Surgery on the front line

In late 1993, the surgeon David Nott travelled from his home in London to a hospital in war-torn Sarajevo on his first humanitarian mission. Two weeks into the trip, a teenage boy was brought in with a metal fragment in his abdomen, sustained from one of the mortars that had been raining down on the city for days. He was anaesthetised and taken to an operating theatre where Nott set about opening his abdomen to inspect the damage. After making the incision, he heard an enormous crash and the lights went out. The hospital had taken a direct hit, leaving him in the dark trying to stem the bleeding by squeezing the boy’s aorta while pressing down on a swab. When the lights eventually flickered back on, Nott realised he was all alone. The rest of the team — an anaesthetist, a scrub nurse and an assistant — had fled the room and taken cover in the basement. The boy, meanwhile, had died.

In War Doctor, Nott’s account of 25 years dispensing life-saving treatment in some of the most dangerous places in the world, he describes his fury at having been abandoned, though later he comes to understand his colleagues’ actions. “This experience taught me two things,” he explains. “First, I’d have to toughen up; second, I also had to take care of myself. Not just because there was no one else there who was going to do that for me, but because I wouldn’t be helping anyone if I was dead.”

We’re hardly short of books by doctors describing difficult work carried out in straitened circumstances — think Rachel Clarke’s Your Life in My Hands or Adam Kay’s This Is Going to Hurt — but Nott’s is something else entirely. Where most people strive to avoid trouble, he actively goes in search of it. “It is a kind of addiction,” he says in the prologue, “a pull I find hard to resist.” His stories of courage and compassion in the face of seemingly certain death are breathtaking. There’s the time, for instance, that Syrian rebels stormed the makeshift hospital in which he was working after spotting him on the roof with a camera. Assuming he was photographing their movements, they were poised to drag him away but were persuaded not to on realising that the camera contained pictures of sunsets. Or there’s the moment he and his head nurse were driven to meet Mullah Omar , the feared Taliban leader, to secure permission to operate on a young Afghan woman who was haemorrhaging after childbirth. “His manner was serene, almost statesman-like,” Nott recalls. “I think just to get rid of us, he agreed to our request.”

His reflections on why he does what he does are compelling in a different way. Why would he so willingly put himself in the path of danger? Part of it, he says, is altruism — a simple desire to save lives and put his skills in general and vascular surgery to the best possible use. However, his first trip to Sarajevo reveals another reason. There, while travelling with a patient in an ambulance across the city, the vehicle was targeted by a sniper. Nott, the patient and the driver survived but the porter travelling with them died from bullet wounds to the chest, neck and face. Nott describes how his shock at the attack was followed by relief at having escaped death. But then he observes another feeling: “I felt elated, exhilarated, euphoric. I had never felt more alive; it was as if I had been reborn ... If I could cope with this, I thought, I could cope with anything.”

We follow his subsequent travels to conflict and disaster zones in Afghanistan, Libya, Sierra Leone, Liberia, Iraq, Haiti, Syria and Gaza. We find him operating in buildings shattered by shelling and gunfire, in mobile hospitals, on one occasion outdoors on a concrete slab in full view of passers-by. Equipment is invariably rudimentary, the staff often (though not always) untrained, and blood and medicine in short supply. Day in, day out — and often at risk of imprisonment or execution from terrorists who regard westerners as political capital — Nott deals with the human cost of modern warfare, with its mortars, barrel bombs and sniper fire. Among the more depressing trends in today’s conflicts is the direct targeting of hospitals and their staff — “To bomb and destroy hospitals is not just sinful,” he says, “it is evil.” Nott is unsparing in his descriptions of civilian injuries — the Haitian baby pulled out of a collapsed building with a crushed arm and a section of her skull missing; the pregnant woman deliberately shot in the stomach by sniper in Aleppo, the bullet coming to rest in her unborn child’s head. All make for astonishing and distressing reading. It’s no wonder that there are times when Nott, a man accustomed to such scenes, breaks down and cries.

Yet amid the chaos and trauma, he is still able to admire a beautiful sky, an elegant piece of architecture or the sounds of the early morning prayer emanating from a nearby mosque. From these stolen moments we get rare snapshots of Nott’s interior life. While this is far from a straightforward memoir — his childhood plus his years of medical training speed by in a single chapter — we nonetheless get a vivid sense of his energy, his determination and his desperate, howling rage at the cruelty that humans wreak on one another. There are glimpses, too, of the personal cost of Nott’s humanitarian work. Back in the UK after six weeks in Aleppo, he mournfully notes that in London “I might save one person’s life a month, whereas in Syria it had been ten a day.” Nott’s private life at the time was virtually non-existent; after each trip he returned to an empty, spartanly furnished flat. With both his parents dead, and no girlfriend, he notes: “There was no one I particularly wanted to be with.” But this changes when he meets Elly, an analyst at the Institute of Strategic Studies, whom he later marries. They have two children, and Nott gradually scales back his overseas odysseys. His current contentment makes for a heart-warming coda to the decades spent amid biblical suffering and horror. If a film about his life isn’t already in development, someone’s missing a trick.

–Guardian News & Media Ltd