Saving lives in Syria

David Nott graduated in 1979 with a BSc in Medicine before heading to Manchester to study for his MB ChB. As a student in St Andrews, his fine leadership qualities and humanitarianism were already very apparent: he was President of the Bute Medical Society, a Rugby Team Captain and was involved with the students’ Charities Campaign.

Now a leading war-zone surgeon, David Nott received an OBE in 2012 for his medical work in war regions. In 2016 he won the Robert Burns Humanitarian Award and a Pride of Britain Award for his work in Syria. Here he talks about his humanitarian work.

“There have been several occasions over the last few years when I wondered if I would ever see my Syrian friends again. The doctors I trained in 2013 and 2014 kept me updated daily with messages over WhatsApp, detailing the bombardment, siege and shortages they were contending with alongside caring for patients in the dwindling number of hospitals in Aleppo. The hardest photos to see were those of wounded children who were brought in with the most horrific injuries; their small bodies blown to pieces by the barrel bombs dropped indiscriminately on their communities.

“War surgery requires special skills. Surgical training in the UK, US and Europe has become super specialised and as a result many surgeons are not comfortable operating outside their narrow areas of expertise. In addition, hospitals provide warm, safe environments with every conceivable scan, test, medicine, equipment and blood supply on demand. These conditions are nothing like the ones you would face if you were the sole surgeon in a field hospital in rural Congo, Chad, Central African Republic or other austere environment. There would be none of the modern equipment, minimal blood supplies, and little support. You have to be able to make the correct decision about every case that comes your way, be it in the field of vascular, general, orthopaedic, facio-maxilliary or neurosurgery, obstetrics or gynaecology.

“The surgeons in Aleppo always stunned me. When war breaks out, many of the senior doctors leave and you are left with surgeons who are young and enthusiastic but their medical education has been disrupted and they don’t always know the best way to treat cases. Their passion to learn and enthusiasm for what I would teach was incredibly moving and inspired me on through the long, dark days we faced together.

“One case that stayed with me was that of a little boy brought in whose foot had been badly damaged by rubble from a barrel bomb. The surgeon’s first instinct was to amputate, as they did not see how the foot could be saved. Instead, I suggested we re-vascularise the foot by taking the long saphenous vein from the boy’s other leg and do a bypass graft to the injured lower leg and foot. The next stage was to cover the graft with a cross leg flap; an important plastic surgical procedure I teach and use a lot in war zones to cover wounds. The little boy’s foot was kept elevated and fixed for three weeks, a month later the flap was cut, and the legs separated. Some weeks after I had returned to the UK, the doctors sent me a WhatsApp video of the little boy walking.

“Despite the horror they faced, the surgeons stayed. I was in constant contact and in September last year directed an operation to reconstruct a man’s jaw over Skype with them. They sent me pictures of cases they wanted advice on and sometimes of those who did not survive. As hospital after hospital was destroyed I feared they too would be hit.

“So when, a few days before Christmas, a convoy of doctors, patients and other civilians were allowed to leave eastern Aleppo, I travelled to meet them in the northern province of Idlib. They were exhausted and drawn but it was a joyful reunion. We were working together again, operating on the scores of evacuated casualties. The vast majority of the cases required plastic surgical reconstructive work and I guided the doctors through the best approach.

Photo copyright to Francesco Guidicini.

“When I arrived in St Andrews in 1975 to study medicine, little did I know where my studies would take me. For the past 24 years I have travelled around the world treating patients with the various aid agencies. Since 2011, I have sought to give back the knowledge I have of war surgery in the countries I visit. I started this in Libya and have since taught in Syria, Turkey and Yemen. I set up my own charity, the David Nott Foundation, for the purpose of raising money to continue and expand this training.

“The David Nott Foundation is the medium through which I want to capture and record all my years’ experience in operating, teaching and training, in Syria and beyond, and make it available to the brave doctors who around the world are striving to save those affected by conflict and catastrophe. Through training courses in the UK and abroad, and using the best of new technology, we want to reach as many as we can and let the doctors know that help is at hand.”

For more information, please visit the David Knott Foundation website or email [email protected].

This article first appeared in the 2017 edition of Chronicle, the annual alumni magazine. Find out more about Chronicle.