“The need in Syria is astonishing”
We’ve just returned from northwest Syria after training 23 local doctors to surgically treat complex wounds caused by the earthquake that shattered parts of Syria and Türkiye in February. Our CEO, Elly Nott, shares her reflections of our latest mission and how we will continue to stand with Syria.
As soon as we crossed the border into Syria, fields of olive trees stretched as far my eyes could see. Row after row, the trees continued until we reached Atmeh.
Our destination was Aqrabat Hospital, where I was leading a surgical mission to train local doctors to provide specialist orthopaedic and plastic surgical care to the survivors of February’s devastating earthquake.
The need for our training is astonishing.
After hearing that ours and Action for Humanity’s specialist doctors were visiting, a staggering 2,000 people sought care at the Hospital.
Action for Humanity’s team, who led the operating arm of our mission, saw 300 in clinic and were able to surgically treat over 60 patients over a week period. At the same time, in rooms above the operating theatres, we taught 23 Syrian doctors with the skills needed to treat complex trauma injuries inflicted by earthquakes or the ongoing conflict. Our team also taught nine Syrian surgeons to become David Nott Foundation trainers themselves, leaving a lasting legacy of shared knowledge and confident doctors in Syria.
Aqrabat sits in northwest Syria and is supported by a remarkable network of civil society organisations and NGOs. Despite this, the region is vulnerable. The hospital serves a population of around four million, the majority of whom are dependent on humanitarian aid. Some 2.6 million of residents have already been forcibly and repeatedly displaced from their homes by the conflict from places including Ghouta, Dara’a, Homs, Aleppo. Families faced food and fuel shortages and health challenges including a cholera outbreak. The recent earthquakes have added further pressure to weakened economies and healthcare systems across the country.
As conflict and the effects of the earthquake continue to fuel instability, we must not abandon Syria.
Speaking to doctors we’ve trained, it’s clear our mission has had a lasting impact. Many have commented on their restored confidence and others that they now feel better equipped to treat those most in need.
A personal highlight for me was meeting Syrian doctors who had learned from, met or heard about my husband and Co-Founder, David Nott. Many had operated alongside David in underground hospitals in Aleppo while the Assad Regime and its Russian allies bombed the east of the city relentlessly in 2013 and 2014. Their connection with David, despite the passing of years, reinforces just how powerful shared knowledge is.
Our Faculty Director for this mission, Dr Ammar Darwish (pictured below), who is originally from Syria, shared:
‘Going back to Syria was one of the happiest days of my life. Crossing the border and seeing Syria again, with all the sadness and monstrosities that have happened, there’s still a sense of happiness, a sense of pride. It was a very special feeling. Training the doctors there and seeing those we’ve worked with and taught before was something else. It put tears into our eyes.’
Northwest Syria faces vast challenges. We cannot remedy a decade of pain, but we can continue to arm surgeons with life-saving skills and show them that we stand beside them.
We’ll be back to train more doctors soon.
Elly Nott, Co-Founder and CEO at the David Nott Foundation
Leaving a lasting legacy with 14 Yemeni surgeons
Dr Shabnam Parkar is a Consultant Paediatric Surgeon at St George’s Hospital in Tooting. After many years treating children in the UK and providing medical care in Nepal, Dr Parkar has joined our team as a surgical trainer. Last month, she led paediatrics and co-led abdominal surgery on our Hostile Environment Surgical Training (HEST) course in Djibouti, empowering 14 Yemeni surgeons with the skills needed to treat children’s trauma injuries.
Faculty Lead: Dr Ammar Darwish. Faculty Trainers: Dr Pete Mathew, Dr Shabnam Parkar, Dr Timo Bullmann, Dr Mohammed Ayman Alshiekh, Dr Jen Oliveira-Davies. Programmes Lead: Chevon Cumberbatch.
Yemen is a territory scarred by conflict. The state’s historic unrest is complex, with civil war, tribal tensions and extremist groups operating across the country. On-the-ground partners share that Yemeni surgeons commonly face injuries inflicted by war, such as gunshot wounds or landmine injuries requiring amputations. Car accidents are also common on uneven roads, leading to severe crush wounds or internal bleeding that demand urgent damage control.
