Strengthening global surgical capacity through HEST-UK training
Building on the success of our partnership with the Royal College of Surgeons of Edinburgh (RCSEd) in June, where 24 surgeons were equipped with vital skills to save lives and limbs in conflict zones, we joined forces again this December to train an additional 23 surgeons. Our trauma surgery training in the UK (HEST-UK) aligns with RCSEd's broader mission to support global healthcare by equipping professionals to address healthcare needs in low-resource or conflict-affected areas.
Designed for medical professionals working in, or preparing to travel to, conflict and disaster zones, our HEST-UK course brought together participants from around the world. Surgeons traveled from as far as Hong Kong, New Zealand, Australia, Ukraine, and the USA to take part in this transformative week of intensive training.
The course provides comprehensive training in surgical techniques for managing injuries frequently encountered in conflict zones, such as blast and shrapnel wounds, with a dedicated focus on Obstetrics and Gynaecology during the final day. Regardless of their specialty, surgeons gain the skills needed to handle complex trauma cases and significantly improve patient outcomes.
This immersive training integrates real-life trauma case presentations from conflict zones like Syria, teaching models designed specifically for our programmes, and hands-on practice using human cadavers, delivering an unparalleled learning experience.
A Global Effort
The David Nott Foundation and the Royal College of Surgeons of Edinburgh are charitable organisations, and our work is made possible by the generous support of donors and sponsors. We are deeply grateful to The Russell Trust, Essity, BBRAUN, Stryker, and BMA Giving for their invaluable provision of equipment and consumables, which enabled us to deliver this course.
BMA Giving generously granted £10,000 to cover the costs of specimens and equipment for this training. Given the nature of this project, there was significant interest from individuals working with NGOs and other non-profit organizations, where high course fees often present a barrier to accessing training. Thanks to the support of BMA Giving, we were able to reduce fees, ensuring the course was more accessible to a broader range of participants.
Empowering Ukrainian Surgeons to Save Lives
As part of our 2024 localisation efforts in Ukraine, we sponsored three Ukrainian doctors who had previously completed our trauma training courses to attend our Hostile Environment Surgical Training (HEST-UK). This advanced training provided a unique opportunity for them to refine their skills further by practicing on cadavers. They also received dedicated mentorship from our expert faculty, including David Nott, who shared insights drawn from over 30 years of trauma surgery experience in conflict zones.
Upon returning to Ukraine, these doctors joined our growing local Ukrainian faculty to train more surgeons on the ground during this difficult period. Their newly acquired skills were put to immediate use, with reports of life-saving interventions within days of their return.
"Just two days ago, I faced a mass casualty incident involving four patients in one hour. Three of them suffered massive hemorrhages from arterial injuries, fractures, and amputations. I was the only surgeon available. The skills and knowledge I gained through the courses offered by the David Nott Foundation saved their lives and their limbs." - Dr Volodymyr H, Ukrainian General Surgeon
Our most recent training in Ukraine
Equipping medical heroes of South and North Kivu
The Democratic Republic of the Congo (DRC) continues to face a complex and multifaceted crisis that is often overlooked on the global stage, making it one of the world's 'forgotten crises.’ Decades of conflict have left the country with over 8 million internally displaced people. Most of these displacements are driven by violence in eastern provinces like North and South Kivu, where armed groups and intercommunal violence exacerbate instability. The humanitarian needs in the DRC are immense, with over 25 million people requiring assistance. This includes a severe lack of basic services such as food, water, healthcare, and shelter.
The crisis has deep historical roots, shaped by colonial exploitation, political instability, and ongoing conflicts fueled by control over mineral-rich territories. Despite some international efforts, the scale of suffering remains overwhelming and largely unnoticed compared to other global crises.
In the hills of Murhesa, South Kivu, medical professionals gathered at Murhesa Medical Centre for the second time for life-saving training on war surgery and emergency care. Organised by the Friends of the David Nott Foundation in the Democratic Republic of Congo who we funded for teaching tools, this mission was more than just a training course—it was a promise of hope.
“To world leaders and the David Nott Foundation, the Democratic Republic of the Congo urgently needs attention, support, and collaboration in health during this time. Thousands are displaced, facing a security and humanitarian crisis. Training doctors, nurses, midwives, and first-aiders in life-saving skills is more critical than ever.” - Chris Kitumaini, President of the DRC FDNF
A journey into conflict medicine
The training was practical, intense, and tailored to the realities of war-zone healthcare specifically in the DRC. Over a period of 2 days, 4 doctors trained 20 medical professionals from across the region. Participants learned to assess and prioritise life-threatening injuries under pressure, master techniques for suturing wounds, controlling hemorrhages, and managing injuries caused by gunshots and explosions, and perform CPR in resource-limited settings.
