“Maternal health isn't just a medical issue, it's a societal barometer.”

 Every two minutes, a woman loses her life to preventable causes related to pregnancy and childbirth. These staggering statistics stress the need for action. In humanitarian crises, where access to healthcare is severely limited, maternal care becomes even more critical.  

“800 preventable maternal mortalities are happening every day, and a woman dies every two minutes from a preventable cause. So that's women dying through pregnancy and pregnancy related conditions,” shared Dr Pippa Letchworth, our Faculty Lead for Obstetrics and Gynaecology.”

This sobering reality is what drives our passionate team to develop an obstetrics and gynaecology course aimed at addressing the most pressing challenges in maternal healthcare. In crisis settings, where resources are scarce, the course equips healthcare professionals with the skills needed to perform life-saving surgeries, particularly focusing on addressing the top global killers of women - haemorrhage, obstructed labour, sepsis, and unsafe abortion. 

“75% of displaced people are women and children, and one of the five of those women will be pregnant.”

The course covers a wide spectrum of topics in maternal and neonatal healthcare in crisis. Participants begin with trauma training before transitioning into obstetrics to understand the complexities of childbirth emergencies.  

Emphasis is placed on neonatal resuscitation techniques with the goal of reducing the number of stillbirths. Subsequent sessions address postpartum haemorrhage management, perineal repair, and navigating challenging deliveries like impaction and breech positions. The course also covers disruptive delivery, crucial for situations where doctors have limited access to caesarean sections.  

Beyond the medical realm, our trainers advocate for a holistic approach to maternal health in their teaching. It's not just about reducing mortality rates, it's about understanding the wider implications of maternal deaths on families, communities, and societies at large. Children left motherless are at a significantly higher risk of mortality and developmental issues, perpetuating a cycle of vulnerability. 

“There needs to be a call to arms to improving maternal health.”

We must advocate for women's rights, improving doctors access to education and dismantling systemic barriers that perpetuate maternal mortality. 

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Joining forces with the Royal College of Surgeons of Edinburgh to deliver our HEST-UK course

In a landmark collaboration aimed at addressing the critical shortage of skilled surgical care in conflict and disaster zones, we are teaming up with the Royal College of Surgeons of Edinburgh (RCSEd) - home to The Faculty of Remote, Rural & Humanitarian Healthcare (FRRHH) - to deliver our Hostile Environment Surgical Training UK (HEST-UK) course.

Taking place from 3 -7 June at RCSEd Edinburgh, the course celebrates a new era of partnership. Our HEST-UK course offers surgeons a unique opportunity to enhance their capabilities and readiness for humanitarian crises. Over the course of five days, participants will delve into decision-making and surgical strategies for austere conditions, covering a spectrum of trauma cases including penetrating and crush injuries, orthopaedic fractures, and obstetric emergencies.

Rapid response

Responding to the escalation of the Gaza-Israel conflict in October, two previous HEST-UK courses were swiftly organised in Bolton in December 2023 and January 2024. Obstetrician and Gynaecologist, Dr Iman Al Mabhooh, expressed his enthusiasm at the opportunity:

“I’m excited about expanding my skill set beyond obstetrics and gynaecology to acquire new abilities that will benefit mothers and their infants in Gaza and the West Bank. I recognise the desperate need for assistance there. This course is unique as it combines obstetrics and gynaecology with trauma care and address complex challenges comprehensively.”

Nick Cartwright, Programmes Manager at our Foundation, said: "Since the DNF’s beginnings in 2015, our team of experienced surgical trainers have upskilled over 1800 doctors and delivered 61 courses in some of the world’s most dangerous corners, including Iraq, Syria, Yemen, Palestine and Ukraine.

With the delivery of our HEST-UK course in partnership with RCSEd, we will grow the number of upskilled, humanitarian surgeons who are ready to volunteer their skills, make rapid and effective clinical decisions under pressure, and manage the broad range of complex trauma injuries that present in the throes of conflict and catastrophe.”

A significant step forward

Angus Watson, FRRHH Executive Committee Member, said:

“By combining the DNF's expertise with RCSEd's dedication to recognise professional standards in humanitarian healthcare, this partnership promises to empower medical professionals and save countless lives in the face of adversity.”