Our teaching faculty, including the latest addition to our training team, Dr Shabnam Parkar, recently upskilled 15 Yemeni doctors in Djibouti, giving them the skills needed to better treat the injuries they see on a daily basis.
Dr Parkar led the paediatric module of our course, helping doctors understand how to use their surgical skills to give children with devastating injuries the very best chance of survival.
The power of education
Speaking with Dr Parkar about her humanitarian history, she shared: “For the past 10 years, I’ve worked with a charity called Health Partnership Nepal providing medical relief. We run health camps, offering medical care to 500 children and adults a day and performing minor surgeries in rural areas.
Every year, we knew we were doing good work, but it felt like applying a temporary plaster to a wound. We weren’t getting to the source or really identifying what the country’s core needs were. The charity’s direction fell into place when I was invited to operate on left-over cases from a previous mission.
I thought, why don’t I teach the local doctors how to perform safe inguinal hernia surgery, rather than patients waiting for my annual visit? A sustainable model of teaching. Today, Health Partnership Nepal provides medical care to local communities and teaches doctors vital clinical skills such as resuscitation.
It was that same ethos of education and training at the David Nott Foundation that I was drawn to.
I worked with David as his Senior House Officer and always knew I wanted to get involved in humanitarian work. After meeting Elly Nott at an event, we stayed in touch and I was later invited to their Train The Trainers course in London. I was honoured to join the Foundation as an official trainer in Djibouti, teaching 15 Yemeni surgeons.
Training in Djibouti
The doctors were highly experienced and mainly consisted of general, trauma, orthopaedic and vascular surgeons from all over Yemen. They received 5 days of intensive surgical training, empowering them with skills, tools and tips for better treating the complex wounds they see daily. From obstetrics to neurosurgery to mass casualty triage, the course is designed to create multi-skilled trauma surgeons that are ready to respond to a wide spectrum of injuries.
Many were familiar with how to handle damage control surgery and use skin flaps to treat large open wounds, however we got great feedback on orthopaedics and paediatrics, and the group discussions were fantastic.
It was lovely to see them presenting cases on their phones and sharing ideas of how they approach surgery with each other. The course created a platform for Yemeni doctors to connect and support each other, no matter the region they worked in.
The team really felt like a family – and everyone helped ensure the course was delivered to the highest standard for the doctors we met.”
A strengthened healthcare system
One participant shared, “Working in any war zone, I know I can use my new skills,” while another said they were more confident and that they could “face any emergency case” as a result of their training.
Our CEO and Co-Founder, Elly Nott, said: “This was our fifth mission with doctors from Yemen and we were honoured to have the opportunity to further expand the state’s network of skilled surgeons and strengthen their healthcare system.
No matter the conflict or disaster, we are passionate about empowering surgeons with skills we know can make the difference between a patient’s life or death.
Education is incredibly powerful – it forms the backbone of our Foundation. We look forward to future courses, led by our talented trainers, that will continue to benefit communities in Yemen.”
To see our training in action, watch our Palestine story
Training Syrian doctors treating earthquake victims
We are joining forces with Action for Humanity (AfH) to train Syrian doctors in the surgical skills needed to treat and rehabilitate those injured in the recent earthquakes in northwest Syria and Türkiye.
New reports from UOSSM International confirm that many survivors are facing ongoing issues with serious wounds inflicted by the earthquake that require surgical attention.
To support doctors treating these injuries and prepare them for any future conflict or catastrophe-inflicted injuries, we are travelling to northern Syria to deliver our Hostile Environment Surgical Training (HEST) course. Over five days, around 30 Syrian doctors will be taught a broad range of surgical techniques that will help them treat complex wounds like those caused by the earthquake, such as crushed bones, large penetrating injuries, deep infection and amputations.
We will also train a cohort of Syrian surgeons to become surgical trainers and share knowledge with their peers, leaving a lasting, life-saving legacy in Syria long after we've left.
