Strengthening global surgical capacity through HEST-UK training
Building on the success of our partnership with the Royal College of Surgeons of Edinburgh (RCSEd) in June, where 24 surgeons were equipped with vital skills to save lives and limbs in conflict zones, we joined forces again this December to train an additional 23 surgeons. Our trauma surgery training in the UK (HEST-UK) aligns with RCSEd's broader mission to support global healthcare by equipping professionals to address healthcare needs in low-resource or conflict-affected areas.
Designed for medical professionals working in, or preparing to travel to, conflict and disaster zones, our HEST-UK course brought together participants from around the world. Surgeons traveled from as far as Hong Kong, New Zealand, Australia, Ukraine, and the USA to take part in this transformative week of intensive training.
The course provides comprehensive training in surgical techniques for managing injuries frequently encountered in conflict zones, such as blast and shrapnel wounds, with a dedicated focus on Obstetrics and Gynaecology during the final day. Regardless of their specialty, surgeons gain the skills needed to handle complex trauma cases and significantly improve patient outcomes.
This immersive training integrates real-life trauma case presentations from conflict zones like Syria, teaching models designed specifically for our programmes, and hands-on practice using human cadavers, delivering an unparalleled learning experience.
A Global Effort
The David Nott Foundation and the Royal College of Surgeons of Edinburgh are charitable organisations, and our work is made possible by the generous support of donors and sponsors. We are deeply grateful to The Russell Trust, Essity, BBRAUN, Stryker, and BMA Giving for their invaluable provision of equipment and consumables, which enabled us to deliver this course.
BMA Giving generously granted £10,000 to cover the costs of specimens and equipment for this training. Given the nature of this project, there was significant interest from individuals working with NGOs and other non-profit organizations, where high course fees often present a barrier to accessing training. Thanks to the support of BMA Giving, we were able to reduce fees, ensuring the course was more accessible to a broader range of participants.
Empowering Ukrainian Surgeons to Save Lives
As part of our 2024 localisation efforts in Ukraine, we sponsored three Ukrainian doctors who had previously completed our trauma training courses to attend our Hostile Environment Surgical Training (HEST-UK). This advanced training provided a unique opportunity for them to refine their skills further by practicing on cadavers. They also received dedicated mentorship from our expert faculty, including David Nott, who shared insights drawn from over 30 years of trauma surgery experience in conflict zones.
Upon returning to Ukraine, these doctors joined our growing local Ukrainian faculty to train more surgeons on the ground during this difficult period. Their newly acquired skills were put to immediate use, with reports of life-saving interventions within days of their return.
"Just two days ago, I faced a mass casualty incident involving four patients in one hour. Three of them suffered massive hemorrhages from arterial injuries, fractures, and amputations. I was the only surgeon available. The skills and knowledge I gained through the courses offered by the David Nott Foundation saved their lives and their limbs." - Dr Volodymyr H, Ukrainian General Surgeon
Our most recent training in Ukraine
24 doctors trained during 1st UK course with Royal College of Surgeons Edinburgh
For the first time in partnership with Royal College of Surgeons of Edinburgh (RCSEd), we delivered a Hostile Environment Surgical Training UK (HEST-UK) course to equip 24 surgeons from across the globe with vital skills needed to save lives in conflict and disaster zones.
Aimed at medical professionals who work in, or are planning to travel to, conflict and catastrophe zones around the world, our HEST-UK course brought together surgeons from across the globe, including Australia, Poland, Finland, Denmark, Libya and six from Ukraine, for a transformative week of intensive training.
This marks the beginning of our brand-new partnership with RCSEd, joining forces to upskill humanitarian surgeons and frontline trainers in the making. Our course combined trauma case presentations taken straight from war zones like in Syria, our cutting-edge teaching models designed especially for our use, and human cadavers.
Dr Igor Belkin, HEST-UK participant and surgeon from Ukraine who we sponsored to join our training, said:
“The course was great! All frontline methods were described in detail in theory, and then with the help of DNF trainers, we then worked on and learned more about using cadavers.
These skills are always useful, especially in a country that is at war. After completing another DNF course in Zaporizhizhia in February 2023, I used many learnings in field surgery. Now in Edinburgh, I got even more practice with cadavers.”
Dr Senka Stojanovic, HEST-UK participant and general surgeon from Poland, said:
"Now, possibly more than ever during our lifetimes, the world is fraught with problems of growing divisions and inequality, which among other things impacts access to quality healthcare, affecting not only the current generation, but future ones as well.
I felt incredibly fortunate and grateful for the opportunity to learn first-hand from some of the leading experts in the field.
