Since the fall of the Assad regime in December 2024, Syria's borders have opened, and in April, our team of Faculty surgeons ran our first ever Hostile Environment Surgical Training in Aleppo.
Against a backdrop of destruction and severe shortages of even the most basic medical supplies, 24 surgeons travelled from Raqqa, Tartus, Idlib, Homs, Hama, Damascus and Al Suwayda to attend the course.
The surgeons – whose specialities included neuro, vascular, urology, orthopaedic, maxillofacial and general surgery - spent five days training with the Foundation’s Faculty members in the first HEST® training of this kind in Syria.
DNF partnered with Action for Humanity, UOSSM, the Syrian Ministry of Health and Aleppo University School of Medicine to run the course, which featured Heston® and other state of the art prosthetic training equipment. The training was delivered by our local Syrian Faculty in Arabic, and supported by UK Faculty leads Dr Ammar Darwish, Dr Pippa Letchworth, Dr Saladin Sawan and Dr Mahmoud Hariri.
Consultant Surgeons in Gynaecological Oncology Dr Pippa Letchworth and Dr Saladin Sawan ventured to Idlib during the HEST® course, where they spent 3 days and performed 10 operations on gynaecological cancer patients. The hospital was supported by SAMS.
Dr Sawan explained: "In addition to delivering this treatment to patients, we focused on enhancing knowledge decision making and surgical skill capabilities of doctors in Idlib with 4 consultants and about 13 residents."
Syrians have been through unimaginable hardship since the conflict began in 2011, and even since the fall of the regime, the situation has been dire.
Dr Mohammad Jazaely, a general surgeon from Damascus Hospital, Al-Mujthid, said: “The hardest experience I went through was on our liberation day on 8th December. There were many injuries, and we had to work with limited resources. In the span of 48 hours, we carried out around 40 laparotomies. Eventually, we ran out of resources. So, we had to make do with what we had.”
For Dr Jazaely, his commitment is unhindered despite the incredibly difficult conditions.
“I love working here, because at the end of the day, this is my country, and these are my people. For this reason, I must give everything I can, and I stayed here in the country."
Hospitals are dilapidated, dirty and crowded, with constant power cuts. There are very few anaesthetists in the country and there is a shortage of all surgical specialisms. Health care workers are exhausted, and morale is low. But Dr Jazaely explained the impact of the course.
"This is the first time we've had this kind of training in Syria, honestly. They're very high-level trainings. The reason is that the trainers are specialists in this field. They've worked hands-on in war zones across different regions."
Medical professionals are also facing a huge number of injuries as a result of landmines. Dr Mohammed Al-Sednawi, General Surgeon from Damascus said: “The most difficult situation we were working on was the landmine injury, because it affects a lot of civilian people, who weren’t involved in the war. So, they come to the emergency sector and they go to the operating room, where there were no resources, such as sutures, and a lot of decrease of resources and suction tubes — a lot of suffering in our operating room.”
Dr Abu Mohammadain, a urologist from Aleppo, worked with our Co-Founder David Nott over a decade ago when they worked together during his first visit to Syria in 2013, and again in 2014. "It was truly a major opportunity for us as surgeons. We didn’t have much experience with war injuries, disaster injuries, or trauma cases. And, thanks to God, the results of that direct engagement with Dr David were outstanding. It helped us save lives, improve patients' outcomes, and reduce disabilities caused by war injuries."
During this time, our Co-Founder was working alongside our Faculty member, Dr Mahmoud Hariri in Aleppo hospitals, risking their lives to save others. It was a seminal moment for him to run this course.
Dr Hariri said:
“This is a historical moment. This is the first course run in Aleppo. This is the first course that has been done for them - the first time seeing such type of demonstration, simulation, practical course rather than just theoretical information. I believe that such course should be run many times, until feeling that most of the surgeons have some experience in trauma cases in this country.”
Our Medical Director, Dr Ammar Darwish, was invited to join the panel on Humanitarian Surgery at the ASGBI (Association of Surgeons of Great Britain and Ireland) Annual Congress, and to lead two half-day training sessions as part of the Pre-Congress Training Village.
Ammar delivered training to 30 participants over the two courses, who were able to learn more about how to deal with major trauma, both blunt and penetrating injuries, that are common in patients on the frontline.
