Addressing the crisis in healthcare
As conflicts continue to devastate civilian lives across the globe, healthcare systems in war zones face unprecedented challenges. In the past decade alone, over 180,000 civilians have been killed in armed conflicts worldwide, with regions like Syria experiencing a mass exodus of healthcare workers—over 70% have fled due to violence. In Ukraine, recent reports indicate that over 17 million people require humanitarian assistance, with healthcare facilities frequently targeted and damaged, leading to significant shortages of medical supplies and personnel. In Palestine, the situation is even more dire, with access to healthcare severely restricted due to ongoing violence. Reports show that over 50% of medical facilities in Gaza are non-functional or operating at reduced capacity due to conflict, significantly affecting patient care.
In response we are equipping healthcare workers with the skills they need to save lives in these volatile environments. Our flagship Hostile Environment Surgical Training (HEST) program provides essential training to doctors, preparing them to handle trauma injuries common in conflict zones, including gunshot wounds and blast injuries. Given that the majority of injuries in modern warfare are caused by explosive devices, this specialised training has never been more critical.
Bridging the skills gap in conflict medicine
Conflict medicine involves the diagnosis, treatment, and management of injuries resulting from armed conflict, encompassing a range of trauma-related conditions. It requires a unique set of skills that go beyond conventional medical practices. In areas like Sudan, and Somaliland where many doctors lack the necessary training to manage complex war injuries, our work is vital.
The Foundation has trained over 2,000 doctors in 17 countries, offering practical skills in triage, emergency procedures, and trauma care. However, the scarcity of surgeons with specialised knowledge in conflict-related trauma exacerbates the situation, as studies indicate that 90% of healthcare workers in these zones feel inadequately prepared to handle such injuries.
Impacting lives in conflict zones
Our trained doctors are now saving lives in some of the most dangerous regions, including Yemen, where half of the healthcare facilities are non-functional. They are not only addressing immediate trauma but also providing long-term care, helping communities recover from the devastating impacts of war.
Through ongoing training programmes, we continue to build a global network of conflict medicine experts who are making a significant difference in conflict zones.
World Humanitarian Day
On World Humanitarian Day, we perhaps allow ourselves a few more minutes to think about others. Perhaps those we often find it hard to think about or to imagine. To remind ourselves that humans, wherever they are, deserve the basic access to freedom, to peace, to equity and to love that many of us enjoy. To have to make a special day each year is both a tribute, and a damning indictment of humankind. On most measures, it has been a relentless and notably horrific few years for humanity.
Moving from the private sector as I have and beginning my first few weeks as CEO of the David Nott Foundation, I have been struck by the unfortunate parallels in the language used. I did not expect to be talking about a “growth market”, but that is indeed what humanitarianism is experiencing.
For the past 12 years, the number of displaced people has increased every year. The number of refugees has tripled in a decade. In 2023, 1 in 69 of us on the planet were forced to leave our homes – 117.3 million people. More specifically to our line of work, conflict related fatalities are also on the rise. The annual number of deaths in conflict since we began our work almost a decade ago has risen by 92% to almost 250,000 this year.
Many of those deaths will be what we call ‘Survivable Deaths’. It is these deaths our teams work tirelessly to prevent by training doctors with the skills they need in conflict and catastrophe.
You can imagine that if we saw these kinds of numbers on a business forecast in a different context, it would be a reason to celebrate. But we are in the business of alleviating suffering. The more suffering there is, the more of a strain and demand it puts on the sector as a whole to meet the vital needs of those we must continuously work to serve.
In a conversation with a Ukrainian diplomat some months ago, I heard her talk of war as “a branding exercise”. She explained to me that Ukraine was not just competing with other wars for international attention and resources, but also with Donald Trump, Taylor Swift and the Climate Crisis. Her point was clear. To win the war, you need to win the media and the requisite public support. It is for this reason that today I believe we should think deeply, not just about the horrors we are seeing on our newsfeed, but to the horrors we are not. With conflicts and catastrophe raging all over the world in Haiti, DRC, the West African Sahel, Afghanistan and Myanmar, to name just a few, we can perhaps be forgiven for feeling overwhelmed and somewhat fatigued. One of our explicit responsibilities at the David Nott Foundation is to think every day about these ‘forgotten conflicts’ and lesser-known catastrophes. Thanks to the incredible generosity of our donors, we are able to consider them in our planning and delivery of vital surgical and medical training. However, the increasing need is so vast, that we and other non-profit organisations worldwide need to think very seriously about how we scale – another regrettable business term that is a sign of our times. Scaling requires funding, partners, innovation, knowledge and an appetite for risk. Many of us do not consider ourselves as direct contributors to humanitarian work, but with the skills and requirements I describe, perhaps today is the day to re-consider. To be more explicit, we certainly wish to hear from you at the David Nott Foundation.
With gratitude, James Gough
CEO
Doctors’ needs in the West Bank
Over 300 days have passed since Hamas’s invasion of Israel and Israel’s retaliatory attacks on Gaza. Gaza is home to many forcibly displaced Palestinian refugees. The 41 kilometers-long Strip has been under siege since 2006, enduring five major wars, with the retaliation of the October 7th conflict being one of the deadliest in recent history.
