:00:00. > :00:00.Much more on that on the BBC website any time.
:00:00. > :00:11.Welcome to HARDtalk. I'm Stephen Sackur.
:00:12. > :00:14.Amid the appalling toll of civilian death in Syria,
:00:15. > :00:17.the loss of hundreds of doctors and medical staff stands out
:00:18. > :00:24.Many have been bombed in their clinics and hospitals.
:00:25. > :00:27.My guest today is David Nott, a British surgeon who has spent
:00:28. > :00:34.decades offering his services in conflict zones, including Syria.
:00:35. > :00:38.Now he's focused on training doctors to work in conflict conditions.
:00:39. > :00:41.But does Syria tell us medical personnel can no longer expect any
:00:42. > :01:27.Thank you. We last spoke in the studio three years ago, 2013. You
:01:28. > :01:31.had just come back from Syria. I ask you then, would you continue to go
:01:32. > :01:38.and work in the midst of war, and you smiled and said, yes, of course.
:01:39. > :01:45.You have been back once since in 2014, but not the last couple of
:01:46. > :01:49.years. I? I did go back in 2014. I wanted to go back to Aleppo in and
:01:50. > :01:52.the people I trained and see how they were getting on. I wanted to
:01:53. > :01:58.help them and justly with them. It was a real joy to go back in
:01:59. > :02:02.September 2014 and spent six weeks with them. I was absolutely
:02:03. > :02:09.delighted to see how they had coped. From being a ragtag bag of amateurs,
:02:10. > :02:13.really, you before that, and not knowing how to stitch public, not
:02:14. > :02:16.knowing how to make the right diagnoses, not knowing how to
:02:17. > :02:21.operate, they had turned themselves into a first-class group of very
:02:22. > :02:25.good surgeons. I'm talking about surgeons that were 28, 29 and 30.
:02:26. > :02:31.They were really very good. It was a joy to see that the training they
:02:32. > :02:35.had had was really paying off. They enjoyed showing me how they could
:02:36. > :02:39.operate. It was really enjoyable. That is the positive. The negative
:02:40. > :02:44.is you were there in the midst of a spate of barrel bombs, attacks on
:02:45. > :02:49.civilian areas and rebel held part of Aleppo. Would it be fair to say
:02:50. > :02:54.even for a man who has risked his life in conflict zones for 20 years,
:02:55. > :03:00.it simply now is too dangerous? I did go, and 2014 was completely
:03:01. > :03:05.different to 2013. The barrel bombs being dropped, there were four or
:03:06. > :03:10.five being dropped a day on the city. On civilian populations. We
:03:11. > :03:14.dealt with really terrible injuries, probably the worst I've ever seen to
:03:15. > :03:18.stop fragmentation wounds on families and children. It was very
:03:19. > :03:23.difficult. There were coming in with smoke inhalation and people would
:03:24. > :03:29.die because of risperidone failure following their operations. I think
:03:30. > :03:33.you said at the time something like 70% of the casualties which would
:03:34. > :03:38.and added ten -- respiratory. Yes, 70% were children under ten. That
:03:39. > :03:44.was the most hard braking part. These barrel bombs were being
:03:45. > :03:47.dropped on civilian houses. -- hard braking. The fathers would be out
:03:48. > :03:51.doing something and the mothers would be looking after children, and
:03:52. > :03:57.they were the ones coming in. It was really terrible. I was doing with
:03:58. > :04:01.that sort of injury. In the midst of hearing oral bombs being dropped,
:04:02. > :04:06.hearing planes going around. -- barrel. We went for a visit run the
:04:07. > :04:09.hospital and were targeted I is Syrian jet flying around firing
:04:10. > :04:18.rockets. It was extremely dangerous. At the time as well, we had 20 or 30
:04:19. > :04:22.kilometres away, Islamic State and the beheadings of all of the
:04:23. > :04:27.Westerners in Raqqa. It may be feel it to me uneasy. There was only one
:04:28. > :04:32.road in and one road out, the Castella Road. In 2014, late
:04:33. > :04:37.October, there were discussions about closing the road. It is nearly
:04:38. > :04:43.two years on from when you with their in those ghastly conditions.
