In a growing field of medical memoirs War Doctor stands out for its purpose – to increase awareness of the reality of modern warfare on the individuals and communities directly affected. The author has volunteered his services as a trauma surgeon in active war zones including: Afghanistan, Sierra Leone, Liberia, Chad, the Ivory Coast, the Democratic Republic of the Congo, Sudan, Iraq, Pakistan, Libya, Gaza and Syria. He pulls no punches in his descriptions of the horrific injuries and personal dangers encountered in each of these places. By describing the treatments offered as he attempts to patch up bodies torn apart by weapons designed to inflict maximum damage, his story avoids polemic. Rather it is a humane account of the many good people risking their lives to help those caught up in evil deeds carried out by those seeking to gain or hold on to power in a region.
David Nott spent his early years in rural Wales before moving with his parents to England. He studied medicine at the Universities of St Andrews and Manchester, staying in the north of England for his Junior Doctor years. He realised during this time that he wished to work in war zones where his surgery could make a significant difference. He set out to gain relevant experience.
“I’d need a fantastic breadth of knowledge in general surgery, which I was on the way to achieving. And I realized it would also be good to know a lot about vascular surgery, too: if I was to spend time in dangerous places, I’d be seeing and dealing with a lot of injuries from bullets or bombs, and knowing how to clamp off blood vessels would be essential.”
Nott’s first consultancy post was at Charing Cross Hospital in London. Surgeon friends there told him about Médecins Sans Frontières, an organisation offering short placements abroad for medical personnel. With agreement from his employer, Nott was able to take unpaid leave from the NHS and go on his first mission – to Sarajevo in 1993.
Over the course of the following decades he would travel to sites of conflict gaining a wealth of experience working in the most challenging environments, often with minimal supplies and equipment. Chapters detail a number of these placements focusing on patients who left key impressions. As a reader it is difficult to comprehend how those who caused the injuries could inflict such pain and suffering on their fellow human beings.
Much of the book focuses on memorable surgeries carried out in makeshift hospitals. With a constant stream of all but destroyed bodies arriving, decisions needed to be made quickly about who it would be worth treating. On one occasion a man required every unit of blood available in the city. When he subsequently died the question of how many others would die for want of a blood transfusion lingered.
On a mission in Africa Nott treated pregnant girls as young as nine years old – victims of rape whose pelvises were not developed enough for full term births – who were brought to the camp hospital after many hours in labour to have their now dead babies removed in an attempt to save the mother’s life. In Afghanistan he witnessed the public spectacle of punishments meted out under Sharia law, Taliban style.
“women being stoned to death after being buried up to their necks in sand; women being placed beside a wall they had built with their bare hands and killed after a truck was driven at the wall at high speed. […] I was astonished and sickened by the cruelty that one human being could bring to bear on another, and it filled me with revulsion. The football stadium was full of people watching and I wondered what they all felt. Were they completely inured to it?”
The impressions left by such monstrous behaviour increasingly affected the doctor when he returned to his job in London. During a private consultation he all but lost it when a patient complained about how she suffered due to unsightly thread veins.
On a mission in Aleppo, Nott noticed that patients would arrive with similar injuries that changed each day.
“Abdulaziz told me that he’d heard that the snipers were playing a game: they were being given rewards, such as packs of cigarettes, for scoring hits on specific parts of the anatomy. […] This sick competition reached its nadir towards the end of my time there when it appeared that one particularly vicious and inhumane sniper had a new target of choice: pregnant women.”
The author treated several of these women whose babies had been shot in utero. It was this experience that finally drove him to try to publicize the horror of what was happening in Aleppo once he returned to London. The media showed interest and he began to offer interviews and share pictures taken. Harnessing his increasingly public profile, Nott sought to help those now trapped and in imminent danger in Syria.
Given the horrors recounted, this book could be challenging to read yet much of it comes across as hopeful due to the determination of the medical teams to continue to offer treatment whatever else is happening in their vicinity. Nott includes many instances when his efforts were unsuccessful, and examples of risks he took that with hindsight were foolish. He does not paint himself as a hero but rather as a man who relished the adrenaline rush of danger. Nevertheless, it is hard to do anything but admire the tenacity and bravery of all the medics.
The writing is precise and succinct but retains a compassion for the suffering of those whose lives have been stripped to a struggle to survive in unimaginable conditions. Details of the medical procedures are fascinating and described in accessible language. And yet, with so many wars included there is a feeling of despair when considering what man is capable of inflicting. Nott admits that his work has left him in need of therapy for PTSD.
I mentioned that the stated purpose of the book was to raise awareness and in this it succeeds. It is, however, difficult to know what to do with such awareness in a world controlled by the egocentric – venal governments willing to turn a blind eye to atrocities carried out by extremists. Whilst being a moving, balanced and insightful account of the horror of war and the commitment of medics, it is also a harrowing read.
My copy of this book was provided gratis by the publisher, Picador.