Humanitarian and Community Award: Mr Morgan McMonagle

Mr Morgan McMonagle FRCSI is the 2025 recipient of the RCSI Humanitarian and Community Award for his commitment and service to protecting the lives of others and the welfare of humanity. Read Morgan's story below.

I’ve always been drawn to big emergencies in my career, especially trauma surgery, so the desire to learn and upskill further has shaped my surgical journey to date.

During the early years after qualification, I moved to Sydney, Australia and did a trauma and emergency surgery year at Westmead Hospital. Following that, while completing my MD research, I also trained with and worked for an aeromedical company called Careflight, which exposed me to a lot of austere environment work, for example, landing on offshore oil rigs or providing mountainside medical care and rescue winching.

It was highly complex as it involved three distinct challenges: helicopter safety, which is paramount given that helicopter retrieval is one of the most dangerous forms of commercial transport globally; a rescue environment that is likely austere and unknown; and then medical treatment on-scene. It provided an incredible opportunity to develop my decision-making, teamwork and communication skills as well as my leadership abilities and was elemental in my next steps career wise. But, after two years working for Careflight, I decided to return to higher surgical training in the UK.

My final year of general and vascular surgery training in the UK was at Queen Elizabeth Hospital, Birmingham which included the military wing, where young injured soldiers from the last Gulf War were evacuated to for surgery and rehabilitation. I had the opportunity to operate on and treat many young soldiers returning from Iraq and Afghanistan, with very complex polytrauma. While the vast number of operations involved amputations and vascular reconstructions, it did provide me with the experience and chops to manage gunshot injuries and shrapnel wounds, which was very valuable when I subsequently moved to Philadelphia to complete a Fellowship in Trauma Surgery.

Working in a world-renowned and state-of-the-art level one trauma hospital in the USA was immensely rewarding and informative. I had second to none mentors, many of whom are considered leaders in trauma surgery on a world level. However, it was the exposure to penetrating injuries, especially gunshot victims, really served as a finishing school for anyone interested in trauma.

Over the course of a month, you could operate on 20 to 30 gunshot victims, in all parts of the human body, which complemented my vascular training, and vice versa (vascular surgeons are still the only surgical specialty that operates in all body regions except inside the skull and spine). In addition, there is a much higher likelihood of needing to operate for exsanguinating haemorrhage after a gunshot wound than after blunt trauma, so after the year in Philadelphia, no trauma can phase you. It has been said, that real surgical experience is the feeling of being comfortable in an uncomfortable situation. That is what I took away from my trauma fellowship.

Mission critical

Toward the latter stages of my Fellowship in Philadelphia, the Haiti earthquake happened. I volunteered to go there and was assigned to a mission but at the last minute it was cancelled. Shortly thereafter, I moved back to the UK as Trauma Consultant for the newly established trauma network at St Mary’s Hospital, London. While in St Mary’s and through lecturing in Imperial College London, I met Professor David Nott, a general and vascular surgeon who had experience volunteering in disaster and conflict zones and subsequently established the David Nott Foundation. I worked alongside David and then joined his Foundation, which trains doctors in countries impacted by conflict and catastrophe.

I had moved to Waterford before undertaking my first mission with the Foundation when I travelled to the West Bank in Palestine. Since then, I’ve been to Ukraine on two occasions, once to Lebanon and more recently on two missions to Gaza. I’m extremely appreciative and indebted to the HSE and management in University Hospital Waterford, in addition to my colleagues who have been very supportive and encouraging of this, without whom I could not take the time away to do these missions.

In my experience, doing this type of humanitarian work requires a certain grit and attitude. Being a stoic helps too. You must be the type of person who likes a challenge and can adapt and optimise regardless of or in spite of the circumstances you are thrust into. You arrive into a high stress environment often with limited equipment – you have to be able to connect with the team, build trust, and adapt. Sleep is limited, food is limited and there is no opportunity for exercise, which can create a real sense of claustrophobia.

For me, the biggest personal adaptation when away is the lack of private space, but again, you do adapt and realise that the population you are there to serve have it far, far worse than this ‘temporary’ set up for us.

In my most recent mission to Gaza, the hospital that I was operating and living in was bombed. I was in the Intensive Care Unit of Nasser hospital when the building was struck. At the time of the strike, I was working on two patients with an American colleague. Some Palestinian staff members ran into the ICU to confirm the building had been hit and I could also see fire and smoke from the window.

I immediately went into survival mode, thinking through the layout of the floor to remember where the fire escapes were – it was very visceral, very instinctive. I don’t remember feeling scared, but I certainly had a strong element of 'anticipatory anxiety'. For about 20 minutes, we didn’t know if it was a one off strike (as it turned out, it was a targeted strike) or whether the hospital was now a target per se and we were about to be repeatedly bombed.

The reality was that there was nowhere to go outside of the hospital and so it was a case of waiting until we got word that we could return to the ICU, where we immediately started operating on patients until about 3am before we finally went back to where we were sleeping. Throughout the strike and afterwards, the Palestinian staff were apologising to us, checking we were okay – I couldn’t believe the concern they showed for us despite all the horrors they had experienced and witnessed for months on end. They still treated us like guests, which is very humbling.

Leaving missions, and most particularly the latest mission to Gaza, I do experience a sense of guilt that I can leave the situation behind. I am hugely conscious of the privilege that I have as a white, Caucasian male. That privilege should be used to make a more positive impact. That is why I’ll continue to volunteer for these missions in the future.

Changing realities of humanitarianism

Traditionally, the fundamental pillars of humanitarianism are humanity, impartiality, neutrality and independence. In recent times I have been very vocal about what I have experienced and witnessed on various missions. Some might call my impartiality into question, but the reality is that the traditional ‘rule book’ for conflict is changing.

Healthcare facilities and professionals are increasingly being targeted in conflict zones from Haiti to South Sudan to Gaza. Journalists are not being given access to conflict zones, hence denying a basic human right of freedom of expression.

I don’t believe that me or any of my colleagues are purposely trying to change the role of humanitarian actors. However, we are kind of being forced to speak out – to advocate on behalf of the people, on behalf of the truth and on behalf of humanity because others are being deliberately blocked from doing so. If something is repugnant, it is behoven on all right minded and reasonably thinking people to call it out.

After all, there is great wisdom to be discovered simply by witnessing a repugnant act. But then acting on this wisdom. This is the true essence and kernel of free speech. Free speech is a shield; never a sword.

I would like to thank the Royal College of Surgeons in Ireland for this wonderful and humbling award and I feel there are now great opportunities for more Irish surgeons to get involved in conflict medicine.

I also want to thank all my family, friends and loved ones for sticking by me in all my madness and in particular Luke, Muireann, Ruadhan and Aoibhe. Finally, I dedicate this award to the brave staff of Nasser Hospital, whose courage and dedication inspires me every day.