For two decades trauma doctor David Nott has taken unpaid leave every year to help the victims of the world’s war zones. He tells Jasmine Gardner why it’s worth putting his life on the line
Never before have I cried while interviewing somebody. But David Nott, one of London’s top consultant vascular surgeons, is showing me a video in his office in Lower Sloane Street and my tears are insistent.
It’s three weeks since Nott returned from Syria, where he was training doctors in Aleppo, one of the war-torn country’s largest cities, in how to save the lives of those wounded in the conflict. In a city of two million people, just 36 doctors remain. “Every day, 12 to 14 people were coming in wounded. Children, women, normal people — all with gunshot wounds,” he explains. Last month an X-ray image Nott took while he was there became front-page news. It showed an unborn baby with a bullet lodged in its skull — the result of pregnant women being targeted by snipers.
I’m watching a short film clip in which Nott leads the doctors operating on one such woman. They are performing a Caesarean section, except in this case the woman’s uterus is damaged by the entry and messy exit wounds of a bullet. When they lift out the nearly full-term infant, it is dead. “I will use this for teaching purposes ... It’s very unusual to have to do this sort of operation but it was important to film it because other people will have to deal with it.”
The mother survived, thanks to Nott’s expertise in war surgery. He may now be settled behind a desk in London but almost every year in the past two decades Nott, 55, has taken six weeks’ unpaid leave from his NHS job as a consultant at the Royal Marsden, Charing Cross and Chelsea & Westminster hospitals to do voluntary humanitarian work in conflict zones such as Bosnia, Chad, Iraq and Libya.
“Working in the UK is completely different: if you’re a hip surgeon, you would never operate on a hand. You don’t just deal with trauma in a war zone but with paediatric surgery, general surgery, neurosurgery, obstetrics and gynaecology, plastic surgery... People look at you and —because you’re a surgeon — think you should be able to deal with all this. I wanted to be that surgeon.”
Nott has made that his mission. Yet seeing children and pregnant women targeted has prompted him to call the conflict in Syria the worst he has ever witnessed.
“I was in Sarajevo when snipers were targeting civilians,” he says. “To see it again, but on a much greater scale, is the reason I’ve called Syria the worst war zone I’ve been into ... and probably the most dangerous place to be a doctor because health workers are also being targeted.”
Nott had to enter Syria via the Turkish border hiding in the back of a vehicle. “I put my face on the headrest so that they couldn’t see I don’t have a beard. Six feet away there is an al Qaeda gunman. If he had known I was in the vehicle, no doubt I would have been hauled out, kidnapped or shot.”
Nott was first inspired to “get out and help people” in 1993, when he saw a documentary on the Sarajevo siege. He approached the charity Médecins Sans Frontières. “Within three days I’d left my flat in Hammersmith and was in the middle of Sarajevo,” he says.
Not every doctor is willing to do this kind of work. “If I had a family and children, would I do this? Probably not,” he says. Nott is unmarried, has no siblings or living parents, and no children. “It needs people like me who will take the risk and don’t have any responsibilities at home,” he says.
Medical students and junior doctors often ask to accompany Nott on his missions, but he says “to take the risk, you need to be someone who can offer significant help”. Last year one of Nott’s colleagues, a young, newly qualified doctor, was killed in an airstrike in Syria. “It was a big shock to me,” he says.
But as more experienced doctors are desperately needed, Nott has a training programme in development. Doctors and health professionals can now express an interest in doing humanitarian medical work via the UK International Emergency Trauma Register.
Nott is in the process of training the 1,000 people already signed up, with funds from the Department for International Development (DFID). So far 30 have been through the £3,000 training, which teaches doctors how to do the all-round surgery to which Nott has become accustomed.
His recent trip to Syria was an exercise in taking that training into a conflict zone.
“In the middle of this war, with bombs going off, I gave lectures every evening on how to deal with particular injuries. Over five weeks, we had patients who came in with every single wound that we had discussed.”
Teaching “damage control” procedures to stem bleeding and sepsis, and letting patients make a moderate recovery before major surgery, was “revolutionary,” says Nott. “The death rate had been very high but now we had a 90 to 95 per cent survival rate. We went through three weeks without losing a single patient.”
Since Nott’s return, he’s been advising the doctors in Syria every day by phone. “I was guiding someone yesterday on WhatsApp,” he says, showing me images of stitched-up wounds sent to his iPhone.
There are no anaesthetists or physicians left in the city. “An anaesthetist from another country has done a wonderful job training up young boys of 19 to 21 to be anaesthetic technicians. None of them is a qualified doctor — they used to be shopkeepers and IT consultants — but they’re now able to intubate and resuscitate.” Others have been given a rudimentary training in cross-matching blood.
Of course, with the successes also come tragedy. One of Nott’s patients, a 14-year-old boy, came in for a straightforward operation on a three-month-old gunshot wound to his leg that had developed into an aneurysm. The operation went well but one of the technicians accidentally matched the boy with the wrong blood. “This poor boy died in front of my eyes of multi-organ failure. I remember him looking at me and waving because he knew he was going to die ... The guy who did it was trying his best. He didn’t have the right training. It’s the first time I’d ever seen it happen... The children who died are still bouncing around in my head.”
Incredibly, Nott went back to work the day after he returned to London. “I know I don’t feel normal at the moment but I can cope with that. It will take me two or three months to get over this,” he says. “You have to be a completely different person in London. If I had the same head on, I couldn’t survive a day here.”
Indeed, when Nott plays me his video, he seems unprepared for my reaction. He wouldn’t have shown me, he says, but for the fact that since his return he’s had to defend himself against accusations that he is putting out propaganda.
“If I never said a single word, that would be as bad as denying that there was anything going on. Awful things are going on,” he says. “There is the evidence.” That evidence was enough trauma for me, and all I saw was a video — a video of one death among more than 100,000 Syrians that even Nott hasn’t been able to save.
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