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."
Bringing future humanitarian surgeons together for the first time
This month, we hosted our first annual Trainees of the David Nott Foundation (TDNF) conference. The conference aimed to bring surgical trainees interested in global humanitarian careers together, to learn from our war doctors and take part in bespoke workshops.
Held as a hybrid event at the University of Salford in Manchester, the conference attracted 200 medical professionals from various specialties and international locations, including Yemen, Pakistan, Albania, Nigeria, Poland, UAE, Singapore, Ethiopia, Thailand, Malawi, Libya, and many more.
Dan Lazenby, the president of the TDNF committee and a plastic and burns training registrar, founded our TDNF network in 2023.
“There was a gap in the market for trainees interested in humanitarian work and global surgery education. I wanted to emulate that for trainees. I believe there is a real lack of platforms and communities for junior members to get involved. The more we involve them early, the better they can contribute.” – Dan Lazenby, TDNF President
TDNF has made significant strides since its birth. The committee has 13 members from various specialties across the UK and plans to expand the community. They have hosted two webinars with participation from 50-100 doctors worldwide, providing information to global trainees on how to get involved in humanitarian efforts. Future initiatives include developing a mentorship program, focusing on basic global surgical skills for trainees through online platforms.
“Our dream is to follow in the footsteps of David Nott and other humanitarian surgeons.”
Workshops focus on essential trauma skills
The conference, held on the 13th July, was a full day of comprehensive lectures and workshops. Our faculty trainers provided trainees with insights into working in war zones, sharing experiences from Syria, Afghanistan, and Gaza. The event featured workshops on orthopaedics, vascular surgery and general trauma, where trainees spent hours practicing casting, suturing, and managing major trauma injuries. Networking between trainees and faculty members was also a highlight, fostering vital relationships between peers and building a strong community.
“The hybrid international platform was invaluable, allowing people to join virtually and in person, inspiring the humanitarian surgeons of tomorrow all around the world."
A vision for the future
Looking to the future, Dan shared: “We aim to host annual conferences, develop mentorship programs, and reach people from more diverse backgrounds. We all have the same goal, to treat patients safely and effectively. One of our ideas is to accompany the David Nott Foundation to teach junior members basic skills, which will make a significant difference.”
We will continue to prepare the humanitarians of tomorrow, ensuring safe, skilled surgical care reaches everyone.
24 doctors trained during 1st UK course with Royal College of Surgeons Edinburgh
For the first time in partnership with Royal College of Surgeons of Edinburgh (RCSEd), we delivered a Hostile Environment Surgical Training UK (HEST-UK) course to equip 24 surgeons from across the globe with vital skills needed to save lives in conflict and disaster zones.
Aimed at medical professionals who work in, or are planning to travel to, conflict and catastrophe zones around the world, our HEST-UK course brought together surgeons from across the globe, including Australia, Poland, Finland, Denmark, Libya and six from Ukraine, for a transformative week of intensive training.
This marks the beginning of our brand-new partnership with RCSEd, joining forces to upskill humanitarian surgeons and frontline trainers in the making. Our course combined trauma case presentations taken straight from war zones like in Syria, our cutting-edge teaching models designed especially for our use, and human cadavers.
Dr Igor Belkin, HEST-UK participant and surgeon from Ukraine who we sponsored to join our training, said:
“The course was great! All frontline methods were described in detail in theory, and then with the help of DNF trainers, we then worked on and learned more about using cadavers.
These skills are always useful, especially in a country that is at war. After completing another DNF course in Zaporizhizhia in February 2023, I used many learnings in field surgery. Now in Edinburgh, I got even more practice with cadavers.”
Dr Senka Stojanovic, HEST-UK participant and general surgeon from Poland, said:
"Now, possibly more than ever during our lifetimes, the world is fraught with problems of growing divisions and inequality, which among other things impacts access to quality healthcare, affecting not only the current generation, but future ones as well.
I felt incredibly fortunate and grateful for the opportunity to learn first-hand from some of the leading experts in the field.
