Life and death

At work yesterday we were invited to hear a lecture by a surgeon, David Nott, who has worked for several decades with the International Committee of the Red Cross, Médecins Sans Frontières and the British military. His talk on the challenges of performing surgery in war zones was accompanied, to the audience's discomfort, by graphic colour slides. The places where he has worked include Bosnia, Iraq, Afghanistan, Gaza, Yemen and Darfur, and he expects to go to Libya soon. He mentioned casually that he had once operated on Osama bin Laden for kidney stones: "If the ICRC weren't so strictly apolitical, I could have changed the course of history."

Some of Mr Nott's grimmest stories came from Gaza and Yemen -- not only because of the horror people have inflicted on each other there, but because the surgeons had so little equipment and medicine to work with. Haemoglobin was measured by holding a blood sample up to the window and comparing its colour with a chart. The surgeons were forced to practice "advanced triage," meaning that they simply did not treat people with certain types of injuries (like severe head wounds), because they knew they didn't have the resources to save them. In Yemen, in addition to treating war casualties, the doctors had to perform numerous Caesarian sections on women carrying children with hydrocephalus or spina bifida; Mr Nott didn't know why such defects were so common in the area. To make matters worse, he told us that MSF were eventually forced out of Yemen, and the hospital where he'd worked was bombed shortly afterward. Many of the patients and native staff we'd seen in his photos, he said matter-of-factly, had died in that attack.*

But worse even than that was Darfur. Here, too, the doctors performed many Caesarians, this time on women and girls -- some very young -- who had been raped by the janjaweed. The operation itself could be performed fairly easily, but virtually every woman there was suffering from malaria, which causes severe anaemia. With no transfusions or clotting agents available, the mothers died from blood loss. One photo from Darfur showed a French surgeon scribbling on a notepad. "This is a living hell," he had written. "We are in a living hell."

In Afghanistan, of course, the military hospitals are far better equipped. In fact, 98% of wounded soldiers who make it to the operating table survive. This is despite sickening injuries -- we were shown pictures that my brain could barely take in. One man had had practically everything below his waist blown off by an IED: legs, genitals, intestines, everything. He lived. But Mr Nott wondered out loud whether saving the life of a horribly mutilated person was always the best choice. "We all die one day," he said. "Maybe it's better to die with some dignity."

* Despite all this, pretty much the only pleasant images I saw during the lecture were -- to my surprise -- the establishing shots of Yemen's scenery. With all the terrible news I'd heard from Sana'a, I certainly didn't expect it to look like this.