“Maternal health - it's a societal barometer.”
Every two minutes, a woman loses her life to preventable causes related to pregnancy and childbirth. These staggering statistics stress the need for action. In humanitarian crises, where access to healthcare is severely limited, maternal care becomes even more critical.
“800 preventable maternal mortalities are happening every day, and a woman dies every two minutes from a preventable cause. So that's women dying through pregnancy and pregnancy related conditions,” shared Dr Pippa Letchworth, our Faculty Lead for Obstetrics and Gynaecology.”
This sobering reality is what drives our passionate team to develop an obstetrics and gynaecology course aimed at addressing the most pressing challenges in maternal healthcare. In crisis settings, where resources are scarce, the course equips healthcare professionals with the skills needed to perform life-saving surgeries, particularly focusing on addressing the top global killers of women - haemorrhage, obstructed labour, sepsis, and unsafe abortion.
“75% of displaced people are women and children, and one of the five of those women will be pregnant.”
The course covers a wide spectrum of topics in maternal and neonatal healthcare in crisis. Participants begin with trauma training before transitioning into obstetrics to understand the complexities of childbirth emergencies.
Emphasis is placed on neonatal resuscitation techniques with the goal of reducing the number of stillbirths. Subsequent sessions address postpartum haemorrhage management, perineal repair, and navigating challenging deliveries like impaction and breech positions. The course also covers disruptive delivery, crucial for situations where doctors have limited access to caesarean sections.
Beyond the medical realm, our trainers advocate for a holistic approach to maternal health in their teaching. It's not just about reducing mortality rates, it's about understanding the wider implications of maternal deaths on families, communities, and societies at large. Children left motherless are at a significantly higher risk of mortality and developmental issues, perpetuating a cycle of vulnerability.
“There needs to be a call to arms to improving maternal health.”
We must advocate for women's rights, improving doctors access to education and dismantling systemic barriers that perpetuate maternal mortality.
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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.
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103 surgical life savers in Tripoli, Libya
We’re back from a week in the Libyan city of Tripoli after completing a first-in-our-history mission. We upskilled 103 doctors – the largest number trained on one mission – and trialled our brand-new obstetrics and gynaecology course.
Libya’s history is marked by political turmoil and civil unrest. The uprising against the rule of Gaddafi led to brutal violence against Libyan civilians and instability across the country. Today, 13 years after the ruler’s death, conflict between armed groups continues and Libya’s security remains fragile.
Outside of politics, Libya has been devastated by natural disaster. In September of 2023, heavy rain caused the collapse of two dams, leading to horrific damage and the loss of thousands of lives. Wounds inflicted by violence or natural disasters often require rapid surgical care, with a need to focus on controlling the worst of the damage first.
Surgical toolkit for any crisis
In a bid to empower Libyan doctors with skills to treat wounds caused by war or natural disaster, we partnered with the Libyan Board of Medical Specialties to deliver four surgical training courses in parallel. Over five intense days, our team of expert trainers delivered two trauma surgery courses, two anaesthesia courses and a brand-new obstetrics and gynaecology course.
According to a 2023 UN agency report, a woman dies from pregnancy or childbirth every two minutes. During conflict, women are less likely to seek maternal care and hospitals are under-staffed or under-resourced. That's why our trainers created a bespoke obstetrics and gynaecology course to help doctors better protect mothers and their babies in war and catastrophe.
During the week, we trained 103 doctors. Doctors we’d previously upskilled in Libya also joined our training faculty and led the teaching of a number of our modules for the first time. Dr Aisha Alghamji was one of them.
It really was paralysing
Dr Alghamji shared: “I remember I have a case of a 70-year-old lady. We found there was a huge bleed in her tummy. Most of her blood is – in minutes – almost drained out. It really was paralysing – what to do? She doesn’t have that much time.
"That lack of knowledge paralysed me. She is a living, human being – with dreams, hopes, a whole community. She is part of it. It keeps haunting you, that feeling. What I could do differently?"
She lost her life.
After 2018 when I attended the course with the Foundation, there is something shifted in my way of thinking. It did that thing for me, that confidence the surgeon needs to do more than their best – to run the extra mile for the patient.
I faced another case similar to it (this lady). I told immediately to me brain – ‘damage control! Damage control!’. I was able to send her home. She is alive, she is a grandmother, she is everything.”
A resilient healthcare system
Dr Moez Zeiton, Consultant Orthopaedic Surgeon and our Faculty Lead for Libya, said: “It is a privilege to have had the opportunity to lead the single most ambitious series of courses for the foundation, training over 100 doctors in a week. It was a huge effort from the foundation’s team and superb faculty to get over the line.
Candidates in Libya travelled from every part of the country with many travelling over 1000km to participate in our surgical training. Their eagerness to learn and share their own experiences was evident and they will now be equipped with the skills needed to deliver high quality care to their patients. "
This marks the beginning of continued training in Libya and a commitment to gifting doctors with extensive trauma skills to handle any challenge.