"The wealth of experience and practical tips brought by the faculty was unmatched and cannot be found in textbooks or surgical atlases."
I highly recommend this unique course to any surgeons who plan to or already work in humanitarian settings around the globe, but who need to build on their confidence and skill to provide surgical care outside of their surgical specialties."
Mariette Naud-Betteridge, Director of Partnerships and Stakeholder Engagement at RCSEd, said:
“Witnessing the course first-hand revealed the extensive practice and diverse disciplines required to deliver surgical care in conflict zones. Not only did the course’s structure and the dedication of David and his faculty bring challenging cases to life, the delegates' intense focus and eagerness to learn emphasised the course’s relevance and necessity.
Collaboration between the David Nott Foundation and RCSEd demonstrates our shared commitment to equipping medical professionals with the critical skills and confidence needed to save lives in the most demanding situations. Special thanks also to all who supported the course, including sponsors B. Braun, Essity, and Stryker. RCSEd look forward to welcoming back the DNF team and a new set of delegates in December for the next HEST-UK Course.”
As fighting intensifies across Ukraine, Palestine, Sudan and beyond, there has never been a greater need for skilled, humanitarian surgeons around the world. That’s why our programme of bespoke training courses are so vital and we will continue to grow our international network of war doctors.
Sign up to our next HEST-UK course
Friends of David Nott Foundation Conference - leaders of tomorrow
This month, we held our third Friends of David Nott Foundation (FDNF) conference, hosted this year by our FDNF at the University of Cambridge in the Clinical School of Medicine. This event brought together 45 dedicated FDNF members from universities across the UK, including Dundee, Leicester, Nottingham, Manchester, Glasgow,Cork, Bristol, and Cardiff, alongside international attendees from the Czech Republic.
Our Friends of David Nott Foundation societies are made up of medical students who wish to embark on a humanitarian career. By bringing them together for teaching and connection with our trainers, our goal is to nourish the next generation of humanitarian surgeons.
The conference featured four specialised workshops led by our faculty members, focusing on vascular surgery, orthopaedics, paediatrics, and general trauma. These sessions provided students with hands-on surgical experience and insights into the challenging yet rewarding field of humanitarian medicine.
Faculty trainer Dr Mahmoud Hariri, a surgeon who met our Co-Founder David Nott in underground hospitals in Syria, led our final lecture. He shared his experiences from Syria and the difficulties of being a surgeon under unimaginable pressure.
“One of the hospitals I worked in was in a cave in a mountain. There are many hospitals like this in Syria. Some are underground or in a gym. Most of our lives at that time (during the siege), were underground."
"Being a war surgeon is not a funny thing, it is difficult. I have experienced soldiers placing bets on what they could hit each day.” - Dr Mahmoud Hariri, faculty trainer
Our Co-Founder Elly Nott opened the event with an inspiring address, expressing her excitement for this annual gathering and highlighting the critical role it plays in fostering the next generation of humanitarian healthcare professionals.
"Our FDNF conference is a highlight of my year. It’s a joy to meet the next generation of humanitarians and see how enthusiastic they are to use their skills to make the world a better place.” Elly Nott, Co-Founder
Through our FDNFs, students contribute significantly to our work by raising awareness, fundraising for missions, and volunteering on our Hostile Environment Surgical Training (HEST) courses offered in the UK.
They are the future of this world, and now more than ever, we need people who want to help and make a difference.
This conference not only reinforced the commitment of current FDNFs but also inspired new additions to engage deeply our mission in helping to ensure safe surgical skills are available to all.
More on FDNF's
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.
REGISTER TODAY
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?”
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
Another successful STAE course
This month, we were honoured to train 14 doctors from Afghanistan, Syria, Palestine and Ethiopia on our latest Surgical Training for Austere Environments (STAE) course. Over five days, the group participated in bespoke surgical workshops, specifically designed for treating traumatic – and often unique – injuries caused by war and catastrophe.
Starting the week off in Brighton and Sussex Medical School, the participants practiced an extensive range of cardiothoracic procedures, such as fast and efficient thoracotomies (gaining access to the chest), heart repairs and how best to manage injuries to the lungs.
Aided by videos taken by our Co-Founder, David Nott, during overseas missions, the group also learned how to repair blood vessels – a vital skill for managing severe blood loss.
Equipped for every emergency
As the week progressed, every doctor was exposed to a different but equally vital field of medicine, from plastic surgery to orthopaedic trauma. This is key, as we know war and catastrophe can present patients with often varied and complex injuries.
In conflict for example, it is not uncommon for junior doctors to be the only healthcare workers left in hospitals. This means they need to step into a number of roles, from cardiothoracic surgeon one day to paediatric specialist the next.
