:00:00. > :00:10.having talks in London. Now it is time for HARDtalk.
:00:11. > :00:18.Welcome to HARDtalk. I am at Stephen Sackur. The international diplomatic
:00:19. > :00:24.effort to push Syria's warring parties to the negotiating table
:00:25. > :00:28.continues as does the mission to eliminate the Asad's regime
:00:29. > :00:32.stockpile of chemical weapons. All the while the suffering of Syrian
:00:33. > :00:36.civilians intensifies. My guess today is David Nott, a British
:00:37. > :00:43.surgeon recently returned from five weeks practising frontline medicine
:00:44. > :00:48.in rebel held Syria. He says it is the most difficult in twenty years.
:00:49. > :00:50.In a conflict such as Syria's, how much difference can a courageous
:00:51. > :01:25.doctor make? David Nott, welcome to HARDtalk. You
:01:26. > :01:29.are a successful surgeon working on some of London's top hospitals, yet
:01:30. > :01:35.for six weeks of every year you take yourself off to some of the most
:01:36. > :01:41.dangerous places in the world. Why did you Which? It is a difficult
:01:42. > :01:48.question to answer. Sometimes I ask myself the same thing. It started in
:01:49. > :01:50.nineteen ninety three when I was watching a programme about somebody
:01:51. > :01:56.looking for his daughter in Sarajevo. I had this enormous
:01:57. > :02:01.emotion. I was watching Sarajevo and the siege and suddenly I had this
:02:02. > :02:05.idea, and met a couple of plastic surgeons at Charing Cross were I was
:02:06. > :02:11.working, and they said why don't you apply to one of the aid agencies. I
:02:12. > :02:17.rang up one of the aid agencies and within three days I had left my nice
:02:18. > :02:24.warm pad in Hammersmith and was en route to Sarajevo. Sarajevo and then
:02:25. > :02:29.over the course of these two decades we've had Afghanistan, Sierra Leone,
:02:30. > :02:35.Iraq, the Democratic Republic of Congo, I could go on, ending up in
:02:36. > :02:38.Syria. Is it personal choice in the end as to where you do or are you
:02:39. > :02:43.part of a network that sends you places? I work for various aid
:02:44. > :02:47.agencies. I donate about six weeks of my time, usually around
:02:48. > :02:51.September. That is when my colleagues have come back from their
:02:52. > :02:58.holidays. That is before university starts. Around then I say I am
:02:59. > :03:03.free. It gives people the knowledge that I am off again. It is almost
:03:04. > :03:09.read into my job description that I do will be in September. Hear'Say
:03:10. > :03:18.donate. You go to these difficult places for free. I take unpaid leave
:03:19. > :03:21.from the hospital. I do on calls on everything before and after. I take
:03:22. > :03:26.completely unpaid leave and completely volunteer to go. I can
:03:27. > :03:32.understand that when you were in your early thirties this, in a way,
:03:33. > :03:35.seemed worthwhile and an extraordinary adventure. Perhaps
:03:36. > :03:39.something of a buzz. Given what you have seen over twenty years, that
:03:40. > :03:46.can surely no longer be the case. There is this issue of danger and of
:03:47. > :03:51.being fair to your own family. Are you nearly at the end of this road?
:03:52. > :03:55.Far from it. Hopefully I am still in the middle of it. It seems crazy to
:03:56. > :04:00.say that the more I do it the more knowledge I have more information I
:04:01. > :04:07.get on how to treat people in difficult environments, the more
:04:08. > :04:09.humanitarian I become and I now am a significantly better humanitarian
:04:10. > :04:17.surgeon that I was fifteen or twenty years ago. Let us get to your most
:04:18. > :04:25.recent experience in Syria. How did you get in? You were working behind
:04:26. > :04:32.rebel lines in rebel held territory. I'm assuming you were smuggled in.
