Dear Professor Domres,
Your professional focus lies in traumatology and disaster medicine. Disaster medicine is an interdisciplinary field, encompassing numerous medical disciplines such as surgery, internal medicine, infectious diseases, anesthesia, and gynecology. It is therefore not only about surgical interventions in war or disaster areas but also about topics such as epidemic control, public health, and care in refugee camps.
About your person:
You have been a Professor of Surgery at the University Hospital of Tübingen from 1980 until your retirement in 2003. From 1985 to 1988, you also led the surgical department of King Khaled Hospital in Hail, Saudi Arabia. In the Nafud Desert, you had the opportunity to accompany a Bedouin tribe over a period of four years, gaining close insight into Islamic culture and the local knowledge of desert inhabitants.
Since 1975, you have been involved as a medical professional in numerous humanitarian missions during disasters, including in Nigeria, Cambodia, Lebanon, Armenia, Pakistan, and many other countries. You are the President and one of the founding fathers of the German Institute for Disaster Medicine and the Foundation of the German Institute for Disaster Medicine.
In 2012, you were appointed President of the newly established Sino-German Institute for Disaster and Emergency Medicine at Tongji Hospital in Wuhan, China. In 2011, you received the “Physician of the Year” award, and in 2012, you were honored with the Federal Cross of Merit, First Class.
And although you are not yet 90 years old, many people see you as a worthy representative of the tradition of Albert Schweitzer, who himself continued his work in Africa even at the age of 90.
Personally, I am inspired by your positive attitude toward life, your inventive ability to improvise under difficult conditions, and your warm, human nature.
Please allow me to ask you: What does your work mean to you?
My work means a great deal to me because it has not only broadened my professional horizons but has also enriched my personal life. A good example of this is my time in Saudi Arabia, which became a very special experience.
During my time as Chief Surgeon at King Khaled Hospital in Hail, I had the opportunity to immerse myself more deeply in Arab culture. One of my hobbies, archaeology, led me into the Nafud Desert, where I discovered millennia-old rock engravings. These engravings date back to a time when the area was still a savannah, around 2000 BCE. I made efforts to classify the engravings both chronologically and stylistically, which eventually resulted in a book that I published many years later.
A particularly memorable story from that time is a lecture I was invited to give by the German ambassador in Riyadh. It wasn’t easy, as photographing the engravings was officially forbidden. In the end, I was still allowed to show my pictures, and the lecture at the German embassy turned out to be a success. These experiences have profoundly shaped me.
I now consider my time in Saudi Arabia to have been a gift, even though it was not easy at first. I learned the Arabic language, gained deep insights into Islam, and was fortunate to live for four years in an oasis in the desert. This gave me a new perspective on life. I often think of Albert Schweitzer, who also chose extraordinary paths, and of his motto: “I dare” – Attempto. Incidentally, this is also the motto of the University of Tübingen.
“Daring” has always been a part of my life and my work, whether in disaster areas, in war-torn regions like Cambodia, or during humanitarian missions. Despite all the risks and challenges, I am grateful that I have always emerged unscathed, apart from a bout of malaria.
My work has shown me how precious life is and how important it is to help other people. For this, I feel a deep sense of gratitude.
Were you able to bring your wife with you during your time in the Nafud Desert, or did you have to spend those years apart?
No, unfortunately, my wife could not accompany me to the Nafud Desert. The conditions at that time were very challenging, both medically and in terms of infrastructure. There were hardly any opportunities for a shared life on site, and my work at the hospital required my full attention.
During that time, we were only able to see each other once a year, which, of course, was not easy for either of us. It was a challenge, but it also taught us how important cohesion, trust, and mutual support are in a partnership. Despite the physical distance, she was always with me in my thoughts and supported me in everything I did. For that, I am endlessly grateful to her to this day.
Such a stay and the associated work undoubtedly require a great deal of courage. Our section is titled “Medical Heroes”, and I believe it fits your life story perfectly. Therefore, I would like to ask: What does the term “hero” mean to you? And in what ways would you perhaps consider yourself more of a pioneer than a hero?
My fundamental attitude is one of gratitude. I have been given so much in life, starting with my family, my wife, and my children, but most importantly, my health.
As for the term pioneer: yes, in a way, I would consider myself a pioneer. In many situations, I was unafraid, even during dangerous missions like the Cambodian war in the 1980s. At that time, during the Pol Pot regime, I was deployed as a senior physician for the International Committee of the Red Cross. It was anything but safe, but I was not afraid, perhaps because I knew deep inside that it was the right thing to do.
When you describe it like this, I can only partially imagine what those situations must have been like. However, I could imagine that there were also moments of doubt, sadness, or even failure. How did you deal with such challenges?
