David Nott | 'Healthcare is seen as a weapon'

David Nott | 'Healthcare is seen as a weapon'

Though I’m sitting in a consulting room in central London, my heart is in my mouth somewhere in eastern Aleppo. World-leading trauma surgeon
Professor David Nott is showing me video footage of a baby being delivered by caesarean section while the Syrian civil war rages outside the hospital. The surgeon’s swift action has saved the baby’s life, for the mother was deliberately shot through her pregnant abdomen by a sniper, the bullet ripping through the umbilical cord.

This miraculous nativity, among many other white-knuckle stories of life and death from Nott’s 25 years of working in war zones, are recounted in War Doctor: Surgery on the Front Line, an utterly gripping memoir which propels you through a whole gamut of emotions, chief among them a profound admiration for Nott and those who work alongside him. They say fortune favours the brave, and Nott’s extraordinary bravery has helped him survive numerous perils, including close encounters with ISIS fighters, Syrian jets and the direct shelling of the hospital in Gaza where he continued to perform a life-saving operation on an injured young girl despite orders to take cover. When asked what motivates him to keep putting himself in harm’s way, he says, with frank self-analysis, that it is "a strange mix of altruism and pure selfishness... chasing the high of living my own life closer to the edge".

Born in Wales in 1956 to an English mother and a half-Indian, half-Burmese father, Nott spent a blissful early childhood living with his grandparents in a Carmarthenshire village while his parents completed their medical training. Once returned to his parents’ care, they moved away from this Welsh "paradise", and from then on his boyhood was lonely and often difficult. He suffered racism at school and was made to feel a failure academically. "I know what it is like not to be wanted and to feel abandoned," he writes in War Doctor.

An early desire to become a pilot was shelved when his father’s ambition for his son to follow him into the surgical profession prevailed, and Nott went to university to study medicine. His future vocation as a humanitarian doctor was ignited after Nott saw "The Killing Fields", Ronald Joffé’s 1984 film about the war in Cambodia. After gaining experience in various UK hospitals to build on his training as a general surgeon, Nott first volunteered to work abroad in 1993 and was posted to Sarajevo in the thick of the Yugoslav wars. The list of places where he has since worked unpaid for periods averaging six weeks a year forms a catalogue of early 21st-century war and disaster zones, and includes Darfur in Sudan, Camp Bastion in Afghanistan, Yemen, Haiti, Gaza, Nepal and, of course, Syria.

The photo that accompanies this feature was taken in the Central African Republic in 2014, and pictures Nott with a four-year-old boy who visited the hospital every day, concerned about the health of his sister. It was his time in another part of Africa—Libya in 2011—watching surgeons making poor medical decisions owing to inexperience in trauma surgery that sparked another equally urgent vocation: that of passing on to others the knowledge he has gained from working in what are professionally (and euphemistically) termed "austere environments".

The write approach
While it was Nott’s interview on "Desert Island Discs" in 2016—still memorable to all who heard it—which brought his work to the attention of a wide audience, the notion that he might write a book dates back to 2014, when Andrew Gordon of David Higham Associates approached him after hearing Nott interviewed by Eddie Mair on BBC Radio 4. Nott agreed to the idea of a book, but due to the demands of working between war zones and his London surgical day jobs in the NHS, found himself too busy to write a word. A ghost writer was appointed to help the book along, but Nott wasn’t happy with the results. "So I wrote it myself in six months." His vivid recall of events derives from many thousands of photos and hours of film footage taken during his missions overseas.

After more than two decades dealing with the results of man’s inhumanity to man, Nott finally began to unravel mentally in Syria in 2014. Working between hospitals in Aleppo, he witnessed "destruction on an industrial scale". Prepare to weep as you read his description of the aftermath of barrel bombing, and then imagine picking up the pieces. Nott—probably the only free Westerner in Syria at the time—also found himself obsessed by the fate of Salford taxi driver-turned-volunteer humanitarian aid worker Alan Henning, kidnapped by ISIS. He then felt compelled to watch footage of his execution which had probably taken place less than an hour’s drive away. "When he was beheaded, I really lost it. I thought, I’ve got to get out of here. Because at any moment they’re going to come for me." Against crazy odds, Nott made it out of Syria alive. As soon as he reached safety in Turkey however, he berated himself for his decision to leave. "I said to myself: ‘You had more to do but you broke, didn’t you? You broke.’"

Ironically, it was love that broke him. After many years of being single, and the only child of deceased parents—and, therefore, feeling responsible to no one—Nott, contrary to all his expectations, had recently begun a serious relationship with a woman named Elly. On his return to the UK, she bore the brunt of his breakdown. In the book, he describes their Christmas skiing holiday during which he would lie in front of the door in a foetal position. "I’d always been able to cope in the past when there was just me to think about. But I couldn’t cope with somebody loving me. That’s what broke me in the end."

And yet Elly’s enduring love also helped him both heal, and continue his life’s work. They married in 2015 and now have two small daughters. Together they founded a charity, the David Nott Foundation. In only two years, it has already done remarkable work in raising money for surgeons from overseas to come for a week’s intensive training in trauma surgery in London. The foundation also runs courses overseas for surgeons unable to travel to the UK. (Should you care to support its work, you could, for example, buy some David Nott Foundation Christmas cards, designed by Chris Riddell and others. Email bakedbybis@hotmail.co.uk for more information.)

Hospitable targets
Nott is a quietly-spoken, self-effacing man; someone not entirely comfortable with being in the limelight. "I’m a pretty private person, to be honest with you," he says. Yet his experiences have compelled him to speak out against the deliberate targeting of doctors and hospitals. He tells me that in Syria alone there have been more than 450 attacks on hospitals in six years of conflict, 90% of them by the government and its allies. "Healthcare is seen as a weapon because if you take out a doctor, you also take out 10,000 people they can’t care for."

A month before our meeting, Nott was working in a part of Cameroon controlled by Boko Haram. In January, he will go to Yemen for three weeks. He has no intention of scaling down his life-saving work in the world’s most desperate places despite his newfound domestic happiness. In fact, War Doctor contains a moving afterword by Elly Nott in which she writes: "I fully support him in what he does—to do otherwise would not only deny David his passion, but also deprive the world of his skills which are so desperately needed."

As we conclude our interview, her husband tells me: "I still need to live on the edge. The older you get, the less time there is left. So you have to try and do as much as you can".