Teaching 86 war doctors in Vinnytsia, Ukraine
86 more Ukrainian doctors are now armed with trauma surgery skills that will help them improve the care they give to victims injured on the frontline. In partnership with UOSSM International, our trainers upskilled both surgeons and anaesthetists in the Ukrainian city of Vinnytsia.
Despite over two years of conflict, many doctors in Ukraine are still facing horrifying injuries - and many they were not trained to treat during standard medical training. War inflicts incomprehensible injuries on those it meets. Shrapnel can tear through multiple parts of the body and it’s a medical team’s job to identify which injury needs treating first. This is done by carrying out damage control to find and reduce sources of bleeding before repairs can take place. Under pressure, this isn’t an easy feat but are vital skills that we teach – alongside guidance on how to stay calm and focused - on our course.
The long road
It’s not just immediate care that doctors need to be trained in. War wounds often require months, sometimes years, of rehabilitation and additional surgeries. Our team visited the Superhuman Center in Vynnyky, Lviv, an outstanding facility supporting adults and children who have lost limbs in the war. It is facilities like these, and training like ours, that help doctors carry out amputations in such a way that the victims will recover well or receive prosthetics when the time comes.
Nick Cartwright, our Programmes Manager who led this course and visited facilities at both Superhuman and Unbroken, said:
“There’s a lot of a hardship in Ukraine today, but a lot of hope. There’s a strong desire for our training – Ukrainian doctors want to know they are doing absolutely everything they can for those injured in their communities. Having now upskilled nearly 600 doctors in Ukraine, the country’s healthcare systems are getting stronger, despite the ongoing pressures of war.”
Frontline stories
We interviewed a number of doctors who took our surgical and anaesthesia courses in Vinnytsia. It’s their experiences that drive us to keep going back to new cities, spreading trauma surgery knowledge further across the country.
“People were burning”
“When the war started we had a lot of humanitarian aid it was so helpful. But we still need it – the war hasn’t finished. This course is so helpful and interesting – there’s a lot of information and practical skills. Many things were new for me. It’s great that I now have new skills and knowledge.
I have some experience of war wounds since the war. We’ve had attacks here in Vinnytsia, a lot people were injured. People were burning, some had head injuries, they came to our emergency hospital. I also volunteered in places like Donbass.
The biggest attack here was on the 14th of July. A lot of people were killed, children. It was hard because we didn’t prepare for this. On this course, we saw a video of how colleagues work in an emergency situation. We have some things we need to change on how we will work in an emergency.
I want to tell the world that war in Ukraine is still going on. A lot of civilian people are dying. We need help to win this war – and I hope it will be soon.” - Daria, General Surgery Resident, Vinnytsia
“I’m going to use these skills in my operations”
“I’m a civilian anaesthesiologist in a country that is under war. I’m going to use these skills in planned operations in critical care in my emergency hospital.
Since we always have a lot of patients, with many civilians, internally displaced people, and military, who have trauma wounds, we are always lacking the materials, medication and equipment. Anything we receive (including training) we always use it.” – Igor, Anaesthetist, Vinnytsia
“I hope people are kind”
"I’m a Resident of General Surgery, trying to do all I can in my specialty. I hope I will not use this knowledge (from the David Nott Foundation training) on the battlefield, but Russia is still attacking.
I have some experience of treating war injuries. We’ve had a lot of injured people and deaths. I want to bring attention to Ukrainian refugees too who are now in other countries. I hope whoever hosts them is kind to them.” – Anastasiia, General Surgery Resident, Vinnytsia
As Ukraine continues to be ravaged by war, we have made a commitment to train every Ukrainian doctor in the country. Help us achieve our goal.
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Two years of war and two years of attacks on healthcare
Two years have passed since Russia's invasion of Ukraine and the scars continue to run deep. As published in the Foreign Policy Centre, our CEO, Elly Nott, shares the realities faced by Ukrainian doctors and the relentless attacks on their healthcare system that continue to persist even after 24 months of war.
Ongoing struggles, relentless weaponisation and devastating attacks on healthcare continue to be perpetrated by Russia. The numbers are staggering with over 1,000 verified attacks on healthcare in Ukraine as confirmed by the World Health Organisation.
"These figures are not just statistics. They represent lives shattered, dreams destroyed, and communities torn apart."
Beyond the numbers, healthcare plays a critical role in upholding societal cohesion and fostering trust between citizens and their government. Despite relentless onslaught, the Ukrainian people have displayed remarkable resilience, refusing to let their national spirit be broken by the brutality of war. But amidst the devastation, there is a glaring absence of justice.