I always remained healthy, apart from a case of malaria. During the missions, we often worked without stopping, frequently in tropical climates, and there was barely time to eat. I remember losing 14 kilograms during that period.
A particularly meaningful event for me was when my wife visited me. This was very important to me. I was in Cambodia several times and even had the honor of meeting His Majesty King Sihanouk personally, which was a great privilege. For this reason, I am now the Honorary President of the German-Cambodian Society.
But I must admit that there were moments of exhaustion. I felt symptoms of burnout syndrome, although one only speaks of a syndrome when the exhaustion persists. I realized that I had to pull back because, in such situations, you begin to question ethical principles that are actually important to you. Something happens in your mind when stress takes over.
But I was lucky. I did not develop post-traumatic stress syndrome. I was able to recover relatively quickly and regain my health. Still, in those moments, I felt what it means to be under extreme stress. It was an important experience for me, which also showed me how crucial it is to take care of oneself.
What differences in the perception of health and illness have you observed in various cultures?
That is a difficult question, but a very interesting one. I have worked in many parts of the world: in Cambodia, in South America, during the earthquake in Haiti, in Nigeria, and repeatedly in the Congo. Naturally, I have experienced various perceptions of health and illness in different cultures.
Personally, I have been fortunate to always have a strong immune system and to be resilient mentally. Although I once had malaria, particularly during my time at a mission hospital in Africa, I always remained fit for duty. Back then, I was the only surgeon on site and had to continue working even under these conditions. After all, lives were at stake, for example, during cesarean sections, especially in Nigeria, where the rate of twin births is the highest in the world.
I remember a case where I had to perform surgery despite a severe malaria attack. My body was shaking so violently that they practically had to hold me still to finish the operation. Afterward, I was taken to a darkened room, malaria feels as though all your limbs are broken, and the pain is almost unbearable. But after three days, it was over again.
Despite these experiences, I hardly felt a sense of suffering and always found the strength to carry on. Perhaps it is my immune system or my mental resilience that has allowed me to process illnesses better and remain able to work.
With all the experiences you have gathered and the relationships you have been able to build worldwide, your work can certainly be viewed through the lens of diplomacy. A key skill in diplomacy is the ability to listen carefully to others, a skills you have undoubtedly practiced extensively through your work in various cultures. In this context, I am particularly interested in the following: How can traditional knowledge, such as that of the Bedouins, which you were able to learn during your four-year accompaniment of a tribe, be integrated into modern medicine? Is this possible, or are these two worlds irreconcilably opposed?
Yes, these are life experiences that have shaped me profoundly.
During my time with the Bedouins, I learned a great deal about medicine using simple means. In the desert, there is no electricity, no modern devices, or facilities as we know them. The Bedouin chief is something of an all-rounder. He takes care of everything. He slaughters and sells animals, treats family members when they are sick, and even performs surgical procedures when necessary. That impressed me deeply.
One example of this is the following. In the desert, we tested lung function, but without technical equipment. Instead, we used a simple candle. If a patient was able to blow out the candle from a distance of one meter, it was assumed that their vital capacity, meaning their lung volume, was within the normal range. In our world, this would be measured with large machines, but the Bedouins demonstrated how one can achieve practical results using improvised methods.
Like I have mentioned, the Bedouin chief fulfils many roles: He is a doctor, midwife, judge, and defender of his family. This stands in contrast to our Western culture, where professions have become increasingly specialized since the Middle Ages. While here everyone focuses solely on a single specialty, one makes shoes, another sews clothes, the Bedouin must master everything.
This experience showed me that traditional knowledge and simple solutions can often be surprisingly effective, especially in environments where modern resources are not available. To witness and understand this was a tremendous gift for me.
What you describe is fascinating and strongly resonates with the concept of frugal innovation, the ability to innovate under significant constraints and limitations, using human ingenuity. In your experiences, you have seen individuals with interdisciplinary skills, overcoming complex problems. Can you name a specific innovation or method that you consider particularly revolutionary in disaster medicine?
That is another story I like to tell.
Back then, during the Pol Pot war, we worked under extreme conditions. Often, we had to work for 14 days or even 3–4 weeks, day and night, without breaks, Sundays, or holidays. There was no internet back then, and the main injuries we treated were limb injuries, particularly open fractures, which were very common in the war situation. More severe injuries to the lungs, abdomen, or head rarely reached our aid stations or field hospitals.
The classical treatment for such open fractures at the time was the use of traction splints. However, this presented a significant problem. If the field hospital had to be relocated for safety reasons, which happened frequently due to repeated attacks, patients who were immobilized in traction splints could not be transported.
Under these difficult conditions, we had to improvise. So, we began to create the fixateur (external fixator) using the simplest materials, such as bicycle spokes. This improvised solution was surprisingly effective, inexpensive, and highly adaptable. This method is also known as “surgical stabilization from the outside.”