"The wealth of experience and practical tips brought by the faculty was unmatched and cannot be found in textbooks or surgical atlases."
I highly recommend this unique course to any surgeons who plan to or already work in humanitarian settings around the globe, but who need to build on their confidence and skill to provide surgical care outside of their surgical specialties."
Mariette Naud-Betteridge, Director of Partnerships and Stakeholder Engagement at RCSEd, said:
“Witnessing the course first-hand revealed the extensive practice and diverse disciplines required to deliver surgical care in conflict zones. Not only did the course’s structure and the dedication of David and his faculty bring challenging cases to life, the delegates' intense focus and eagerness to learn emphasised the course’s relevance and necessity.
Collaboration between the David Nott Foundation and RCSEd demonstrates our shared commitment to equipping medical professionals with the critical skills and confidence needed to save lives in the most demanding situations. Special thanks also to all who supported the course, including sponsors B. Braun, Essity, and Stryker. RCSEd look forward to welcoming back the DNF team and a new set of delegates in December for the next HEST-UK Course.”
As fighting intensifies across Ukraine, Palestine, Sudan and beyond, there has never been a greater need for skilled, humanitarian surgeons around the world. That’s why our programme of bespoke training courses are so vital and we will continue to grow our international network of war doctors.
Sign up to our next HEST-UK course
Joining forces with the Royal College of Surgeons of Edinburgh
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.
REGISTER TODAY
Royal Parks runners help us train more doctors
We are continuously amazed by our supporters. This year's Royal Parks Half Marathon saw many of our supporters take to London's streets to raise thousands for doctors living and working in the world's most dangerous corners. Thanks to their determination, doctors in territories such as Ukraine, Yemen, Palestine and Syria will receive the surgical training needed to treat traumatic injuries and save lives.
Our photographer and videographer, Lucy Lyon, swapped her camera for trainers and took part in the Royal Parks Half Marathon with her brother, Duncan. Together, the pair have raised over £3000 for our mission.
"It was an amazing day in many ways. Golden leafed London parks with warm sun, every shape and ethnicity, age and gender moving along side by side, in a steady tide, for thousands of different causes.
Everyone smiled, no one pushed or shoved. There was a human tree, and a very hot lion, tiger, and a bear. Even a rhino. A man with a fridge on his back, and people in wheelchairs.
The supporters were everywhere, drumming and cheering us along. It was a morning well spent and all the while jogging along beside me was my little brother.
We agreed that running that distance together was more like running with a pet - a silent but constant companion. And the best bit about running in your late 40s is the gratitude you feel to those legs and feet for their constancy and power.
We have so far raised enough to support the training of at least two surgeons from a conflict zone, who will go on to save hundreds of lives in their region."
If you'd like to set yourself a challenge or raise funds for a cause that changes the lives of communities in conflict, get started today. Thank you to each and every person who supports our mission.
This World Humanitarian Day
This World Humanitarian Day, we reflect on our commitment to the humanitarian values that inspire our work - training medical professionals to provide safe, skilled surgical care in countries impacted by conflict and catastrophe.
Our flagship Hostile Environment Surgical Training (HEST) course continues to provide the best in surgical training to those who need it most. Using innovative teaching materials such as our prosthetic hearts, kidneys, arteries and veins, our world-class trauma surgery modules are brought to life by the remarkable, talented training faculty who deliver it. We are so grateful to our team of trainers who give up their time to share knowledge with doctors around the world. We know they also learn as much from them in return.
In addition to training surgeons, we have developed an anaesthesia module, expanding our focus from the surgeon to the wider - any equally important - operating theatre team. As with surgery, conflict presents unique challenges for anaesthetic practice including severe blast injuries, blood loss and resource constraints.
I was inspired to start our Foundation by a single, grainy photograph of David.
In a room in a hospital in Aleppo, lit solely by the steady beam of a projector, he was discussing cases with a group of Syrian doctors at the end of a day of operating. I started thinking how that life-saving training delivered by David in Aleppo, built on decades of frontline experience, could be brought to hundreds, perhaps thousands, more doctors.