Our work at the David Nott Foundation stands as testament to our commitment to supporting those affected by conflict. As the conflict unfolded in 2022, our Co-Founder, David Nott, conducted a series of intensive training sessions, upskilling 573 Ukrainian doctors over Zoom. In the subsequent years of 2022 and 2023, we expanded our efforts, providing specialised training to 442 surgeons and anaesthetists through 11 comprehensive surgical training courses.
We have forged crucial partnerships with Ukraine's Ministry of Health, the World Health Organisation, and UOSSM. As part of our broader Ukraine program, we've also funded scholarships to further empower healthcare professionals. Specifically, we funded a Ukrainian surgeon and anaesthetist to undergo paediatric trauma surgical training.
As the war wages on, we will continue to support Ukraine's healthcare heroes, ensuring they are equipped with the knowledge and skills needed to save lives and alleviate the suffering caused by the ongoing conflict.
Elly Nott,
Co-Founder
Two Years On: Russia Continues to weaponise and attack healthcare in Ukraine
Addressing healthcare challenges in Moldova
In the wake of the escalating conflict in Ukraine, Moldova, a neighbouring country, is grappling with the concern of being somehow drawn into the war. To extend support during these challenging times, the David Nott Foundation, in collaboration with the World Health Organisation, conducted two specialised Hostile Environment Surgical Training-Anaesthesia courses in Moldova.
The refugee influx and healthcare strain
Since Russia's invasion of Ukraine, Moldova has witnessed an influx of over 700,000 refugees seeking peace and safety by passing through its borders. Recognising the strain these precipitates to available healthcare resources, the Foundation has provided ongoing support over four courses since January 2023.
The anaesthesia (HEST-A) courses, conducted from December 11th to 16th, aimed to up skill 25 anaesthetists to better handle healthcare challenges arising from the crisis. The training spanned six days, with the first three days conducted in English and the subsequent three days in Moldovan.
Participants expressed satisfaction with the course structure, emphasising the benefit of discussions and supervised practical activity over a lecture-heavy approach. As the anaesthetists underwent training, they raised concerns about resource availability and hospital capacity in the face of refugee movements. In response, our highly skilled teaching faculty offered valuable advice and information.
Innovative training models
The courses saw three UK-based faculty members delivering in-person sessions, with an additional faculty member, the Foundation’s lead consultant for anaesthesia, delivering a virtual training session on chemical weapons.
The David Nott Foundation's HEST-A course in Moldova not only aimed to enhance the skills of healthcare professionals but also addressed specific challenges posed by the Ukraine crisis. By fostering collaboration with WHO and adapting the course content to local needs, the Foundation continues its mission of providing essential medical training in conflict zones to save lives and alleviate human suffering.
“There is nothing more heart-warming, more fulfilling, than seeing the impact of our work through the stories of those we teach. To see that connection brought to life is truly a testament to our mission.” - Hannah Graham-Brown, Programmes Officer at The David Nott Foundation
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.
80 surgeons and anaesthetists upskilled in Kyiv, Ukraine
Our new Chief Operating Officer, Tim Law, recently returned from his first mission. Tim supported our trainers to deliver two surgical training courses in Kyiv. With logistical support from our partner World Health Organisation (WHO), 80 surgeons and anaesthetists from frontline cities learned how to treat mass trauma injuries using world-leading surgical teaching models.
To continue upskilling Ukraine’s frontline doctors, our team embarked on the challenging journey to Kyiv, first flying into Poland and travelling by bus to our final training location two days later. Despite a temporary bus breakdown in scorching heat and consequent concerns about entering Lviv before curfew, our trainers arrived safely in Kyiv and began preparing teaching materials, tools and models for the arrival of more than 80 Ukrainian doctors.
Over six days, our faculty of trainers delivered two condensed hostile environment surgical training (HEST) courses, rich in trauma surgery teachings and practical sessions.
This year, we expanded our course to include anaesthetics – a vital component of trauma surgery care. During this mission, two new faculty trainers, Dr Ian Tyrrell-Marsh and Dr Tom Dolphin, led our anaesthetics module and upskilled 22 anaesthetists from across Ukraine.
Doctors united in learning
Although united by a shared desire to manage catastrophic injuries, attendees came to our training from different Ukrainian cities.
Tim Law, our COO at the Foundation, shared: “Participation in the course was designed such that about two thirds of doctors came from front-facing oblasts or provinces. They came from Zaporizhizhia, Dnipro, Kyiv and beyond. Most of them were based in civilian hospitals.