With our improvised fixator, we were able to stabilize fractures without immobilizing the patients, which not only allowed for better treatment but also enabled safe and efficient transport of the injured when the situation required it.
For me, the fixateur was a true revolution in disaster medicine. This method greatly helped us under these challenging conditions. Its unique value lies in the fact that it costs almost nothing and can be implemented with simple materials, often with readily available items such as wood or metal.
This is truly impressive. Let’s perhaps elevate the topic to a broader level. In Europe, despite all challenges, we still have the great luxury of resources being more readily and frequently available compared to many “developing countries”. In this context, I would like to ask: What challenges do you see for Europe regarding medical technology and innovation, particularly in light of your extensive experience and background knowledge?
Yes, that is a very interesting question. Although I have been retired from active university medicine for 20 years now, I still give lectures, conduct examinations, and follow developments in medicine closely. What truly fascinates me is the immense progress that medicine has made during this time, often to the great benefit of humanity.
For me personally, it is an incredible thought that we may one day succeed in defeating cancer, in truly curing carcinoma. This seems increasingly within reach, and I follow these developments with great curiosity and hope.
However, despite all these impressive technological advancements, I have a certain fondness for the simple things in medicine. The progress we are witnessing is increasing almost logarithmically in speed and scale, and yet we must not forget that there will always be situations, such as in disaster areas or during resource shortages, where we need to rely on simple, pragmatic methods.
I think of improvised tools like the fixateur that I used in my work. Even with all the technological innovations, which I may not have entirely kept up with in recent years, it remains crucial to keep grounded solutions in mind. In a world where not everyone has access to the latest technology, simple methods can often make the decisive difference.
That is very exciting. I have one more question on a macro level, specifically regarding Europe. How do you see the future of disaster medicine in light of the challenges posed by climate change? And what role do you think non-governmental organizations (NGOs) play in this context?
Yes, that is a very important question. In disaster medicine, our goal is always to manage a disaster; however, by definition, a disaster is a situation that cannot be fully controlled.
The critical point, and this is often overlooked, is the chaos phase, the first 6 to 8 hours after a disaster occurs. During this time, when no organized aid is yet on-site, most lives are lost, and the number of casualties decreases logarithmically afterward. If we truly want to make improvements, we must focus precisely on this chaos phase.
The key here is risk management. Countries that are particularly at risk, whether from earthquakes, volcanic eruptions, or other disasters, must be empowered to act independently and immediately. This means they need both the training and the tools to save as many lives as possible during the chaos phase. It is not about controlling the disaster but about responding effectively during those crucial hours. Currently, the focus often lies on the quality of aid. Teams from highly developed countries are deployed, but they require time to examine the situation and only then begin to act on-site. Unfortunately, this is often too late. The problem is this: the more we prioritize quality, the more we lose speed.
The solution lies in enabling affected countries to respond quickly on their own. Only in this way can they intervene directly during the first, critical phase and provide immediate help. It is not a question of quality but primarily of speed. Highly developed countries cannot cover the chaos phase alone if they must first travel to the affected areas, often in the developing world.
In summary: We need to focus on the chaos phase, address risk management where it matters most, and train and equip countries with high disaster risk so that they can act immediately. From my experience, this is the most effective approach to saving lives.
In your opinion, what can policymakers do specifically to better promote and sustainably fund disaster medicine?
Yes, if I may put it this way: for a long time, Germany was the only country in Europe where disaster medicine was not taught at universities. This was a chapter that I particularly took on. In other countries, there are universities where one can study disaster medicine, but this was not the case in Germany for a long time.
The reason lay in our historical past. After the lost war and the guilt we had taken upon ourselves, Germany wanted to avoid anything related to war and crisis preparedness. There was a prevailing belief that the only conceivable disaster would be a nuclear war, and in that case, there would be no help anyway. Thus, the need for disaster medicine was categorically dismissed.
I argued strongly against this mindset, even in major forums, such as with the IPPNW (International Physicians for the Prevention of Nuclear War), which is globally active. I made it clear that we must teach disaster medicine to be able to provide effective assistance in case of an emergency. At the time, this was a difficult discourse, but I am pleased that the IPPNW has since begun to rethink its position.
A major breakthrough in Germany was achieved through the Protection Commission, of which I was a member. This commission consisted of scientists who analyzed what must be done during disasters or in case of war, and what gaps exist in the state’s preparedness. It was this work that ultimately led to disaster medicine being integrated into the licensing regulations for physicians. Today, it is an elective subject at universities and can also be chosen as an examination subject.
