The last thing Mustafa Ghazwan's small ears heard was the thunderous roar of the U.S. missile that slammed into his neighbor's home in Iraq 18 months ago and left him deaf.
Since then, the world has been a very quiet place for the 3-year-old boy. He has not heard the sounds of the war that has torn apart his country. He has also not heard the voices of his parents, the music from the living room stereo and the sound of the singing toys he was just beginning to play with.
On Friday, in a San Francisco operating room half a world away from the war, he took his first step back from the silence. In a 90-minute operation that was both routine and anything but, surgeons implanted an electronic cochlea inside the boy's right ear.
Doctors and nurses donated their services. Another charity donated the device. The rest of the $85,000 tab was paid by a Los Angeles-based foundation that seeks out war victims and strives to make them whole.
Three hours after the operation, Mustafa was sitting in his father's lap in a hospital meeting room, playfully tossing toys and hugging a stuffed dog. But for the large white bandage that covered his right ear, he might have been any other rambunctious kid.
Ear surgeon Lawrence Lustig, who performed the procedure, said it hardly felt like work.
"It was fun," he said. "With so much in the world that's wrong, it's nice to do something good."
Mustafa's father, 33-year-old Baghdad University Professor Ghazwan al-Nidawi, tried to keep his emotions in check as he praised his benefactors.
"Today is the second day for Mustafa to be born again," he said, speaking through an interpreter, his voice faltering. "After the (bomb), my son died. Now he is alive again."
He turned to Lustig and searched for words.
"Whatever I say will not be enough. You are No. 1 in the whole world. You are my hero."
In two weeks, after the swelling from the operation goes down, doctors will switch on the implanted cochlea and Mustafa will begin the long process of rejoining the world of sound. The small electronic device, located partially inside the ear and partially below it, captures sound waves and transforms them into electronic impulses to stimulate the auditory nerve and partially restore the sense of hearing.
Mustafa and his father will stay in the Bay Area for six months while the boy works with hearing and speech therapists.
In was June 12, 2007, inside their home in Baquba, north of Baghdad, that a U.S. missile exploded in a neighbor's house, killing two people and turning off the volume in Mustafa's world. The boy was just beginning to talk.
"I hope the first word he says again is 'papa,' " said Al-Nidawi. "I would like to hear him call me 'papa' again."
Also keeping vigil at the hospital was Cole Miller, a Los Angeles writer and the founder of No More Victims, the foundation that arranged for the operation.
Mustafa, he said, represents the hundreds of thousands of other victims in Iraq who are still awaiting miracles, benefactors and rebirths of their own.
"The doctors in Iraq are up to their elbows in human mire," Miller said. "We work with a very small group there. We have very specific criteria. It's almost as if the children choose us, not the other way around."
Cochlear implants were largely developed at UCSF, and the procedure became routine beginning in the 1980s. About 150,000 of the devices have been implanted worldwide. But it was only about five years ago, Lustig said, that most health plans decided it was routine enough that they would actually pay for it to be done.
Even then, the doc said, it's a loss leader.
"A health plan only pays about a third of the bill," he said, with a grim smile. "My department loses a little on every implant we do."
Mustapha, whose world is still silent for the time being, was having a hard time sitting still, which, the doctors pointed out, is completely normal for toddlers.
"The hardest part of all this was keeping him settled and not running around," Dr. Lustig said. "He's just trying to be a 3-year-old kid."
In the hours after the operation, his father was having just as much difficulty keeping his boy in check as he was expressing his gratitude to the medical staff and to Miller. Mustafa, who has become increasingly frustrated since his world turned silent, tried to bring the meeting to an end by throwing his toys, scribbling on a blackboard and then taking a playful bite of his father's arm while Dad was speaking words of gratitude that the boy couldn't hear.
The father winced. He also made a sound that needed no translation.