In the West Bank, Palestinians live under Israeli military occupation, with Israel controlling essential resources like water and electricity. The intensifying Gaza-Israel war has exacerbated these difficulties. On-the-ground reports reveal that those who live in the West Bank face increasing attacks from Israeli settlers, checkpoints, military raids, increase in settlements, and the detention of Palestinian men, women, and children.
We reached out to Dr Mariam Aweidah, a general surgeon and our Faculty Lead for Palestine, to shed light on doctors’ needs in the West Bank. Mariam lives in Ramallah and travels to Jericho to work, a journey that should take an hour but often stretches to several due to road conditions and checkpoints.
"Every day is different. We always check the news before leaving to see if there are settlers or checkpoints on the roads. As Palestinians, this is part of our daily routine to ensure the roads are somewhat safe for travel." – Mariam Aweidah, Faculty Lead for Palestine.
Mariam works at a peripheral hospital in Jericho, where resources, infrastructure, and specialisations are limited. They frequently need to refer patients to the Palestine Medical Complex in Ramallah to seek the care they need but face significant checkpoint challenges which can prevent patients from passing through, even in ambulances.
Despite being a general surgeon, Mariam sometimes operates on paediatric cases due to the limited capacity at the Palestine Medical Complex in Ramallah. Patients come from across the West Bank, but intensified travel challenges between cities and villages have increased the difficulties for both patients and doctors.
"We don't have intensive trauma training. With more trauma cases and cities isolated from each other, this causes a heavy burden because we aren't all trained for this. We often have numerous gunshot cases, and hospitals can't handle them due to a lack of resources and trained personnel."
Now more than ever, we are committed to training medical professionals in territories that require urgent support such as Palestine. As soon as it is safe to do so, we aim to raise doctors' skills through our training.
"I received training with the David Nott Foundation, which has greatly influenced my ability to manage, stabilise, and save lives quickly”, shared Mariam. “However, not all doctors in Palestine have had this opportunity. I hope to organise another training course to enhance the skills of more medical professionals in the West Bank and in Gaza."
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,
Co-Founder
Two Years On: Russia Continues to weaponise and attack healthcare in Ukraine
Our second mission for Palestine's medical workforce
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.
Addressing healthcare challenges in Moldova
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
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 size. This 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
Doctors rapidly trained to treat trauma injuries in Gaza
During a remarkable four-day Hostile Environment Surgical Training (HEST) course, surgeons and anaesthetists from the UK, Germany, Sweden, Norway and Qatar gathered in Bolton to learn how to treat trauma injuries in the Gaza Strip.
Organised in two weeks in collaboration with Palmed, 42 doctors headed for the Middle East were trained to treat complex trauma injuries incurred in the Israel-Gaza conflict. This course not only marks a significant step towards preparing medical professionals for future missions in Palestine but also reflects a shared commitment to saving lives in conflict zones.
"Thank you to the David Nott Foundation. Without them, this training would not have been possible. Together, we are organising this course to assist the people in the Gaza Strip once it is safe and travel becomes feasible. The response from numerous doctors expressing their desire to help has been overwhelming, and we are hopeful to conduct a second course in the coming weeks." - Riyadh Al Masharqa, Plastic surgeon, PalMed
Addressing urgent medical needs in Gaza
The course was organised in response to the pressing humanitarian crisis in Gaza, Palestine. According to on-the-ground partners, medical professionals are stretched to their limits and hospitals are overwhelmed.
The group included specialists in orthopaedic surgery, cardiothoracic surgery, obstetrics and gynaecology, paediatric anaesthesia, and general surgery. Some brought valuable, first-hand experience from regions affected by conflict, like Afghanistan and Syria, while others joined to grow their understanding of how to treat war wounds before heading on mission.
"I'm excited about expanding my skill set beyond obstetrics and gynaecology to acquire new capabilities that will benefit mothers and their infants in Gaza and the West Bank. I recognize the desperate need for assistance in this region. This course is unique as it combines obstetrics and gynaecology with trauma care. This training aims to address complex challenges comprehensively and I look forward to it.” - Dr Iman Al Mabhooh, Obstetrician and Gynaecologist
A troop of volunteers
For the very first time, 11 FDNF volunteers from our Friends of The David Nott Foundation (FDNF) and Trainees of The David Nott Foundation (TDNF) societies volunteered to help arrange and assist during the course. This joint effort meant it could be organised at lightning speed, rapidly creating a network of well-trained war doctors.
“Given not only the humanitarian crisis in Gaza but with the targeting of healthcare workers in particular it's never been more important to strengthen our healthcare colleagues and equip them with the skills to do their incredibly difficult jobs and to support them through a very precarious situation.” - Nadia, FDNF Manchester President
Our surgical HEST and anaesthesia courses were held simultaneously, demonstrating our commitment to enhancing the skills of all those striving to preserve life in the operating theatre.
"What has been great about this course is meeting people that have experienced things in the field. From the anaesthetics point of view, it's been helpful to learn how they deal with limited resources and supplies, and we have been using airway mannequins and practicing with video scopes."- Dr Douglas Philpott, Anaesthetist
We’re committed
As war continues to rage, we are working on a second surgical training course with the goal of upskilling even more frontline medical professionals. We won’t stop empowering doctors with the knowledge needed to save lives and limbs against the odds.
Our latest training in Palestine