David Nott - Conflict zone surgeon HARDtalk

having talks in London. Now it is time for HARDtalk.

Welcome to HARDtalk. I am at Stephen Sackur. The international diplomatic

effort to push Syria's warring parties to the negotiating table

continues as does the mission to eliminate the Asad's regime

stockpile of chemical weapons. All the while the suffering of Syrian

civilians intensifies. My guess today is David Nott, a British

surgeon recently returned from five weeks practising frontline medicine

in rebel held Syria. He says it is the most difficult in twenty years.

In a conflict such as Syria's, how much difference can a courageous

doctor make? David Nott, welcome to HARDtalk. You

are a successful surgeon working on some of London's top hospitals, yet

for six weeks of every year you take yourself off to some of the most

dangerous places in the world. Why did you Which? It is a difficult

question to answer. Sometimes I ask myself the same thing. It started in

nineteen ninety three when I was watching a programme about somebody

looking for his daughter in Sarajevo. I had this enormous

emotion. I was watching Sarajevo and the siege and suddenly I had this

idea, and met a couple of plastic surgeons at Charing Cross were I was

working, and they said why don't you apply to one of the aid agencies. I

rang up one of the aid agencies and within three days I had left my nice

warm pad in Hammersmith and was en route to Sarajevo. Sarajevo and then

over the course of these two decades we've had Afghanistan, Sierra Leone,

Iraq, the Democratic Republic of Congo, I could go on, ending up in

Syria. Is it personal choice in the end as to where you do or are you

part of a network that sends you places? I work for various aid

agencies. I donate about six weeks of my time, usually around

September. That is when my colleagues have come back from their

holidays. That is before university starts. Around then I say I am

free. It gives people the knowledge that I am off again. It is almost

read into my job description that I do will be in September. Hear'Say

donate. You go to these difficult places for free. I take unpaid leave

from the hospital. I do on calls on everything before and after. I take

completely unpaid leave and completely volunteer to go. I can

understand that when you were in your early thirties this, in a way,

seemed worthwhile and an extraordinary adventure. Perhaps

something of a buzz. Given what you have seen over twenty years, that

can surely no longer be the case. There is this issue of danger and of

being fair to your own family. Are you nearly at the end of this road?

Far from it. Hopefully I am still in the middle of it. It seems crazy to

say that the more I do it the more knowledge I have more information I

get on how to treat people in difficult environments, the more

humanitarian I become and I now am a significantly better humanitarian

surgeon that I was fifteen or twenty years ago. Let us get to your most

recent experience in Syria. How did you get in? You were working behind

rebel lines in rebel held territory. I'm assuming you were smuggled in.

Yes. I am not sure how much I can do vault. The Turkish government, or

Turkey itself, have been fantastically responsible in helping

the Syrian people. They turn a bit of a blind eye to people crossing

the border. You have to go through a sort of passport control whereby you

give a name, which may not be your own, which is written down and that

is taken as read, and then you go over the border without a passport

and you then go to do what you need to do. Are you put in the hands of

rebels? Not necessarily. It depends on the organisation. If you are with

an organisation that has headquarters on one side and a

mission on the other side, it you would go with that organisation. Are

you taken to where you are going to work, your makeshift hospital, by

men with guns? Yes. Does that not plant a seed of concern and worry in

your mind, that you are actively part of one side in this civil

conflict? What you are trying to do is alleviated human suffering. The

human suffering at the moment is rife in Syria. It is a civilian

population. If the government allowed the organisation is to go to

the government side I would have gone bad. If the organisations

didn't allow about, where could I go, I had to go to the rebel side. I

have no affiliation with the rebels or with anybody. I am going in there

to help people. But you are dependent on them for your

security. I am because it is extremely dangerous going over the

border. The road to where I was going was very dangerous. Can you

tell me where you were? I would not like to say where I was. It was one

of the biggest cities in the North in Syria. For security reasons I

would rather not say the name. Libya's former Health Minister who

has been working on a panel trying to raise awareness of the

humanitarian crisis in Syria has said that Syria is the most

dangerous place on earth to be a doctor right now. You think that is

true? I think it is true for many reasons. The city where I worked in

the hospitals had been targeted and some of the major hospitals have

been levelled out of the ground. I am apolitical. I do not wish to take

any sides. It has to be one side which are fighting the rebel side.

Take it as government or as somebody else. If something has SCUD missiles

and sends those in to level the hospital, then presumably it is from

a government that has these weapons. Anybody who has the vaguest sense of

the Geneva Convention knows that is a war crime, deliberately targeting

medical facilities and hospitals is a war crime. It is a war crime.

