“The need in Syria is astonishing”
We’ve just returned from northwest Syria after training 23 local doctors to surgically treat complex wounds caused by the earthquake that shattered parts of Syria and Türkiye in February. Our CEO, Elly Nott, shares her reflections of our latest mission and how we will continue to stand with Syria.
As soon as we crossed the border into Syria, fields of olive trees stretched as far my eyes could see. Row after row, the trees continued until we reached Atmeh.
Our destination was Aqrabat Hospital, where I was leading a surgical mission to train local doctors to provide specialist orthopaedic and plastic surgical care to the survivors of February’s devastating earthquake.
The need for our training is astonishing.
After hearing that ours and Action for Humanity’s specialist doctors were visiting, a staggering 2,000 people sought care at the Hospital.
Action for Humanity’s team, who led the operating arm of our mission, saw 300 in clinic and were able to surgically treat over 60 patients over a week period. At the same time, in rooms above the operating theatres, we taught 23 Syrian doctors with the skills needed to treat complex trauma injuries inflicted by earthquakes or the ongoing conflict. Our team also taught nine Syrian surgeons to become David Nott Foundation trainers themselves, leaving a lasting legacy of shared knowledge and confident doctors in Syria.
Aqrabat sits in northwest Syria and is supported by a remarkable network of civil society organisations and NGOs. Despite this, the region is vulnerable. The hospital serves a population of around four million, the majority of whom are dependent on humanitarian aid. Some 2.6 million of residents have already been forcibly and repeatedly displaced from their homes by the conflict from places including Ghouta, Dara’a, Homs, Aleppo. Families faced food and fuel shortages and health challenges including a cholera outbreak. The recent earthquakes have added further pressure to weakened economies and healthcare systems across the country.
As conflict and the effects of the earthquake continue to fuel instability, we must not abandon Syria.
Speaking to doctors we’ve trained, it’s clear our mission has had a lasting impact. Many have commented on their restored confidence and others that they now feel better equipped to treat those most in need.
A personal highlight for me was meeting Syrian doctors who had learned from, met or heard about my husband and Co-Founder, David Nott. Many had operated alongside David in underground hospitals in Aleppo while the Assad Regime and its Russian allies bombed the east of the city relentlessly in 2013 and 2014. Their connection with David, despite the passing of years, reinforces just how powerful shared knowledge is.
Our Faculty Director for this mission, Dr Ammar Darwish (pictured below), who is originally from Syria, shared:
‘Going back to Syria was one of the happiest days of my life. Crossing the border and seeing Syria again, with all the sadness and monstrosities that have happened, there’s still a sense of happiness, a sense of pride. It was a very special feeling. Training the doctors there and seeing those we’ve worked with and taught before was something else. It put tears into our eyes.’
Northwest Syria faces vast challenges. We cannot remedy a decade of pain, but we can continue to arm surgeons with life-saving skills and show them that we stand beside them.
We’ll be back to train more doctors soon.
Elly Nott, Co-Founder and CEO at the David Nott Foundation
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.
Overcoming hurdles to train doctors in Palestine
In collaboration with Juzoor for Health and Social Development and the Palestine Medical Council, we trained 34 surgeons in Ramallah, Palestine, in July. Despite logistical challenges, our faculty delivered a course that met the urgent needs of Palestinian doctors.
At the David Nott Foundation, we have a strong connection with Palestine and the dedicated healthcare workers serving their communities in acutely challenging circumstances. We first delivered our HEST course in Ramallah in March 2017 and, as part of our commitment to sustainability, also trained a dozen Palestinian surgeons on our UK course. It was a joy to return to Ramallah, seeing several familiar faces among very welcome new ones.
Daily challenges
Providing healthcare in Palestine is complicated by the realities of displacement and occupation. Since 2002, the construction of a separation wall cutting into Palestinian territory has severely inhibited freedom of movement across the West Bank.
The wall is a barrier to Palestinians seeking to exercise their fundamental human rights, including their right to healthcare. The movement of ambulances, healthcare workers and resources is impeded by military checkpoints and arbitrary closures.
During our latest mission in Ramallah, our Co-Founder and Chief Executive Elly Nott visited the Augusta Victoria and Al-Makassed Hospitals in East Jerusalem and heard about the challenges they face in providing care. Travel from the West Bank and Gaza to these hospitals requires a permit. Applications – and therefore treatment - is often delayed or denied.
Describing the city of Ramallah, Dr Salwa Najjab, Co-Founder and Chairwoman at Juzoor, said:
“I love Ramallah. But we don’t have control of our borders, we are living in a big prison. Our people should be exposed to the world. We are very happy and thankful to the David Nott Foundation, to come and see what we are doing, to understand our situation and see it in their eyes.”
