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
Training anaesthetists in war zones
Dr Elma Wong is a consultant anaesthetist in Worcestershire Acute Hospitals NHS Trust. For the past ten years, Elma has taken several months of unpaid leave to volunteer in conflict zones each year. Elma and a small team of faculty recently returned from training 71 doctors in the Ukrainian cities of Poltava and Zhytomyr. Here, she reflects on her experience after delivering our first-ever anaesthetics HEST course module alongside Dr Rachael Craven.
After a decade of volunteering in war zones, Elma knows all too well how important education is. When she heard we were looking to deepen our impact by upskilling anaesthetists in conflict zones, Elma jumped at the chance to get involved.
“I’m interested in building up local workforces, making communities in conflict more sustainable. It’s about the longevity of the impact you want to have in a place.
The biggest gift you can give to a healthcare worker in a conflict zone is self-sufficiency – the dignity to be able to do everything themselves. It’s important to empower people to look after their own patients. A job well done is ultimately making yourself redundant.”
Training anaesthetists in war zones
“I first heard of the Foundation after reading War Doctor. As a fellow humanitarian, I could relate to David’s experiences. When I heard the Foundation wanted to develop an anaesthetics training module, it felt like a great fit for me.”
In October, Elma, David and a small team of trainers travelled to Poltava and Zhytomyr to deliver two HEST courses – Elma’s first time in Ukraine since the war began.
The team flew to Warsaw and with the support of our partner, UOSSM International, crossed the border before driving for most of the day to eastern Ukraine.
“During our first course in Poltava, there was a lot of unknown. We designed the module ourselves but didn’t know exactly who we’d be training or how it would be received.
In the end, we trained around 10 anaesthetists in Poltava and 12 in Zhytomyr and it was wonderful - I think they found it refreshing to have dedicated trauma training with practical advice. They were really excited to handle different kit and learn new techniques.”
Adapting in conflict
When it comes to war anaesthetics, there are two main considerations. Firstly, the injuries anaesthetists face in war are starkly different to cases seen in the west.
“Blast injuries from explosives are devastating to the body. Patients can have multiple life-threatening injuries and lose so much blood. The priority is stabilising the situation and giving blood.
We taught specific techniques for giving drugs and blood via the bone (intra-osseous), for when you can’t find a blood vessel. Many had not used this life-saving equipment and really benefited from learning this skill.
Many of these cases would need care on the intensive care unit - supporting patients with complicated head and lung injuries on our breathing machines and giving dialysis therapy to people with kidney failure as a result of crushing injuries.”
The other consideration in a war setting is reduced resources. Hospitals may be faced with electricity cuts or low oxygen supplies.
“We trained the groups on alternative anaesthesia machines - very different to ones we use in our hospitals here. They are portable enough to fit into a bag or small case and they can be life-saving in critical conditions - when you don’t have electricity or oxygen yet need to perform emergency operations.”
Teaching the group how to use basic machinery, available in most hospitals, will help them continue to save lives despite slashed resources.
“The rest of the world hasn’t forgotten you”
“Often, I think when you are stuck and living within conflicts, you feel the rest of the world has forgotten you.
But seeing people travel far distances to come and help, standing in solidarity with them, I hope shows them some humanity."
Contemplation on safe ground
“It can be challenging dealing with the trauma of what you experience on missions. Often its worse when you get back home and have time to process things, devastating things you’ve seen.
The more missions I’ve done, the more I realise the importance of looking after yourself. Finding time to have breaks, even on busy missions. In Yemen, we were working and living in the hospital. Each day around 5pm I would try and go to the roof for 10 minutes to take in some fresh air, watch the sunset, whilst listening to the atmospheric call for prayer from the nearby mosques. It was time just for me.
The important thing is to be kind to yourself - and ask for help when you need it.
When reflecting on my time in Ukraine, it’s difficult to know quite how to describe how I feel. ‘Privileged’ comes to mind – for being able to work hand in hand with people on the ground and support them as best I can.”
More on our training in Ukraine
Photographer: Annabel Moeller
“One day, change will happen. Until then, we’ll keep the flag flying”
On Friday 21st October, David was interviewed by the Chair of Action for Humanity, Dr Ayman Jundi, at the University of Central Lancashire (UCLan). He shared stories from the frontline, the bonds he formed in Syria’s underground hospitals, and how he copes with the monstrosities of conflict.