The highlight for many was the hands-on neurosurgery workshop, where they practiced emergency craniotomy techniques under the guidance of a skilled neurosurgeon.
Commitment, passion, and motivation
The training concluded with the award of certificates to all participants, symbolising their commitment and the skills acquired during these intensive sessions.
“Driven by the desire to make a positive difference, the David Nott Foundation's support and donation of equipment has helped me organise a training workshop for Congolese doctors to work in resource-limited settings and save millions of lives.”- Chris Kitumaini, President of the DRC FDNF
As the program concluded, we were inspired by the determination and resilience of every individual involved in the organisation of this training, from our Congolese FDNFs to the surgeons they worked with to deliver the training. Their commitment fuels our drive to continue this work. This is why we do what we do, and we won’t stop.
Please note that Friends of the David Nott Foundation (FDNF) operate independently and are not training entities of the David Nott Foundation.
Strengthening trauma response in Northwest Syria
Northwest Syria continues to face escalating hostilities, compounded by regional conflicts that have intensified instability across the area. In October 2024, airstrikes targeting Idlib resulted in numerous casualties, reflecting the ongoing humanitarian crisis. Healthcare facilities, already strained by over a decade of conflict, are now bracing for an increase in trauma cases due to anticipated surges in violence.
Amid this dire backdrop, the World Health Organization (WHO) launched a Trauma Emergency Response and Preparedness (EPREP) plan to strengthen trauma care and emergency preparedness in Northwest Syria. Recognising the David Nott Foundation’s expertise in trauma training, WHO invited us to partner in their efforts to enhance local healthcare capacity. This initiative was generously funded by USAID, whose support has been instrumental in bringing this project to life.
We are honoured to contribute through the delivery of our renowned Hostile Environment Surgical Training (HEST) course, which WHO has identified as a “central pillar” of its trauma response strategy.
From collaboration to local leadership
From November 18 – 22, we delivered a specialised HEST course in Idlib, training 25 Syrian doctors. This marks a milestone in our partnership with WHO and our broader localisation efforts. Notably, this training was entirely led by our Syrian faculty, supported by UK-Syrian faculty members, emphasising the importance of building sustainable, local capacity.
“The new generation of surgeons must learn all of these skills delivered on our courses to save more lives” - Dr Mahmoud Hariri, faculty member
The training focused on equipping participants with critical skills in trauma response, including the management of blast injuries, gunshot wounds, and advanced surgical interventions required in conflict zones. This hands-on course, tailored to address the specific challenges of Northwest Syria, underscored the power of collaboration and the value of empowering local medical professionals to lead in their own communities.
Building resilience amid crises
This mission is part of WHO’s broader plan to enhance the capacity of Northwest Syria’s healthcare system, which prioritises equipping hospitals with essential supplies, creating dedicated triage areas, and improving coordination across trauma networks. Together, we aim to strengthen the region’s ability to respond to mass casualty incidents, ensure communities receive life-saving care during these volatile times, and work towards the sustainable development of the trauma system in Northwest Syria. Building on this foundation, we will continue to contribute to capacity-building efforts in the coming years, with plans to deliver HEST, HEST-A, and HEST-O&G courses early next year.
The devastating events of this past week in Northwest Syria, with fresh waves of airstrikes and escalating violence, have once again underscored the region’s urgent need for enhanced trauma care. We are humbled to have been there just days before, providing Syrian doctors with the life-saving skills they now rely on to manage the growing number of critically injured patients. Our training was not just a response to the immediate need but a long-term investment in the resilience and readiness of Syria’s healthcare system.
Find out more about our work in Syria
A milestone mission in Ukraine
In October, we partnered with the World Health Organization (WHO), UOSSM, and the Ukrainian Ministry of Health to deliver our frontline surgical courses in Ukraine. Thanks to the support of our partners, we were able to train 71 medical professionals from across the country, including the frontlines, who travelled to Kyiv to gain essential trauma care skills. These newly acquired skills will be crucial as they return to their hospitals and provide care in some of the most difficult conditions imaginable.
