Since the fall of the Assad regime in December 2024, Syria’s borders have opened, and in April, our team of Faculty surgeons ran our first ever Hostile Environment Surgical Training in Aleppo.

Against a backdrop of destruction and severe shortages of even the most basic medical supplies, 24 surgeons travelled from Raqqa, Tartus, Idlib, Homs, Hama, Damascus and Al Suwayda to attend the course.

The surgeons – whose specialities included neuro, vascular, urology, orthopaedic, maxillofacial and general surgery – spent five days training with the Foundation’s Faculty members in the first HEST® training of this kind in Syria.

DNF partnered with Action for Humanity, UOSSM, the Syrian Ministry of Health and Aleppo University School of Medicine to run the course, which featured Heston® and other state of the art prosthetic training equipment. The training was delivered by our local Syrian Faculty in Arabic, and supported by UK Faculty leads Dr Ammar Darwish, Dr Pippa Letchworth, Dr Saladin Sawan and Dr Mahmoud Hariri.

Consultant Surgeons in Gynaecological Oncology Dr Pippa Letchworth and Dr Saladin Sawan ventured to Idlib during the HEST® course, where they spent 3 days and performed 10 operations on gynaecological cancer patients. The hospital was supported by SAMS.

Dr Sawan explained: “In addition to delivering this treatment to patients, we focused on enhancing knowledge decision making and surgical skill capabilities of doctors in Idlib with 4 consultants and about 13 residents.”

Syrians have been through unimaginable hardship since the conflict began in 2011, and even since the fall of the regime, the situation has been dire.

Dr Mohammad Jazaely, a general surgeon from Damascus Hospital, Al-Mujthid, said: “The hardest experience I went through was on our liberation day on 8th December. There were many injuries, and we had to work with limited resources. In the span of 48 hours, we carried out around 40 laparotomies. Eventually, we ran out of resources. So, we had to make do with what we had.”

For Dr Jazaely, his commitment is unhindered despite the incredibly difficult conditions.

“I love working here, because at the end of the day, this is my country, and these are my people. For this reason, I must give everything I can, and I stayed here in the country.”

Hospitals are dilapidated, dirty and crowded, with constant power cuts. There are very few anaesthetists in the country and there is a shortage of all surgical specialisms. Health care workers are exhausted, and morale is low. But Dr Jazaely explained the impact of the course.

“This is the first time we’ve had this kind of training in Syria, honestly. They’re very high-level trainings. The reason is that the trainers are specialists in this field. They’ve worked hands-on in war zones across different regions.”

Medical professionals are also facing a huge number of injuries as a result of landmines. Dr Mohammed Al-Sednawi, General Surgeon from Damascus said: “The most difficult situation we were working on was the landmine injury, because it affects a lot of civilian people, who weren’t involved in the war. So, they come to the emergency sector and they go to the operating room, where there were no resources, such as sutures, and a lot of decrease of resources and suction tubes — a lot of suffering in our operating room.”

Dr Abu Mohammadain, a urologist from Aleppo, worked with our Co-Founder David Nott over a decade ago when they worked together during his first visit to Syria in 2013, and again in 2014. “It was truly a major opportunity for us as surgeons. We didn’t have much experience with war injuries, disaster injuries, or trauma cases. And, thanks to God, the results of that direct engagement with Dr David were outstanding. It helped us save lives, improve patients’ outcomes, and reduce disabilities caused by war injuries.”

During this time, our Co-Founder was working alongside our Faculty member, Dr Mahmoud Hariri in Aleppo hospitals, risking their lives to save others. It was a seminal moment for him to run this course.

Dr Hariri said:

“This is a historical moment. This is the first course run in Aleppo. This is the first course that has been done for them – the first time seeing such type of demonstration, simulation, practical course rather than just theoretical information. I believe that such course should be run many times, until feeling that most of the surgeons have some experience in trauma cases in this country.”