Adapt and overcome
We were honoured to train 34 surgeons working in a number of Palestinian cities and towns, such as Ramallah, Jenin, Hebron and Jericho. Due to delays caused by the shipping company and customs, much of the course had to be taught with a fraction of our usual cutting-edge teaching equipment. However, the energy and enthusiasm of our faculty, led by Course Director Dr Rebekka Troller, ensured it was an engaging and successful course.
Our team, Juzoor, and the Palestine Medical Council worked together to recreate practical parts of the training. Until our simulation model arrived, we used soft silicone hearts, prosthetic blood vessels, and sponges to mimic lung repairs. Animal organs were also donated to allow attendees to practice kidney repairs.
Dr Morgan McMonagle, consultant trauma and vascular surgeon, and member of our teaching faculty, said:
“It’s always challenging holding a training course, even in the UK. When you train overseas, the hurdles are both different and magnified, but we rose to the challenge in Palestine.
Hospitals in conflict zones are often faced with reduced resources. Like any good doctor in an austere environment, we adapted to what was in front of us and were still able to deliver an excellent course for our attendees.”
An ongoing partnership
Addressing the doctors, Elly Nott, our Co-Founder and Chief Executive, said: “The goal of our training is the same wherever we go. To empower local surgeons and share our knowledge with them, in the hope that it will save more lives.
We see this course as the start of an ongoing journey with Juzoor and Palestine - training which we hope will strengthen doctors’ surgical education.”
The Palestinian surgeons we trained, and our partner Juzoor, will be remembered for their warmth, generosity and optimism.
From underground hospitals in Syria to training in Gaziantep
For the first time, we delivered two surgical training courses over a four-week period in different countries. Our latest course was for Syrian doctors in the Turkish city of Gaziantep, some of whom had worked together in hospitals in Aleppo between 2011 and 2016.
After a memorable course at Edna Adan Hospital in Somaliland, we partnered with Syria Relief to train 26 healthcare professionals in Gaziantep.
A Turkish city near the border with Syria, Gaziantep is home to a number of doctors who know the destruction of war all too well. Many were forcibly displaced from Syria by conflict and some had operated with David in underground hospitals when eastern Aleppo faced military bombardment and siege.
Unbreakable bonds
When the Syrian government, with Russian air support, began targeting medical workers and healthcare facilities, doctors started treating patients in secret hospitals with extremely limited resources. David travelled to Aleppo to help the doctors manage complex injuries and save lives. His sharing of surgical knowledge often led to life-long bonds with those he taught.
Dr Mahmoud Hariri from Aleppo shares: “I first met David in 2013. He came to us in Aleppo, and we learned many things. We learned to be multi-tasking surgeons. I can now do surgery on the kidney, heart, vessels. This is the notion of the multi-tasking doctor. A lot of lives have been saved.”
Dr Hariri and 25 others joined our Gaziantep course with the help of our Course Director Dr Ammar Darwish and the Syrian Board of Medical Specialties (SBOMS), an organisation dedicated to helping Syrian medics work as specialised doctors in northern regions of Syria.
Trainees becoming trainers
The course was taught by accomplished Faculty - some who had learned from David in Syria or during a previous HEST course - and were now excellent surgical teachers.
Helping trainees become trainers is what we are here for. We want to empower doctors within countries affected by conflict and catastrophe to be surgical and health system leaders, serving their own communities.
The group learned how to manage and treat complex war wounds, such as blast injuries, gaping holes in the body, or deep burns. They also learned what to prioritise when faced with multiple wounds, the majority of which they will never have seen during standard medical training.
New skills in practice
Others on the course had also worked with David in conflict. Dr Ehab Baydak, a maxillofacial surgeon from Idlib, Syria, saved a man’s life with David’s help over skype. Since then, Dr Baydak has put his skills to practice in his community.
“During the siege of Aleppo, I was working in an underground hospital and received a patient whose face was severely injured from a bombing. We hadn’t seen this type of injury before and didn’t know how to deal with this,” Dr Baydak shares.
“Due to the siege, we couldn’t transfer patients outside of the city. Dr Murhaf Assaf and I contacted David who talked us through how to do the operation over Skype.
After the Syrian regime took control of Aleppo, I moved back to Idlib to be with my family. There, I came across the same injury, and I was able to do the surgical procedure alone – all because of my experience with David.”