Action for Humanity provide aid and assistance to people affected by natural and man-made disasters and are partnering with us to run an operating mission in parallel to our teaching mission.
Together, we're calling for £100,000 donations to fund their joint earthquake surgical mission.
Professor David Nott, our Co-Founder, said:
“From my experience of volunteering in conflict and catastrophe zones for the past 30 years, I know communities can be left with devastating and complex injuries. What’s more, hospitals are facing limited resources, low blood stocks or reduced staff numbers.
Our surgical course is designed to educate doctors on the broad range of injuries seen in war and natural disaster, while empowering them with the skills needed to become competent trauma surgeons.
We’re also looking forward to helping some doctors become surgical trainers in their own right. Knowledge and networks are incredibly powerful. We hope it will help our Syrian friends heal from this tragedy.”
Elly Nott, our CEO and Co-Founder, said:
“The Syrian people have endured enormous hardship during almost thirteen years of conflict. The health system in northwest Syria was already fragmented and under strain, and there is no doubt this earthquake has stretched it even further.
The scale of this disaster demands international support that will have a lasting impact. We are honoured to be able to offer local doctors the opportunity to learn surgical skills that will help them better serve their own communities and heal the nation’s wounds.”
Othman Moqbel, CEO at Action for Humanity, said:
“Action for Humanity is once again honoured to be partnering with the David Nott Foundation for a surgical mission to Northwest Syria. Last month, after the devastating earthquakes claimed thousands of lives and flattened entire towns and villages, thousands were left with horrific injuries which require surgical intervention.
Before the earthquakes, this region was already facing an emergency of an unimaginable scale, now we have seen yet more disaster unfold and more need for medical support. Syria’s healthcare infrastructure has been decimated by 12 years of conflict, that is why medical care has been at the core of our work inside Syria for over a decade.
Together with our friends at the David Nott Foundation, we are calling on our supporters to help us send teams of experienced doctors to the region to volunteer their surgical skills and support in training of doctors on the ground. Through surgical education, we want to create a network of doctors, ready to help their communities recover from this tragedy.”
Support our earthquake mission today
“As soon as Russia invaded, we started seeing the wounded”
After troops crossed Ukraine’s borders in March 2022, Igor Belkin, a surgeon from Zaporizhzhia, watched our translated war surgery videos in a bid to better treat devastating wounds inflicted by the war. Last month, Igor furthered his skills and training during our latest HEST course in Ukraine.
Faculty Trainers in Zaporizhzhia and Lviv: Professor David Nott, Dr Pete Mathew, Dr Ammar Darwish, Dr Rachael Craven, Dr Ian Nesbitt.
“On the night of the 7th of May, the first attack on our hospital took place. Hospital walls and communications were damaged,” shared Igor. “After that, the shelling of Orikhov became even more intense. The hospital was shelled again later in May, which led to it being evacuated.”
Igor was forced to transfer to a military hospital in the field to continue treating the injured. Right from the beginning of the war, he and his team were faced with severe trauma injuries - many of which they had never seen before. Patients with internal and external damage caused by blasts, penetrating wounds and severe burns were entering their doors for the first time.
“I decided I needed to study combat trauma. A medical colleague told me about videos made by Professor David Nott.”
Armed with life-saving tools
Just days after Russia’s invasion, we ran a 12-hour surgical training course on zoom with former consultant neurosurgeon and author, Dr Henry Marsh. Together, David and Henry trained 573 Ukrainian surgeons, giving them surgical techniques, tools and tips for treating a range of traumatic war wounds. It was only when David lost his voice 12 hours in that the training stopped.
As attention started to mount around our online training, we created a series of surgical training videos in a bid to reach even more doctors in need of life-saving skills.
“It (the video series) was very informative, clear and concise. In just a few hours of viewing I grasped the main fields of trauma medicine - damage control and important techniques for cardiovascular surgery.”
Upskilling 114 Ukrainian doctors
Last month, David and a team of our trainers travelled to Zaporizhzhia and Lviv to deliver our HEST course. 114 doctors and anaesthetists were empowered with the knowledge needed to treat neurological, plastics, vascular, cardiothoracic, paediatric, orthopaedic and abdominal trauma cases – creating a powerful network of multi-skilled surgeons.