These two training sessions focused on Cardiothoracic and Abdominal Trauma, and mirror closely what we teach in our HEST® course, through a lecture, presentation of real-life cases seen by our faculty and an opportunity to get hands-on practical experience making use of the prosthetic organs and Heston® to build skills, knowledge, confidence and proficiency.
These types of training sessions allow doctors in training to gain some insight into the world of humanitarian surgery and continues to shine a light on the training needs of those doctors living and working on the frontline.
I was training surgeons on chest trauma and abdominal trauma and I gave a talk about training surgeons in conflict zones and the work of the DNF which had a huge positive impact on the audience who where surgeons and trainees from the UK and overseas.
We’re often moved by messages from readers of War Doctor – David’s written account of over 25 years of volunteering surgical skills on the frontline. But sometimes, a story comes along that reminds us exactly why we do what we do, and resonates so deeply that it feels important to share.
Anastasiia, our inspiring Ukrainian supporter, shares how War Doctor changed her perspective on conflict, deepened her empathy for others, and helped her find purpose in uncertainty.
"This book… I don’t know, it’s something special, something that came into my hands at the right time and in the right place. I’ve read many books in my life, and I’ve never been interested in surgery or war stories. But when war came to my home, and I had to leave everything I was used to and everything I held dear, I finally decided to read this book – one that had come to me long ago and quite by accident. I just bought it in a supermarket in Ukraine when my mom and I were planning to attend a first aid course at the very beginning of the war. I had no idea what this book was really about.
At first, it was hard to read because I’m quite a sensitive person, and reading about injuries or surgeries was difficult – I’d start to physically feel pain. A neighbour even joked that sometimes my face looked like it had “subtitles” for the book – “Caution: I’m in shock.” It probably took a month before I could really get into it – I just couldn’t read it sometimes, even though I was curious.
Then one day, I got stuck at an airport for 12 hours after my last visit to my family, and knowing I had no way out, I opened the book I had brought with me – and it suddenly became so engaging and easy to read that I read almost half of it that night.
That’s how my journey with David Nott’s story began. Everything – from his bravery, dedication, and honesty, to the incredible resilience of his wife – deeply moved me.
When I got temporary shelter in Austria, I found myself surrounded by many other refugees, including Syrians. We’re learning the language together now, and before this, I knew nothing about their history or the horrors they had lived through. When we were all sharing our stories, some of them said they walked here on foot – and I was shocked. After reading this book, I began learning about many other armed conflicts I had only ever vaguely heard of, reduced to the phrase “there’s a war going on somewhere over there” – and that was it. I couldn’t empathize, and I couldn’t help.
When I finished the book, I sat in silence for a while, just thinking that I also want to be useful to people who’ve gone through things like this. I have to admit, I’ve faced many challenges in Austria. One of the hardest is that people don’t understand and don’t even want to try to understand that I’m here not because this was the dream of my life, but because circumstances forced me. I wasn’t prepared for this, and that’s why I don’t speak German. A lack of knowledge and an unwillingness to know what others have been through makes us cruel – and that’s what happened to many people here. Even though I’ve been living here for over a year, I still sometimes cry out of frustration, because my home and the future I wanted – a peaceful youth, my dreams – were stolen from me.
But before this, looking at my Syrian classmates, I too was cruel in my own ignorance. I didn’t want to know their stories, and I wasn’t interested – even though I myself had lived through war, and should have had more compassion for others who had suffered the same.
In the end, I just want to say this book gave me hope – both in my personal situation and, together with everything I’ve been through.
"War Doctor made me realise that no matter what happens, even one person, if they have good intentions and a strong will, can change the world."
Stories of people like Martin Luther King and Mahatma Gandhi always felt distant – in far-off places with different rules and ways of life. But this story felt like it was here, close to my heart in every way.
This is how this book turned my world and my detached way of living into a desire to be part of those who live to help others. I’m still looking for the field where I can do that – but I know for sure that I don’t want to stand aside anymore."
"The book opened my eyes, heart and became a direction – helped me make a choice in life. It shaped what I want to do and how to relate to the horrors around me.”
David’s Book War Doctor is available below.
Surgeons and anaesthetic surgeons from regions all over Ukraine gathered in Lviv, in late March and early April, for two HEST® courses delivered by our foundation.
