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Larrey’s flying hospital

BMJ 2008; 337 doi: (Published 21 October 2008) Cite this as: BMJ 2008;337:a2231
  1. Tony Delamothe
  1. tdelamothe{at}

    “Why do people always expect me to talk about what’s wrong in the Middle East?” asked Daniel Barenboim. “This is what’s right with the Middle East,” he answered, indicating the orchestra he’d just been conducting through a programme of Haydn, Schoenberg, and Brahms. The orchestra was the West-Eastern Divan Orchestra, founded by Barenboim and Palestinian academic Edward Said in 1999 and made up of young musicians from Israel, Palestine, and various Arab countries. Their goal was to enable a dialogue between the various cultures of the Middle East. Visiting the BBC Proms this August, the orchestra received tumultuous applause—for the quality of its playing, certainly, but also for its aspirations.

    What’s this got to do with medicine, you might well ask. It’s a question I asked myself during the Schoenberg, as my attention began to wander. What would a medical equivalent of a West-Eastern Divan Orchestra look like? I got as far as thinking it would be a hospital somewhere, staffed by Israeli and Palestinian doctors, training Israeli and Palestinian medical students, and treating Israeli and Palestinian patients. Health care would be the beautiful music they would create together.

    A glimpse at the concert programme snapped me out of my reverie. The orchestra is not based somewhere straddling the main Middle Eastern cultures, like Jerusalem, but in Seville, Spain. Its very first concert in the Middle East, in Ramallah, Palestine, had to wait until 2005. Far from being accorded any privileged status as artists, the musicians’ association with the orchestra apparently jeopardises their safety—their names had been omitted from the programme at their request.

    So, not a promising model for my middle eastern medical institution, I concluded, and I dropped that line of thought as the Brahms began. How arrogant (or just plain stupid) to think I might have anything to offer this afflicted region (doi:10.1136/bmj.a2225).

    And then, two months after the concert, I read the blog of Ohad Oren, a fourth year medical student in Israel ( During his medical school’s ceremony to mark the transition from the preclinical to the clinical years, Oren found himself reflecting on the life of military surgeon, Dominique Jean Larrey (1766-1842).

    It wasn’t Larrey’s flying ambulances for the speedy evacuation of battlefield casualties or his concept of triage that most impressed Oren. It was his practice of collecting injured enemy soldiers, as well as his own men, and treating them as best he could.

    Larrey’s actions left Oren feeling guilty: “I was fully aware of the severe humanitarian crisis on the other side of the border, and I had not even tried to make a difference in the horrible daily scenario faced by the citizens of Gaza.” So he suggests building a hospital on Israel’s side of the border, a few minutes from Gaza, with as many nations as possible lending a hand. It would be named Larrey’s Flying Hospital in recognition of the surgeon’s idea for battlefield ambulances. It would have enough drugs and beds, and operations would be performed undisturbed.

    The final message of Larrey’s story, as Oren points out, is that the life you save may be your own. Although captured by the Prussians at the Battle of Waterloo, Larrey evaded the death sentence. It turned out that one of the soldiers whose lives he had saved was the son of the Prussian Field Marshal, von Blücher. Larrey was treated with respect, offered food and money, and allowed safe passage home to France.


    Cite this as: BMJ 2008;337:a2231

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