realised that I would have to fire if I was fired upon. I just made that decision - you have to defend yourself. I wanted to go home alive and I wouldn't be much use to the refugees and the KLA if I was dead."

Jurisevic has worked in many war zones. Kosovo and Albania aside, he has treated the wounded, indeed saved lives, in Israel and Gaza, East Timor and Afghanistan. He says there is nothing glamorous about war, though it is easily glorified.

"It doesn't matter who is fighting whom. The stories of the victims are always awful."

Hence a key reason for his book. He wanted to portray the visceral reality of conflict.

"The main reason was to tell the story of the victims of this war on both sides as I saw it. Very rarely do the victims of war get a chance to speak out and tell their stories. In this particular war, the ethnic hatred and conflict had been going on for centuries, so often when stories are told by one side or the other they are viewed as being very biased. I thought I could give a reasonably unbiased account of the event ... in the brief period I was there."

The process of turning notes on his experiences into a narrative (helped by co-writer Robert Hillman) has also been cathartic. For several years after his return from the Balkans, Jurisevic suffered from post-traumatic stress disorder.

"I didn't realise but my wife knew within six months of my return. I had had trouble sleeping for a long time after I got back. It took a turn for the worse about 2005. There was so much else going on in my life that I could hide it from pretty much everyone. But the dreams and flashbacks became more common. But I think being older and busy actually helped. I didn't have too much time on my hands."

Still, his experiences of 1999 didn't stop him joining the Australian Defence Force, serving in East Timor (2006) and Afghanistan (2008) as a member of the Royal Australian Army Medical Corps.

"Yeah, that was smart," Jurisevic laughs.

"I was encouraged by many friends to join the Australian Defence Force because of my experience. I kept putting it off, but I thought if my sons or daughters were at the frontline I would want someone who knew what they were doing to be looking after them. But that was a real strain on my family. The family does suffer.

"I'm still in the army, in the reserves. I am on call to go to Afghanistan and I would probably go again. It is reasonably dangerous."

- OTAGO DAILY TIMES

OLD WOUNDS, NEW WEAPONS

Battlefield doctors have discovered the endless war in Afghanistan offers, perversely, what some might describe as "professional development".

Having dealt with a vast range of wounds, caused mainly by high-velocity projectiles developed and honed by scientists, engineers and businessmen in factories around the world, trauma teams are encountering fresh medical challenges.

Craig Jurisevic was there two years ago and remains ready to return.

"The Taleban are using old artillery ammunition and mortar shells and configuring them as IEDs (improvised explosive devices). Basically, artillery shells are being fired at point-blank range from under the road at vehicles. It is like having a tank fire at the base of your vehicle. They will configure five or six of these shells in a row so when the first one is triggered and stops a convoy, the others will go off," he says.

"These are true blast injuries; a combination of blast, penetrating wounds and burns all in one. It is a new type of warfare."

The process of prioritising patients according to likelihood of survival becomes all the more difficult when the extent of a person's wounds is unclear.

"In a blast injury, part of a limb might be blown off but there is terrible damage to the limb that remains. You might amputate below the knee but find the tissue above the knee has died within the next 48 hours," Jurisevic says.

"You have to be completely dispassionate. You expend resources on those who may survive."