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The Telegraph
The Telegraph
National
Jessamy Calkin

Renowned war surgeon David Nott: ‘I don’t think Putin will ever stop trying to get Ukraine’

David Nott
David Nott

In January of this year, the world’s most experienced war surgeon was working at St Mary’s, Paddington when he heard about Russian troops massing on the Ukrainian border. That surgeon, David Nott, knew exactly what he had to do. Within 10 days of the war starting, he had put together a 12-hour Zoom course, with renowned neurosurgeon Henry Marsh, to teach surgeons essential techniques about how to deal with war injuries – fragmentation wounds, burns, mass casualty events. The course has so far been viewed by 1,000 surgeons in Ukraine and saved many lives. 

Three months later, Nott was there. “I was working in operating theatres in Zitoma which had no windows because they had all been blown out by cruise missiles, and I had 20 surgeons watching who were really happy to see me [because] they had patients with terrible injuries; somebody with his shoulder blown off, holes in peoples’ legs – injuries that they just didn’t know how to treat.”

“I don’t know how this is going to pan out,” he says. “I don’t think Putin will ever stop trying to get Ukraine. There is potential for it to go on for years, but I do think that the situation is changing for the better now and hopefully it will be brought to a conclusion much quicker with significant Western help.”

Nott has been going to war zones for 30 years. He first went to the frontline in 1993, to Sarajevo with Medecins Sans Frontieres, and since then he has completed 32 missions in 21 different territories, receiving an OBE for his work. He has written a best-selling memoir, War Doctor, and moved people to tears on BBC Radio 4’s Desert Island Discs in 2016, when he talked about meeting the Queen shortly after returning from Syria. Overcome by trauma, he found himself unable to speak when sitting next to her at lunch; she suggested they spend 20 minutes feeding the corgis together instead. “The Queen’s sharp perception and kindness following my return from Aleppo will always stay with me,” he says now. “It was an example of her ability to lift people’s spirits in times of need.”

Nott is not unfamiliar with traumatic incidents – he recounts the time in Sarajevo when the ambulance he was travelling in was hit by snipers; the operation in Syria when the object he removed from a woman’s leg turned out to be a detonator; the moment when the nurse standing next to him in Yemen was felled by a bullet, or how several members of IS turned up at an operating theatre in Aleppo to monitor his surgery on one of their fighters. 

David in Syria in 2015, outside the hospital he had been working at the year prior - Andrew Crowley
David in Syria in 2015, outside the hospital he had been working at the year prior - Andrew Crowley

He loves his job. Conflict, he wrote in his book, “was the only thing that made me feel alive”. But in 2014, when he was 58, he met Elly Jupp at a charity dinner. They were married the following year. “Elly is fantastic, but I went through some sort of nervous breakdown because I was totally torn between loving her and going to war. I didn’t know what to do. My heart was really pulled apart. So Elly said: ‘Well, why don't we set up a foundation and you can use all the knowledge you’ve accumulated to teach other people?’” 

So they did. The main objective of the David Nott Foundation, of which Elly is CEO, is to train surgeons and medical professionals to work in conflict and natural disaster zones around the world.

So, you’ve had your cake and… “Yep, I’ve had my cake – and I’m still eating it,” he grins. “It’s fantastic to be able to meet the surgeons on the frontline. And to be able to say ‘I know what you’re going through, I’ve been there’.”

David’s Zoom course has now been viewed by more than 1,300 surgical professionals in Ukraine - Emre Caylak
David’s Zoom course has now been viewed by more than 1,300 surgical professionals in Ukraine - Emre Caylak

We are talking today at St Mary’s where he has worked for 30 years. Nott is in scrubs, ready to go straight into action if summoned (he is on call for trauma surgery today – “stabbing injuries more often than not,” he says, sadly. “There’s an epidemic of it.”)

The Hostile Environment Surgical Training Course is amalgamation of everything he has learned distilled into a five-day programme. He is now, he admits rather ruefully, more “front of class” than “frontline”. “I’ve always been on the frontline, but I’ve got a family to look after now. And this course is the best way to deliver the teaching to frontline surgeons.”