Against the backdrop of continued trauma for the country, as Russian attacks intensify, our focus was to deliver our bespoke Hostile Environment Surgical Training courses: HEST A™ and HEST®, and to identify and train potential instructors - localising the teaching and the skills for the long-term future.
Faculty lead for anaesthesia, Ian Nesbitt, who trained in our HEST A™ course, said: “Every time we come and deliver training, we identify people who we think have potential to be instructors and to be Ukrainian faculty members. They're incredibly impressive people. They have enthusiastically come back again and again, and we have trained them in some teaching techniques, and we've taught them with the exact skills that they use on this course, and they are now basically starting to run the courses themselves.”
Our foundation has been training surgeons in Ukraine since the war began over 3 years ago. In late March, 33 participants and 14 Instructor Potential candidates gather for the 5 day course. Uliana Kaschii a doctor and anaesthetist, originally from Mariupol is one of the Instructor Potential candidates. She was working in the frontline when she first heard about our HEST courses in 2014 and is now leading many of the trainings herself.
I came to do this course as an IP, and the last couple of months I felt a little burn out from the medicine, because I was really tired, I’ve been coping with a lot of stress, and I didn’t feel a lot of motivation from my environment, and the first day I came here I got this motivation for medicine again – yesterday I agreed to go to the front line again.
“From participating as an Instructor Potential, I like to see how the knowledge is spread, how we improve the anaesthetics field in Ukraine. In general I see the people who want to improve medicine and develop anaesthesia, and improve the care of the patient, and I love to see that in this course and see that we are moving somewhere in medicine.”
Our second course, HEST® for surgeons in early April, trained 39 participants and 5 Instructor Potential candidates.
Yaroslav Kulachek, a Ukrainian frontline surgeon and IP told us one of the most difficult things is working under fire, under missile strikes. “You have to perform the triage and you have choose who will live and who will die, because we don’t have the capacity. One of the most difficult is when you deal with children, and a lot of casualties who come to you and you see they’re not ill but it’s a war - when one human being tries to hurt or kill another human being. It’s most striking for a person to understand how horrible a war can be and what scars and consequences will be left after this.
I want for this course to share my knowledge with surgeons, and to help them improve their skills for the battlefield area and for those who need the surgical help, and any other kind of help for soldiers, civilians, children, no matter where they will work and with whom they will deal."
Ian Nesbitt reflects:
We come, we teach, we go, we leave echoes behind us. And those echoes, I think, will grow and grow. They're like a stone being thrown into a pond. The ripples will keep going. And that, I think, is one of the very exciting things that ultimately, these ripples will keep going by themselves without us being here.
Scoping mission to Syria
Syria’s health system is on the brink after 14 years of devastating conflict. But since the fall of the Assad regime in December last year, the country’s borders are now open, which provided a vital opportunity for members of our team to visit and see how we can best support the Syrian people in a surgical capacity as they rebuild.
Last month, our Co-Founder and Senior Advisor Elly Nott travelled to Syria with three of our Lead Faculty members, Ammar Darwish, Mahmoud Hariri and Saladin Sawan.
Over the course of five days, in every major Syrian city – Damascus, Hama, Homs, Aleppo and Idlib, they visited teaching hospitals and cancer hospitals, and had meetings with a wide variety of health directorates including the ministry of health and the UN Health Cluster.
They also had the chance to meet Faculty trained by our Foundation – the first in 2013 in eastern Aleppo, and the most recent in Idlib in November 2024. We have trained over 250 Syrian medical professionals in that period of time.
For Saladin Sawan, Consultant in Gynaecological Oncology, it was the first time he had visited Damascus since 2010. As he explains in his video here.
"The overwhelming happiness to be back in my home country was mixed with emotions of pain about the state of healthcare."
Shortage of surgical specialisms
Hospitals are dilapidated, dirty and crowded, with constant power cuts. There are very few anaesthetists in the country and there is a shortage of all surgical specialisms. Health care workers are exhausted, and morale is low.
Prior to an operation, patients are given a list and told to buy the syringes, dressings and sutures needed themselves. At the specialist cancer hospital in Damascus, two children share beds meant for one.