Because everybody is so scared there, all the doctors and

everybody, everybody has left the city there were five thousand

doctors there two years ago, there are now thirty six doctors left. In

the whole of the city there are now thirty six doctors? The healthcare

system is entirely broken. It has completely collapsed. The thirty six

doctors that are still there have got themselves organised so that

they are working in field hospitals and doing as best as they can. There

are several field hospitals around the city which have some really

excellent doctors that are left that to the surgery and so on. There is

no`one if possessed. Not a single one. Given what you saw, it strikes

me as utterly disastrous. You have described seeing streams of

civilians coming in with terrible gunshot wounds. I went to to be

specific about the nature of these wounds. You have described them in a

way that suggests there are patterns involved. Every day we would receive

between twelve and fourteen gunshot wounds. These were high velocity

gunshot wounds. A small entry wound, a large exit wound, causing huge

amounts of damage within the body. The sort that would come from a

sniper rifle? Without a doubt. The wounds were in the chest, in the

neck, in the abdomen, in the pelvis, in the groin, any junctional areas

between the arm and the chest which is a difficult area to get to

because you have major vessels, and people were bleeding to death as

they were shot. Al Hospital was about a kilometre from the

frontline. We were receiving patients who had been shot up to

fifteen minutes before being admitted. So you have a patient who

is bleeding to death and we do not have that many resources. We have a

lot of blood, but they were running out of test tubes, running out of

swabs, running out of sutures, running out of everything. So much

is used per day. You seem to be suggesting that there was a daily

pattern in terms of wear on the body of the injuries would occur almost

as though the snipers were instructed on a particular day to go

for a shoulder shot or a groin shot or, in certain cases, and this is

where it gets important to be details, you indicated that they

appeared to be a pattern of targeting heavily pregnant women in

their stomach area. Aiming for, one can only assume, the features. Yes.

There was. After a while, it took me a few days to realise there was

something not quite right, why did we receive semi` groin wounds in one

day and the next chest wounds and another there would be led wounds,

then I started asking to see if it was normal to receive patients like

this. The reply was that we think they are targeting various parts of

the anatomy and they are doing that to get a present at the end of it,

like a packet of cigarettes or something like that. I do not know

how the snipers there were, but I have been told there were seventy

two around the city. They can't have all got together to make a decision

on Monday. There must have been for five sitting together deciding what

they were doing. Your question about heavily pregnant ladies was

completely correct. It was obvious that a lady is heavily pregnant.

Some of them were targeted in the abdomen. We would receive patients

that had, that were bleeding to death, you take their garden off and

they were heavily pregnant. These are extraordinarily powerful images.

Horrible images that you are conjuring up for ours. It is really

important that you have as much data, as much recorded evidence

catalogues, to back up your images as possible. There will be people,

inside Syria, inside the regime, who will say that what you just said is

propaganda that comes from the side of the rebels. But I am not a rebel.

And I not part of the government. I'm a single British doctor who has

no allegiance is to anybody. All I am doing is reporting that what I

have seen. I have photographs. If people want to see the photographs,

if they want to watch a video of a Caesarean section with pulling out a

baby, they are welcome to come and talk to me and watch them. This is

the evidence I have. This is the evidence that I have available. What

I have seen was absolute targeting of children, of women, of everybody,

of civilians. I don't think I operated on, maybe one or two,

fighters. All of them were civilians. A lot of the children did

not make it. To be a doctor operating on a child shot in the

shoulder who you are doing your desperate best to save their life,

and then the baby dies or the child `` dies in front of you. It is a

difficult thing to cope with. Are you still find a get for good? I

have been out of Syria for ten days. I am beginning to suffer a bit. In

what way? Sometimes, it is not post dramatic stress. It is just the

realisation that you are back to work. You are working in your

environment. I was working with a very nice team around me, we were

doing another difficult case. We got together and worked out how to do

it. I saw him this morning and he was fine, everything was great.