The Faculty's commitment to supporting surgeons is exemplified by its decision to grant participants of the course a complimentary one-year affiliation membership to the Faculty of Remote, Rural, and Humanitarian Healthcare. This membership provides an invaluable opportunity to connect with a broader humanitarian community within a professional setting tailored for humanitarian, remote, and rural healthcare professionals.

Spaces on the course are limited and will be allocated on a first come first serve basis.

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“The patients. The families. They’re all in my head.”

Our Co-Founder David Nott recently travelled to Rafah, Gaza, to help treat the thousands suffering from war injuries, malnourishment, and everyday ailments that have progressed to life-threatening conditions because of delayed treatment. Here, David shares what he witnessed, what the urgent medical needs are on-the-ground, and how those he met are tattooed onto his mind.

After travelling from Cairo and getting closer to Gaza, it was quite a shocking experience. At the Rafah crossing, you could see miles worth of trucks in a queue trying to get in.

Driving through Gaza, it was like an enormous refugee camp with tents everywhere. Every single place that wasn't occupied by somebody had a tent on it. Most of the tents were so packed against each other it was difficult for people to walk.

Thousands and thousands of people were in a small area. They had nowhere to go.

Treating those more likely to live

The hospital I was working in was called Al Najjar Hospital, the only semi-functioning hospital in Rafah. It was small, with a limited number of beds, but ended up housing thousands of people. Every corner was full. Patients were in the corridors, all over the wards, lying on the floor, five people where one might stand. There were people on the floor that were dying, some that had died - people crying out for help.

I had to step over people to get to patients. I had to make rapid decisions on whether or not they could be saved – decision-making techniques that we teach to those that attend our courses.

The hospital only had two operating theatres. There was no intensive care unit and no ventilators, so I had to decide which patients should be operated on with the best possible outcome. On ward rounds we reviewed those that had been treated, but many had infections because of limited sterile space or antibiotics.

18th century illnesses

Because thousands of people have been compressed into small spaces, and many haven’t sought medical care for their everyday conditions, the clinical needs in Gaza today are astonishing.

It’s not just war wounds that doctors face – ruptured appendices, hernias, ulcers, gangrene. General surgery has been delayed for months on end and people are dying or losing limbs as a result of problems that could have been resolved quickly.

This is the reality of trauma in war – some traumas that were not traumas to begin with become life-threatening – racking up death tolls even further.

Outside of war wounds, 21st century doctors are dealing with 18th century illnesses.

Children with chest infections were developing a condition called empyema - their infections had become so bad that their lungs were filling with pus. I’d never seen that before – it’s an 18th century condition that you would never see today.

Post-operative care felt impossible. Say you amputate somebody’s leg, there’s nowhere for them to go to recover safely. Tents aren’t sterile and it has been so cold, with the wind coming off the beach.

Calm amongst the chaos

Despite the chaos, Gazan doctors are truly outstanding. They were so warm and helpful. They were grateful that people were there to help, and together we did everything we possibly could.

This war zone is different to the others I’ve been in. The volume of people and the lack of basic medical or human resources made it incredibly challenging.

They urgently need field hospitals, more staff, a huge amount of medical resources. They need more doctors, nurses, rehabilitation services, physiotherapists. But not only that, they need a safe place for patients to go to recover after operations. Their medical aid needs are huge and doctors in the field need to be supported.

Seeing Gaza reminds me of the vital importance of our foundation’s work. Training doctors, operating on patients in war zones, bearing witness to doctors’ needs on the ground, I’m more driven than ever to help the charity grow so we can reach even more people in need.

The patients, the families, they’re all in my head. They will always stay in my head.

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Our new Betty Boothroyd Scholarship Fund

We are delighted to announce the launch of our new Scholarship Fund in memory of our late Patron and beloved friend, The Rt Hon. The Baroness Boothroyd OM. The fund invites applications from medical professionals living, working or volunteering in conflict zones, including surgeons, clinicians and nurses, who wish to further their surgical training.