“I was very pleased to attend this course and meet David personally. I got very concise, practical information and was able to practice my skills and learn how to provide assistance in areas of medicine I don’t specialise in.
I’m grateful to David, his entire team, and the foundation for sharing their great experience and imparting their knowledge of medicine in war zones”
Before the course, I used to use a technique called a lateral thoracotomy which involves turning the wounded onto their side (entering the chest from the side). Given the fact that chest injuries can make patients very unstable, this sort of movement could worsen conditions.
Now, I only do thoracotomies while patients are on their backs. This is a far better method for both surgeons and anaesthetists to approach trauma injuries.
I also learned how to use external fixations to secure bones and now perform fasciotomies on patients needing urgent pressure release in the limbs.
This sort of knowledge, acquired from experienced frontline doctors like David and the team, will help me and my fellow Ukrainian doctors save more lives.”
We’re committed to training and instilling confidence in Ukraine’s doctors until the war is over.
Help us train others like Igor
The Rt Hon. The Baroness Boothroyd OM, our beloved Patron
It was with great sadness that we learnt of the passing of our beloved Patron and friend, Baroness Boothroyd.
People like Betty Boothroyd do not come around often. She fought hard to enter Parliament, succeeding in doing so in 1973. She had a distinguished career serving on many select committees and as a whip before making history by becoming the first woman Speaker of the House of Commons. She won respect for her firm but fair application of the rules of the House and admiration for her authority, warmth and wit.
Her presence and unmistakeable star quality elevated any meeting she attended and to have Betty as our Patron was a point of huge pride for all of us. She took a keen interest in our work and would often call David or I, having watched news reports from Syria or Ukraine, and ask what we could do to help. She was with us from the start, when we launched the Foundation in 2016 at the Royal College of Surgeons of England, and she will leave a space quite impossible to fill. We will honour her legacy by striving to be as fearless, and as tireless, as Betty.
A star has gone out in Britain tonight, but the heavens are all the brighter for her presence. For your service to our country, support for our Foundation and friendship to David and I; thank you Betty.
Elly Nott, CEO and Co-Founder
26th February 2023
Joining forces with WHO to train 30 Moldovan surgeons
At the invitation of the World Health Organisation (WHO), we were honoured to train 30 surgeons during our first Hostile Environment Surgical Training (HEST) course in Moldova’s capital city, Chișinău.
Faculty Lead: Dr Ammar Darwish. Faculty Trainers: Dr Pete Mathew, Dr Una Walsh, Dr Moez Zeiton, Dr Mahmut Hariri, Dr Jennifer Oliveira-Davies. Programmes Lead: Darius Bahmaie.
https://vimeo.com/800555645
When we formed the David Nott Foundation, we did not anticipate running a training course in Moldova for surgeons facing trauma injuries inflicted by conflict. However, due to its geographical proximity to Ukraine, Moldova’s health system has faced a range of challenges in the past year following Russia’s invasion of its neighbour.
The state of 2.7 million people has opened its borders to Ukrainians forced to flee Russia’s aggression. It hosts the highest number of Ukrainian refugees per capita compared to other EU and EU-neighbouring countries. Refugees arrive with a variety of needs, including requirements for care for pre-existing health conditions, psychological trauma and physical injuries.
To support Moldovan doctors as they seek to accommodate the health needs of Ukrainian arrivals, the World Health Organisation invited us to deliver our 5-day HEST course to 30 local surgeons, giving them life-saving surgical skills in addition to useful tools for effective triage and overall management of mass casualties.
To make the course as accessible as possible for Romanian-speaking attendees, WHO secured two outstanding medical translators. Digiwave translation headsets were handed to every participant, giving them the opportunity to experience our training in a language familiar to them.
Elly Nott, our Co-Founder and CEO at the David Nott Foundation, said:
“We believe access to safe, skilled surgical care is a human right. It motivates everything we do, and every decision we make.