Everyone was very happy. But in the environment I just came from, it is

they and this is is of. `` opposite of that. It is not a stable

environment. Every case, you only have one or two hours to deal with

the case. Then the patient has to get off the operating table because

you have another case, and another case. You do not have enough time to

know who you are operating on. Before we move on to other eat

ethical issues, described me whether you have ever felt your doctoring

principles have been undermined by having to work in a situation where

many people in a makeshift environment have gardens and are

sometimes requesting that you treat a fighter before a civilian, or a

member of their family. How difficult is it to stick to your

principles in those extreme conditions? That has to be able that

nobody comes into the hospital with a weapon. Weapons have to be left

outside. You can be confronted with a situation where someone does have

a weapon. In the end, you only have the force of your work. You cannot

require somebody. Thank goodness it has never happened to me. It has

happened to colleagues, forced to treat someone by gunpoint. What

would you do if someone marched into the operating figure and said, my

friend has been shot, you have to cheat him now. Unfortunately, I

would have to treat that patient. Once I have triggered that patient,

I can treat others. You have made a Pt in saying that a lot of your work

now, when you go to Syria and other places, is about training the next

generation of local dock is to be able to act as front`line emergency

medics in the way you can. `` DRS. What are your keys in training up

his local dock is? It requires a huge amount of experience and

knowledge. I have been very fortunate in having worked in some

interesting and violence and realised I did not know as much as I

would like to know. `` interesting environment. About five or six years

ago, I decided I would join the British military simply as a

reservist so I could go to war and really see what it is like to be a

proper war surgeon, having had all the military training. I did. They

run the most amazing courses, training courses, on how to deal

with casualties, wounds and so on. You went to war, and you say,

serving with the British military in Iraq. And yet you would now work ``

you now work for groups that are absolutely determined to draw a line

of separation between themselves and any military intervention force. I

cannot imagine they like the fact that you have voluntarily signed up

with the British Army. It is an interesting topic. There is the Pt

of taking sides. Far from it. I wanted to learn how to do things

properly. I decided to do this, to learn how to do it properly. At the

end of the day, I learnt so much. I went out for six weeks or so. When I

came back, the uniform is removed. I continue my normal job. And then use

the information to go out in the future with another agency and be

able to give that back. Two things before we finish, the ever worry

that by providing emergency medical assistance in terrible conflict

situations, you could at times be perpetuating that conflict? You

could be mending fighters so they can go back to the front to fight.

You could be giving support to the family members of fighters to give

the fighter he says there is something worth fighting for. Some

people believe, at times, it is better not to offer assistance and

intervene. I disagree. Humanitarian surgery means you are treating a

humid being. You do not know who that person is. The majority people

a cheat in the UK, I do not know who they're. I am treating patients as

individuals, as a human being and making them better again. I do not

care who they're, what side they're on, and what the ad going to do. My

job as a human Kerian surgeon is to make them better. `` humanitarian.

Let's bring it back to Syria. There are millions of people who are

suffering in a humanitarian crisis. Do you believe there is anything

bought the international community could be doing right now to

alleviate that suffering? Yes. There are a lot of political talks today

about... No doubt Syria needs to be sorted out politically, that is how

it will end. At the moment it is all humanitarian. The government

people, a few months ago, they said we were not use weapons but

humanitarian action. But where is the humanitarian action? I never saw

anything from the British government in Syria when I was there. The only

thing in Syria was me. What can they do, realistically? They can open up

a humanitarian corridor and make it easy for people like me to go in and

out. I did not want to go back again to face how dangerous it was.

Humanitarian caught up rings with it the thought they would have to be

some sort of military intervention force to protect and safeguard that

corridor and the flow of supplies, medical help, and doctors such as

yourself. That means guns and boots on the ground. No government in the

West is ready to commit to. But how else will be do it? It will not get

done. It will have to get done. The UN what have to stop talking and get

some action. I am sorry to say, looking back twenty years ago when I

was in Sarajevo, I remember all the turquoise hats. That is what needs

to happen again. If we leave it for more months and more months, there

will be more factions, it will get worse and worse and worse. Nobody

will ever do anything. There will be people like me who will not want to

go again because what is the Pt of going in there for a six`week

mission when he put one foot in and you either get kidnapped or

murdered? There has to be some action to get people in safely. I am

sorry to say but I think the UN may well come boots on the ground just

for human Kerian detection. `` humanitarian protection. Will you go

back? Of course. David Nott, we have to end their. Think is very much

being on talk might. `` HARDtalk. If you are not having to venture out

in the next couple of hours, you are one of the lucky ones. It is not

pretty out there at all. Some very heavy downpours of rain, accompanied

by some strong winds. Making its way across the UK. This will greet us

first thing Wednesday morning, good rush of heavy downpours across the

UK. On the plus side, not too cold. Mild start to the day. Temperatures

around thirteen or fourteen. Showers will be with us for a while. Across

Scotland, some heavy downpours to start the day in many places. Also

for Northern Ireland as well. Perhaps fewer and further between

the more south you