Our Patron

Betty became our Patron in 2016, when the conflict in Syria was at its most intense. Areas of the country were besieged, civilian infrastructure targeted and the passage of humanitarian aid restricted.  Betty would often call our Co-Founders to express her concern at what was happening and ask what the Foundation could do to help.

In conflict, surgeons need a particular set of skills and decision-making strategies to be able to respond effectively to the waves of devastating injuries they encounter daily. The work of training doctors began in Misrata, Libya, moved on to Aleppo, Syria, and we have since then trained 1,825 surgeons and anaesthetists in conflict setting including Iraq, Cameroon, Palestine, Ukraine and many more.

From the very beginning of her journey with us, Betty remained deeply passionate about our training of frontline doctors working relentless hours. In honour of Betty’s commitment to our mission, we are proud to launch the Betty Boothroyd Scholarship Fund.

What’s the funding criteria?

Whether you’re a Sudanese nurse interested in a Masters in Trauma Management, a Palestinian doctor wishing to complete a paediatrics course, or a humanitarian surgeon interested in joining one of our HEST-UK courses, we may be able to support you with funding.

Guidelines

1. Applications are open to any surgical team members who wish to further their medical training or education (e.g. surgeon, anaesthetist or surgical nurse)

2. The training that applicants are seeking funding for can be held anywhere in the world

3. Applicants must meet one of three criteria below:

- Living and/or working in a conflict or catastrophe zone

- Your country of origin is a territory that has experienced conflict or catastrophe, however you currently reside in another country

- You are a humanitarian surgeon who travels to, and volunteers in, conflict and catastrophe zones

Our CEO and Co-Founder, Elly Nott, shared: “Thanks to Betty’s generosity to our Foundation, she will continue to make a difference to doctors striving to heal their wounded communities for decades to come.”

Register your interest and contact us at [email protected]

103 surgical life savers in Tripoli, Libya

We’re back from a week in the Libyan city of Tripoli after completing a first-in-our-history mission. We upskilled 103 doctors – the largest number trained on one mission – and trialled our brand-new obstetrics and gynaecology course.

Libya’s history is marked by political turmoil and civil unrest. The uprising against the rule of Gaddafi led to brutal violence against Libyan civilians and instability across the country. Today, 13 years after the ruler’s death, conflict between armed groups continues and Libya’s security remains fragile.

Outside of politics, Libya has been devastated by natural disaster. In September of 2023, heavy rain caused the collapse of two dams, leading to horrific damage and the loss of thousands of lives. Wounds inflicted by violence or natural disasters often require rapid surgical care, with a need to focus on controlling the worst of the damage first.

Surgical toolkit for any crisis

In a bid to empower Libyan doctors with skills to treat wounds caused by war or natural disaster, we partnered with the Libyan Board of Medical Specialties to deliver four surgical training courses in parallel. Over five intense days, our team of expert trainers delivered two trauma surgery courses, two anaesthesia courses and a brand-new obstetrics and gynaecology course.

According to a 2023 UN agency report, a woman dies from pregnancy or childbirth every two minutes. During conflict, women are less likely to seek maternal care and hospitals are under-staffed or under-resourced. That's why our trainers created a bespoke obstetrics and gynaecology course to help doctors better protect mothers and their babies in war and catastrophe.

During the week, we trained 103 doctors. Doctors we’d previously upskilled in Libya also joined our training faculty and led the teaching of a number of our modules for the first time. Dr Aisha Alghamji was one of them.

“It really was paralysing"

Dr Alghamji shared: “I remember I have a case of a 70-year-old lady. We found there was a huge bleed in her tummy. Most of her blood is – in minutes – almost drained out. It really was paralysing – what to do? She doesn’t have that much time.

That lack of knowledge paralysed me. She is a living, human being – with dreams, hopes, a whole community. She is part of it. It keeps haunting you, that feeling. What I could do differently?

She lost her life.

After 2018 when I attended the course with the Foundation, there is something shifted in my way of thinking. It did that thing for me, that confidence the surgeon needs to do more than their best – to run the extra mile for the patient.

I faced another case similar to it (this lady). I told immediately to me brain – ‘damage control! Damage control!’. I was able to send her home. She is alive, she is a grandmother, she is everything.”

