The doctor stitching up Syria’s wounded

Published by The Times (2nd March, 2019)

War Doctor: Surgery on the Front Line by David Nott (Picador)

David Nott was about to stitch up a vein in the midst of a complex chest operation when the doors to his operating theatre burst open and six Islamic State soldiers stormed the room. His heart froze as he realised that the bearded man on the table must be one of their comrades — and they were Chechen, the most feared Islamists in Syria. A quick-thinking colleague whispered to him to stay quiet under his surgical scrubs, then told the black-clad thugs that the senior doctor could not be disturbed if they wanted their fighter to survive.

For the next hour, as gunfire rattled outside, the British doctor tried to stay calm as he was watched by a terror group rounding up westerners for beheading. Although not religious, he prayed to God for control of his shaking hands. He could not speak, because that would betray his origins, and knew if the patient died he would be shot on the spot. Finally the masked men left. ‘Afterwards I found myself feeling confused and a bit lost,’ he wrote. ‘My dilemma was that I had, once again, saved the life of someone who might go on to commit terrible crimes.’

Such are the dangers and moral minefields for a medic on the front line of war. Yet Nott is no ordinary doctor, as this dramatic telling of his extraordinary life makes clear. He was a lost soul who found his life’s mission in rushing towards the sounds of gunfire to patch up the wounded and try to save the dying, often in terrifying conditions and while witnessing hideous barbarity. Butchered babies, children blown apart, crushed men, even pregnant women shot in the womb for fun by bored snipers. Fellow doctors were killed and a nurse shot in the stomach standing beside him at the operating table.

Nott, a general and vascular consultant surgeon with the NHS, became a war doctor in 1993 during the Balkan conflict. He worked in a hospital in Sarajevo nicknamed ‘Swiss cheese’ because it had so many holes blown in it. His first serious patient was an old woman with both legs and one arm sliced off by shrapnel. After 45 minutes cutting away dead tissue and removing bone fragments, the anaesthetist tapped him on the shoulder and said: ‘She’s gone.’ Two weeks later the hospital was hit mid-operation, the lights going out as Nott squeezed a teenage boy’s aorta to keep him alive. He kept pumping away, blood dripping down his legs, but when the lights flickered back on the boy was dead and his team had fled. It taught him to toughen up and take more care of himself, he writes.

Yet the 62-year-old seems to do the opposite as he dashes around the globe to embrace danger in conflict and disaster zones. He admits: ‘It is a kind of addiction.’ Yet it makes also for gripping stories. In Afghanistan, Osama bin Laden failed to come in for his kidney stone appointment. Then the author pleaded with Mullah Omar, the Taliban leader, to permit a procedure on a mother in danger of dying after an illiterate policeman, who had to consent to operations, ruled it out. He also admits, to his own disgust, one day going to see grisly public executions, including women stoned to death.

Often the hospitals are shattered, supplies lacking, skills low. In Sudan he uses an outside concrete block in a village for his surgical table, watched by hundreds of locals, some fanning away flies. In the Democratic Republic of the Congo he relies on a text message from a professor friend to guide him through the amputation of an upper arm and shoulder. He admits that there can be tensions when foreign doctors drop in, disrupting weary local teams — although senior doctors, rich enough to escape with their families, often abandon junior staff with little trauma experience to save limbs and lives.

‘The first night in a war zone is always filled with a mixture of anxiety and exhilaration,’ writes Nott, something that feels familiar to those of us who report from such places. So why does this doctor, who flies helicopters and planes in his free time, put his life on the line? Perhaps because he was bullied at school, where teachers warned that he would be a failure. ‘I know what it is like to not be wanted and to feel abandoned.’ So partly it is a profoundly humanitarian gesture. However, he also admits to the explosive intensity of feeling after a brush with death. ‘I felt elated, exhilarated, euphoric,’ he says after surviving one lethal attack in Sarajevo.

He is, inevitably, left mentally scarred. Much of this book feels almost like a prelude to the insanity of going to Syria at the height of its dreadful war, the pace of his writing speeding up like a spiralling thriller. After entering Aleppo — ‘the most dangerous place in the world’ — for six weeks in the summer of 2013 he formed an intense bond with his small team as they saved many lives from gunshot wounds. One year later, shortly after meeting his future wife, he returned to enter the darkest of nightmares as jihadists killed westerners and devastating barrel bombs targeted schools and hospitals. His descriptions of pitiful carnage and desperate surgery are painful just to read, one more glimpse into the horrors of human savagery.

Little wonder that on his return he almost breaks down over lunch with the Queen. Seeing his state, she focused the conversation on her corgis to distract him from having to discuss Syria. Ultimately, this is a book about two doctors. One was a ‘very pleasant and respectful’ ophthalmologist whom Nott met in London many years ago, long before Bashar al-Assad became one of the most barbaric monsters of our age. The other is this intense vascular specialist of immense courage who discovered his life’s meaning carrying out surgery on the front line of Syria’s hell.

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