Medical capacity building is an arduous endeavor, particularly in war-torn, politically unstable regions. Regardless, medical capacity can be built through perseverance and careful deliberation. We present our 28-year experience of capacity building in Kurdistan, Iraq. Methods: We annotated our experience with surgical capacity building in Kurdistan, Iraq since 1992. Annually, 1-2 trips were undertaken. Prior to each trip, colleagues with desired surgical expertise were invited. A symposium was also organized at the end of each trip. Results: Over 80% of cholecystectomies are now done laparoscopically, compared to none prior to our arrival. Other advanced laparoscopic operations include adrenalectomy, splenectomy, nephrectomy, Nissen fundoplication, and gynecologic procedures. More than 3,000 renal transplantations have been performed since 2004. Complex neurosurgical procedures such as craniotomy, spinal decompression/stabilization, and complex HPB and surgical oncology operations such as Whipple, liver resections, gastrectomies, and pelvic exenterations are now routinely performed. Care of trauma patients includes prehospital patient care, mass casualty triage, and management of patients exposed to chemical weapons. Other accomplishments include helping local surgeons to gain membership to the American College of Surgeons, supporting the establishment of a medical journal, and assisting with the creation of a new medical school. Conclusion: With good intentions and perseverance, it is possible to empower war-torn nations to build advanced surgical programs. What we have achieved in Kurdistan over two decades is testament to effective and meaningful collaboration with major stakeholders.