Navigating geopolitical challenges

Dr Joseph Lelo, Medical Director at AMREF Flying Doctors, agreed that robust planning, advanced technology, and experienced personnel are paramount to managing unforeseen circumstances. He explained that, at AMREF Flying Doctors, “our aircraft are equipped with state-of-the-art medical equipment specifically selected for operations in challenging environments. We maintain a full-time team of experienced, highly trained flight nurses and pilots. 

Their combined experience and expertise enable the organisation to adapt and respond quickly to new situations.” AMREF Flying Doctors provided insights into the measures it takes to retain valuable staff, observing that working under pressure and in challenging environments can take  its toll on personnel. Dr Lelo said: “AMREF Flying Doctors places a high priority on the safety and wellbeing of our staff. We provide comprehensive training to prepare them for the specific challenges they may face, including security protocols and stress-management techniques. For example, our personnel involved in evacuations from conflict zones like Yemen and South Sudan receive extensive training in operating under hostile conditions.

Strong relationships with government agencies are crucial for our operations, especially in regions with political instability

“Additionally, we offer robust support systems, such as counselling services, to help our staff cope with the psychological impact of working in high-risk areas. The reassurance that staff will only go into an area after all safety and security criteria have been met helps build their confidence.”

Jason Davies, Risk Analyst at Northcott Global Solutions (NGS), underscored the importance of having a security operations centre staffed by highly skilled personnel. He explained that NGS’s 24/7 global security operations centre has a multilingual and expertly trained team. “These operators are ready to respond to a range of emergencies, including medical, security, and environmental crises,” he said. “The centre is supported by our security and travel risk management department, which provides ongoing support to travellers during both calm and chaotic times. This set-up has enabled NGS to respond quickly and effectively to recent crises, such as the conflict in Ukraine, Sudan, and Israel, and the earthquake in Turkey and Syria.”

Additionally, he outlined NGS’s role in enhancing the safety and operational efficiency of its clients through detailed risk assessments: “By providing this comprehensive information,” he said, “we help our clients feel prepared and secure, making it easier to retain skilled personnel in challenging environments.”

Lara Helmi, Managing Director of CONNEX Assistance, reiterated that staff expertise is essential, and emphasised the need for preparation in the company’s alarm centres. “Part of our alarm centre training includes preparedness for unforeseen circumstances, national emergencies, and political crises. As an assistance company, it is a core part of our job to plan for the unexpected, and as an assistance coordinator in our alarm centre, you will need to be prepared too.”

It is of utmost importance that we share ideas and experiences with all industry peers and colleagues to ensure the best solutions are used for the greater good

Helmi noted that in the 25 years CONNEX Assistance has operated in the Middle East and Africa, the region has experienced significant political change, including the Arab Spring, many terrorist incidents, several wars, a pandemic, and numerous mass accidents. “Our alarm centre is fully equipped to handle these unexpected incidents with vigorous training on how to handle a surge in emergency cases due to major crises,” she continued. “Our operations managers, supervisors, and team leaders have a wealth of experience to fall back on, planned processes for crisis management, as well as a network of providers and government contacts.”

Government collaboration is fundamental

“Relations with government agencies are of utmost importance,” stated Helmi. “CONNEX Assistance ensures it has strong relationships with various government agencies in all the countries we operate in. We have established lines of communication with government agencies including the military, the police forces, civil aviation authorities, the ministry of foreign affairs, health authorities, judicial authorities, and national crisis management centres.”

Dr Lelo agreed. “Strong relationships with government agencies are crucial for our operations, especially in regions with political instability,” he said. “These relationships enable us to coordinate effectively with national authorities, ensuring we can obtain necessary permits, access restricted areas, and receive timely updates on the security situation.” Dr Lelo highlighted AMREF Flying Doctors’ partnership with African governments in responding to disasters, for example when conducting emergency medevacs during major mass casualty incidents. He explained that AMREF Flying Doctors’ aircraft also deliver vital supplies such as vaccines and medicines to remote African regions, and they are licensed to transport biohazardous materials such as blood samples during disease outbreaks.

Additionally, Dr Lelo noted that liaising with national and local government agencies, international organisations, and embassies allows them to prioritise safety. “Key partners include the local health ministries, civil aviation authorities, and international bodies such as the United Nations. We have also incorporated a ‘boots-on-ground’ approach and have developed local contacts in the region to enable timely access to accurate situational safety and security information,” he said.

