War surgeon set to bring A&E care to disaster zones

British surgeon David Nott has carried out thousands of war zone operations. Now, he's hoping to pass his hard-earned skills on to a small army of frontline volunteers

David Nott is having a busy week. The 59-year-old surgeon is in the midst of teaching a five-day course at the UK’s Royal College of Surgeons of England: Surgical Training for the Austere Environment (STAE). The title belies the intense days of training that could just as easily be billed as a beginner’s guide to war surgery.

Based on Nott’s volunteer work in conflict and catastrophe zones, the course distils his 23 years of field experience into a practical primer for bare bones surgery. These are operations that take place where there are few drugs, little blood, no diagnostic aids to speak of and danger is as close at hand as the scalpels. The training will ready 32 students, all experienced surgeons in their own right, for volunteer missions in some of the world’s most desperate locations. By guiding them through more than 50 procedures, it will also give them the skills to pass on their knowledge to local doctors everywhere from the warzones of Syria and Yemen, to the quake-struck foothills of Nepal.

The David Nott Foundation, which marked its official launch on Wednesday, is behind the design and delivery of the course, the seeds of which first germinated on the battlefields of Libya in 2011.

“The surgeons there were poorly trained in how to manage very severe injuries and trauma,” explained Nott. “I decided to teach them and give them the hands on experience of how to deal with all the severe injuries that were coming into the hospital.

“If you are in a war situation most of the senior surgeons have gone because they want to protect their families. So you are left with fairly junior surgeons without much experience, yet they are dealing with the most difficult war wounds you could ever possibly imagine.”

In these austere environments, surgeons need to rely more on their medical skills than on equipment, medication and resources. Nott’s foundation is aiming to deliver surgical training to those who need it most, raising the profile of what it terms ‘humanitarian surgery’ worldwide and giving surgeons the skills to cope with desperate situations. It will fund scholarships for surgeons to be trained by Nott, as well as take a war surgery course with a smaller and changeable faculty - Hostile Environment Surgical Training (HEST) – on the road to educate medics on the frontline. A website and app are under development to add to the resources for surgeons in the field.

"Once you’ve tasted it, it’s addictive. It’s difficult to stop doing it”Nott is keen to pass on the experience gained over a volunteer career that started in the Balkan conflict and the besieged city of Sarajevo. He went there with Medecins SansFrontiers (MSF), having been moved to volunteer after seeing an interview about the conflict by BBC journalist Jeremy Bowen.

“What happened to me there changed my life,” says Nott. “Operating as a single surgeon and realising that as a surgeon in these circumstances you really had the opportunity to help people. It was that which sparked me off.

“I quite enjoyed the danger and coming back was an almost euphoric experience. Once you’ve tasted it, it’s addictive, it’s difficult to stop doing it.”

Since that first time, Nott has seen highs and lows across the world’s conflict zones, volunteering with MSF, the ICRC and in the last few years for Syria Relief, up to three times each year. He has been threatened at gunpoint in the Congo - “That was the one where I thought I was going to die” - and performed complex surgeries guided only by text messages from a colleague back in London. On returning home, he regularly receives WhatsApp messages with pictures of his successes.

“I was in Aleppo and a little boy who came in having had his leg partially blown off,” says Nott. “With lots of reconstructive and orthopedic surgery I put his leg back together again. The Syrian surgeons there just sent me a message and I could see him running around.“

"In Aleppo in 2014, five of my colleagues were killed going from hospital to hospital"

He has seen first hand the situation in Syria deteriorate from the relatively black and white conflict of 2012, to the horror of ISIS’s engagement and the destruction of the current sustained bombing campaigns.

“It’s got much worse really,” says Nott. “When I was in Aleppo in 2014 five of my colleagues were killed going from hospital to hospital. You really felt the likelihood of being killed was much greater than it had been at any other time I’ve been there.”

Despite the very visceral threats to life and limb Nott continues to return to environments "where your hospital could get blown up any minute". His foundation will train others to do the same. Its STAE course is now compulsory curriculum for ICRC and MSF volunteers. Nott will head back to the frontlines in April, teaching the HEST course to a group of surgeons on the Turkish-Syrian border, where need for the skill he shares will likely remain robust.

“People will go and do humanitarian work but won’t always do it in areas where it’s really required: you won’t find people going to a war zone.” said Nott. “It will be left to local doctors and surgeons to manage and that’s why HEST will hopefully have a positive impact on that.”