For me personally, this was an important goal that I achieved, of course, together with others. It demonstrates that policymakers can actively contribute to promoting disaster medicine by ensuring its integration into the education system and providing the necessary funding to advance training and research in this field.
At the beginning of the interview, we tried to look at two levels. On the one hand, how you looked within yourself, with all the experiences, doubts, and challenges you have overcome. On the other hand, we considered your environment, and how your work has impacted so many different individuals and regions. Now, in the final part of our conversation, I would like to encourage you to look beyond yourself. In this context, the question of faith and one’s actions quickly arises. Therefore, I would like to know: What role has your personal faith played in your decisions and your actions?
My personal faith has always played an important role in my life and my decisions. My father was a deacon in Bethel, a Christian institution, as you may know. Back then, it was customary for marriage proposals to be suggested there, but my father had already met my mother and wanted to marry her, which he did. This decision caused a certain rift between him and the church, though he never lost his faith. Both my mother and father were deeply Christian but, at times, had distanced themselves from the institutional church.
I, myself, am a child of war, born one year before the war began. During the bombings in Dortmund, the two eldest of my five siblings were sent away, and I had the good fortune of going to my aunt in Neuwied. She not only took me in but also had me baptized when I was six years old. After the war, I returned to my family in Dortmund. While my siblings played football on Sundays, I attended church services and later even helped with Sunday school.
A major influence on my faith was our pastor, an impressive personality who supported me greatly. We were a poor family, and when I wanted to visit my aunt, he paid for my travel. It was also he who brought my parents closer to the church again. They then became actively involved in youth work.
Of course, there are moments of doubt in life. I, too, have wondered whether it makes sense to continue paying church taxes. But my confirmation verse still accompanies me to this day: “Continue in what you have learned and have become convinced of, because you know those from whom you learned it.” This Bible verse remains a constant in my life, reminding me of my faith.
Therefore, I cannot and will not leave the church. I may be extremely conservative in this regard, but the wisdom and support of my former pastor shaped me deeply. For all of this, I am very grateful. My faith has always been a pillar of support in my life, providing me with guidance and strength, both personally and in my professional actions.
Were there moments of existential closeness to the transition between life and death, and if so, what insights about life were you able to gain from them?
Yes, as a trauma surgeon and through my experiences in war surgery, I had to confront death many times. This is a trauma that affects all of us humans, the realization that our lives are finite and that we will not live forever. Now, at 86 years old, I think about it more often, and it remains something that occupies me, and at times, I do suffer from it a little.
Nevertheless, I was fortunate to have a very special experience for which I am deeply grateful. I lived in the desert for four years. There, in the midst of solitude, under the starry sky at night, you feel something that is difficult to put into words. It is as if you become part of the cosmos, embedded in nature, without borders, without fences, just vastness. In the desert, there is no limitation, no stagnation, you can reach any place. It is only uphill, downhill, or through the sand.
I often slept outside, sometimes a fox would even visit, and on those nights, I felt at one with nature. It was as if I could transition into this environment naturally, without any fear of dying. That experience was a true gift for me. The desert was the place where I could accept the transience of life without feeling fear.
Interestingly, this feeling of calm and connectedness fades as soon as you return to the fast, industrialized world. Here, death suddenly seems more threatening, and the fear of impermanence grows. Yet my time in the desert showed me that we are part of something much greater, and that realization has brought me peace.
To conclude, I have one final question for you. Let’s end, if possible, on a joyful and positive note. What insights have you gained on your life’s journey that were particularly significant for your personal growth and for your service to the people you have had the privilege to accompany? What was especially important to you, and which moments do you recall with joy and positive energy?
The most important insight I have gained on my life’s journey is that one must always remain humble and never show arrogance. I am influenced by ancient Greek philosophy, and for me, the greatest evil is hubris, the belief that humans know and can do everything, including rejecting God. That is why I say: humility is the most important thing. It means stepping back, meeting others at eye level, regardless of their background or status.
Throughout my life, I have had the privilege of interacting with people from all walks of life. I was fortunate enough to meet King Sihanouk of Cambodia in person. Moreover, I served as the personal physician to Prince Muqrin, the First Crown Prince of Saudi Arabia until 2015. These were extraordinary encounters, but equally significant to me were the simple, everyday people: the beggar, the disabled person, the locksmith, or someone without a profession or suffering from illness.
What is important to me, and what I view with joy and positive energy, is the equality of all people. Whether someone stands at the top of society or at its margins, in the end, we are all human. We should remain humble and grateful for what we have been given and for the life we are fortunate enough to lead.
Dear Professor Domres, I would like to hold this as the closing remark. I thank you for the time you have given us and for the interview.
The interview was conducted and documented virtually on December 13, 2024, in German. The translation into English was carried out with the support of a professional translation service.
