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.
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