Medical support in the conflict resolution

and post-conflict rehabilitation phases of

campaigns – benefits of using the private

sector to deliver hybrid solutions

Ewen McLay

International SOS

9 October 2015

ewen.mclay@internationalsos.com

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Scope

• The crisis spectrum.

• The issue for Civilian Missions.

• A case study – OSCE in Ukraine: overcoming the challenges.

• Key benefits of using the Private Sector.

• Discussion.

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Context – the Spectrum of Crisis

In a post-intervention era, States and International Organisations are aligned

around the requirements to:

• Anticipate instability and the triggers for conflict.

• Deliver ‘upstream prevention’ with the intention of building strong and legitimate

institutions in fragile countries.

• Contain crises by developing the capabilities needed to take rapid, appropriate,

and effective action to prevent or stop them escalating or spreading.

Pre-Conflict

Resolution Post Conflict

Rehabilitation

Civilian Military Civilian

The Issue

Witnessing a growth in civilian

missions – UN, EU, OSCE,

national…..

Characteristics of the operating

environment: • High risk.

• Underdeveloped or degraded host nation

health and medical infrastructure.

• No in-place military support.

• Remote at the local level.

• Remote from points of definite care.

• Complexity at the points of transition in

the care pathway.

• A diverse, dispersed and changing

Population at Risk.

Civilian missions:

• Don’t generally have

comprehensive and organic

medical support systems.

• Do have high duty of care

requirements.

• Require cost-effective

solutions.

But…

Driving a requirement for cost-effective and innovative health

and medical support solutions at the pre-conflict resolution

and post-conflict rehabilitation ends of the spectrum.

“Necessity is the mother of invention”

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Case Study – OSCE Special Monitoring Mission to

Ukraine

• A unique civilian mechanism to engage on a multi-lateral basis through the

conflict cycle, which cannot necessarily be provided in isolation by individual

nations, EU, UN or NATO.

• Identifies itself as a strategic rapid reaction civilian capability.

• Deployed its monitoring Mission into Ukraine in March 2014 – potentially

increasing to 1000 monitors.

OSCE – Eastern Oblasts

Indirect fire (small arms/artillery), being caught in cross fire – HIGH

TO VERY HIGH

Mines, improvised devices and unexploded ordnance – HIGH TO

VERY HIGH

Abduction (kidnapping and hostage taking) – HIGH

Opposition to OSCE (restriction of movement) – MEDIUM

Criminal related threats (robbery, theft, burglary) – MEDIUM

Road and traffic related incidents – MEDIUM

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Case Study – OSCE

Characteristics Condition Requirements Condition

High risk. Organic health and

medical support

Underdeveloped or

degraded host nation

health and medical

infrastructure.

High Duty of Care

Expectations

No in-place military

support.

Running the risk of mission

failure unless an acceptable

health and medical solution

was put into place.

Remote at the local level.

Remote from points of

definite care.

Complexity at the points

of transition in the care

pathway.

A diverse, dispersed and

changing Population at

Risk.

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Case Study – OSCE

Favourable

Characteristics

Assessment Requirements Condition

Low risk. Organic health and

medical support

Well developed and

complete host nation

health and medical

infrastructure.

High Duty of Care

Expectations

Military support system in

place.

Running the risk of mission

failure unless an acceptable

health and medical solution

was put into place.

Primary MEDEVAC

immediately available

Easy access to points of

definitive care.

Well developed

transitions between

levels of care.

A stable and accessible

PAR.

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OSCE’s Approach – go to the Private

Sector

“No medical, No armour – No Mission”

• Stage 1 – Immediate uplift.

– Deployment of paramedics within 72

hours.

– Provision of Personal Trauma Kits, Team

Trauma Kits and Medical Training Aids

within 30 days.

• Stage 2 – Develop a health and medical

support plan.

– Conduct a medical reconnaissance on

both sides of the Line of Conflict.

Acceptability and accessibility as key

criteria.

• Stage 3 – Implementation.

– Identify and fill gaps in coverage, creating

a hybrid local and contracted solution.

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OSCE – benefits of using the Private Sector

The OSCE was able to create a comprehensive medical system within

weeks – and one which was specifically tailored for its requirements in

Ukraine.

Benefits to the OSCE included:

• Capability/Capacity Acceleration. From nothing to a comprehensive

medical system within weeks. Generating immediate freedom of

decision and action on the ground.

• Cost effectiveness. Only paying for services used from a provider.

• Risk reduction. By engaging with a provider with the knowledge and

experience of delivering solutions in highly challenging operating

environments.

• Value-Add. The ability to capitalise on innovation and developments in

technology, such as the rapidly developing telehealth market.

• Choice. A commercial market place that allows competition.

• Control. No dependency on others and no associated political

complexities.

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The OCSE’s Hybrid Solution

Levels of

Medical

Support

Key capabilities

Lines of Medical Support – Primary Functions

Non-Emergency Medical

Support

Emergency Medical

Support

Level 1 24/7 Reach-Back. Contracted Capability Contracted Capability

Local Capability

Level 2 24/7 Reach-Back.

Local Medical Facilities.

Local Capability Local Capability

Level 3 Strat AEROMED provider.

24/7 Reach-Back.

Home nation point of

definitive medical care.

Contracted or home nation capability.

Contracted or home nation capability.

Medical Enabling Activities

Underpinning these Lines and Levels are: clinical governance, a medical control, coordination and

informational management systems; activity to refine (time and event sensitive) understanding of

the local medical informational picture; training for Monitoring Team personnel; and medical

supply chain.

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Hospitalization

Primary

CASEVAC/MEDEVAC

Transfer

Stabilization in

local medical

facility

Secondary

MEDEVAC

Monitoring Patrol

Command and Control

Aeromedical

Evacuation

Communicate and

report

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Benefits from using the Private Sector

• Immediate coverage of gaps in capability/capacity. A tailored solution

to supplement or enhance.

• Immediate Institutional Expertise and Knowledge. An in-place global

footprint, with long-standing knowledge and experience of delivering

medical support around the world in many of the most challenging of

operating environments.

• Cost-Effectiveness. Availability of rapidly deployable capability available

at readiness and/or on a call-off basis. This provides agility and flexibility

in planning whilst only paying for services used.

• Value-Add. The ability to capitalise on innovation and developments in

technology, such as telehealth.

• Control. No dependency on others and no associated political

complexities or agendas.

• Flexibility and certainty. Contracting solutions such as strategic

partnering arrangements, or call-off contracts which entail no upfront

costs.

• Choice. A commercial market place that allows competition.

Discussion