Timidly clinging to the hand of his uncle, the 3-year-old Iraqi boy walked into the office of a Manhasset plastic surgeon.
The pair had left Baghdad early last week, flying first to Istanbul and on to New York. On Thursday afternoon, they arrived at the doctor's office carrying photographs of the boy's disfigured face. They also brought with them the hope that the doctor can make him whole again, that the boy, who turns 4 tomorrow, can be reborn.
"We only have God and you," the uncle told the doctor in Arabic, his words relayed through an interpreter.
"That puts me under a little pressure," Dr. Kaveh Alizadeh replied with a grin.
The Iraqi boy, Zeenabdeen Hadi, has come to Long Island for extensive reconstructive surgery. He will remain here for the next several months, staying with his uncle, who is 20, in a Ronald McDonald House in New Hyde Park. Beyond the goal of rebuilding the boy's face, doctors have to close a wound in his forehead that could expose his brain to infection.
The boy had been hurt a few weeks before his first birthday when a car bomb exploded outside his home in Dujail, a restive city 40 miles north of Baghdad long beset by sectarian strife. The explosion sent a live wire from a utility pole snaking across Zeenabdeen's face, burning his flesh down to the bone.
Zeenabdeen's uncle, Hasan Khazaal, was a 17-year-old high school student at the time. He was on his way home from classes when he heard the blast. He was the first to reach the child.
"His face was all burned," Khazaal said through an interpreter. "I started doing CPR but pieces of his face were coming off -- his nose, his lips."
Khazaal said Zeenabdeen's injuries were so grave that Zeenabdeen's parents eventually would conclude it would have been better to let him die. The lower portion of his face was burned to the bone, and all but the corners of his lips were gone.
He lost so much of his lower right jaw that he has no teeth there, and now can only chew by using his fingers to push food to teeth on the left side of his mouth. A gap in the bones of his forehead caused by the burns remains so severe that Zeenabdeen is at risk of contracting potentially lethal meningitis.
War and violence has been with Zeenabdeen all his life. On the day he was born -- April 25, 2007 -- at least 44 Iraqi citizens were killed in war-related violence, according the website Iraq Body Count, which tallies deaths reported in the media. Car bombs, suicide attacks, sectarian murders and errant military strikes claimed thousands of lives that year.
In the aftermath of the explosion, Khazaal said he persuaded American soldiers at a compound about 200 yards from his home to take his nephew to a military hospital at nearby Balad Air Base. There, doctors performed more than 20 surgeries on the child over four months, including one during which they used screws to affix his right forearm and bicep to his lips and jaw so that skin would seed new skin on his face.
But even with the help of American military doctors, life looked grim for Zeenabdeen.
So grim, Khazaal said, Iraqi doctors suggested it might be better to let the child die. Khazaal said his brother and sister-in-law, Zeenabdeen's parents, abandoned the child. Khazaal's parents -- the boy's grandparents -- also shunned the child. It was left to Khazaal to be an uncle, a father, and the bearer of hope that Zeenabdeen might one day recover.
Khazaal, who turns 21 on Thursday, said he would have it no other way. To meet his new responsibilities, he dropped out of high school and threw himself at the task of providing a life for his nephew.
For a while, Zeenabdeen attended day care. But children harassed him over his appearance so viciously that Khazaal pulled him from the program.
"I lost hope that I could be helped in Iraq," Khazaal said. "I was desperate."
An American soldier in Iraq told Khazaal about Elissa Montanti, a former hospital worker from Staten Island who runs a charity out of her home to help victims of war. Khazaal found the website of her charity, Global Medical Relief Fund and, on Dec. 10, sent her an email.
He told her that the Iraqi doctors had not been able to treat the boy "and told me to leave until the child dies." He said he had run out of options.
"I kept thinking, 'Please, let her help me,' " Khazaal said.
A week before Zeenabdeen landed in New York, Montanti sat in a car attending to details of the boy's trip. She leafed through papers she had poured from her handbag onto her lap, all the while thumping her foot to the beat of the car's stereo and cocking a cell phone to her ear.
Working out of her home, Montanti has spent much of the past 15 years persuading medical providers in America to provide free care for children hurt in wars around the world. The nonprofit she founded in 1997 and runs out of a converted closet in her home, has brought 137 children for treatment in the United States. Most have returned to America for treatment an average of five times.
While in the car last week, she learned a visa she had helped arrange for Zeenabdeen had been approved. She punched the number of a waiting travel agent into her cellphone. "Yes, you can book the flight. . . . Turkish Airlines, from Istanbul. Call me when you get it."
The doctor cradled Zeenabdeen's head in his lap -- his fingers probing the child's damaged mouth, jaw, nose and forehead -- while making a mental inventory of the medical procedures the child would need.
Something alarmed him. He spotted a pulsing where Zeenabdeen had been injured on his forehead.
The electric shock had left a fissure in the bone of Zeenabdeen's skull. There was nothing between the child's skin and his brain. Something as simple as an infected pimple could leave Zeenabdeen with potentially deadly meningitis.
"This is more serious than I expected," he said to an attendant. "Let's start making a list."
Alizadeh said the threat of infection will force him to prioritize the damage to the boy's skull. First, he plans to close the fissure by transplanting bone from another part of the head.
Over the course of several months, and if all goes well, Alizadeh will graft tissue from other parts of Zeenabdeen's body to repair his damaged face. He will also use surgical balloons to expand Zeenabdeen's face, then restore it to its normal size by cutting away the scars.
The process is a long and potentially painful one.
As the exam proceeded, Zeenabdeen became less apprehensive. By the end of the examination, he was playing with a handful of tongue depressors and a surgical glove Alizadeh had inflated like a balloon.
"He is not afraid," Khazaal said. "He just wants to know how they are going to fix him."
Enhanced sense of purpose
Dr. Kaveh Alizadeh began practicing medical philanthropy after visiting a refugee camp in Afghanistan while studying medicine at Weill Cornell Medical College in New York City.
Alizadeh, a partner with Long Island Plastic Surgical Group, which has offices in Manhasset and other locations in the region, spent four months working among refugees on Afghanistan's border with Iran in 1993, after having worked in a hospital burn unit the year before.
"The sense of camaraderie I got from working with the other doctors was unparalleled," Alizadeh said of his work in Afghanistan. "It seemed to be a pure form of practicing medicine. You realized people really benefitted from your work, that there was nowhere else that they could get that help."
Alizadeh, 44, who was born in Iran and immigrated to the United States, said working with refugees gave purpose to his medical career, and afforded him the chance to reciprocate some of the good fortune that had helped shape his life.
He is meeting that goal by operating on Zeenabdeen Hadi, an Iraqi child who turns 4 tomorrow. The boy will need multiple surgeries to repair the tissue scarred and bone removedby a damaged electrical cable while he was an infant. The cost is being paid for by Alizadeh's medical group.
Alizadeh said first he will graft bone taken from Zeenabdeen's scull to repair a fissure in the child's forehead.
Later surgeries will involve more straightforward plastic surgery, Alizadeh said. One will involve taking a flap of skin from Zeenabdeen's forehead to seed new skin on the child's nose. Another will borrow tissue from Zeenabdeen's back or leg to reconstruct the child's mouth, which is prevented by thick scar tissue from opening more than a crack.