:04:44. > :04:49.Do you now feel that you suffered, or maybe are still suffering, post-
:04:50. > :04:53.ratted stress? We talked about that in 2013, and you were confident you
:04:54. > :04:58.had steered clear of that -- post-traumatic stress. I did suffer,
:04:59. > :05:03.no doubt about it. I often say a small amber would get into a fire
:05:04. > :05:07.and maybe go into a rage. I did not realise at the time I was almost
:05:08. > :05:12.having a personality change. My wife now, who was with me during this
:05:13. > :05:16.time, really suffered, and occasionally does still suffer when
:05:17. > :05:20.things don't go to plan and I lose the plot slightly and it comes to
:05:21. > :05:25.listening to what is going on at the moment. I do put myself back in that
:05:26. > :05:31.situation. I do suffer. No doubt about it. Do you see images,
:05:32. > :05:38.particular images? Even with me now, you are talking about the barrel
:05:39. > :05:45.bombs and the concrete dust and the children ayes ravaged bodies. Do
:05:46. > :05:49.images come into your head? I see it now. I see it when I go to bed. I
:05:50. > :05:55.have constant communication with my colleagues in Aleppo and they
:05:56. > :05:58.discuss cases with me. They semi- photographs of the most awful
:05:59. > :06:04.injuries that I look at. -- they sent me. Most of it is blunt trauma
:06:05. > :06:07.and the occasional stabbing in this country, perhaps a bow energy
:06:08. > :06:12.gunshot wound to the chest. But there I am seeing images which would
:06:13. > :06:19.make the hearts of anybody basically sink. They are terrible injuries.
:06:20. > :06:24.They are asking me what can I do with this case? What can I do?
:06:25. > :06:28.Sometimes I am sitting there at a dinner I did need the table tapping
:06:29. > :06:34.away saying have you done this? Have you done at? I would do this. How
:06:35. > :06:37.much blood have you got? What is the neurology like? Is the spinal-cord
:06:38. > :06:43.damaged? Constant images come to me all the time. There are hundreds of
:06:44. > :06:48.thousands of civilians living in the still rebel held part of Aleppo. The
:06:49. > :06:53.latest reports suggest there are perhaps 38 doctors of whom may be a
:06:54. > :06:58.handful or actual surgeons. How on earth are these people being given
:06:59. > :07:04.any meaningful healthcare at all? Given bail are still under on by
:07:05. > :07:09.then. -- even they are. It is worse now. Since the siege of Aleppo and
:07:10. > :07:14.since the Russians ramped up their air and bombing, they are not
:07:15. > :07:19.coping, and they are dealing with mass casualties on a daily basis.
:07:20. > :07:23.I'm getting picked is my phone saying, David, look at the cases we
:07:24. > :07:27.are dealing with now. We don't have any blight, we don't have any
:07:28. > :07:31.agreement. We are doing operations which are not the right operations
:07:32. > :07:36.to do in these circumstances -- equipment. They are making terrible
:07:37. > :07:39.decisions whether they can operate all leave a child, operate on
:07:40. > :07:46.somebody else. They are not coping. That is the big problem. Do you ever
:07:47. > :07:50.feel, and we have talked about this safety aspect, and the impossibility
:07:51. > :07:56.of getting in in many ways, but do you ever feel one way or another, I
:07:57. > :08:02.should be there? Yes, I do. I really feel, I said to my wife, she looks
:08:03. > :08:06.at me and says what are you thinking about? Why are you gazing into the
:08:07. > :08:12.abyss? I am thinking about the people and the doctors. I wanted to
:08:13. > :08:19.be with them to help them, and the only way I can do it now is to of
:08:20. > :08:23.advice over the phone. I know you have difficult conversations. I was
:08:24. > :08:29.struck by one that you spoke about a little while ago. This was with a
:08:30. > :08:35.young student doctor that you know well, and I think he sent you a
:08:36. > :08:41.picture of a girl who had been very badly hurt in eight bomb attack, and
:08:42. > :08:47.she had lost a child of her arm, and terrible facial damage. You
:08:48. > :08:54.contacted him and said, that is terrible, will she survive? His
:08:55. > :08:59.response was, unfortunately yes. To me, there is a problematic ethical
:09:00. > :09:08.thing going on it in Aleppo right now. If doctors can save a life but
:09:09. > :09:11.I'm not able to offer any after-care, rehabilitation, if the
:09:12. > :09:18.damage is so severe any is so awful, is there a point where saving a
:09:19. > :09:23.life, literally, is counter-productive? It is a very
:09:24. > :09:30.good question. There is no right and wrong in the answer to it. A
:09:31. > :09:35.doctor's job is to save human lives, and to alleviate human suffering.