Our courses teach healthcare professionals how to perform procedures just like this – operations that David has undertaken in war zones over 30 years of voluntary humanitarian work. We were honoured to contribute to the surgical education of 26 doctors in Gaziantep, giving them the skills needed to save lives and limbs against the odds.
Mosul to Manchester: Our war surgery training in practice
Dr Moez Zeiton is one of our surgical trainers. As a humanitarian surgeon, Moez has witnessed the realities of war, but never expected to see similar horrors on British ground. Here, Moez shares his journey to joining our teaching faculty and how he’s used his surgical skills around the world.
Moez’s first exposure to medicine was through his father training as a general surgeon and specialising in oncoplastic breast surgery.
“I sort of drifted into medicine myself. I loved biology at school, but my love for the sciences and in particular, my inspirational high school Biology teacher shaped my decision to study it. When I started the course at the University of Leeds, I remember loving the anatomy and dissection work and knew surgery and acute trauma were fields I was interested in,” Moez shares.
A fork in the road
“My entry into humanitarian work started by accident. I always felt a connection to the Middle East through my family and having regularly travelled there as a child to visit extended family and friends.
So, when the Arab Spring uprisings in 2011 arose, I got involved with charitable initiatives sending medical aid and worked on advocacy, opinion pieces and articles. I knew I wanted to be there on the ground, so I negotiated a one-year sabbatical from my surgical training. At the age of 25, I left for Libya to do my part.”
Moez worked with non-government organisations and local Libyan doctors, opening him up to the world of humanitarian health. This led to him taking on a voluntary role as National NGO Coordinator for six months. He also attended courses on analysing disrupted health systems with the World Health Organisation (WHO).
Taking part in our training
After his sabbatical, Moez continued his surgical training in the UK and fed his interest in humanitarian surgery with research. He was part of The Lancet’s series on health in the Arab world and commission on global cancer surgery. He also attended the Scholars in Health and Research Programme at the American University of Beirut.
Working at a major trauma centre in the UK, Moez worked alongside some of our senior faculty and was introduced to our Surgical Training in Austere Environment (STAE) course. He was one of the first doctors to benefit from our scholarship programme, attending our STAE course in 2017.
“On the final day of the course at the Royal College of Surgeons, I met people from WHO and Aspen Medical International who were looking for doctors to help with trauma victims in Mosul, Iraq, following ISIS invasion. Two months later, I found myself there, with a group of expat and Iraqi doctors.
Immediately, I was able to put my new war surgery knowledge to practice - damage control and how to save lives and limbs.”
War wounds in Manchester
Two weeks after returning from Mosul, Moez was unexpectedly faced with war injuries in Manchester – blast wounds following the Manchester Arena bombings.
“The injuries I saw were very similar to what I’d seen in Iraq and had been teaching on the Foundation’s courses - blast injuries from shrapnel and metalwork. I was able to use what I’d learnt but now in my home country.
Although it was shocking and very stressful, things worked seamlessly in our hospital and the camaraderie, hard work and collaboration I saw across 7 or 8 local hospitals that received injured patients was unlike anything I had seen before. I truly saw the NHS at its best.”
Becoming a trainer
“After my return from Mosul, I was invited to join the Foundation’s orthopaedic faculty. Being part of the Foundation’s faculty for the past 5 years, teaching the skills I learned on that STAE course in 2017, is incredibly special.”
For the first time, Moez led the orthopaedic section of our recent course in Gaziantep.
“Although I had been teaching on the STAE course in London for some time, the oversea HEST course required a slightly different approach. I needed to prepare and familiarise myself with the course material. Attending the Train the Trainers course which was put on by the Foundation really helped with this.
The 26 Syrian surgeons we trained shared incredible stories and the cases they faced during conflict with limited resources. Rather than teaching, I facilitated discussions around patient cases, learning from shared experiences and taking things back to fundamental principles. I learned just as much from the inspiring candidates as they learned from me!
This was also the first time that I had delivered an all-day comprehensive professional course in Arabic. It was extremely challenging considering I’ve only practiced medicine in English. However, the feedback and appreciation that I received from attendees is certainly one of the best achievements in my career.”
Leaving a legacy
Looking to the future, Moez wants to continue serving those in need in the UK and around the globe.
“I feel passionately about my humanitarian work and want to continue this in tandem with my NHS role, ideally doing one or two missions a year.
The NHS is such a huge organisation and has a vast resource of skills, knowledge and cultural experiences that can be tapped into. The world is incredibly connected. No matter how far away they may seem, conflict and disasters that happen in other countries continue to affect us directly or indirectly through human migration, security and the economy. We should be using our training and unique cultural experiences to help others around the world.”
