Middle East and North Africa: coping with medical emergencies

01-04-2011 Interview

As unrest and violence continue to spread across the Middle East and North Africa, ICRC deputy director of operations Dominik Stillhart outlines the challenges that local health workers and hospitals are facing in the region and the support that the ICRC is giving them.

What are the greatest medical challenges and priorities in the wake of the latest outbreak of unrest?

In general, violence has resulted in many deaths and vast numbers of injuries. The armed conflict in Libya has been raging for weeks now and casualty figures there continue to mount, while humanitarian access to some parts of the country remains restricted.

In other places, civil unrest has flared up against the backdrop of an existing armed conflict, as in Yemen, where a protracted – although largely unreported – armed conflict is under way in the north of the country. In Iraq, too, recent demonstrations have resulted in casualties, while hundreds of people continue to be killed or injured every month by violence linked to the ongoing armed conflict. When you add civil unrest to an already precarious humanitarian situation in a country weakened by years of armed conflict, the result can be disastrous in terms of the cost in human lives.

That's why one of our top priorities is to support local health staff in saving lives and ensuring that people in need of emergency medical care – in particular, those wounded in the violence – receive the help they’re entitled to. I cannot emphasize enough the importance of giving health-care workers immediate access to the wounded and sick and allowing them to do their jobs safely. It's literally a matter of life and death.

What is the ICRC doing to address these challenges?

Caring for the wounded and the sick, relieving suffering and saving lives is really at the heart of what we, and our partners within the International Red Cross and Red Crescent Movement, do on a day-to-day basis.

In the wake of the recent civil unrest and violence in North Africa and the Middle East, we've been doing all we can to support first-aid providers. This means working hand-in-hand with the national Red Crescent or Red Cross societies in the affected countries and with health ministries, other government authorities and local organizations.

In Egypt, for example, the health ministry is in charge of first aid and emergency care. The Egyptian Red Crescent helps identify needs, while a number of other organizations also play an important role, as do private individuals who spontaneously volunteer their services when violence erupts, as many did in Cairo's Tahrir Square. The ICRC maintains a good network of contacts with all concerned, which enables us to assess needs and respond effectively.

Humanitarian organizations must have safe access to those in need and everybody must respect and protect medical personnel, medical facilities and vehicles that are transporting the wounded.

What are the main risks for health-care personnel?

Whether they’re navigating their way through road blocks or handling a sudden influx of patients with weapon-related injuries, local health workers face considerable risks and challenges. Some of them have paid a high price. In Libya, two volunteers were injured on 3 March when the Red Crescent ambulances they were travelling in were shot at in Misrata, west of Benghazi.

It is totally unacceptable to attack those providing medical care and to obstruct the safe passage of ambulances. All those taking part in the violence must safeguard medical personnel, medical facilities and any vehicle used as an ambulance. Health personnel and Red Crescent and Red Cross staff must also be respected and allowed to carry out their life-saving work in safety.

First-aiders are particularly exposed to serious danger and obstructions in performing their tasks, because they're often first on the scene. It's vital that they be allowed to perform their duties safely and quickly.

While minor injuries can often be treated on the spot, severely wounded people have to be taken to hospital. Emergency medical services stabilize patients and use triage to ensure that the patients with the most serious needs are treated first. The ICRC supports local medical services in their efforts to care for the injured and ensure that all the sick and wounded receive assistance, regardless of their allegiance. Our priority is to ensure that they obtain the care they need.

How does the ICRC promote compliance with the rules protecting the sick, the wounded and those who are treating them?

By raising awareness that the aim of health workers is to help people, and that everyone must respect and protect patients and health workers. One way we do this is through dialogue with everyone involved in the violence – security and police forces, but also demonstrators – and with the parties to an armed conflict. Basically, one of our roles is to keep reminding everybody of their obligations as often as necessary and for as long as it takes.

To my mind, there's a humanitarian imperative that security and police forces, and anyone else taking part in the violence, respect and protect medical personnel, facilities and ambulances at all times. It's that simple. Failure to do so is totally unacceptable.

Could you give us a few examples of how the ICRC has been supporting medical staff in countries affected by violence?

This kind of activity lies at the core of our mandate, and we've been protecting the wounded and sick for more than 150 years. So even before the civil unrest erupted, we were already supporting health activities in several of the countries where violence has occurred recently.

In Tunisia and Egypt, the ICRC has long been cooperating with the national Red Crescent Societies. During the recent events in Egypt, we provided a dozen hospitals with enough supplies to treat up to 1,000 severely wounded patients. In addition, we gave the Egyptian Red Crescent enough bandages and dressing materials to treat 5,000 patients. We also made sure we had enough additional emergency dressing kits on hand to treat 5,000 people with minor injuries.

In other countries, such as Yemen and Iraq, the ICRC has been supporting local health facilities for decades. In Yemen, the Red Crescent is currently working around the clock to provide first aid in areas where demonstrations are taking place, while the ICRC is delivering surgical and medical supplies and providing first-aid training for volunteers. In Iraq, medical staff regularly receive ICRC training to help them cope with influxes of mass casualties from the ongoing armed conflict. We stand ready to provide further assistance should the need arise.

In Bahrain, which is covered by our regional delegation in Kuwait, we carried out an assessment mission on the ground in cooperation with the Bahraini Red Crescent during the very early stages of the unrest. We have pre-positioned stocks of first-aid materials with the Bahraini Red Crescent, along with enough surgical supplies to treat up to 250 casualties.

During the early stages of the fighting in Libya, we sent in two medical teams, including surgeons and nurses, to help local doctors cope with the large number of casualties arriving at hospitals in Benghazi and Ajdabiya. Together with the Libyan Red Crescent, we also replenished those facilities' emergency stocks of supplies. In addition, in coordination with the Benghazi Health Committee and the Libyan Red Crescent, the ICRC's medical teams held a surgical seminar for more than 70 Libyan doctors and nurses at Al Jalaa hospital. The latest news from Libya is that a team of ICRC delegates arrived in Tripoli on 30 March to discuss issues of humanitarian concern with Libya government officials.



Dominik Stillhart, ICRC’s deputy director of operations.


Tahrir Square, Cairo. Doctors, nurses and ordinary citizens set up an improvized dressing station to treat people injured during the demonstrations.
© ICRC / N. Cohen / eg-e-00011

Al Jalaa Hospital, Benghazi. Libyan doctors and nurses treat a patient in the accident and emergency unit. 

Al Jalaa Hospital, Benghazi. Libyan doctors and nurses treat a patient in the accident and emergency unit.
© ICRC / Getty image / G. De Moustier

Al Bayda Hospital. A patient with a gunshot wound receives a visit from his family. 

Al Bayda Hospital. A patient with a gunshot wound receives a visit from his family.
© ICRC / Getty / G. De Moustier / ly-e-00029

Cointrin Airport, Geneva. Ground staff load medical supplies onto two ICRC-chartered aircraft bound for Libya. 

Cointrin Airport, Geneva. Ground staff load medical supplies onto two ICRC-chartered aircraft bound for Libya.
© ICRC / T. Gassmann / ch-e-00742