“There’s a desperate need for training our specialist colleagues – since over the last 10 -15 years there has been an arrested development. But there’s a wonderful opportunity for the DNF to play its role in helping to rebuild Syria with our expertise in surgical training.”
We have delivered over 10 HEST courses since the conflict began, and Dr Sawan also ran many courses in emergency care and obstetrics for doctors and midwives, including surgical missions to perform gynaecological surgery, and training surgical residents and specialists to screen for and treat women with cervical cancer.
“At the time we were worrying when the next bomb was going to happen, whether I’ll be hit while I’m in the operating theatre. But today was a peaceful day, no such a worry.”
For Elly Nott, it was an opportunity to visit the M1 hospital in Aleppo where her husband and Co-Founder David Nott, together with surgeons including Mahmoud Hariri and Ammar Darwish, risked their lives to save others.
“They spent many, many weeks with the doctors operating alongside them and training lots of them. It's where the David Nott Foundation was born and when we met, it's where I got my inspiration to start the charity that is now reaching its 10th birthday.”
“That's where we come in at the David Nott Foundation, because we've been training Syrian doctors in places like this for 14 years, and it's now time for us to take the next step and move forward with Syria as it seeks to rebuild this beautiful, proud nation."
We will continue to support the people of Syria with our HEST®, Frontline Obstetrics Courses, surgical missions, HEST UK® and HEST Anaesthesia™
Our Foundation remains committed to supporting Syria in the rebuilding of its health infrastructure at this critical time.
Visit to Ukraine: the significant challenges of the present and what the next decade will hold
Travelling through Ukraine, its overwhelming cultural power is palpable and unavoidable. No amount of challenges, obstacles and setbacks, as evil as they might be, seem able to hold this nation back.
At the beginning of Russia’s full-scale invasion in 2022, our Co-Founder David Nott was one of the first foreign surgeons on the frontline. Kharkiv surgeon Prof Kyrylo recalls the reaction of his hospital directors, upon learning of the rumoured arrival of the world’s most famous war surgeon. “We do not need this so-called ‘expert’.’’ Prof Kyrylo knew that not to be the case. “I risked my head to get him into my Operating Room. I knew we needed him. I knew we had a fixed mindset in Ukraine. He changed us and so many owe their lives to him.”
In those early days of the full-scale invasion, David would operate with Prof Kyrylo and teach teams of surgeons whenever time allowed. Three years on, the Foundation has run 24 courses and trained 769 surgeons and anaesthetists in Ukraine. 15 of those Ukrainian doctors are now established David Nott Foundation faculty, delivering our courses alongside our teams of international faculty. This life-saving knowledge now has the opportunity to stay and to grow exponentially across all corners of this extraordinary nation.
My visit to Ukraine this week was focused on both the significant challenges of the present, and what the next decade will hold. I wanted to better understand how our Foundation can support the Ukrainian doctors, ministries, and medical institutions into the future. In essence, how can we ensure the knowledge cultivated within our foundation is shared over the next decade in such a way that allows Ukrainian doctors and hospitals to have the skills and resources to be self-sufficient? For this surely should be the long-term intention of all those in international development, wherever we work.
We can and will do a lot with what we have. But making a lasting change happen at scale may take longer. We are just one connection in a delicate balance of competing interests.
Not by design, my week in the country coincided with the much-publicised cuts to global health budgets. The immediacy of their effect was extraordinary to witness. Global health is a web of dependencies. Each link in the chain a vital but vulnerable connection. In Ukraine, the vast majority of these links rely at least in some capacity on the budgets of the WHO.
At a burns centre in central Ukraine, we visited a soldier who had sustained catastrophic burns to his face and his lungs. His life had been saved by the doctors there, three of whom had been trained by the David Nott Foundation. The soldier’s face no longer looked like a face. A charred, expressionless surface, with a tube going through a hole that was once a mouth. The tube connected to a machine that was breathing for him. The machine was donated by funding routed through the WHO. Each of these machines requires disposables, maintenance and expert knowledge to keep it going. It is now uncertain whether this machine can continue to be used, given the funding cuts that haven taken place this week. Pulling funding could mean pulling breathing tubes from the critically unwell soldiers and civilians injured in this war.