:04:33. > :04:39.Yes. I am not sure how much I can do vault. The Turkish government, or
:04:40. > :04:42.Turkey itself, have been fantastically responsible in helping
:04:43. > :04:48.the Syrian people. They turn a bit of a blind eye to people crossing
:04:49. > :04:54.the border. You have to go through a sort of passport control whereby you
:04:55. > :04:59.give a name, which may not be your own, which is written down and that
:05:00. > :05:04.is taken as read, and then you go over the border without a passport
:05:05. > :05:11.and you then go to do what you need to do. Are you put in the hands of
:05:12. > :05:16.rebels? Not necessarily. It depends on the organisation. If you are with
:05:17. > :05:21.an organisation that has headquarters on one side and a
:05:22. > :05:28.mission on the other side, it you would go with that organisation. Are
:05:29. > :05:39.you taken to where you are going to work, your makeshift hospital, by
:05:40. > :05:46.men with guns? Yes. Does that not plant a seed of concern and worry in
:05:47. > :05:52.your mind, that you are actively part of one side in this civil
:05:53. > :05:57.conflict? What you are trying to do is alleviated human suffering. The
:05:58. > :06:03.human suffering at the moment is rife in Syria. It is a civilian
:06:04. > :06:07.population. If the government allowed the organisation is to go to
:06:08. > :06:12.the government side I would have gone bad. If the organisations
:06:13. > :06:16.didn't allow about, where could I go, I had to go to the rebel side. I
:06:17. > :06:22.have no affiliation with the rebels or with anybody. I am going in there
:06:23. > :06:27.to help people. But you are dependent on them for your
:06:28. > :06:30.security. I am because it is extremely dangerous going over the
:06:31. > :06:38.border. The road to where I was going was very dangerous. Can you
:06:39. > :06:43.tell me where you were? I would not like to say where I was. It was one
:06:44. > :06:49.of the biggest cities in the North in Syria. For security reasons I
:06:50. > :06:54.would rather not say the name. Libya's former Health Minister who
:06:55. > :06:57.has been working on a panel trying to raise awareness of the
:06:58. > :07:02.humanitarian crisis in Syria has said that Syria is the most
:07:03. > :07:07.dangerous place on earth to be a doctor right now. You think that is
:07:08. > :07:12.true? I think it is true for many reasons. The city where I worked in
:07:13. > :07:20.the hospitals had been targeted and some of the major hospitals have
:07:21. > :07:28.been levelled out of the ground. I am apolitical. I do not wish to take
:07:29. > :07:35.any sides. It has to be one side which are fighting the rebel side.
:07:36. > :07:39.Take it as government or as somebody else. If something has SCUD missiles
:07:40. > :07:47.and sends those in to level the hospital, then presumably it is from
:07:48. > :07:51.a government that has these weapons. Anybody who has the vaguest sense of
:07:52. > :07:56.the Geneva Convention knows that is a war crime, deliberately targeting
:07:57. > :08:03.medical facilities and hospitals is a war crime. It is a war crime.
:08:04. > :08:12.Because everybody is so scared there, all the doctors and
:08:13. > :08:14.everybody, everybody has left the city there were five thousand
:08:15. > :08:21.doctors there two years ago, there are now thirty six doctors left. In
:08:22. > :08:26.the whole of the city there are now thirty six doctors? The healthcare
:08:27. > :08:31.system is entirely broken. It has completely collapsed. The thirty six
:08:32. > :08:36.doctors that are still there have got themselves organised so that
:08:37. > :08:42.they are working in field hospitals and doing as best as they can. There
:08:43. > :08:46.are several field hospitals around the city which have some really
:08:47. > :08:56.excellent doctors that are left that to the surgery and so on. There is
:08:57. > :09:07.no`one if possessed. Not a single one. Given what you saw, it strikes
:09:08. > :09:13.me as utterly disastrous. You have described seeing streams of
:09:14. > :09:16.civilians coming in with terrible gunshot wounds. I went to to be
:09:17. > :09:20.specific about the nature of these wounds. You have described them in a
:09:21. > :09:26.way that suggests there are patterns involved. Every day we would receive
:09:27. > :09:35.between twelve and fourteen gunshot wounds. These were high velocity
:09:36. > :09:40.gunshot wounds. A small entry wound, a large exit wound, causing huge
:09:41. > :09:46.amounts of damage within the body. The sort that would come from a
:09:47. > :09:51.sniper rifle? Without a doubt. The wounds were in the chest, in the