HELP US FUND MISSIONS IN LIBYA
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
Doctors rapidly trained to treat trauma injuries in Gaza
During a remarkable four-day Hostile Environment Surgical Training (HEST) course, surgeons and anaesthetists from the UK, Germany, Sweden, Norway and Qatar gathered in Bolton to learn how to treat trauma injuries in the Gaza Strip.
Organised in two weeks in collaboration with Palmed, 42 doctors headed for the Middle East were trained to treat complex trauma injuries incurred in the Israel-Gaza conflict. This course not only marks a significant step towards preparing medical professionals for future missions in Palestine but also reflects a shared commitment to saving lives in conflict zones.
"Thank you to the David Nott Foundation. Without them, this training would not have been possible. Together, we are organising this course to assist the people in the Gaza Strip once it is safe and travel becomes feasible. The response from numerous doctors expressing their desire to help has been overwhelming, and we are hopeful to conduct a second course in the coming weeks." - Riyadh Al Masharqa, Plastic surgeon, PalMed
Addressing urgent medical needs in Gaza
The course was organised in response to the pressing humanitarian crisis in Gaza, Palestine. According to on-the-ground partners, medical professionals are stretched to their limits and hospitals are overwhelmed.
The group included specialists in orthopaedic surgery, cardiothoracic surgery, obstetrics and gynaecology, paediatric anaesthesia, and general surgery. Some brought valuable, first-hand experience from regions affected by conflict, like Afghanistan and Syria, while others joined to grow their understanding of how to treat war wounds before heading on mission.
"I'm excited about expanding my skill set beyond obstetrics and gynaecology to acquire new capabilities that will benefit mothers and their infants in Gaza and the West Bank. I recognize the desperate need for assistance in this region. This course is unique as it combines obstetrics and gynaecology with trauma care. This training aims to address complex challenges comprehensively and I look forward to it.” - Dr Iman Al Mabhooh, Obstetrician and Gynaecologist
A troop of volunteers
For the very first time, 11 FDNF volunteers from our Friends of The David Nott Foundation (FDNF) and Trainees of The David Nott Foundation (TDNF) societies volunteered to help arrange and assist during the course. This joint effort meant it could be organised at lightning speed, rapidly creating a network of well-trained war doctors.
“Given not only the humanitarian crisis in Gaza but with the targeting of healthcare workers in particular it's never been more important to strengthen our healthcare colleagues and equip them with the skills to do their incredibly difficult jobs and to support them through a very precarious situation.” - Nadia, FDNF Manchester President
Our surgical HEST and anaesthesia courses were held simultaneously, demonstrating our commitment to enhancing the skills of all those striving to preserve life in the operating theatre.
"What has been great about this course is meeting people that have experienced things in the field. From the anaesthetics point of view, it's been helpful to learn how they deal with limited resources and supplies, and we have been using airway mannequins and practicing with video scopes."- Dr Douglas Philpott, Anaesthetist
We’re committed
As war continues to rage, we are working on a second surgical training course with the goal of upskilling even more frontline medical professionals. We won’t stop empowering doctors with the knowledge needed to save lives and limbs against the odds.
Our latest training in Palestine
Our action in response to the Israel-Gaza war
As a humanitarian organisation delivering surgical training to doctors in regions affected by conflict and catastrophe, we have been devastated by the recent escalation of violence in the Middle East.
We have been in contact with our partners, including Juzoor and Action for Humanity, local faculty of trainers, and those we’ve previously trained, to gather a comprehensive picture of the injuries being encountered and needs of medical professionals on the ground.
Reports reveal that many healthcare facilities are under severe strain. Emergency departments are under immense pressure, with growing numbers of trauma injuries due to shellings, shrapnel or collapsed buildings. Supplies at blood banks and basic medical resources are also running low.
Our action
To support hard-to-reach medical professionals at this time, we:
Turned our world-class surgical training course into a series of short videos that can be watched in their own time. We’ve shared our English and Arabic videos with local doctors across the region.
Shared our videos with local partner medical professional networks, ensuring even more doctors in need can benefit from the resource.
Invited local doctors to our global case study discussion forum to share patient cases and gain advice from peers around the world.
Exploring a bespoke discussion forum for doctors affected by this crisis, where our faculty of trainers and others can offer advice and surgical guidance more personally.
As the emergency unfolds, we will continue to monitor how best to support doctors under pressure until we are able to deliver our surgical training course in person.
Elly Nott, our Co-Founder and CEO, said:
“We are appalled by the violence and loss of life in Israel and Gaza and extend our condolences to all who have lost loved ones.
Following the attacks, many are contending with injuries of vast complexity, scale and intensity.
Healthcare workers should be able to deliver life-saving care to their communities free from the threat of violence and parties should uphold their obligations under international humanitarian law.