Since the onset of the war, we have remained steadfast in our commitment to support Ukraine’s medical community. Our mission has been clear: to empower medical professionals who face the realities of war injuries every day. To date, we have trained a total of 666 healthcare workers across Ukraine and built a dedicated team of Ukrainian instructors who, this October, successfully led the Hostile Environment Surgical Training (HEST) course. This October mission was a milestone, as it included an adaptation of the courses tailored to Ukraine’s needs, extending our usual three-day Hostile Environment Surgical Training-Anaesthesia (HEST-A) course to five days, allowing us to deliver even more course content.
Empowering Frontline Nurses and Strengthening Local Healthcare
This mission to Ukraine marked many milestones for us, one being the pilot of our Hostile Environment Surgical Training (HEST) course specifically designed for nurses. In this pilot course, we trained 15 nurses, equipping them with vital trauma care skills. Just as importantly, this course offered us an opportunity to learn from the participants themselves. As they shared their insights, experiences, and specific challenges they face on the ground, we were able to gain a deeper understanding of how we can adapt and enhance our training to best meet their needs in conflict settings.
Nurses are at the heart of frontline healthcare, providing continuous care in some of the most intense and difficult environments. Their bravery and commitment are essential not only in treating patients but also in strengthening healthcare systems in conflict zones. We firmly believe that building resilient healthcare systems requires empowering and supporting nurses.
In addition to training, we are committed to localisation in Ukraine. We do this in a number of ways, including the local employment of key programmatic team members, building relationships with local suppliers and ensuring our strategy is fully in line with that of the Ministry of Health and affiliated bodies. This approach ensures that our training sessions are adapted to locally available resources, we support the local economy, and we deliver a sustainable product for the future of Ukraine.
Our team’s dedication has been unwavering. They travelled long hours, often overnight, and took shelter alongside Ukrainians as they navigated the challenges of delivering these courses amidst ongoing conflict. This commitment was evident in every moment of training.
“As my first deployment with the Foundation, seeing the dedication and resilience of the Ukrainian surgeons, anaesthetists and nurses, who both delivered and attended the courses, palpably highlighted the importance of DNF’s role in providing not only training, but also solidarity.” – Hetty Cane, DNF Programmes Officer
The Power of Partnerships
Our work would not be possible without the strength and commitment of our partners. With critical funding from the WHO, logistical support from UOSSM, and guidance from the Ukrainian Ministry of Health, we have been able to deliver life-saving training in Ukraine. These partnerships are central to our mission, enabling us to empower frontline medical professionals and make a lasting impact on healthcare in conflict zones. Together, we are building a future where medical teams are equipped, resilient, and ready to save lives when it matters most.
“This mission was a huge step towards our goal of localising our HEST courses in Ukraine. It was a mission of firsts. It was a privilege to collaborate with UOSSM, headed up by Ahmed Aldbis and Muhammad Zaydiye, who, with their team, worked with us to enable these courses. We're indebted to the Ukrainian Ministry of Health, WHO-Ukraine and Bogomolets National Medical University for partnering with us.” - Nick Cartwright, DNF Head of Operations
Find out more about our work in Ukraine
Serving low-resource hospitals in the DRC
This year, we were contacted by a doctor from the Democratic Republic of Congo (DRC) to set up a Friends of David Nott Foundation (FDNF) society – our very first FDNF in Africa. In a bid to support the development of African doctors in hospitals with poor resources, we provided funding for teaching tools used to upskill medical professionals in deep DRC territory.
In June 2023, a WHO report found that the number of internally displaced persons (IDPs) in the DRC has more than doubled to 6.3 million, since the end of 2022. The crisis has emerged as decades of conflict and food insecurity soars in the DRC, made worse by extreme flooding and disease outbreaks throughout the Ituri and North Kivu Provinces.
Chris Kitumaini, a medical doctor and President of our FDNF in the DRC, arranged a training course for doctors at the Murhesa Medical Center, a modest hospital with very limited resources, medical equipment and staff. He shared:
“We travelled to Bukavu, in the South-Kivu Province in the DRC, and then went onto Kabare’s deep territory to get to the Murhesa Medical Center. We picked this location to train in because it is a hospital with very low income. Resources are so limited there."
"In the operating rooms, there is nothing. Women are giving birth on wooden tables. The doctors there are working with the smallest amount of materials, no beds, no anaesthesia machines. Nothing but the doctors and medical assistants."
Basic medical skills
The surgical teaching team, some of whom had travelled from Bordeaux, taught a range of basic medical and surgical skills to a group of 20 doctors from different territories. Some had travelled from small villages to get to the training in Murhesa Medical Center.