:09:52. > :09:56.neck, in the abdomen, in the pelvis, in the groin, any junctional areas
:09:57. > :10:03.between the arm and the chest which is a difficult area to get to
:10:04. > :10:12.because you have major vessels, and people were bleeding to death as
:10:13. > :10:16.they were shot. Al Hospital was about a kilometre from the
:10:17. > :10:21.frontline. We were receiving patients who had been shot up to
:10:22. > :10:27.fifteen minutes before being admitted. So you have a patient who
:10:28. > :10:36.is bleeding to death and we do not have that many resources. We have a
:10:37. > :10:40.lot of blood, but they were running out of test tubes, running out of
:10:41. > :10:45.swabs, running out of sutures, running out of everything. So much
:10:46. > :10:52.is used per day. You seem to be suggesting that there was a daily
:10:53. > :10:55.pattern in terms of wear on the body of the injuries would occur almost
:10:56. > :11:01.as though the snipers were instructed on a particular day to go
:11:02. > :11:06.for a shoulder shot or a groin shot or, in certain cases, and this is
:11:07. > :11:10.where it gets important to be details, you indicated that they
:11:11. > :11:14.appeared to be a pattern of targeting heavily pregnant women in
:11:15. > :11:24.their stomach area. Aiming for, one can only assume, the features. Yes.
:11:25. > :11:29.There was. After a while, it took me a few days to realise there was
:11:30. > :11:34.something not quite right, why did we receive semi` groin wounds in one
:11:35. > :11:43.day and the next chest wounds and another there would be led wounds,
:11:44. > :11:49.then I started asking to see if it was normal to receive patients like
:11:50. > :11:53.this. The reply was that we think they are targeting various parts of
:11:54. > :11:57.the anatomy and they are doing that to get a present at the end of it,
:11:58. > :12:00.like a packet of cigarettes or something like that. I do not know
:12:01. > :12:04.how the snipers there were, but I have been told there were seventy
:12:05. > :12:10.two around the city. They can't have all got together to make a decision
:12:11. > :12:16.on Monday. There must have been for five sitting together deciding what
:12:17. > :12:21.they were doing. Your question about heavily pregnant ladies was
:12:22. > :12:26.completely correct. It was obvious that a lady is heavily pregnant.
:12:27. > :12:34.Some of them were targeted in the abdomen. We would receive patients
:12:35. > :12:44.that had, that were bleeding to death, you take their garden off and
:12:45. > :12:47.they were heavily pregnant. These are extraordinarily powerful images.
:12:48. > :12:54.Horrible images that you are conjuring up for ours. It is really
:12:55. > :13:01.important that you have as much data, as much recorded evidence
:13:02. > :13:07.catalogues, to back up your images as possible. There will be people,
:13:08. > :13:13.inside Syria, inside the regime, who will say that what you just said is
:13:14. > :13:20.propaganda that comes from the side of the rebels. But I am not a rebel.
:13:21. > :13:26.And I not part of the government. I'm a single British doctor who has
:13:27. > :13:31.no allegiance is to anybody. All I am doing is reporting that what I
:13:32. > :13:37.have seen. I have photographs. If people want to see the photographs,
:13:38. > :13:41.if they want to watch a video of a Caesarean section with pulling out a
:13:42. > :13:49.baby, they are welcome to come and talk to me and watch them. This is
:13:50. > :13:55.the evidence I have. This is the evidence that I have available. What
:13:56. > :14:03.I have seen was absolute targeting of children, of women, of everybody,
:14:04. > :14:06.of civilians. I don't think I operated on, maybe one or two,
:14:07. > :14:17.fighters. All of them were civilians. A lot of the children did
:14:18. > :14:21.not make it. To be a doctor operating on a child shot in the
:14:22. > :14:26.shoulder who you are doing your desperate best to save their life,
:14:27. > :14:36.and then the baby dies or the child `` dies in front of you. It is a
:14:37. > :14:40.difficult thing to cope with. Are you still find a get for good? I
:14:41. > :14:53.have been out of Syria for ten days. I am beginning to suffer a bit. In
:14:54. > :14:58.what way? Sometimes, it is not post dramatic stress. It is just the
:14:59. > :15:02.realisation that you are back to work. You are working in your
:15:03. > :15:10.environment. I was working with a very nice team around me, we were
:15:11. > :15:15.doing another difficult case. We got together and worked out how to do
:15:16. > :15:20.it. I saw him this morning and he was fine, everything was great.