In 2023 we collaborated with the WHO in Ukraine for the first time. They saw the massive influence on surgical practice that our courses were having. They wanted us to do more. We have since delivered five courses with their funding assistance. Six more courses are scheduled for 2025. Courses that will train 180 doctors. The WHO informed us on Wednesday that the funding for these courses has been paused. This was not just a meeting with an international NGO. This was a meeting with Ukrainians fighting for their freedom and the health of their nation, using the power and solidarity of the international community to save the lives of injured soldiers and civilians. After our meeting I called my WHO colleague in Syria. His answer to my question about ambitious joint plans for this year in Syria was, by this time, inevitable: without funding, the David Nott Foundation can continue to support doctors and hospitals with our life-saving training, but not at the scale that these global crises demand.
Over dinner, a Ukrainian General reminded me of Winston Churchill’s quote:
“Gentleman, we have run out of money; now we have to think.”
We are blessed at the David Nott Foundation to have the support of so many extraordinary donors. We are not as vulnerable as many of the NGOs around the world. We can and will do a lot with what we have. But making a lasting change happen at scale may take longer. We are just one connection in a delicate balance of competing interests. If the global health community does not act fast to establish a new normal, breathing tubes, real and metaphorical, will have to be pulled out.
https://davidnottfoundation.com/donate/
Funding a Palestinian doctor for Paediatric trauma training
The conflict in Israel and Palestine has put Palestinian medical professionals under extreme pressure, and we remain committed to supporting them. Recently, we funded Dr Fuad Al Qadi, an anaesthesia specialist from Hebron in the West Bank, to attend a PACTS (Paediatric Advanced Cadaveric Trauma Surgery) course in the UK.
Hebron is no stranger to turmoil, and Dr Al Qadi, who has practiced anaesthesia for nearly a decade, commutes for hours daily between Hebron and Jerusalem.
"The situation is a nightmare, though not as devastating as Gaza, so one feels guilty to even complain. Frequent raids, countless checkpoints, and a complete lack of safety make life incredibly difficult. Traveling short distances takes hours, and for someone like me, who travels daily, it’s physically and emotionally exhausting. The humiliation we face as Palestinians is extreme, and the longer this continues, the worse it gets."
Building expertise to save lives
The PACTS course, organised by the Newcastle Surgical Training Centre (NSTC), is a two-day, hands-on workshop designed for surgeons, anaesthetists, and theatre nurses. It focuses on managing major trauma in children through practical cadaveric sessions, team decision-making, and communication under pressure. Cadaveric training is important as it provides a realistic and safe environment for participants to practice surgical techniques and refine their skills, ensuring they are better prepared for real-life emergencies. Topics covered include thoracic, abdominal, and head and neck injuries, as well as advanced techniques such as updated protocols for massive blood transfusions. Participants also engage in time-limited, scenario-based exercises to simulate real-life trauma situations.
“At the start of the war there were a lot of clashes between the Palestinians in the West Bank, the Israeli military and the Israeli settlers, and a lot of cases I could have saved if I'd had these skills. It feels like people - well children, actually, just died due to lack of expertise that I now have.”
Supporting healthcare in conflict
We’ve been supporting Palestinian doctors since our founding and will continue to do so. Funding doctors to attend courses like these will strengthen healthcare systems in war torn regions. In 2023 we also funded 2 Ukrainian doctors to attend this same course, who then returned to Ukraine and undoubtedly saved many lives in their homeland.
“I am truly speechless at the opportunity the David Nott Foundation has given me. This experience was incredibly rich and helpful. The team made everything as smooth and easy as possible, and I am deeply grateful for their support. Although I haven’t had the chance to meet David Nott, it’s clear even from the PACTS course discussions that he is an important figure in the field of conflict and trauma surgery. I hope to put these skills to good use and wish I could be in Gaza, where the need for surgical expertise is huge. Though sadly, as a Palestinian, I cannot go. Thank you to everyone involved, Kirstin, Hetty, and the whole team. This was no small thing for me or the Palestinian people.”
Support our mission in Palestine
End of year reflection from our CEO
As 2024 draws to a close, we must steal a moment for reflection. The relentless change in the character of conflict and catastrophe around the world makes it difficult to occasionally stop and think.