David’s unwavering connection with the doctors of northwest Syria goes back a decade and when the devastating earthquake hit southern Türkiye and northwest Syria in February, we immediately started discussing with local partners and colleagues what they were seeing and how we could help. It rapidly became clear that thousands of survivors were left with life-altering injuries in need of surgical treatment and rehabilitative care.
Thanks to expert navigation of local permissions by our partners, we were able to run a joint teaching and operating mission with Action for Humanity in Aqrabat Hospital, Idlib. The Action for Humanity team saw 300 patients in clinic before completing 60 surgeries the following week. Above the operating theatres, we equipped 35 Syrian doctors with the surgical techniques they need to treat complex injuries inflicted by the earthquake or ongoing conflict.
Ninety percent of our training faculty on the mission were Syrian and based in the northwest, therefore able to better understand local health system challenges and teach the course in Arabic.
Sustainability is vitally important to us; we want surgical knowledge to be embedded in communities to the extent that it is self-perpetuating and we are no longer needed. Until it is, we’ll keep returning as long as we are needed, No Matter What.
As a small charity, we are able to deliver so much more in terms of training and value for our donors’ money by partnering with other humanitarian organisations like Action for Humanity. Our training partners are diverse in scale and size. We delivered training in Moldova with the World Health Organisation and for Yemeni surgeons with Médecins Sans Frontières. We are excited to collaborate with MedGlobal in the coming months, and in Ukraine, were proud to partner with our friends at UOSSM, a charity initially formed to provide relief and assistance to Syrian civilians affected by the deadly conflict there.
Unfortunately, risks for humanitarians and attacks on healthcare have increased in recent years.
Last week, Physicians for Human Rights reported that 1014 attacks have been perpetrated against Ukraine’s hospitals, health workers, and other medical infrastructure since February 2022. Recent Elrha research also revealed that attacks on Syrian health facilities have deterred people from accessing health services and seeking help when needed.
Every hospital bombed, every healthcare worker killed, denies people vital care and destabilises communities both physically and psychologically. These atrocities are under-reported and we are honoured to support the campaigning efforts of Action for Sama, seeking to raise awareness of and ensure accountability for attacks on healthcare.
We believe in safe, skilled surgical care for all and stand with the communities we serve, No Matter What.
Elly Nott, Co-Founder and CEO
Trekking to Everest's viewpoint in Lucy’s memory
We were recently contacted by Dominic Cahillane, the beloved brother of Lucy who sadly passed away on the 12th of March. Dominic, additional family members and friends of Lucy’s came together to raise funds in her memory. We were honoured when Lucy’s loved ones told us they were trekking to Mount Everest's viewpoint and raising funds for us, a mission that was close to Lucy's heart.
Dominic, Lucy’s brother, shared:
“On March 12th of this year, my amazing sister Lucy Cahillane left this life for what we can only hope is a serene and fitting higher plane, where her energy can be used for the betterment of those in need, both past and present.
Lucy gave herself tirelessly to the needs of others, always there to listen, to shoulder a burden, offer advice, and make you feel safe in the toughest of periods. Her focus was that the people she came across in her life should always feel loved and have an optimism for the future, the painful juxtaposition being that she was eventually unable to do this for herself.
In her memory, and on behalf of the David Nott Foundation, a charity that was close to Lucy's heart, my partner Radka Nemcova and friend Katerina Tumova (pictured above) took on a 5-day return hike in the Himalayas from Lukla to Everest Viewpoint above Namche Bazaar.
I hope you can join them in this feat to donate to those who look to make even the slightest of difference in an increasingly marginalised and difficult world where those in need are rarely heard.
‘Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind.’ - Bertrand Russell
Miss you sis, love Dom xxx”
We are incredibly honoured to receive donations in Lucy’s memory, with £2,300 raised so far. If you’d like to donate, please visit the family’s JustGiving page.