Since starting our mission in 2015, we’ve offered surgical knowledge to our brothers and sisters in conflicted territories such as Syria, Libya, Palestine, Kenya, and most recently, over 200 surgeons across Ukraine. We know how vital it is for healthcare workers to feel seen, supported, and be prepared.
We have been truly overwhelmed by the commitment of the Moldovan surgeons we’ve trained to better serve their communities and learn new skills.
It is our sincere hope that our Moldovan friends will never need to use the surgical skills we taught them, but if so, well-trained doctors will be equipped to build healthcare resilience and save more lives.
We hope this is the beginning of our relationship with the healthcare workers of Moldova, and our WHO partners, and are immensely excited for the future.”
Addressing course attendees on the first day of training, Dr Vitalii Stetsyk, Technical Officer in the Health Emergencies Programme at WHO Europe, said:
“This course is a unique opportunity to learn from specialist trainers who have spent years in countries facing emergency situations, such as conflicts and wars.
The Foundation’s course will strengthen surgical competencies while helping doctors to build new networks. Building networks and sharing knowledge are vital. They save lives.”
When we are prepared, we are empowered.
Dr Ammar Darwish, General Surgeon and Faculty Lead on this course, said:
“It was a pleasure to run such a successful HEST course with an excellent group of Moldovan surgeons. They were experienced, and eager and enthusiastic to engage and build their surgical skills.
The professionalism and commitment from the World Health Organisation and the Moldovan Surgical Society to deliver shared success and benefit Moldova, led to great collaboration and an impactful mission.”
Earthquake causes widespread devastation in Turkey and Syria
We are appalled by the devastating earthquake which struck northwest Syria and southern Turkey. It is apparent that there has been destruction on an enormous scale and a correspondingly huge loss of life.
The people of northwest Syria have endured enormous hardship during almost thirteen years of conflict. The health system in northwest Syria was already fragmented and under strain and this will stretch it even further.
Rescue efforts have been mounted by the White Helmets and the locally-led NGOs that have sustained the northwest for the past decade have commenced a humanitarian response. The scale of the disaster demands an international response, yet in northwest Syria there is no state capacity to resource and lead it. All efforts must be made to keep aid travelling swiftly through the Bab al-Hawa crossing, the last UN-mandated border crossing between Turkey and northwest Syria.
Our Foundation is deeply proud of the close links we have with Syrian healthcare workers. In Gaziantep, Idlib and Aleppo, we have trained Syrian doctors in both lecture and operating theatres. We stand in solidarity with all those in Turkey and Syria affected by this catastrophe and are ready to help in whatever way is constructive and helpful to our partners.
Upskilling doctors in Malaysia during Tripartite Conference
In December, we were delighted to be invited by the Royal College of Surgeons of Edinburgh (RCSEd) to attend the AFSM Tripartite Conference 2022 in Borneo, Sarawak. We upskilled 42 doctors and medical students during a condensed, one-day Hostile Environment Surgical Training (HEST) course.
Faculty Lead: Dr Pete Mathew. Faculty Trainers: Dr Una Walsh, Dr Ankur Thapar and Dr Pippa Letchworth. Programme Support: Christie Norris.
The Academy for Silent Mentor (AFSM), RCSEd, College of Surgeons Academy of Medicine of Malaysia (CSAMM), and the Ministry of Health of Malaysia (MOH) joined forces to develop a comprehensive 3-day conference program on healthcare challenges in the 21st century.
Our Faculty Lead Dr Pete Mathew (right) delivered a lecture to conference attendees. He shared details of his experience as a neurosurgeon, working to save lives in conflicted countries such as Afghanistan and Iraq with the Royal Air Force, and volunteering with humanitarian organisations such as the International Committee of the Red Cross before joining our team as a surgical trainer.
Wounds seen in war
The following day, we delivered a condensed version of our Hostile Environment Surgical Training course to 42 participants covering damage control, cardiothoracic and vascular surgery, maxilla-facial trauma, plastics, and obstetrics and gynaecology.
