“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
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.
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
Over 160 Ukrainian doctors now trained to treat war wounds
David Nott and Faculty Trainers Dr Pete Mathew and Dr Ammar Darwish recently returned from delivering two back-to-back surgical HEST courses in Odessa, Ukraine. The team upskilled 74 doctors in a city battered by targeted missiles and heavy shelling.
Standing in solidarity
Continuing our mission of standing shoulder to shoulder with Ukrainian healthcare professionals, David, Dr Ammar Darwish and Dr Pete Mathew returned to Ukraine in August with UOSSM International, this time running two of our surgical training courses in the southern city of Odessa.
Over an exhausting six days, the team delivered a condensed version of our HEST course to 74 healthcare professionals, taking the number of Ukrainians who have received our training this year up to 160.
We deliver our training to those in need of our help, no matter their experience or seniority. During the two courses, the team trained junior doctors, senior consultants, anaesthetists and Ukrainian army officers.
From burr holes to skin grafts
To prepare the group for any trauma injury, our trainers used cutting-edge teaching tools to illustrate a range of techniques such as how to pin and stabilise the pelvis, drill burr holes to relieve cranial pressure, repair heart tears, prepare healthy skin grafts for burn injuries, or how to insert and stitch emergency chest tubes using our prosthetic skin pads (pictured below).
Speaking exclusively to The Telegraph, David said: “I was fairly sure it (the war) would go the same way as Aleppo in Syria. I knew we would see a lot of blast injuries, such as lung trauma, shrapnel wounds and burns."
David was right. Speaking to frontline doctors in Odessa, they are seeing multi-organ injuries for the very first time, such as penetrating damage to the heart and lungs, caused by flying shards of metal. The confidence and skills learned on our courses better prepare doctors for war injuries like these, not commonly presented in standard medical training.
We are incredibly proud of David and our Teaching Faculty as they continue to upskill and support healthcare professionals in Ukraine. "If I was a pessimist, I’d never be able to do what I do”, says David. “You can always make things better for people.”
David's story in The Telegraph
Inspiring the next generation of war doctors
On Friday 21st October, David and a key member of our Training Faculty, Dr Ammar Darwish, met over 100 sixth form students at Whalley Range School in Manchester. The pair shared their experiences as frontline doctors and some of our cutting-edge teaching equipment, such as our war wound model Heston, 3D printed hearts and model blood vessels.
Earlier this year, we received a letter from Waad Fellag, a sixth form student who dreams of becoming a doctor. After reading our Co-Founder’s book, War Doctor, Waad shared: “David Nott showed me the impact he and his team have had on families, especially children. I grew to understand that the simplest and slightest words or actions make a real difference in a person’s life.
Waad asked if we would visit her school to meet the “many bright minds who are passionate about become doctors”, some of which have lived in war-torn countries such as Syria, Libya and Afghanistan.
“A medical degree gives you a passport”
Speaking to over 100 female students, David shared stories from 31 surgical missions and his time treating the wounded following two natural disasters. His first humanitarian mission to Sarajevo in 1993 will always stay with him.
Students listened intently as he reflected on operating in a makeshift hospital, nicknamed ‘The Swiss Cheese’ due to gaping holes in the walls caused by bomb blasts and artillery. Steam escaped the edges his mask as he operated in the freezing cold with no electricity.
David shared: “A Lancet article revealed that 17 million people die every year due to conditions that require surgical treatment. It’s a wonderful thing to have the skills, hands and brain to make people in need better again. A medical degree gives you a passport to help people anywhere in the world.”
Future leaders
Elly Nott, our CEO and Co-Founder, said: “David receives dozens of invitations to speak each year, but Waad’s message, with her desire to inspire her fellow students to become humanitarian doctors, struck a chord with us. Encouraging the next generation of humanitarian doctors, in particular those attending state schools and young women, is an important and valued arm of our work.
I was also pleased to share with students that there are many different ways to lead a humanitarian life. Your contribution may not be medical but is just as valued no matters its form, be that legal, administrative, operational or diplomatic. It was an incredibly uplifting and inspiring afternoon for our team.”