:09:36. > :09:39.But that alleviation of suffering may not be happening. The suffering
:09:40. > :09:45.may be, in some awful ways, prolonged. Exactly, exactly. Without
:09:46. > :09:49.backup support. What will you do with that patient? Where will they
:09:50. > :09:56.go? To a bond at home? And suffer even more. A doctor's job is not to
:09:57. > :10:00.decide on somebody... If summary is in front of you dying and you have
:10:01. > :10:04.not got the agreement to deal with them, you have to let that patient
:10:05. > :10:08.die -- somebody. If summary comes in with their arm blown off and they
:10:09. > :10:11.are still alive, you cannot put them in a corner and say I will come back
:10:12. > :10:15.in ten hours and see if you are still alive. You cannot do that. You
:10:16. > :10:20.have to save their life. It is a very difficult decision. It
:10:21. > :10:25.certainly is a completely different job, in a doctor in Aleppo, compared
:10:26. > :10:27.to what you do in some of the best and most posh hospitals in London.
:10:28. > :10:33.There is a strange disconnect in a word. But it was best encapsulated
:10:34. > :10:38.when you were awarded an honour in the UK, and soon after it went to
:10:39. > :10:42.see the Queen. She asked you what it was like in Aleppo. You very
:10:43. > :10:47.honestly said, you actually could not answer. You thought your grip
:10:48. > :10:54.trembling and felt she would break down. -- lip. I still think about
:10:55. > :10:57.that time, really. I think I would come back ten days after being in
:10:58. > :11:03.Aleppo, and I was severely traumatised. My really good friend I
:11:04. > :11:07.worked with who was an anaesthetist, he was great, and the picture I got
:11:08. > :11:12.when I walked over the border, some sent me an image of him in the
:11:13. > :11:16.shower, he had just been killed. I arrived home and I was severely
:11:17. > :11:20.traumatised, and then I got this in fight to go to see the Queen at
:11:21. > :11:26.Buckingham Palace and have light without -- shroud. It was fabulous,
:11:27. > :11:31.a wonderful thing. -- have lunch. My mind was not there. It was in Aleppo
:11:32. > :11:35.and with all the people. It was with the people I wanted to be with. I
:11:36. > :11:40.was in an environment whereby I could not speak. She asked me, you
:11:41. > :11:45.know, we have you come back from? I said I have come back from Aleppo.
:11:46. > :11:53.How was it? I could not describe what it was like. I was unable to
:11:54. > :11:58.discredit. -- describe it. It was so bad, I just sat there and looked at
:11:59. > :12:07.her. I remember vividly my bottom lip starting to quiver. She
:12:08. > :12:10.obviously saw this, and then turned to the courtiers and said let's do
:12:11. > :12:16.something else, shall we? Let's get the dogs in. So be called his
:12:17. > :12:23.Kenyan, and we just fed the dogs for the rest of the lounge -- corgis
:12:24. > :12:28.came in. She saved you from breaking down. She did. If she had continued
:12:29. > :12:34.to ask me, I would have been sobbing. Let's talk about what you
:12:35. > :12:38.are doing right now. As we have established, you were not able to go
:12:39. > :12:44.back. But you are focusing on a particular aspect of medical
:12:45. > :12:48.assistance, training. Training young doctors in conflict surgery, in
:12:49. > :12:52.emergency trauma care. I know you have done it on the Turkish Syria
:12:53. > :12:55.border. You have done it in Yemen as well. How much difference do you
:12:56. > :12:59.think it really makes goods like yes, I think it makes a lot of
:13:00. > :13:04.difference. What we do, I run this course with the Royal College of
:13:05. > :13:11.surgeons, and it is a five-day course whereby surgeons from all
:13:12. > :13:15.over the world come. And Ostia environment being a euphemism for
:13:16. > :13:19.what some -- Ostia. You don't have an MRI, you don't have much blood,
:13:20. > :13:22.and you have to make the right decision for your patience. Over the
:13:23. > :13:26.extent I have had, aborted altogether. The course is based on a
:13:27. > :13:31.lot of the cases I have dealt with and how would you manage these? --
:13:32. > :13:34.and brought it all together. But the shorter course is called the hostile
:13:35. > :13:39.environment surgical training course, a three-day course which I
:13:40. > :13:44.put everything together, and then I have setup with my wife a foundation
:13:45. > :13:47.Kolbe David Nott foundation. It basically pays for surgeons to come
:13:48. > :13:51.from all over the world to come on the course. But the small course is
:13:52. > :14:03.also paid for by our foundation. We took it to the Syrian border, and 30
:14:04. > :14:07.surgeons came over the border. We taught them everything from top to
:14:08. > :14:13.bottom, but they would need to know as a surgeon. Of course they looked
:14:14. > :14:18.at me and said, in fact, we deal with significantly worse injuries
:14:19. > :14:20.then you can show us. I said no we don't. Let's talk about your
:14:21. > :14:24.injuries and the correct management. We had this dialogue during all of
:14:25. > :14:27.the surgeons they can over. They were saying, we have had this
:14:28. > :14:32.terrible case. How would you manage that? Then I said we would manage it
:14:33. > :14:36.by this technique. But it was not just me, it was a group of us that
:14:37. > :14:41.when. About four or five that go to this course.