Help us train more war doctors
We’re back where we belong
We are delighted to be back training doctors on the frontline. Our latest Hostile Environment Surgical Training (HEST) course in Erbil, Iraq, equipped 31 local healthcare professionals with skills that will serve their communities. Our Chief Executive, Elly Nott, shares her experience of the course.
Our latest course in Erbil was an incredibly humbling experience. Facilitated by our partners at Médecins Sans Frontiers-Belgium (MSF), we were able to train 31 Iraqi healthcare professionals in the surgical skills they need to manage any case they might encounter in an emergency or conflict situation.
During the course, our faculty used our cutting-edge anatomical model, Heston (pictured below), to teach a range of surgical techniques for treating traumatic injuries. Model hearts and synthetic skin helped them practice how to manage cardiac injuries and chest tube insertion. Virtual reality headsets also immersed our participants in emergency scenarios, putting their mass casualty triage and decision-making skills to the test.
A number of the participants were from Mosul, a beautiful and historic city that freed itself from the oppressive rule of Daesh in 2017. The resilience, courage and grace of the doctors was an inspiration to us all.
We are so grateful for your support of our mission. Every donation helps us deliver world-class surgical training that saves and improves the lives of those most in need.
Operating and Teaching in Yemen: an Interview with David Nott
In April, David travelled to Yemen with Ammar Darwish, Mounir Hakimi and Asan Raffee to deliver both teaching and hands-on surgery in the World's worst humanitarian crisis. Below is a short interview that we conducted with him on his return.
How did this trip come together?
It came about with a telephone call from Syria Relief. Mounir Hakimi (of Syria Relief) had been in contact with several of the doctors who had been working in Marib. They were operating on a large amount of cases and they wanted help. Some of the surgeons who were there had difficult wounds or injuries presenting, and they wanted advice and teaching on how to cope with those injuries. That was how we heard about it.
The Syria Relief - DNF Team break their fast in Marib.
What did you see of the city of Marib?
It was pitch black at night when we arrived. We landed in Seiyun and it was a 6 or 7 hour drive to Marib. We arrived very early in the morning and went to a hotel local to the hospital. A few hours later, in the morning, we went to the hospital and were very much welcomed by the medical team working there.
What was the hospital like?
We had a very nice tour around. The Medical Director was extremely enthusiastic in showing us exactly what they had been able to continue to do. They had a very good blood transfusion bank, they had very good blood chemical laboratories. They had an intensive care unit, they had well-stocked theatres and they had a good array of back-up support. There were a lot of nurses on the wards.
At the time, Marib was becoming the epicentre of the civil war. Could you see that that hospital and its staff had been affected by escalating conflict within and around the City?
Yes. It was the epicentre. And it still is. The fighting is intense. Probably about 15km north of Marib. At the moment, Marib has about two million refugees and it is very densely populated. The fighting is continuing and obviously the hospital that we were in was the frontline hospital to accept all those casualties that were wounded. Both civilian and non-civilian.
We heard jets going over the top and we also heard rockets coming into Marib. You were aware that you were in a very hot war zone.
Who did you meet at the hospital?
Some were senior doctors. Some had just come in the last couple of months from Egypt to help out. There were quite junior doctors. There were those that required quite a lot of teaching and understanding of how to manage injuries. The hospital had stopped almost all of its elective surgeries. They were focusing purely on the war-wounded patients. Unfortunately those patients that had cancer problems weren’t really dealt with at this time.
Which case stands out the most in your memory?
I think the case that stood out most was after the teaching we gave the night before on gunshot wounds to the chest and abdomen. The surgeons had never done a thoracotomy before for a gunshot wound to the chest. The following night we were called back to the hospital with a surgeon who had watched our lecture and we found there was a patient who needed a thoracotomy. Because we were there, we were able to show him exactly how to do it and exactly how to extend this incision onto the abdomen and do a thoracoabdominal procedure. The patient did extremely well and thanked us a couple of days later.
We discussed a lot of reconstructive work. Most of the flaps that we discuss on our HEST course, we did in Marib. There was a lot of surgery done with a view to the surgeons being able to do that kind of surgery when we left.
Going forward, what do you think the Foundation's work in Yemen is going to look like?
I think that we will be going back to Marib, and I think we will continue to go back and support them both with teaching the DNF HEST course and perhaps this time taking our models with us as well so that we can run a course during the day or the evening and then operate as well. I think the future of the DNF is operating as well as hands-on teaching as well as the classroom for some courses. The future lies both within the operating theatre and the classroom.