Access and protection for humanitarians delivering assistance to those civilians affected is essential.”
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.
41 Syrian doctors upskilled to screen and treat women with cervical cancer
Dr Saladin Sawan, Consultant Surgeon in Gynaecological Oncology and one of our faculty trainers, recently returned from a surgical mission in Idlib, Syria, upskilling 41 surgical residents and specialists to screen for and treat women with cervical cancer. Here, Dr Sawan shares his hopes for healthcare and future training in northwest Syria.
Syria remains engulfed in a complex humanitarian crisis. Over a decade of conflict has forced more than 12 million people to flee their homes and left displaced communities with reduced access to food, shelter and protection.
Cancer under the radar
Due to a buckling healthcare system and greater focus on other urgent needs, many are not seeking or receiving the cancer screening, diagnosis or treatments they need. Medical professionals also face challenges with transferring patients over the border to Turkey, which means cancer patient numbers in-country are growing.
Cervical cancer is preventable and curable, as long as it is detected early and managed effectively. According to the World Health Organisation (WHO), it is the 4th most common form of cancer among women worldwide.
Our faculty trainer, Dr Saladin Sawan, travelled to Idlib to upskill Syrian surgeons to offer the best possible surgical care for patients with gynaecological cancers including cervical cancer.
“During my mission, I delivered gynaecology training to a group of doctors. Every day, we practiced surgical techniques. We used chicken thighs and a cutting-edge mannequin, provided by the David Nott Foundation, to practice performing cervical smears, colposcopies to assess the cervix for cancer or pre-cancer changes, and diagnostic punch biopsy, in addition to safely performing treatments for pre-cancer cell changes, in the form of loop excision (using heat to remove cells). Each doctor had hands-on practice and then we put skills to the test in operations.”
Dr Sawan trained 41 local doctors during the mission, which will improve cancer patient care while strengthening northwest Syria’s healthcare system in the long-term.
“I performed approximately 14 surgeries of different magnitude, some small procedures, some far more complex, for example radical hysterectomies for cervical cancer patients and debulking surgery for women with ovarian cancer. We used operations as teaching opportunities for local doctors – residents were assisting me and watching over my shoulder. We trained anywhere between three and seven obstetrics and gynaecology residents per day. Some doctors followed me, but I made it my goal to visit as many hospitals as I could to deliver training to those who could not travel. I was very happy.
I felt appreciated amongst a family of doctors and health professionals who looked after each other to deliver the best they could for their patients in some of the most difficult circumstances. I was certainly privileged to have had the chance to be with them.”
Eliminating cervical cancer
Due to ongoing conflict and accessibility issues, doctors in northwest Syria have limited access to training. The province also lacks a screening programme for cervical cancer prevention and early detection, leading to increased numbers of cases that require complex, radical surgery.
“WHO launched an Elimination of Cervical Cancer Elimination Initiative, which mainly targets low-income countries. The local doctors are really excited about establishing this program for women in Syria. They know the benefit, they believe in its value and importantly they feel it is only right to do since women disproportionately suffer the results of human papilloma virus infection which causes cervical cancer, unlike men. This would promote healthcare equity.”
In his training, Dr Sawan actively encouraged the local doctors not to fear making mistakes.
“Doctors become more confident and patients as a result will be safer. We strive for the doctors to test, try, play, make mistakes. The intention is that the doctors are more competent by the time they perform the operation on patients.
I am lucky to be part of the David Nott Foundation where the emphasis is also on building local expertise and sustainable care by training local health professionals in crisis areas. The donated equipment and surgical instruments meant I was able to deliver comprehensive training without compromises.”
Glimmers of peace
“Around me in Idlib, despite being in a region struck by war, there were people trying to rebuild their lives. Developing roads, restaurants opening, people moving into the city. People have started to live their lives – the dust of war settling and communities trying to get their lives back.”
Since Dr Sawan’s mission and apparent signs of a healing community, the Regime has targeted 45 cities and towns in four days, killing 52 and injuring over 240, according to an October recent report led by Assistance Coordination and Information Management Units (ACU, UMI). Despite glimmers of hope, northwest Syria remains in the thralls of conflict.
What’s next?
As unrest continues, the need for training and sharing of knowledge remains. We are committed to upskilling even more obstetric and paediatric residents in northwest Syria, but there’s much more to do.
“Outside of returning to deliver more surgical training, we also want to deliver dedicated cervical cancer screening training to residents,” shares Dr Sawan.
On-the-ground partners have also identified other, urgent areas of need.
“A local humanitarian organisation, the White Helmets, are looking to develop training for paramedics, including resuscitation and emergency obstetrics, gynaecology and neonate training. To make sure we provide the right training material for paramedics, we want to speak to them to understand exactly what their needs are in the field.”
We’ll continue to do all we can to support medical professionals in Syria.