After David’s stories, Faculty Trainer, Dr Ammar Darwish, talked the group through our one-of-a-kind war wound model, Heston. Students gasped as he used Heston to illustrate the damage caused by penetrating head injuries, the benefits of using skin flaps to encourage wound healing, and how to stop severe bleeding in the heart and lungs.
Scrubbed Up
Dr Darwish was followed by Scrubbed Up, an outstanding student-led organisation that supports prospective and current medical students, offering guidance on every career step from university applications to exam preparations.
Miss Toyin Bakare, Assistant Head Teacher at Whalley Range School, said: “We are grateful to David Nott, Scrubbed Up and the team for going above and beyond the request made by one of our incredible students, Waad, to visit our school.
It was a demonstration of the power of the written word, which can sow seeds, nurture ideas, and empower others to make a meaningful impact in their spheres of influence.”
What can you do?
We were in awe of each and every student’s enthusiasm, vibrancy and determination to make a difference in the world in their own way. In Waad’s words, “I ask you all – what can you do to help those who need us the most?”
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.
"The skin is alive - it's all because of you."
“Here – you do it.” These were the words of our Co-Founder David, as he handed a skin grafting instrument to Ivan, a junior doctor in eastern Ukraine attending our surgical training course.
During a Russian shelling, a woman suffered catastrophic leg injuries. Working to repair her wound during a mission in Ukraine, David used the surgery as an opportunity to train local doctors.
He showed them how to perform a skin graft to treat the injury – and that wrapping the graft in fluffy gauze can help with healing. This technique differs to standard wound treatment, which often involves the application of antiseptic spirits and bandages.
David and Ivan have kept in touch since his returned to the UK – a common story for David and our trainers. We are proud to have created a supportive community of war doctors that can ask questions or share cases with us at any time, from anywhere.
When Ivan looked at his patient’s wound in recovery, he was overwhelmed with joy to see that it was healing. During a phone call, he shared with David:
“The skin is alive! It’s all because of you.
I’ve started a little revolution in my hospital. I’ve started to do what you do - using the fluffy gauze for skin grafts. The patient’s granulation (tissue that is an important component of wound healing) is awesome. We haven’t needed to use any antibiotics.
It was one of the best moments of my life doing this operation. I can only say thank you for your knowledge.”
Ivan, a junior doctor facing the horrors of his country’s war, is now armed with a skill that can be used to treat devastating injuries. He plans to teach this technique to his peers – and potentially even senior doctors who typically use other methods.
Although unusual for a junior doctor to teach senior consultants, in war, titles are stripped away. All that matters is the sharing of knowledge and saving of lives.
To carry out the next phase of the patient’s skin graft surgery, David offered his help over Skype. Ivan and his father, a Chief of Surgery based in Kharkiv, will work together with David to rebuild the woman’s leg and remove as many traces of the evidence of war as possible.
Surgery over Skype isn’t new to our Co-Founder. During the historic siege in Aleppo, David guided surgeons online as they reconstructed a man’s shattered jaw. The Syrian surgeons, Dr Assaf and Dr Baydak, successfully carried out the operation and put the man’s face back together again.
The stark similarities between Syrian and Ukrainian conflict do not go unnoticed. As witnessed in Aleppo, healthcare workers in Ukraine are in urgent need of our support. As the war continues to wage on, we are more driven than ever to train doctors and help them prevent needless deaths.
“You have given me new breath in surgery,” shared Ivan. “You were not scared to come here and share knowledge. Thank you.”
More on our training in Ukraine
We’re back from training frontline doctors in two Ukrainian cities
An experienced team of trainers have just returned from delivering two HEST courses in Dnipro and Kharkiv. Here, consultant neurosurgeon and faculty member Pete Mathew shares his experience of teaching frontline doctors in Ukraine and what makes a course successful.
After David volunteered in Ukraine in April, it became clear there was an urgent need to return and deliver our war surgery training course to doctors in the country.
We decided it was best to send a small but experienced team, consisting of David, myself and Ammar Darwish. The three of us have worked in a number of war zones over the past decade – and Ammar and I have been part of the Foundation’s teaching faculty for years.