A lot of their cities are subjected to bombardment on a reasonably regular basis. As we’re still seeing in the news, attacks lead to casualties of war, some of which are military, but many are everyday people.
Often civilian hospitals treat both civilian and military casualties, as many frontline fighters are transferred from military hospitals to make space for the next round of injured.”
Unrivalled education
Witnessing my first surgical training course in action – there is no doubt it is world-leading education.
"It was fascinating to be able to see the real value that the David Nott Foundation can add to the skills of medical professionals forced by circumstance to react to the challenges presented by armed conflict. It’s world-class education delivered by seasoned practitioners, and based on years of accumulation of course materials and conflict-specific skills.
The combination of experience within the training faculty, course material quality and the practical sessions with Heston, our human body war wound simulator, enables demonstrations that otherwise aren’t possible in Ukraine,” continued Tim.
Cadavers cannot be used for teaching in Ukraine, and our war wound model has been described by surgeons as even more effective than cadaver training.
Some shared that they’ve never had access to such state-of-the-art materials and were excited to be able to take our hand-made silicone hearts back to their hospitals to continue their practice of cardiac suture repair.
Remnants of war
Although the likelihood of active conflict in Kyiv has lessened, remnants of war can be seen in and around the city. Air raids are a common backdrop, often ignored by locals as they try to continue with their everyday lives.
On the road from Lviv into Kyiv, you can see signs of Ukrainian defence. Minefield markings, skull and cross bone signs and string between trees signpost dangerous land.
On the anniversary of Ukraine’s independence, approximately 40 Russian military vehicles had been lined up along the main street. A sign that although life goes on in Kyiv, national pride and the community’s acknowledgement of their country’s continued battle remains.
“We aim to continue to develop this world-class training, such that we can continue to deliver training in the world’s most challenging environments, enabling medical professionals to enhance their skills whilst remaining close to where they are most needed", shared Tim.
"We will develop our offering to include new modules on hospital management and surgical nursing and are in the process of building a second synthetic full-body simulator and of increasing the scale of our teaching faculty. Taken together, this should enable us to increase the scale, scope and quality of our future interventions. Thank you to our supporters for helping to make these dreams a reality.”
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
Hospice Ukraine raises over £50,000 to better serve the terminally ill
Photo credit: Hospice Ukraine and the Royal Society of Medicine, London
As part of a special Hospice Ukraine event raising funds for palliative care in Ukraine, our Co-Founder David Nott was invited to share his reflections of upskilling over 200 Ukrainian doctors during eight missions, and the importance of fighting for continued holistic healthcare - from the beginning of life to the end - during war.
Since Russia’s violent attacks against Ukraine began last February, the Ukrainian people’s access to healthcare has suffered immensely. We know conflict leads to reduced medical equipment, medicines, specialist care and hospital staff numbers. Despite our mission focussing on saving lives with skilled surgery, palliative care for the terminally ill remains of equal and vital importance.
Hospice Ukraine is a charity that believes everyone deserves access to high-quality palliative care, no matter where they live. But the upheaval of war has overwhelmed the ability of Ukrainian healthcare professionals to support those nearing the end of life.
To better provide comfort, dignity and care for the terminally ill, Emily Maitlis and Jon Sopel came together at the Royal Society of Medicine in London to host a special fundraiser organised by palliative care doctor, writer and Co-Founder of Hospice Ukraine, Dr Rachel Clarke.
When asked how David copes working in war zones like Ukraine, he shared: "Humans become incredibly resilient under pressure. It's what we train (during our courses too). We're not going to waver, we'll be here for our friends in Ukraine until this war is over."
David was joined by fellow speakers such as writer and comedian, Adam Kay, and world-renowned former neurosurgeon, Dr Henry Marsh, who holds deep connections with doctors and academics in Ukraine. Guests also heard a selection of beautiful songs from a Ukrainian refugee choir now based in the UK.
Speaking of the remarkable ability for the terminally ill to exude love and concern for others as they near death, Adam Kay shared, "The thing I realize (during a 2-hour conversation with a patient) is that none of her many concerns are about herself; it's all about the kids, her husband, her sister, her friends. Maybe that's the definition of a good person."
A live auction, which included a piece of work donated by Grayson Perry, led to a final fundraising figure of £50,000. We will continue to advocate for healthcare excellence and the people of Ukraine, for as long as this war wages on.
“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
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