Review: Vivien Horler

War Doctor – surgery on the front line, by David Nott (Picador)

Here at the southern tip, caught up in our own news cycles, world dramas like Afghanistan and Libya, Haiti, Bosnia and Syria, seem a long way away.

Sometimes that’s just fine too. Who needs to know about barrel bombs and cluster bombs and what they can do to soft human flesh?

Fortunately for humanity there are people, like London surgeon David Nott, who know only too well the damage bombs do, and try in the face of horrific cruelty to make things better.

Welsh-born Nott works as a general and vascular surgeon attached to several major  London hospitals. But for the past 20 years, for several weeks a year, he goes to places of disaster and war and tries to make a difference. He has worked under the auspices of Médecins Sans Frontières and the Red Cross, the Red Crescent and Syria Relief.

He has seen some terrible things and been in some terrifying situations, ones where he thought he was about to die. He writes self-deprecatingly (“I have travelled the world in search of trouble”) with no sense of heroics. Yet there is no doubt he is a hero.

And he has some astonishing stories to tell. One of the first, in this gripping book, is about the time he was trying to treat a Syrian woman who was bleeding profusely from a wound in her leg.

It turned out her husband had been making a bomb in their kitchen when it detonated prematurely. The bomb maker died, the house was destroyed, and the woman was rushed to hospital. With her unconscious on the theatre table, Nott put his finger into a large hole just above her knee joint, and felt a piece of metal.

But it wasn’t the usual jagged shard – it was a smooth, cylindrical object. He carefully pulled it out, only for the Syrian helper in the theatre to shout: “Mufajir!” and flee.

The anaesthetist took cover behind a cupboard, while a mystified Nott held the object in his hands. Then the Syrian helper came back with a bucket of water into which Nott dropped the object. It turned out to be a detonator.

He writes: “I was told later that it probably would not have killed me, but it would most likely have blown off my hand – not the end of my life, maybe, but certainly the end of my career…”

His experiences in the Syrian city of Aleppo in 2013 are seared into his brain. He has worked there three times in the section of the city held by the rebels and later besieged by forces loyal to Bashar al-Assad. The regime believed that anyone in east Aleppo was an enemy, including the doctors who treated civilian bomb victims.

There was more food in rebel-held east Aleppo than in government-held west of the city, so 10 000 civilians were crossing from one side to the other every day via a single crossing, a perfect spot for snipers to do their work.

It became clear the snipers were playing a macabre game. One day all sniper victims admitted to one of the secret hospitals where Nott worked would have arm injuries, or groin injuries, but rarely head shots. The aim, it seemed, was to wound, to disfigure or disable. Nott was told by a Syrian doctor that the snipers were given rewards for shooting at specific parts of the anatomy. The nadir of this “sick competition” arrived when several pregnant women were admitted, having been shot in the stomach.

In many of the war-torn places Nott visited, he realised that the local doctors tended to be young and inexperienced, as the older, more established doctors had taken their families and left.

It occurred to him that he could be more useful if, instead of patching up individuals, he was able to train the young doctors to deal with the kind of war injuries they were encountering.

Today, while still heading to war zones, he and his wife Elly have set up the David Nott Foundation, with the support of the Britain’s Royal College of Surgeons. The foundation offers training courses in life-saving surgeries that are crucial in what are known as “austere environments” – such as field hospitals on the front line where there may be few or no tools such as X-ray machines or CT scanners. Some of the courses are held in the war-torn countries, while others are held in London, with the foreign doctors are flown in for training.

Why does Nott do it? He says it stems partly from the desire to use his surgical knowledge to help suffering people, but then he adds honestly: “It is a kind of addiction, a pull I find hard to resist…. partly from the thrill of just being there in those terrible places, living in a liminal zone where most people have neither been nor want to go.”

Thank God for people like him.