Using our human simulator model, Heston (below), the group got to grips with a range of injuries commonly seen in conflict and mass emergencies, such as penetrating head wounds and shrapnel injuries.
They manoeuvred skin flaps on Heston’s body, practicing how to cover blast injuries and encourage healing, and performed lung twists in Heston’s open chest to stop severe haemorrhage.
We also used our new, state-of-the-art birthing simulators to allow attendees the opportunity to experience how to manage challenging deliveries, such as obstructed labours, breach positioning, or C-sections.
Care without boundaries
Rural communities in Sarawak often have limited access to healthcare due to their remote locations. For some, it can take many days to reach hospital facilities. Outstanding local charities such as Mercy Malaysia and Andante coordinate regular medical and dental visits to communities in urgent need, thanks to the generosity of trained volunteers.
Basic clinics have also been built in hard-to-reach regions, with the goal of ensuring expectant mothers receive better care. Outreach doctors who take part in our comprehensive obstetrics training could have a significant – and potentially life-saving - impact in rural communities.
Professor Angus Watson, Consultant General and Colorectal Surgeon and Chair of the Research RCSEd Committee, said:
“Having an internationally renowned charity, like the David Nott Foundation, delivering their highly acclaimed course to healthcare providers in Malaysia, was one of the highlights of the conference.
The feedback received from course participants was very good and we hope this is the start of a highly productive global partnership between the Royal College of Surgeons of Edinburgh and the Foundation.”
Speaking of our training, a medical student from University Putra Malaysia who attended the course, said:
“Me and my medical peers participated in the Hostile Environment Surgical Training (HEST) during the conference. We were deeply amazed by this course. It gave us very different exposure from other courses we’ve been to.”
We look forward to exploring future courses in Malaysia and thank the RCSEd for their invitation.
Watch our video and reflect on 2022's successes
Expanding our global network of surgical trainers
Last month, we were delighted to hold our annual Train the Trainers course, giving 29 doctors from around the world the skills they need to become David Nott Foundation Trainers within their home countries and better serve their communities.
Our goal is to create a model of sustainability in conflicted countries by helping doctors strengthen their own healthcare systems. It was this thinking that led us to develop our Train the Trainers course. What if we could upskill doctors in conflict zones around the world to become skilled surgical trainers themselves, helping them to train their own peers, strengthen their own healthcare systems and support their own communities?
This November, we brought previous HEST course participants together - from regions such as Somaliland, Ethiopia, South Sudan, Syria and Palestine - to solidify their trauma surgery knowledge, while assessing and strengthening their teaching skills.
Dr Mariam Aweidah, a long-standing friend of the Foundation and participant from Palestine, said: “Being part of the David Nott Foundation family, and helping it to grow, is a privilege.”
For the first time we invited anaesthetists to the course, as part of our mission to upskill additional surgical team members in conflict zones, not just surgeons. Each participant learned how best to approach a wide range of traumatic injuries seen in war and disaster, and how to efficiently triage mass casualties.
During the triage lecture, David shared: “Showing footage of mass casualties and the chaos that can result in hospitals without proper planning and roles makes this module particularly shocking.
But it’s deliberate – it stays with you. At this point, I ask each of you, what will you do now that you’ve seen this?”
The group replied together, “make a mass casualty plan.”
Elly Nott, CEO and Co-Founder of the David Nott Foundation, said:
“It was a privilege to host 29 surgeons from across the UK, Europe, Middle East and Africa at the Wellcome Collection for our 2022 Train the Trainers course.
Train the Trainers aims to expand our number of teaching faculty, enabling us to undertake more training courses and reach more areas in need.
Russia’s brutal invasion of Ukraine this year shocked us all, but the diverse backgrounds of our delegates remind us that dozens of conflicts demanding our attention continue to simmer worldwide. Our mission is to equip the doctors treating those affected by these conflicts with the best surgical training available, enabling them to better treat the complex injuries inflicted by war.
Initiatives like TTT demonstrate our commitment to making our training truly sustainable by empowering local surgeons with the knowledge to teach our courses. As ever, we are motivated by our belief that well-trained doctors save more lives.”
Help us train more war doctors