Four courses were delivered during two intensive days of training, using surgical toolkits, mannikins and anaesthesia tools funded by us. Dr Raïssa Kizungu, a cardiologist from Bordeaux, led the management of cardiovascular pathologies in the context of war and environments with limited resources. The team used mannikins to teach the group cardiopulmonary resuscitation (CPR) and essential tools for resuscitation to preserve life in resource-limited settings. Dr Elie Bugashane, a general surgeon, led the management of battlefield wounds and suture techniques in resource-limited environments. Finally, Dr Charles Kachungunu led the management of head trauma and how to deliver excellent nursing care.
During other practical sessions, the surgeons learned how to do a craniotomy to stop serious bleeding, as well as suture techniques to manage wounds in war and low-resource contexts.
A thirst to learn
“Our first workshop, funded by the David Nott Foundation, was a success. We chose doctors and medical professionals who really needed training. It was a big moment for us.
We now want to focus on training in other places that need us the most – villages deep in the Congo forest. Learning simple procedures, like how to secure broken limbs, could really help people that cannot move to other hospital easily.”
We remain committed to supporting medical professionals living and working in countries impacted by war and disaster.
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
Friends of David Nott Foundation Conference - leaders of tomorrow
This month, we held our third Friends of David Nott Foundation (FDNF) conference, hosted this year by our FDNF at the University of Cambridge in the Clinical School of Medicine. This event brought together 45 dedicated FDNF members from universities across the UK, including Dundee, Leicester, Nottingham, Manchester, Glasgow,Cork, Bristol, and Cardiff, alongside international attendees from the Czech Republic.
Our Friends of David Nott Foundation societies are made up of medical students who wish to embark on a humanitarian career. By bringing them together for teaching and connection with our trainers, our goal is to nourish the next generation of humanitarian surgeons.
The conference featured four specialised workshops led by our faculty members, focusing on vascular surgery, orthopaedics, paediatrics, and general trauma. These sessions provided students with hands-on surgical experience and insights into the challenging yet rewarding field of humanitarian medicine.
Faculty trainer Dr Mahmoud Hariri, a surgeon who met our Co-Founder David Nott in underground hospitals in Syria, led our final lecture. He shared his experiences from Syria and the difficulties of being a surgeon under unimaginable pressure.
“One of the hospitals I worked in was in a cave in a mountain. There are many hospitals like this in Syria. Some are underground or in a gym. Most of our lives at that time (during the siege), were underground."
"Being a war surgeon is not a funny thing, it is difficult. I have experienced soldiers placing bets on what they could hit each day.” - Dr Mahmoud Hariri, faculty trainer
Our Co-Founder Elly Nott opened the event with an inspiring address, expressing her excitement for this annual gathering and highlighting the critical role it plays in fostering the next generation of humanitarian healthcare professionals.
"Our FDNF conference is a highlight of my year. It’s a joy to meet the next generation of humanitarians and see how enthusiastic they are to use their skills to make the world a better place.” Elly Nott, Co-Founder
Through our FDNFs, students contribute significantly to our work by raising awareness, fundraising for missions, and volunteering on our Hostile Environment Surgical Training (HEST) courses offered in the UK.
They are the future of this world, and now more than ever, we need people who want to help and make a difference.
This conference not only reinforced the commitment of current FDNFs but also inspired new additions to engage deeply our mission in helping to ensure safe surgical skills are available to all.
More on FDNF's
“If this training can work in Gaza, it can work anywhere else.”
Dr Israar Ul-Haq joined our HEST-UK (Hostile Environment Surgical Training-UK) course in Bolton to improve his trauma surgery skills before entering the heart of Palestine’s crisis – the Gaza Strip.
Dr Israar Ul-Haq is a doctor with a primary focus on urgent and pre-hospital care. Volunteering his expertise, Dr Ul-Haq joined two separate missions to Gaza, serving in Khan Younis and Deir al Balah.
“As I entered Gaza I felt a mix of emotions—eager to employ the skills I learned from HEST and help those in need, yet wary of the drones I can hear as soon as I entered.”
With minimal resources and an overwhelming patient load, ranging from 500 to 1000 individuals daily according to Dr Ul-Haq, the medical staff faced immense challenges. The injuries they treated ranged from blast injuries and crush wounds, to traumatic amputations and fatal head injuries, or gun shot and sniper wounds. Techniques learned during the HEST course, such as medical triage or procedures for getting access to the chest quickly, such as thoracotomies, were immediately put into action.
It impacted every aspect of my work in Gaza
Dr Ul-Haq shared: “The course impacted every aspect of my work in Gaza, such as understanding the local environment and the types of injuries we encountered. Whether it was performing chest drains, managing blast injuries, conducting debridement, or treating burns, the training equipped me with the necessary skills I needed.