:14:42. > :14:49.That seems a continuation of your dedicated work, trying to improve
:14:50. > :14:53.the healthcare environment. I see the continuation with your actual
:14:54. > :14:57.bodily presence on the ground. But you seem to have gone in a new
:14:58. > :15:03.direction over the last few years. You have become phenomenally
:15:04. > :15:08.outspoken. And not just outspoken on specific detailed healthcare issues
:15:09. > :15:12.by political issues as well. In particular, what it seems you feel
:15:13. > :15:17.to be the flagrant violation of the Geneva Conventions, and in the case
:15:18. > :15:23.of Syria, you appear to be pointing the finger of blame at Assad's
:15:24. > :15:28.forces and the Russians as well. Very much so. I have become far more
:15:29. > :15:33.political because there needs to be a voice. The people they need a
:15:34. > :15:38.voice. The only ones who can talk are those who have in there. It is
:15:39. > :15:43.difficult to wave a flag and say this is what we should do unless you
:15:44. > :15:48.have been there. It is those people who should voice and say how
:15:49. > :15:53.terrible it is. I completely understand the point that people
:15:54. > :15:59.say, well, yes no, David, you are not a politician, you are a dog to.
:16:00. > :16:05.That is true. You are a man who has four years offered humanitarian care
:16:06. > :16:13.to all who present themselves. From the Red Cross, to MSF, to any other
:16:14. > :16:19.medical organisation, there is a principle of nonpartisanship,
:16:20. > :16:25.independence, for the Red Cross in particular, neutrality. You have
:16:26. > :16:32.walked a long way from that. I have. I am happy to say I am glad I have
:16:33. > :16:38.done it. Someone needs to speak out. We can't just sit there and be
:16:39. > :16:46.basically, umm, walked over by what is going on. I am upfront about what
:16:47. > :16:56.is happening in Syria at the moment. Should they do that? This doctor
:16:57. > :17:00.has. I am taking sides against people who are killing and maiming.
:17:01. > :17:04.Against people who have no idea what is going on in the war. And things
:17:05. > :17:09.like that which happened before my eyes. I can't bear to witness it any
:17:10. > :17:15.more. It is such an important principle. The Theory of Everything
:17:16. > :17:25.if you were able to go back, the Russians in particular, having seen
:17:26. > :17:30.you in using the word, et al ET, of what they are doing, they might take
:17:31. > :17:35.the decision that they are going to target you. -- brutality. That
:17:36. > :17:40.wouldn't be a problem just for you but for all your colleagues. I
:17:41. > :17:50.wonder whether, and I don't mean this to be rude, but whether ego and
:17:51. > :17:55.sort of personal profile... The best way to do your work, is it the best
:17:56. > :18:02.way to do your work? No, I don't think that is correct. I am not
:18:03. > :18:08.egotistical. I am not wanting to push myself forward. I am just
:18:09. > :18:16.basically standing up for people that have been severely almost
:18:17. > :18:21.destroyed. And that is what I am standing up for. Not for anything
:18:22. > :18:32.else. Not for myself. I want to do it and say there has been a complete
:18:33. > :18:37.ignoring of humanitarian law. Hospitals have been bombed. The
:18:38. > :18:40.Geneva Conventions are there for a reason. They are not there to just
:18:41. > :18:54.the walked over and laughed at. That is what is happening now. President
:18:55. > :18:57.Putin, President Assad, they are laughing at the West. No one is
:18:58. > :19:02.standing up and doing anything. Let's push the politics further.