A resilient healthcare system

Dr Moez Zeiton, Consultant Orthopaedic Surgeon and our Faculty Lead for Libya, said: “It is a privilege to have had the opportunity to lead the single most ambitious series of courses for the foundation, training over 100 doctors in a week. It was a huge effort from the foundation’s team and superb faculty to get over the line.

Candidates in  Libya travelled from every part of the country with many travelling over 1000km to participate in our surgical training. Their eagerness to learn and share their own experiences was evident and they will now be equipped with the skills needed to deliver high quality care to their patients. "

This marks the beginning of continued training in Libya and a commitment to gifting doctors with extensive trauma skills to handle any challenge.

HELP US FUND MISSIONS IN LIBYA

Two years of war and two years of attacks on healthcare

Two years have passed since Russia's invasion of Ukraine and the scars continue to run deep. As published in the Foreign Policy Centre, our CEO, Elly Nott, shares the realities faced by Ukrainian doctors and the relentless attacks on their healthcare system that continue to persist even after 24 months of war.  

Ongoing struggles, relentless weaponisation and devastating attacks on healthcare continue to be perpetrated by Russia. The numbers are staggering with over 1,000 verified attacks on healthcare in Ukraine as confirmed by the World Health Organisation.  

These figures are not just statistics. They represent lives shattered, dreams destroyed, and communities torn apart.

Beyond the numbers, healthcare plays a critical role in upholding societal cohesion and fostering trust between citizens and their government. Despite relentless onslaught, the Ukrainian people have displayed remarkable resilience, refusing to let their national spirit be broken by the brutality of war. But amidst the devastation, there is a glaring absence of justice. 

Our work at the David Nott Foundation stands as testament to our commitment to supporting those affected by conflict. As the conflict unfolded in 2022, our Co-Founder, David Nott, conducted a series of intensive training sessions, upskilling 573 Ukrainian doctors over Zoom. In the subsequent years of 2022 and 2023, we expanded our efforts, providing specialised training to 442 surgeons and anaesthetists through 11 comprehensive surgical training courses.  

 

We have forged crucial partnerships with Ukraine's Ministry of Health, the World Health Organisation, and UOSSM. As part of our broader Ukraine program, we've also funded scholarships to further empower healthcare professionals. Specifically, we funded a Ukrainian surgeon and anaesthetist to undergo paediatric trauma surgical training. 

As the war wages on, we will continue to support Ukraine's healthcare heroes, ensuring they are equipped with the knowledge and skills needed to save lives and alleviate the suffering caused by the ongoing conflict. 

Elly Nott,

CEO and Co-Founder  

Two Years On: Russia Continues to weaponise and attack healthcare in Ukraine


Our second mission for Palestine: Empowering medical heroes

In the ongoing Israel-Gaza conflict, tens of thousands have lost their lives and hundreds of thousands are now displaced. Hundreds of casualties have been reported in the West Bank. Our commitment to supporting affected communities continues and we will do all we can until we reach doctors on the ground.  

Despite recent escalation, Palestine has been engulfed by conflict for decades. Recognising a need for upskilled doctors, we first delivered a Hostile Environment Surgical Training (HEST) course in Ramallah in March 2017 and another in 2022 in collaboration with Juzoor. We also taught Palestinian surgeons on our latest UK Train the Trainers course, giving them the skills needed to teach their own peers. 

“I love Ramallah. But we don’t have control of our borders,” shared Dr Salwa Najjab, Co-Founder and Chairwoman at Juzoor in 2022. “We are living in a big prison. Our people should be exposed to the world. We are very happy and thankful to the David Nott Foundation, to come and see what we are doing, to understand our situation and see it in their eyes.”  

Following the resounding success of our Hostile Environment Surgical Training (HEST)-UK course for doctors heading to Palestine, we once again joined forces with Palmed to train another group who intend to offer their skills on the frontline.  

At Bolton University, we taught six anaesthetists and 31 surgeons from the UK, Germany, Ireland, Denmark, and Norway. The doctors share a common passion for using their hands to help those affected by the aggression on Gaza. 

