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Skip to 0 minutes and 13 seconds So how do we organise logistics in a humanitarian emergency? Well, there’s certain principles of planning. You have to think about what is actually happening and get the raw detail, which is often imprecise, and very contradictory, at the beginning. And then you have to decide what is important and identify your highest priorities. Then you’ve got to decide what can be done. What can be solved, not just what is needed. Because there’s a lot of constraints, which will help you establish the priorities. Then you’ll decide what will be needed and take in– very important to take into account the existing norms of the local community and set realistic objectives. Then you have to plan what you are going to do.

Skip to 1 minute and 2 seconds And then put it into action. And lastly decide what you have done, and evaluate and reassess the programme. Before leaving, you must find out the impact of the problem at an international level, before arriving into the emergency area. And, as you get closer to the disaster area, you have to compare the local population as a baseline for relief needs. On arrival in the disaster area, you have to analyse the information available. You’ve got to listen, ask questions. Who are the victims? What are their needs? How many of the victims are there? It’s no good saying thousands or hundreds. Is it 10,000 or 100,000? It is always very difficult to evaluate this.

Skip to 1 minute and 44 seconds But you have to try and get a realistic estimate, as planning and logistics will rely on these figures. Now the decision for action requires a lot of thought and analysis, not only of the victim’s needs, but of the limitations in meeting those needs. Limitations would include finance, is it available or not, transport, security, staff, supplies. When I was in Ethiopia, many years ago, but there was no finance. Transport was negligible, because all the roads were mined, and there was not a proper airport. Security, it was a war zone. We didn’t have people trained. And supplies were not available. And you’ll find this again and again in humanitarian emergencies.

Skip to 2 minutes and 28 seconds My first mission with the ICRC was working in Lebanon– that was 1983, ‘84, during the main Chouf Mountain War– based in Saida which, at that time, was controlled by the Israelis. And my role as a field nurse was to cross the front lines, into the main fighting area, resupply the medical facilities, pick up the wounded on the battlefield. Because often it was too dangerous for them to be picked up by their own sides. And under the protection of the Red Cross, take them across front lines, into a safe neutral hospital to be looked after. We also had several hostages that we visited and prisoners of war. The hostage villages nobody could get in, nobody get out.

Skip to 3 minutes and 10 seconds There was thousands of people there. But we were allowed in as an ICRC convoy. We took medical supplies, and food in. Sometimes we were allowed to evacuate the wounded. The prisoners of war we were allowed to visit. It was a silent witness visit. Meaning we went in, we didn’t broadcast that we did this. But just the fact that we went in, took the names of the people, made sure they had basic facilities to survive– like the basic food, and water, and blankets, air, light– it helps to keep them alive. And I can remember the first time I went into the field. And I had to come up to the fighters and stop the vehicle.

Skip to 3 minutes and 58 seconds Because you’ve only got a vehicle with a red cross on it for your protection. And say, could you arrange a cease fire between 10 o’clock and 1 o’clock? We’re going to this area to pick up the wounded, to resupply the medical facilities. And these people who I spoke to, the fighters on the ground, I knew they had killed people. I knew they had blood on their hands. I knew they tortured people. And getting out the vehicle, and talking to them for the first time, I was really scared. And what hit me was how they worried about their families, their children, their schools, their homes, and they wanted peace. And they were fighting for peace.

Skip to 4 minutes and 34 seconds And one day I had– it was a truck that had been blown up on mines. So I had 15 wounded. Some of them really their legs blown off. Others with chest injuries. And I put them all inside one Land Cruiser. And drove them home. That Land Cruiser had two stretchers. It didn’t mean I took two people. It means there was– I didn’t– it means each stretcher had two people. The children were in the arms of the people on the stretcher. Up front with me I managed to put three people, even though there was only two seats, and there were chest injuries. Now I’m not proud of that. It’s not right.

Skip to 5 minutes and 14 seconds But I knew I had to get them out of the area. Because we wouldn’t be able to go in for the next 24 to 48 hours. And they all were seriously injured and needed to be operated on. If I left them, they would probably die. So quality of care is very, very difficult. And in emergency situations, you just have to do your best. Real emergency situations, until more help arrives. In Ethiopia when I was there, there was all these thousands of children, and adults, that needed to be fed, who needed food. They didn’t need new trainers or colour television. They just needed basic food of flour, beans, oil. And we had insufficient for everybody at the beginning.

Skip to 6 minutes and 4 seconds And that’s a horrendous situation to have to be in, choosing who could come in and who couldn’t. The feeding centre was children under five-year-old. So what do you do with their brothers and sisters of seven and eight, and their children, and their parents? And selecting them to come in or not to come in, or to have food? They didn’t have food. At the time what I did was I concentrated on what I could do. And you sent reports back to headquarters. But it seemed that the world didn’t know what was going on or, more likely, they weren’t interested about what was going on. Because it is a political situation. And the finances were not there.

Skip to 6 minutes and 47 seconds So, I think quality of care at the very, very beginning you have to do your best for each person that’s in front of you. Triage is very different in emergency situations to what it is in a high-income country. High-income country you get all the major injuries in first. And then you get the second grade, which can wait a bit, and the third grade that are going out, that have died. In emergency sit– in crisis situations, war situations, resource-poor areas, you’re going to get the really severely injured people that come in. And they’ll be put in a quiet area, and they’ll be given painkillers.

Skip to 7 minutes and 31 seconds And the next level, people who have a chance to survive, more of a chance to survive with minimum intervention, will be looked after. And the third, walking wounded who will wait. But you don’t deal with the most seriously injured. Because you’ll be operating on them for hours. They’ll use all your blood supplies, and all the fluids you’ve got. So you’re looking at helping the majority of people, rather than individuals. And I think that’s something we have to remember in emergency situations. It’s all very well, and very important, to send in– for instance after an earthquake– teams of dogs and rescuers to bring out the dead.

Skip to 8 minutes and 20 seconds But, actually, it’s more important to look after the wounded that are there, and make sure they have some sort of facilities, definitely water, sanitation, food. Any small wounds that aren’t dealt with and looked after, because even a break, it can be lead to osteomyelitis very easily if it’s not looked after quickly and correctly. So although you say– when you hear on the news, hundreds have died and there’s 10,000 injured or something, I’m really worried about the 10,000 injured and the facilities available to look after those. Not the six or seven that are taken out of the rubble two or three days later.

The reality of delivering healthcare in humanitarian emergencies

In practical terms, what is it like to be a healthcare worker during a humanitarian emergency?

In this video, Dame Claire Bertschinger explores the contextual and practical challenges of response planning, deployment, and logistics in humanitarian settings. She discusses a personal example of the challenges faced on the ground from her work in Lebanon, and recalls her experiences of passing through front lines and arranging cease-fires during conflicts to provide medical care.

If you have worked in a humanitarian healthcare context yourself, what were some of the challenges you faced? If you haven’t done this, think about your own personal or professional experiences. How would regular or day-to-day tasks become more difficult as a result of being caught up in a conflict or natural disaster?

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This video is from the free online course:

Health in Humanitarian Crises

London School of Hygiene & Tropical Medicine