Reaching as many doctors as possible
To have a bigger impact, we decided to deliver two courses in Ukraine. We held one three-day course in Dnipro and another in Kharkiv – two cities that have faced significant attacks over the past few weeks.
To enter the country and support us on our mission, we worked with UOSSM International. Together, we travelled from Poland and made our way to our first training destination – what appeared to be a teaching facility in Dnipro.
On the walls, there were pictures of students happy and smiling, a stark difference to Ukraine’s present reality.
Training overseas is always a leap into the unknown. We never quite know where the teaching location will be. We don’t always know what sort of doctors will arrive. But it always comes together.
Once we got our bearings, we set our equipment up before the doctors arrived – from Heston our war wound model to David’s comprehensive training videos on a projector. Heston is an excellent teaching aid for describing injuries or techniques.
Making an impact in Dnipro
In Dnipro we had over 30 attendees of varying seniority and specialties - junior doctors, consultants, emergency doctors and an anaesthetist. We had a fantastic Ukrainian translator with us, which was amazing. Different doctors arrived on different days, which is quite normal in an emergency, resource-poor setting. They need to return to treating patients on the frontline.
Sometimes it can take a little time to gain the trust of attendees. We need to prove our worth – which is absolutely understandable.
Creating a community
Some of the surgeries are quite simple, but the hurdle is finding the confidence to do them under challenging, high-stress circumstances. We want doctors to feel empowered - sometimes all that’s needed is confidence. We want doctors to feel inspired to learn and try the techniques they’ve seen on our course.
We hear from those we train that we offer a morale boost, but perhaps more importantly we provide a forum for surgeons with different levels of experience to have discussions and raise questions – a safe space for doctors to debate views.
Speaking with the doctors we met in Dnipro, it was clear they were resigned to the inevitability of returning to the frontline after our course ended. They are solemnly grinding away. Some of the very junior doctors were more anxious about returning to work.
The road to Kharkiv
After three days, we packed up and travelled up to Kharkiv to deliver our second course. The group – 28 doctors - were very happy to see us.
Back-to-back courses can be very tiring, but we are always happy to do it. It’s always very tempting to do two in a row, to reach more people.
There was a marked change in behaviour from the beginning to the end of our courses. Being an effective teacher requires getting your message across with enthusiasm. If you don’t feel drained after a course, or you don’t see excitement in your audience, you haven’t given it everything.
You also need to be able to adapt to the needs of your attendees. It’s important to be flexible and go off-script – to deliver the course in a way that best suits those in front of you.
Standing in solidarity
When training in active war zones like Ukraine, an experienced team, support from the Foundation and partners like UOSSM International are important.
I hope our training has boosted Ukrainian doctors. As long as this war wages on, we will continue to offer whatever support we can.
Surgery on the frontline in Ukraine: David Nott in conversation with Bridget Kendall
We are delighted to announce that The BEARR Trust is hosting an event with our Co-Founder David, to discuss his work providing emergency surgical care and training local doctors in Ukraine.
David will be in conversation with award-winning journalist and BEARR patron, Bridget Kendall, to share his stories of working in crisis and catastrophe zones for over 25 years - including the delivery of two HEST courses in Ukraine. The online event will take place at 18:30 BST on Monday 27 June via Zoom.
About Bridget Kendall
Bridget Kendall worked for the BBC for over 30 years, specialising in Soviet and Russian affairs after graduating from Oxford and Harvard universities. From 1989 to 1995, Bridget was the BBC’s Moscow correspondent, covering the final years of the USSR and the first years of post-Soviet Russia.
As the BBC’s Diplomatic correspondent from 1998 to 2016, she covered conflicts in Chechnya, Georgia, Tajikistan and Ukraine, among others, and in 2001 and 2006 she conducted two interviews with Vladimir Putin, both broadcast live to the world from inside the Kremlin.
In 2016, Bridget was elected Master of Peterhouse Cambridge. She is also a patron of The BEARR Trust.
Register to attend this special event today