Dr Israar Haq, a general surgeon who joined our course shared, "If you have any grain of humanity in your heart, you want to help." 

BBC spotlight 

BBC-Northwest took notice of our efforts and joined our training. They spoke with experienced surgical trainer, Dr Rebekka Troller, who shared: "The aim is to give the doctors the skills to do damage control, save lives, be the first to respond, and stabilise a patient before they can be transferred."

Our presence at Bolton University also attracted attention from university professors, medical students and doctors. They explored our world-class teaching models and extended a warm welcome to our team in appreciation of our commitment to war doctors. 

Our latest course for Palestine reaffirms our unwavering commitment to helping communities facing the horrors of war. We remain steadfast in our mission to empower medical heroes and make a lasting impact on the lives of those in need. 

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Anaesthesia course in Moldova addresses healthcare challenges amidst Ukraine crisis

In the wake of the escalating conflict in Ukraine, Moldova, a neighbouring country, is grappling with the concern of being somehow drawn into the war. To extend support during these challenging times, the David Nott Foundation, in collaboration with the World Health Organisation, conducted two specialised Hostile Environment Surgical Training-Anaesthesia courses in Moldova. 

The refugee influx and healthcare strain

Since Russia's invasion of Ukraine, Moldova has witnessed an influx of over 700,000 refugees seeking peace and safety by passing through its borders. Recognising the strain these precipitates to available healthcare resources, the Foundation has provided ongoing support over four courses since January 2023.

 

The anaesthesia (HEST-A) courses, conducted from December 11th to 16th, aimed to up skill 25 anaesthetists to better handle healthcare challenges arising from the crisis. The training spanned six days, with the first three days conducted in English and the subsequent three days in Moldovan. 

Participants expressed satisfaction with the course structure, emphasising the benefit of discussions and supervised practical activity over a lecture-heavy approach. As the anaesthetists underwent training, they raised concerns about resource availability and hospital capacity in the face of refugee movements. In response, our highly skilled teaching faculty offered valuable advice and information.                   

Innovative training models

The courses saw three UK-based faculty members delivering in-person sessions, with an additional faculty member, the Foundation’s lead consultant for anaesthesia, delivering a virtual training session on chemical weapons. 

The David Nott Foundation's HEST-A course in Moldova not only aimed to enhance the skills of healthcare professionals but also addressed specific challenges posed by the Ukraine crisis. By fostering collaboration with WHO and adapting the course content to local needs, the Foundation continues its mission of providing essential medical training in conflict zones to save lives and alleviate human suffering.

“There is nothing more heart-warming, more fulfilling, than seeing the impact of our work through the stories of those we teach To see that connection brought to life is truly a testament to our mission.” - Hannah Graham-Brown, Programmes Officer at The David Nott Foundation

Our training in Moldova


End of Year Reflection from our CEO

At the David Nott Foundation, we strive for a world where access to safe, skilled surgical care is a reality for all.   

In areas affected by conflict and catastrophe, every day doctors are striving to provide care to communities contending with the horrors of war. From Ukraine to Syria, Palestine to Sudan; health systems are under strain and sometimes under attack.

With our small staff team of eight, we deliver training that exceeds what might be expected of an organisation of our sizeThis year, we are immensely proud to have trained 433 surgeons and anaesthetists from Moldova, Yemen, Ukraine, northwest Syria and the UK. That means we’ve trained 1,589 doctors since 2015, expanding our global network of surgical life savers. 

 Responsive. Open-hearted. Committed. It inspires all we do.

 

As 2023 draws to a close, we want to express our heartfelt thanks to each and every one of you who has been a part of the David Nott Foundation journey. This year presented unimaginable challenges, from earthquakes to conflicts, yet your unwavering support allowed us to train 433 surgeons and anaesthetists across the world.

In the face of adversity, our commitment to providing access to safe, skilled surgical care remains stronger than ever. With your generosity, we've made a real impact in communities facing crises. Here's to a future filled with continued growth, empowerment, and positive change. Thank you for being a vital part of our mission.

Wishing you a compassionate and hopeful New Year!

With gratitude, Elly Nott

CEO and Co-Founder

Gaza Emergency Response