:15:21. > :15:25.Everyone was very happy. But in the environment I just came from, it is
:15:26. > :15:32.they and this is is of. `` opposite of that. It is not a stable
:15:33. > :15:37.environment. Every case, you only have one or two hours to deal with
:15:38. > :15:39.the case. Then the patient has to get off the operating table because
:15:40. > :15:45.you have another case, and another case. You do not have enough time to
:15:46. > :15:52.know who you are operating on. Before we move on to other eat
:15:53. > :15:59.ethical issues, described me whether you have ever felt your doctoring
:16:00. > :16:04.principles have been undermined by having to work in a situation where
:16:05. > :16:09.many people in a makeshift environment have gardens and are
:16:10. > :16:14.sometimes requesting that you treat a fighter before a civilian, or a
:16:15. > :16:18.member of their family. How difficult is it to stick to your
:16:19. > :16:24.principles in those extreme conditions? That has to be able that
:16:25. > :16:32.nobody comes into the hospital with a weapon. Weapons have to be left
:16:33. > :16:38.outside. You can be confronted with a situation where someone does have
:16:39. > :16:43.a weapon. In the end, you only have the force of your work. You cannot
:16:44. > :16:48.require somebody. Thank goodness it has never happened to me. It has
:16:49. > :16:53.happened to colleagues, forced to treat someone by gunpoint. What
:16:54. > :16:58.would you do if someone marched into the operating figure and said, my
:16:59. > :17:05.friend has been shot, you have to cheat him now. Unfortunately, I
:17:06. > :17:10.would have to treat that patient. Once I have triggered that patient,
:17:11. > :17:15.I can treat others. You have made a Pt in saying that a lot of your work
:17:16. > :17:21.now, when you go to Syria and other places, is about training the next
:17:22. > :17:27.generation of local dock is to be able to act as front`line emergency
:17:28. > :17:34.medics in the way you can. `` DRS. What are your keys in training up
:17:35. > :17:39.his local dock is? It requires a huge amount of experience and
:17:40. > :17:43.knowledge. I have been very fortunate in having worked in some
:17:44. > :17:47.interesting and violence and realised I did not know as much as I
:17:48. > :17:56.would like to know. `` interesting environment. About five or six years
:17:57. > :18:00.ago, I decided I would join the British military simply as a
:18:01. > :18:05.reservist so I could go to war and really see what it is like to be a
:18:06. > :18:12.proper war surgeon, having had all the military training. I did. They
:18:13. > :18:19.run the most amazing courses, training courses, on how to deal
:18:20. > :18:22.with casualties, wounds and so on. You went to war, and you say,
:18:23. > :18:34.serving with the British military in Iraq. And yet you would now work ``
:18:35. > :18:38.you now work for groups that are absolutely determined to draw a line
:18:39. > :18:42.of separation between themselves and any military intervention force. I
:18:43. > :18:50.cannot imagine they like the fact that you have voluntarily signed up
:18:51. > :18:59.with the British Army. It is an interesting topic. There is the Pt
:19:00. > :19:04.of taking sides. Far from it. I wanted to learn how to do things
:19:05. > :19:11.properly. I decided to do this, to learn how to do it properly. At the
:19:12. > :19:17.end of the day, I learnt so much. I went out for six weeks or so. When I
:19:18. > :19:25.came back, the uniform is removed. I continue my normal job. And then use
:19:26. > :19:32.the information to go out in the future with another agency and be
:19:33. > :19:38.able to give that back. Two things before we finish, the ever worry
:19:39. > :19:43.that by providing emergency medical assistance in terrible conflict
:19:44. > :19:49.situations, you could at times be perpetuating that conflict? You
:19:50. > :19:53.could be mending fighters so they can go back to the front to fight.