To think about the individuals and communities we have had the pleasure to connect with. To think about the supporters of the Foundation and all that they enable; our donors, our fundraisers, our partners, our trustees and the many volunteers. To think about our Faculty and my team, who put themselves at risk delivering training in some of the world's most challenging environments. And of course, to think about the 2158 doctors we have trained since 2015, and the patients they have subsequently treated. With safe, skilled surgical care, these doctors are bringing hope to so many.
Today, we think of the three Ukrainian surgeons who joined us for HEST-UK in Edinburgh a few weeks ago. They are back on the frontline and working 24/7 to save lives and limbs. We think about our Syrian Faculty, who have worked tirelessly since 2011 to mitigate the suffering of hundreds and thousands of victims in such a devastating war. We can just hope that, now the page has been turned on the Assad regime, new light is shone on this extraordinary country. This year, many of our Faculty members have traveled to Gaza, witnessing unimaginable horrors. We think of those in Gaza that are trapped in what seems to be a version of hell. I want to thank our Palestinian Faculty and partners for all they do to ensure the Foundation can play its part, teaching where and when possible.
The state of the world can feel overwhelming, but acting in ways that create tangible change can move us from hopelessness to hopefulness, and from lives lost to lives saved. I want to take this moment to thank you for providing that hope and for continuing to be a part of this David Nott Foundation family.
I wish you a very Merry Christmas and a Happy New Year.
With gratitude,
James Gough, CEO
Strengthening global surgical capacity through HEST-UK training
Building on the success of our partnership with the Royal College of Surgeons of Edinburgh (RCSEd) in June, where 24 surgeons were equipped with vital skills to save lives and limbs in conflict zones, we joined forces again this December to train an additional 23 surgeons. Our trauma surgery training in the UK (HEST-UK) aligns with RCSEd's broader mission to support global healthcare by equipping professionals to address healthcare needs in low-resource or conflict-affected areas.
Designed for medical professionals working in, or preparing to travel to, conflict and disaster zones, our HEST-UK course brought together participants from around the world. Surgeons traveled from as far as Hong Kong, New Zealand, Australia, Ukraine, and the USA to take part in this transformative week of intensive training.
The course provides comprehensive training in surgical techniques for managing injuries frequently encountered in conflict zones, such as blast and shrapnel wounds, with a dedicated focus on Obstetrics and Gynaecology during the final day. Regardless of their specialty, surgeons gain the skills needed to handle complex trauma cases and significantly improve patient outcomes.
This immersive training integrates real-life trauma case presentations from conflict zones like Syria, teaching models designed specifically for our programmes, and hands-on practice using human cadavers, delivering an unparalleled learning experience.
A Global Effort
The David Nott Foundation and the Royal College of Surgeons of Edinburgh are charitable organisations, and our work is made possible by the generous support of donors and sponsors. We are deeply grateful to The Russell Trust, Essity, BBRAUN, Stryker, and BMA Giving for their invaluable provision of equipment and consumables, which enabled us to deliver this course.
BMA Giving generously granted £10,000 to cover the costs of specimens and equipment for this training. Given the nature of this project, there was significant interest from individuals working with NGOs and other non-profit organizations, where high course fees often present a barrier to accessing training. Thanks to the support of BMA Giving, we were able to reduce fees, ensuring the course was more accessible to a broader range of participants.
Empowering Ukrainian Surgeons to Save Lives
As part of our 2024 localisation efforts in Ukraine, we sponsored three Ukrainian doctors who had previously completed our trauma training courses to attend our Hostile Environment Surgical Training (HEST-UK). This advanced training provided a unique opportunity for them to refine their skills further by practicing on cadavers. They also received dedicated mentorship from our expert faculty, including David Nott, who shared insights drawn from over 30 years of trauma surgery experience in conflict zones.
Upon returning to Ukraine, these doctors joined our growing local Ukrainian faculty to train more surgeons on the ground during this difficult period. Their newly acquired skills were put to immediate use, with reports of life-saving interventions within days of their return.
"Just two days ago, I faced a mass casualty incident involving four patients in one hour. Three of them suffered massive hemorrhages from arterial injuries, fractures, and amputations. I was the only surgeon available. The skills and knowledge I gained through the courses offered by the David Nott Foundation saved their lives and their limbs." - Dr Volodymyr H, Ukrainian General Surgeon
Our most recent training in Ukraine