I think we had developed a significant rapport with the doctors such that I heard recently that they desperately want us to go back again to show them more and more. I think that is the perfect opportunity for the DNF to show what it is worth really.
This mission epitomised what the DNF is all about. The DNF goes out to the field, it saves lots of lives as well as teaching the doctors so that they can continue to save lives. The DNF leaves a legacy.
You can read Ammar Darwish's story of the mission here.
David Nott and Ammar Darwish Return from Yemen Mission
Surgery on the Frontlines of the Yemen Civil War
Ammar Darwish's experience of operating and teaching in the world's worst humanitarian crisis.
"The Yemeni medical staff in Marib sent a call for assistance as they have been extremely overwhelmed with injured patients from the war"
David and Ammar were called up by Syria Relief to assist the medical staff in the city of Marib, who were facing an unprecedented number of patients injured in the intensifying conflict of which the city had become an epicentre. The team left London excited to get back to their roots, operating in areas of conflict and austere environments.The team left London ready to begin the long journey to Yemen, where they would meet with Syria Relief - a charity that provides support to Syrians needing medical intervention, food, education and other necessities. The team arrived at Seiyun airport in Yemen, and travelled through the night to reach the hospital in Marib that was to be their home for the next two weeks.
Marib is just 10 or 15 kilometres from the front-line of fighting, a grim reality that was ever-present as the team arrived and changed immediately into their theatre clothes.
After meeting the local medical team David, Ammar, Mounir and Dr Asan Rafee had a quick tour and then immediately started working. For the patients at this trauma centre, there was no time to lose.
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"This is one of the first operations that we dealt with. A gunshot wound to the abdomen in a young man who was left in a state of shock. He bled a lot and we had to do a trauma laparotomy and damage control surgery. We operated on him immediately.
David is just behind me in the background. He is getting ready to go to another theatre to deal with another case."
Although the local surgeons are very experienced, they have not dealt with many of these cases before. David and Ammar spent many hours training the local surgeons, imparting their years of knowledge gained through war surgery and taking them through complex operations.
They opened the chest to stop the bleeding, performed damage control surgery and took the patient into intensive care. All the while, David and Ammar were teaching their local counterpart how to perform this procedure, and to deal with these injuries.
After 7 days, the patient was discharged. His life had been saved.
"This is the team after a long day of operating, dealing with different kinds of injuries. We sat down, I think it was almost 8 O'clock in the evening to break our fast after a long day of operating - I think 12 or 13 hours of operating".
"When everything had calmed down, especially at night, we used to give teachings. David gave lectures on different kinds of injuries and how to manage those injuries. David did the main teaching, and Mounir and I helped to translate".
The team did around 45 operations in Yemen. This ranged from life-saving trauma surgeries to complex reconstructive surgeries.
They returned home to the UK ready to deploy again as soon as possible, to wherever they are needed.
The mission itself was organised and conducted by Syria Relief. Head to their website (https://syriarelief.org.uk/about-us/) to learn more about them.
April 2021 Newsletter: 10 Years of Conflict in Syria
10 Years of Conflict in Syria
Welcome to the David Nott Foundation’s April update. To those observing, we hope that you had a restful Easter and were able to come together with loved ones to celebrate. Today, we at the Foundation have been profoundly saddened by the new that His Royal Highness The Prince Philip has passed away. We wish to express our deepest condolences to Her Majesty The Queen, and the Royal Family. It has now been ten years since the civil war erupted in Syria. The price paid over the last terrible decade by Syrian civilians is incalculable, and millions still reside in vulnerable, crowded camps. Children have lost schools, friends and family members. So many thousands have lost their homes, businesses and loved ones. Hospitals, deliberately targeted by the Syrian regime now struggle to cope with the COVID-19 pandemic. As a show of solidarity with the Syrian people, the David Nott Foundation dedicated our social media accounts to small NGOs, individuals, civilians, humanitarians and journalists who have lived experience of the civil war. We hoped to provide a platform through which to amplify these voices. We encourage you to look back through our Tweets and Re-Tweets (@NottFoundation) to read first-hand accounts of the atrocities and reflect on the profound loss that we all feel after ten years of conflict. The David Nott Foundation has taken our HEST course to Syrian surgeons before, and plans to again soon. You can view an interactive map of where we have taken our training course by visiting the ‘Overseas Course’ section of our website. Good luck to our RPHM RunnersWhile we’re on the subject of challenge running events, the Foundation would like to wish good luck to our Royal Parks Virtual Half Marathon runners for the 11th of April. We asked some of those competing to raise money for the DNF what inspired them to do so:
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