:19:54. > :19:56.You could be giving support to the family members of fighters to give
:19:57. > :20:02.the fighter he says there is something worth fighting for. Some
:20:03. > :20:10.people believe, at times, it is better not to offer assistance and
:20:11. > :20:13.intervene. I disagree. Humanitarian surgery means you are treating a
:20:14. > :20:20.humid being. You do not know who that person is. The majority people
:20:21. > :20:29.a cheat in the UK, I do not know who they're. I am treating patients as
:20:30. > :20:32.individuals, as a human being and making them better again. I do not
:20:33. > :20:38.care who they're, what side they're on, and what the ad going to do. My
:20:39. > :20:45.job as a human Kerian surgeon is to make them better. `` humanitarian.
:20:46. > :20:52.Let's bring it back to Syria. There are millions of people who are
:20:53. > :20:55.suffering in a humanitarian crisis. Do you believe there is anything
:20:56. > :21:01.bought the international community could be doing right now to
:21:02. > :21:07.alleviate that suffering? Yes. There are a lot of political talks today
:21:08. > :21:11.about... No doubt Syria needs to be sorted out politically, that is how
:21:12. > :21:19.it will end. At the moment it is all humanitarian. The government
:21:20. > :21:25.people, a few months ago, they said we were not use weapons but
:21:26. > :21:29.humanitarian action. But where is the humanitarian action? I never saw
:21:30. > :21:35.anything from the British government in Syria when I was there. The only
:21:36. > :21:41.thing in Syria was me. What can they do, realistically? They can open up
:21:42. > :21:47.a humanitarian corridor and make it easy for people like me to go in and
:21:48. > :21:53.out. I did not want to go back again to face how dangerous it was.
:21:54. > :21:56.Humanitarian caught up rings with it the thought they would have to be
:21:57. > :22:01.some sort of military intervention force to protect and safeguard that
:22:02. > :22:10.corridor and the flow of supplies, medical help, and doctors such as
:22:11. > :22:13.yourself. That means guns and boots on the ground. No government in the
:22:14. > :22:19.West is ready to commit to. But how else will be do it? It will not get
:22:20. > :22:25.done. It will have to get done. The UN what have to stop talking and get
:22:26. > :22:31.some action. I am sorry to say, looking back twenty years ago when I
:22:32. > :22:37.was in Sarajevo, I remember all the turquoise hats. That is what needs
:22:38. > :22:41.to happen again. If we leave it for more months and more months, there
:22:42. > :22:46.will be more factions, it will get worse and worse and worse. Nobody
:22:47. > :22:50.will ever do anything. There will be people like me who will not want to
:22:51. > :22:54.go again because what is the Pt of going in there for a six`week
:22:55. > :22:57.mission when he put one foot in and you either get kidnapped or
:22:58. > :23:07.murdered? There has to be some action to get people in safely. I am
:23:08. > :23:11.sorry to say but I think the UN may well come boots on the ground just
:23:12. > :23:20.for human Kerian detection. `` humanitarian protection. Will you go
:23:21. > :23:23.back? Of course. David Nott, we have to end their. Think is very much
:23:24. > :23:54.being on talk might. `` HARDtalk. If you are not having to venture out
:23:55. > :24:01.in the next couple of hours, you are one of the lucky ones. It is not
:24:02. > :24:06.pretty out there at all. Some very heavy downpours of rain, accompanied
:24:07. > :24:14.by some strong winds. Making its way across the UK. This will greet us
:24:15. > :24:20.first thing Wednesday morning, good rush of heavy downpours across the
:24:21. > :24:26.UK. On the plus side, not too cold. Mild start to the day. Temperatures
:24:27. > :24:33.around thirteen or fourteen. Showers will be with us for a while. Across
:24:34. > :24:37.Scotland, some heavy downpours to start the day in many places. Also
:24:38. > :24:41.for Northern Ireland as well. Perhaps fewer and further between
:24:42. > :24:42.the more south you