Logistics in a crisis
Supply management and logistics are an integral part of emergency planning and response efforts. In this step Dr Lucy Reynolds outlines what prevents us from making sure we have the supplies needed to deal with emergencies as and when we need them.
The challenges of distributing supplies to where they are needed varies with each type of crisis, as well as with the physical environment and people who need assistance. Mountainous terrain inaccessible by vehicles, places where access roads are washed away by monsoon rains, and dust storms that make long-distance driving impossible are all challenges to us equipping staff with much-needed resources.
How are supplies deployed?
Generally essential humanitarian supplies, such as soap and buckets, can be obtained in markets close to crisis areas. These goods are distributed by local transport, including trucks, trains, carts, and boats. Although local procurement supports local economies, doing this in bulk can cause shortages and drive up the price of essential supplies beyond the reach of local people.
In remote areas un-served by rail, road, or river, helicopter freight and air drops from small planes may provide some solutions. This method was used to restock clinics in war-affected Central Congo in 1999-2000, with a single small plane able to resupply a large area. For the final phase of the transport in remote mountainous areas, pack animals such as donkeys (used in northern Afghanistan), or porters must carry essential supplies to their destination. Goods that cannot be sourced locally must be imported, typically through commercial airports or overland trucking. When a humanitarian crisis hits, long-distance shipping is too slow, though as the crisis stabilises a shift to shipping of bulk commodities will occur due to the lower price of this compared to air freight.
What challenges might we face in accessing affected populations?
The most dramatic challenges are often the direct consequences of an emergency: destruction of transport infrastructure by natural disasters, conflict zone front lines severing usual supply lines, or the systematic diversion of resources to or away from warring parties.
Additionally, in a crisis there can be great competition for transport vehicles and fuel as existing vehicles may be in poor repair while the import of new ones is slow and administratively challenging. Vehicles used by aid agency logistics teams are extremely valuable to underfunded militia who are able to capture them. For instance, in Congo’s 1998-1999 war, South Kivu aid agencies lost several 4x4 vehicles in ambushes which were later seen on roads being used by parties to the conflict1. Potential local drivers may also be scarce or unwilling to become involved if the population has fled a crisis, and in some parts of the world only a small proportion of people are able to drive.
Furthermore, insecurity may be problematic for logisticians, even in countries at peace that are hit by disaster. This may involve road ambushes, raids, and other banditry, poorly controlled police, troops, or militia, or ‘informal taxation’ of road users at unofficial road-blocks. In 2007, humanitarian efforts in Haiti were threatened by road ambushes emanating from gangs in Port-au-Prince slums until the UN blocked off the ambushers’ escape route with an unused tank2. Incidents can be minimised through care in planning routes to avoid easily ambushed places and conflict zones, and by variation of journey timings, since predictably timed, high value cargo journeys are vulnerable to theft. Care should be taken not to publicise logistical arrangements by radio or word of mouth, as this may enable the interception and theft of goods and vehicles and the kidnapping of staff for ransom or to make a political statement.
If aid vehicles are intercepted, it may still be possible to negotiate safe passage as humanitarians providing survival services to those in need as an act of human solidarity. Local community leaders are often able to assist in protecting essential aid personnel and supplies through their influence in the community.
Funding can also be an issue. In rapid onset disasters, news broadcasts elicit public sympathy and mobilise far more funding, but protracted crises tend to run short of resources as media coverage and public interest move elsewhere. In all crises, competition between assisting agencies for staff, vehicles, and other resources develops depending on the nature of the crisis. In a cholera outbreak soap and buckets may become scarce, while after a hurricane tents may quickly sell out in local markets.
Which logistical issues are specific to humanitarian health?
Many further challenges specifically affect healthcare delivery in crisis settings. Outbreaks of disease are likely and will spread quickly in this context. Immediate vaccination programmes are often recommended when a refugee camp is established. However, maintenance of storage and warehousing facilities, including a cold chain (a relay of refrigeration facilities throughout the journey) for vaccines and other heat-unstable medicines is logistically demanding. If the cold chain is broken before reaching the patient, such medication can become inactive or even dangerous to use3,4.
While this may affect numerous aspects of a response, maintaining a continuous electrical supply is also essential to keep vaccines and medicines in a usable condition. Where power supplies have been interrupted or where they have never been present, electrical generators can be used to power refrigerators, while vaccination programmes often use kerosene-fuelled fridges in remote areas.
During infectious disease outbreaks quarantine restrictions may block supply operations, although in practice this is rarely a serious difficulty. However, humanitarian teams must take great care not to spread contamination around and outside affected areas, even where no official restrictions on movement are imposed. In Haiti, the first epidemic of cholera was an Asian strain which appeared during the 2010 earthquake response, reportedly originating from UN peacekeepers from a country where cholera is endemic5. Hypochlorite bleach is an essential supply for this reason, particularly in the case of cholera outbreaks, but special care must be taken by logisticians in transporting this material. If barrels of the calcium hypochlorite bleaching powder happen to overheat, for example by being transported in direct sunlight, they have been known to explode6.
The importance of strong logistical support to crisis response cannot be over-stated. This is an essential area of work at the heart of humanitarian response which involves complex challenges and the chance of providing substantial and lifesaving assistance to people hit by crises.
© London School of Hygiene & Tropical Medicine