MEMOIR

Syria, 2012 – Location: Atmeh. A woman was rushed to the operating theatre with severe bomb damage to her leg.

Dr David Nott, a trauma surgeon, clamped the artery to prevent her from bleeding to death and gently pressed a finger into the gaping hole above her knee joint. He felt an object. It was probably some kind of shrapnel, but it was strangely smooth and cylindrical.

Dr Nott grabbed it with his fingers – “very carefully”, he recalls – and pulled it out. Once extracted he held it up to examine it. His Syrian helper took one look and went visibly pale; he obviously knew what was being presented and blurted out, “Mufajir!” before turning tail and leaving the room.

Nott and the anaesthetist locked eyes in panic. Was this some kind of bomb? The room fell silent, bar the hiss of the patient’s ventilator. The anaesthetist backed away and Nott felt his hand begin to shake so vigorously, he was in danger of dropping the thing.

Then the Syrian helper rushed back in with a bucket of water and motioned for Nott to place the metal object carefully into the bottom of it. He later learned that “mufajir” means “detonator” and it could have blown off his hand.

The woman was injured when a bomb her husband had been making in their kitchen had prematurely detonated, killing him instantly.

You can sense Dr Nott’s frustration and anger at the speed with which the Syrian civil war escalated. It had begun in March 2011, when a peaceful protest against the oppressive regime of Bashar al-Assad was met with shocking brutality.

By chance, Nott had met al-Assad in the early 1990s, when the dictator-in-waiting was working as an ophthalmic senior house officer at the Western Eye Hospital, London.

“He seemed very pleasant and respectful,” recalls the surgeon who would later treat Assad’s victims, including a heavily pregnant woman whose unborn child had been shot through the head by a sniper.

In his devastating memoir of more than two decades volunteering his services in some of the world’s most dangerous places, Nott doesn’t speculate on what changed al-Assad’s attitude to his fellow human beings.

He does, however, pinpoint the precise moment that a shy boy from rural Wales realised he wanted to become a “war doctor”, his epiphany occurring in 1985 when he first qualified as a surgeon. His parents took him to the cinema to see The Killing Fields (Roland Joffe’s 1984 drama about the civil war in Cambodia).

Nott’s father, also a doctor, was born in Burma and Nott had endured racist bullying as a child.

“The film lit a torch in me,” he says. “I could relate to its themes of innocent people being bullied, pushed around or dismissed. It gave a vivid depiction of the horrors of war. But, more than that, the film depicted the incredible power of human love in the face of unimaginable adversity.”

Some eight years later, Nott was standing over an operating table in Sarajevo. He had taken a month’s unpaid leave from the NHS to volunteer for the French aid organisation Médecins Sans Frontieres. The Bosnian civil war opened his eyes to a new medicine, in which decisions had to be made quickly, without the diagnostic tests and specialist equipment on which he had come to depend.

“I had never seen injuries like the ones that were coming in every hour.”

THE damage inflicted by bombs and high-velocity bullets was of an entirely different order from those received in even the most catastrophic trauma car accidents.

Multiple limbs were often missing. Many patients were dead on arrival, accompanied by relatives begging for help that Nott could not provide.

When he could attempt surgery, the hospital generators would often fail, and the team would have to wait until a porter brought in a wheelbarrow full of car batteries to get the theatre functioning again.

When bombs fell on the hospital itself, Nott’s team fled, leaving him alone in the dark, his hands around the failing heart of a teenage boy.

Stumbling from the room, soaked in his patient’s blood, Nott felt angry and betrayed. But he soon learned that, as an aid worker, his first duty was to keep himself alive so that he could help more people.

It was the first of many difficult moral choices he would have to make in Afghanistan, Sierra Leone, Chad, the Ivory Coast, Libya, Gaza, the Democratic Republic of Congo, Iraq and Pakistan.

In his scrubs, would you defy the Taliban policeman forbidding you to treat a woman bleeding to death in childbirth? Would you save the life of an ISIS fundamentalist likely to kidnap you on recovery? Would you give money to the children of dead patients?

Dr Nott had to make all these calls under extraordinary pressure.

He describes numerous near-death experiences and there was some terrible emotional fallout.

After returning from one mission, Nott found himself unable to bear the complaints of a British patient fretting about her “unsightly” thread veins and began a screaming, feigned sciatic attack until she left his consulting room.

He also had a panic attack when invited to a private lunch with the Queen. Overwhelmed by the contrast between the luxury of Buckingham Palace and the desolation he had seen in Syria, Nott found himself unable to answer Her Majesty’s questions.

As visions of limbless children filled his head, she placed her hand gently on his and encouraged him to pet her dogs. “There,” she said. “That’s so much better than talking, isn’t it.”

These days, the 63-year-old medic still travels the world to help victims of disaster. But his priorities changed after meeting his wife, Elly, at a charity event for Syria Relief in 2013.

The relationship came as a “bolt from the blue” to the man with a “monastic existence”. But, before they could arrange a first date, Nott made a trip to Gaza, where he elected to stay in the operating theatre to save the life of a little girl called Aysha, even though he had been ordered to evacuate the hospital because an airstrike was expected in minutes.

It was a story that Dr Nott told on Radio 4’s Desert Island Discs in 2017, reducing listeners to tears as he described how he still treasures the photograph he has of her, smiling as she recovered.

David married Elly in 2015 and welcomed daughter Molly the same year. Elly – an Oxford graduate with an MA in international relations – was the chief executive of the David Nott Foundation (a charity training surgeons to work in conflict zones) until the beginning of 2019.

Although as a husband and father, Nott tries harder to avoid danger, he finds it hard to be optimistic about the situation in Syria.

But he remains committed in continuing to train doctors working there.

On the final page of his book, Nott quotes the Koran: “Whoever saves a life, it shall be as though he had saved the lives of all mankind.”

– (Memoir) War Doctor: Surgery On The Front Line by David Nott is published by Picador for £18.99, 304pp