His most important ally is Heston, a replica of a 6ft man made of silicon, with flaps to access his insides. “You can open his abdomen, his head, his neck, his face; you can do plastic surgery on him or take skin grafts.” There are organs made to Nott’s specifications – a heart, for example, that feels just like a real heart. Heston was enormously expensive to make (the actual cost remains secret) and there is only one of his kind, though plans are underway for a second one – maybe a Hester.

Heston does everything except bleed. He travels in a special bag accompanied by eight suitcases full of simulated body parts and special equipment – “without doubt the most important piece of kit that we have”.

David using Heston for a demonstration - Emre Caylak
David using Heston for a demonstration - Emre Caylak

So when Nott heard what was going on in Ukraine, he was determined to get involved. “I was fairly sure it would go the same way as Aleppo, because that’s the way the Russian military takes war to the people. I knew there would be shelling and that we would see a lot of blast injuries [such as lung trauma, shrapnel wounds and burns]. I wanted to train the surgeons how to deal with mass casualty [when the number of casualties exceed the resources available]. 

“Over my career, I’ve seen about 14 mass casualty events in war and they are always a disaster – people don’t know how to triage patients or work out how much equipment is needed.” 

But he had never been to Ukraine and he needed a way in. Although they had never met, he knew that Marsh had been to the country many times and worked in hospitals there. He tracked him down and within 24 hours Marsh agreed to help.

“I wanted us to urgently give a Zoom tutorial about how to deal with blast injuries and all the effects of fragmentation wounds – fragments of shrapnel which penetrate the body. If survivors come into hospital, they’ve got a chance, but if the doctors don’t know how to treat them, they will die.”

David Nott - Emre Caylak
David Nott - Emre Caylak

He and Marsh worked around the clock to condense a three-day course into 12 hours (and translate it into Ukrainian). Three days after he had first met Marsh and 10 days after the war had started, they ran a live Zoom session. In fact, they ran it “until I couldn’t speak”, says Nott. 

It was a huge success. Thanks to Marsh’s contacts, they managed to reach 573 surgeons all over Ukraine with the live session, which has now been viewed by more than 1,300 surgical professionals. “It has everything – burns, plastic surgery, abdominal surgery, vascular surgery, head injuries, blast injury – so they can just refer to it whenever they need it.” 

In April, Nott decided he had to go to Ukraine himself “to see what I could personally do to help”. He undertook a three-week trip – to Kyiv, Zaporizhzhya, Dnipro – working with UOSSM International (Union of Medical Care and Relief Organisations) which provided him with support and security. With its help, he has since done three trips there. In total he has trained 160 surgeons in person, assisted by Heston. The trips were gruelling and dangerous – long drives from Warsaw through uncertain territories, with cruise missiles and Grad rockets coming in every night in Kharkiv. But they were worth it, he says, and he plans to do more. 

He shows me some WhatsApp messages starting “Dear Dr David”, with reports of operations and pictures of patients who would have died without the training. Following one course, he says, a paediatric surgeon from Kharkiv operated on a 12-year-old girl who had fragmentation injuries to the chest: “They saved her life. They said that Heston was so realistic, it didn’t feel as if they were doing it for the first time.”

Heston has been an invaluable teaching aid - Emre Caylak
Heston has been an invaluable teaching aid - Emre Caylak

Nott and his wife Elly have two daughters of their own, aged seven and five. Shortly after marriage, Nott began to experience post-traumatic stress syndrome. Even now, he says, he can’t handle the memories of some of the things he has seen. It’s the terribly injured children who he struggles to get out of his head. “I couldn’t do the job I did 10 years ago, if I’d had children then. When I came back from Syria, I was severely affected. And sometimes, when I’m in an airport or something and I hear children crying, it brings it all back.” 

He is visibly moved when talking about the children. In his book, he writes about a little girl in Haiti who was orphaned and badly injured by the earthquake. She needed to be flown to Britain for life-saving surgery, and Nott refused to leave the embassy – the security men were literally prising him off the chair – until they had given her a passport. She was successfully treated and adopted by a family in Leicester and he still keeps in touch. 

Nott is an extraordinary man, who has witnessed the absolute worst of human nature. Is he still able to be an optimist? “Totally. If I was a pessimist I’d never be able to do what I do. You can always make things better for people.”

Click here for more on the David Nott Foundation

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