The lectures on burns were very useful, they directly influenced our treatment protocols. Techniques like thoracotomy and bleeding control learned during the course became standard procedures in our daily practice. The emphasis on conducting primary and secondary surveys, along with fast scanning helped us to quickly assess and address critical issues in a high-pressure setting."
Patients that stay with us
“One patient's case is stuck in my head. He presented with a shrapnel injury to his back, which had penetrated his thorax. While we stabilised him initially, signs of Beck's triad (low blood pressure, distended neck veins, and distant or muffled heart sounds) alerted us to a possible cardiac tamponade (a serious condition where fluid builds up around the heart) - I had learned to identify this issue through fast scanning during the course. We rushed him to the operating theatre. Employing techniques like the clamp shell procedure, we successfully removed the bleeding around his heart, stabilising him.”
“We had a four-year-old brought into the hospital with a pneumothorax, severe head injuries, and burns. We immediately admitted the child to the ICU. We performed a chest drain to treat the pneumothorax and employing rapid sequence induction (a method to quickly administer anaesthesia and secure the airway) to stabilise the child's condition. We debrided the wounds at the back and used fluid therapy to manage shock and maintain stability.”
Our course is not just about building medical skills, it's about cultivating problem-solving abilities in the most challenging of circumstances. In environments where resources, staffing, and traumas are at their peak, the course empowers doctors to think laterally and use whatever limited resources they have. From using different pain management drugs to conducting fast scans to evaluate a patient's condition rapidly, every aspect of the training is geared towards equipping doctors with the tools they need to save lives, no matter where they are.
“Upon arrival, another patient had no bleeding or shrapnel injuries, but vitals would not stabilise. drawing on what we learned from the HEST course, we identified a left-sided pneumothorax. Despite initial stabilization efforts, the patient's vital signs remained unstable,” shared Dr Ul-Haq. “I often used the fast-scanning technique taught in the course. ; I detected an additional right-sided pneumothorax. Without hesitation, I proceeded to insert a chest tube, a procedure ingrained in our training. Had we delayed any longer, the outcome could have been disastrous.”
“Gaza is facing unimaginable suffering, and HEST was incredibly helpful there. If it can work in Gaza, it can work anywhere else too.”
READ MORE ABOUT OUR WORK FOR PALESTINE
The anaesthetist in a war zone
It takes a team to save a life in a war zone. Recognising the vital need for anaesthetists in conflict, we developed a bespoke anaesthesia course, to prepare anaesthetists for working in war hospitals. One of our experienced trainers, Dr Hussein Nagi, recently taught anaesthetists from Kuwait who are heading to Palestine.
Managing pain in different ways
“Treatment and anaesthesia do not end in the operative theatre. In a war zone, you could have a whole ward of people with post-operative pain, for example after amputations. Anaesthetists must do what they can with what they have to continue their care," shared Dr Nagi in Kuwait.
"A colleague once shared that a boy was screaming in the night with phantom limb pain after getting an amputation, he was shouting ‘my toe is hurting’. His toes were not there.
They found a stock of epidural kits in their hospital (for maternal care) and gave it to him through a catheter – the boy was almost pain free. You can resolve severe pain, by nerve blocking, with a range of drugs. You just need to be able to adapt to your environment.”
Our course teachers share tips and tricks just like this, with the goal of making anaesthetists adaptable to the challenges of a conflict-affected environment.
The science behind war
A trainee from Kuwait, during our latest HEST-A course in the Middle East, shared: “The trainers were combining their war experience with theoretical teaching, which added a lot to the course – showing us what to expect.
There were three main sessions that I learned the most from. Damage control, the ballistics science behind bullets and bombs, and the chemical weapons session. They’re not taught during medical training so knowing more about them, how to deal with these situations, understanding the science to then anticipate what we may meet in A and E, was the highlight of the course.”
Triage is critical
“It was an impressive course. The most interesting part for me was the triage, and making decisions using the information we have learned over years in studies, but applying it to a conflict zone.
"You have to adjust and accommodate to different situations, especially areas where you don’t have all the resources."
Gaza today urgently needs resources, food, water, equipment and man power. From what we hear from doctors on the ground, medical resources are much needed. It is very desperate.”
We have trained over 80 surgeons and anaesthetist in the UK and Kuwait who have, or intend to, volunteer their skills in Palestine's frontline hospitals. We will continue to upskill doctors in support of the people of Gaza.