:19:03. > :19:11.Because of your position, you have actually said that you believe the
:19:12. > :19:21.Western powers, and you are speaking mostly about Britain, should have
:19:22. > :19:34.intervened militarily, 2013 you say, much earlier. But you say that in
:19:35. > :19:37.your view, Western military boots on the ground were and are required to
:19:38. > :19:41.offer salvation to Syrian people. And again this point, is it right
:19:42. > :19:47.for a doctor to be calling for a new and expanded military intervention
:19:48. > :19:52.when war is always cost lives? I called for humanitarian corridors in
:19:53. > :19:57.2013. I called for united humanitarian corridors. You asked me
:19:58. > :20:06.who was going to police that and I said ousts on the ground. It had to
:20:07. > :20:11.be United Nations boots on the ground, not Britain or the US. What
:20:12. > :20:17.I am saying from 2013, when Obama said we had crossed a red line by
:20:18. > :20:23.dropping chemical were 10 cents to 1500 people, that, you know, that
:20:24. > :20:30.there was a time where the West should have shown leadership and
:20:31. > :20:35.sincerity to the Syrian people. We have talked about the situation in
:20:36. > :20:40.Aleppo. What do you think should be done today? I don't think boots on
:20:41. > :20:47.the ground are the right thing to do today. I think that of course be an
:20:48. > :20:51.Nusra Front, who have changed their name to Al Sham, they have decided
:20:52. > :20:58.not to go with Al Qaeda, and they have a huge amount of people on the
:20:59. > :21:01.ground now. What should happen is that the Western governments,
:21:02. > :21:03.talking about Europe, all the Western governments, they should
:21:04. > :21:12.come together and say, look, we cannot have three... Sorry, 300,000
:21:13. > :21:18.people in Aleppo being killed and under siege. What should happen is I
:21:19. > :21:25.think that the Western governments should first of all put massive
:21:26. > :21:30.pressure on President Putin to say you cannot just use a power and kill
:21:31. > :21:36.as many people as you want to kill. -- air power. What you are doing is
:21:37. > :21:39.a war crime and you will be held responsible and taken to The Hague
:21:40. > :21:46.in due course by the international community. So will President Assad.
:21:47. > :21:52.You will both be taken to The Hague. So, smile now, you won't be smiling
:21:53. > :22:00.later. It is international pressure that needs to be put on the Russian
:22:01. > :22:04.regime. We should also be talking to the Al Sham, the new groups of
:22:05. > :22:10.fighters now in Aleppo, we should be talking to these people. That is
:22:11. > :22:16.what I think we should do. That is your political, sort of, diagnosis.
:22:17. > :22:21.But is now back to doctoring for the very end. You said all those years
:22:22. > :22:26.ago, you know what, I have made a conscious decision not to have a
:22:27. > :22:31.family, a wife, children, because I could not do what I want to do if I
:22:32. > :22:36.was in that situation. Now you have been blessed by not just a wife but
:22:37. > :22:44.a one-year-old daughter. Does that mean your days of this hour Rover?
:22:45. > :22:47.Probably. -- are over. I have a great responsibility to my wife and
:22:48. > :22:52.daughter. I feel that I can voice for the people that have been
:22:53. > :22:57.severely injured and wounded around the world. I can go and train
:22:58. > :23:03.doctors that can give to the best of their abilities the help to people
:23:04. > :23:08.wherever they are. When I was in the Yemen, it is a smaller warzone, not
:23:09. > :23:14.a big one, and I can still go to these places where the security is
:23:15. > :23:19.not too bad. But places like Aleppo now, I don't think I could go to
:23:20. > :23:26.them. I can relate to this as a former war reporter. We have talked
:23:27. > :23:31.about the adrenaline and bars. It is not just a truism. -- buzz. There is
:23:32. > :23:38.something powerful about risking it all. You don't have that any more? I
:23:39. > :23:45.do. I do. I just suppress it. I have to suppress it. Because if I don't I
:23:46. > :23:52.would the letting my family down. David, we have to end it there. But
:23:53. > :23:58.thank you very much for coming on HARDtalk. Thank you. It is a real
:23:59. > :24:16.pleasure to have you back in the studio. Thank you.
:24:17. > :24:21.If we take a quick look at the chart for the start of Wednesday you get