Robust planning, advanced technology, and experienced personnel are paramount to managing unforeseen circumstances

Helmi agreed that liaising with multiple entities and acquiring on-the-ground information is vital for ensuring safety. “Communication with various authorities, as well as monitoring local reports and having our ears to the ground, gives us a full picture of the situation during a crisis. Who you liaise with depends on the crisis. During the Egyptian Revolution we were liaising with embassies, civil aviation authorities, and the Ministry of Interior to understand how to plan the safest evacuations and move legally during curfews. This communication, in addition to our on-ground information, gives us a full picture so we may undertake missions in the safest possible manner,” she noted.

Davies explained that NGS’s risk analysis team follows a similar approach, collaborating with a wide range of geopolitical advisers to create a detailed threat assessment. “They gather data, reports, and intelligence from sources including ACLED (Armed Conflict Location and Event Data), private intelligence services, and government sources like the UK Foreign, Commonwealth & Development Office (FCDO), the Overseas Security Advisory Council (OSAC),  and Australian Department of Foreign Affairs and Trade (DFAT). This information helps NGS build a comprehensive threat picture of a country or region, ensuring that its advice aligns with state bodies’ recommendations, he said. Furthermore: “To enhance our knowledge and address local issues we engage with a global network of service providers,” he concluded. Edlin stressed that collaborative response efforts between private security firms and government agencies lead to more effective outcomes. “This involves joint operations, shared strategies, and coordinated communication channels.”

Helmi concluded that communication within the industry is also crucial. “In major hazardous environments, it is of utmost importance that we share ideas and experiences with all industry peers and colleagues to ensure the best solutions are used for the greater good,” she said. 

Customised repatriation solutions 

Edlin further emphasised the importance of collaboration during the repatriation process, and stressed the need for tailored measures when organising evacuations from hostile environments. “In the realm of medical repatriation, wherein the paramount aim is to securely repatriate an individual to their country of origin for medical care or proximity to their familial and support framework, bespoke measures frequently become imperative to guarantee the patient’s welfare and security throughout the journey,” he said. “This entails orchestrating collaboration among assistance providers, medical practitioners, transportation entities, insurance entities, and other pertinent stakeholders to facilitate specialised medical conveyance and logistical assistance meticulously aligned with the patient’s requisites.”

No two patients or medevacs are the same. We find ourselves offering tailor-made solutions every day

Dr Lelo also acknowledged that personalised measures are often necessary, highlighting the individuality of each case: “No two patients or medevacs are the same,” he said. “We find ourselves offering tailor-made solutions every day. Tailored measures for customer travel, especially for medical repatriation, are necessary when dealing with complex cases or high-risk environments. Each situation is unique, and our approach is customised based on the specific needs and circumstances of the patient. In severe medical conditions we deploy specialised medical teams and equipment to provide the highest level of care during transit. Communication with all stakeholders, including the patient’s family, local healthcare providers, and insurance companies, is essential to coordinate these tailored measures effectively.”

Rudy de Kort, Flight Registered Nurse (RN) and CEO of Jet Companion, shared insights into the operational challenges faced by companies such as Jet Companion that operate as commercial medical escort providers. “The logistics of our transport missions are organised in the public space, along the lines of regular passenger flows, as opposed to the more private environment of an air ambulance. Thus, despite the many similarities, some risks carried by our aeromedical  crews and patients are non-comparable,” he explained.

“At Jet Companion we assess the places where we go to on a case-by-case basis, and in real time. If a country is flagged due to hostile events or geopolitically challenging circumstances, we dig in deeper to get the most up-to-date information before we decide if we can fly or not,” he said. 

Echoing the focus on communication, De Kort continued: “The most accurate picture is painted by multiple sources of information. For example, we’d consult a consular mission, but at the same time, we’ll also ask a partnering aeromedical company on the ground how the current situation reflects on our safety in the context of a patient transport mission, and what to expect in the specific region that we are flying into, rather than the country as a whole. If we decide to fly, there are several actions that we can undertake to mitigate the risk. For example, we may opt for a rendezvous with a local crew at the airport, followed by a quick exit of our own crews to a neighbouring country.”

Maintaining high standards

To conclude, Edlin discussed the strategies employed by providers such as Hotspot Cover to ensure they uphold the quality of medical support in conflict zones. In addition to previously flagged measures, such as partnerships with specialised providers, employing expert personnel and medical professionals, working closely with government organisations, and advanced technology, he emphasised the importance of quality assurance and monitoring. He noted that Hotspot Cover conducts regular audits and evaluations of medical facilities and service providers in conflict zones to ensure they maintain high standards. Furthermore, he said implementing client feedback mechanisms is essential to continuously improving the quality of care delivered.