New obstetric simulators
On the last day of training, the participants completed a range of obstetrics workshops in the beautiful new facilities of the Royal College of Obstetricians and Gynaecologists in London. Using our new simulators (pictured below), the group refined their C-section techniques and learned how to address emergency scenarios, such as breech births or neonatal resuscitation.
Listening and learning
We were honoured to be joined by doctors from Palestine, Syria, Afghanistan and Ethiopia, and each country is recovering from - or still facing – conflict. To ensure we continue to deliver the highest quality training and meet the needs of our doctors, we listen to participants’ experiences of their home countries.
Dr Naseebah Nayef left Syria in 2013. She shared with us: “(During the war) I treated Syrian protestors in my private practice. Post-that, my house was bombed, and I had to flee with my three children from Syria. I am so very, very grateful for being a part of this course.”
Training of Trainers: Future-proofing the Foundation
Last weekend, the David Nott Foundation invited 24 leading surgeons to London to attend a Training of Trainers course. The aim of the course was to introduce each surgeon to the HEST Course, with the hope that many will want to travel to conflict zones with the Foundation to teach it.
The Foundation receives many requests to run HEST courses, in so many locations affected by war. By expanding our faculty, we can reach more of these places in a timely manner.
The 3-day course was held at the iconic Wellcome Collection, a monument to the health sciences in Central London. Our extant faculty, led by David Nott, took participants through the different modules that comprise the HEST course. By the end of the weekend, participants felt ready to teach the course overseas. One participant said:
"David and colleagues have lots of experience and I am in awe of what they have been able to achieve. The practical tips in management of patients in humanitarian settings are equally valuable for trainees and established consultants in this country. "
Interspersed with surgical modules was discussion of the practicalities of attending humanitarian missions:
" I found the session delivered by Mr Hakimi on the practicalities of what to expect when travelling and working in countries where HEST is being delivered to be excellent and insightful."
We were additionally delighted to welcome students from the Friends of the David Nott Foundation Societies to the course. Delegates from Manchester, Leicester and Queen's University Belfast came to get a taste of their future humanitarian careers.
Training the Trainers has allowed us to invigorate the Foundation with new and enthusiastic teaching faculty. The DNF is poised to return to in-country HEST courses future-proofed and with more courses than ever.
Taking on the Royal Parks Half Marathon
On 13th October, six runners took on the Royal Parks Half Marathon and were successful in raising over £10,000 for the David Nott Foundation. Their dedication and perseverance means we are now able to fund the training of ten more surgeons working in austere environments. Read more about our fantastic runners below.
Anna-Lucia
A 6th year medical student at the University of Cambridge, Anna-Lucia has a passion for global surgery and has wanted to be a surgeon since before she even applied to med school. Whilst going on runs to train for her first half marathon last March, Anna-Lucia listened to the War Doctor audio book. She was so enthusiastic about it, that she made her entire family read the book and bought it for friends as a birthday present.
Sima
67 year old Sima also took on the 13.1 mile course in support of the Foundation. Though she has previously completed a whopping nine full marathons, this was her first half marathon in five years.
Ameera
Over the last four years, Ameera, a senior A&E nurse, has volunteered with various organisations and has taken unpaid leave with the NHS to work in Lesvos, Iraq and Macedonia. Whilst looking for new NGOs to volunteer with, Ameera came across David's book and was unable to put it down. She was even able to meet David in person at a book signing back in July!
She told us: "David’s experiences and drive to improve training for surgeons in countries of war, conflict and poverty is what motivated me to run for the foundation."
As an added challenge, Ameera also ran the 13.1 mile course in a surgical gown and cap!
Lindsey
After stumbling across David's Desert Island Discs a few years back, Lindsey was deeply touched by Dr Nott's humility and compassion. A medic herself, she said: "Like David I, too, as a senior GP see no borders, no one person better than any other."
Caitlin
Since the Foundation was first started by David and Elly in 2015, Caitlin has been working behind the scenes for us, and is one of our valued trustees. Faced with the frightening prospect of running non-stop for two hours, Caitlin nonetheless emerged victorious and crossed the finish line at 2 hours 13 minutes. You can read more about the work that Caitlin does for us here.
Jamie
As David and Elly's neighbour, Jamie has long been a supporter of the David Nott Foundation and we are very grateful for everything he has done for us over the years. An avid long distance runner, Jamie managed to finish the 13.1 mile course in an incredible 1 hour 29 minutes!
We are always excited to hear about anyone taking on a challenge event for the Foundation, so please don't hesitate to get in touch! If you'd like to learn more about how you can fundraise for us, please visit out Get Involved page.