We were delighted to be joined by over 200 attendees, consisting of supporters, medical students and UCLan staff members. All listened intently as David offered a personal insight into his work and mind.
Becoming a war doctor
“Back in 1993, I’d just become a consultant surgeon at Charing Cross,” shared David. “I was watching the news about the Bosnian war and the terror going on there. Similar to Ukraine, Sarajevo at that time was being shelled heavily. I remember the story of a man looking for his daughter. He found her, pulled her out the rubble and took her to hospital, but there was no doctor there.
That’s when I thought, I have to do something.
The following morning, I couldn’t wait for the sun to come up. I called Médecins Sans Frontières (MSF) and two days later I was in Sarajevo.”
David’s experience in Bosnia - performing difficult surgeries on injured civilians in the freezing cold – lit a fire in him and he was soon grabbing every opportunity he could to take unpaid leave and travel to where he was needed. In 2012, David’s work in Syria began.
The first Syrian mission
“I was in Libya with MSF. It was then that I got a call about a conflict in Syria. I first travelled to Atmeh in Northern Syria, which was very dangerous. The medical set-up was not good.”
There were few ambulances in the region, so cars and vans were used to transport the injured to make-shift hospitals. They’d screech to the entrance and beep their horns to alert doctors inside.
“The hospital we worked in at that time was a converted house. The dining room was the operating theatre, the kitchen - A and E, and bedrooms were turned into wards.
At the beginning of the conflict, there were incidents of people making bombs in their homes. Unfortunately, there were many accidents, leading to awful blast injuries and loss of limbs.”
Action for Humanity
Following Atmeh, David began working with Action for Humanity (formerly Syria Relief) to lead multiple surgical missions in Syria.
“Starting my work with Syria Relief, now Action for Humanity, was the best thing I’ve ever done. They helped me enter the heart of Aleppo, which will always stay with me.
In Aleppo, I was predominantly teaching, so skills were left with the doctors living there. I did some operations to show them how to do things, but after they learned a procedure, I would assist and help. They knew what to do.”
“I was determined to get them out”
Working shoulder to shoulder with Syrian doctors naturally led to strong friendships built on the foundation of shared humanity. In 2016, bunker-busting bombs were destroying buildings and obliterating underground hospitals in Aleppo.
“I thought everyone I’d come to know, all of the doctors I’d met, were going to get killed. I was determined to get them out.”
David contacted President Assad’s office and after four days of trying, his call was connected and he made his case with passion. David will never know if his efforts contributed to the ceasefire that later followed, but he was elated when his friends were granted safe exit from eastern Aleppo.
“There were so many wonderful people working incredibly hard to get a ceasefire. I hope I was able to play a small part.”
Coping with conflict
When asked during a very engaged Q and A how he copes working in conflict zones, David shared:
“You have to be resilient. It can’t be taught to be honest - it’s learned with life experience. There are some things that are out of your control though – the terror that someone might come for you.
After Aleppo, I needed treatment, which helped. But if it’s terror during work or a patient case, talk about it, share the load, you’ll get through the hard times and become more resilient over time.”
A Masters of Disaster Medicine student at UCLan asked, ‘What can we do about healthcare systems being targeted in conflict?’
“Healthcare is indeed used as a weapon of war,” said David. “It’s like a form of psychological warfare. The act of killing a doctor takes down the psychology of whole communities.
We’ve stood on podiums and talked about how we need to protect doctors, written a letter to the Prime Minister, raised placards on a protest in London. We’ve got to do what we can to support healthcare workers.
One day, change will happen. Until then we’ll keep going, we’ll keep the flag flying.”
Meeting Heston
The event ended with a reception, giving guests a chance to meet our team and our one-of-a-kind surgical simulator model, Heston, beautifully presented by Manchester’s Friends of David Nott Foundation (FDNF) Society.
Dr Ayman Jundi, Chair of Action for Humanity and Clinical Senior Lecturer and Disaster Medicine Course Leader at the University of Central Lancashire, said:
“I was honoured and privileged to have a conversation with David Nott. His honest, down-to-earth and inspiring approach engaged the audience and instigated a wonderful and fulfilling discussion.”