Operating under pressure: evacuations from conflict zones
Assistance industry experts speak to Alysia Cameron-Davies about the intricacies of conducting medical evacuations in conflict zones
Navigating the complexities of medical evacuations from conflict zones demands a multifaceted understanding of challenges, logistics, and strategic planning. Staff working in hostile environments are required to keep their cool while working under pressure. So how do assistance and repatriation companies secure safe evacuations in such extreme situations? ITIJ spoke to experts in the air ambulance, insurance, and assistance sectors about the challenges of evacuating from hostile environments, and the strategies that are implemented to overcome obstacles, ensuring a safe and successful mission.
Stephen Gitau, CEO of AMREF Flying Doctors, told ITIJ that the challenges are “multiple, and can be complex. They range from bureaucratic delays and complex clearance processes to the need for longer flight routings and the critical risks of active conflict zones. Practical challenges can involve an actual attack happening while our crew are on the ground – like the one experienced in Mogadishu in 2015 when there was a bombing at the airport while our crew were picking up a patient for medevac.”
At AMREF Flying Doctors, Gitau said that their approach to overcoming problems is “both strategic and comprehensive”. He explained: “The cornerstone of our operations is the continuous training of our operations team, which is complemented by a rigorous commitment to staying informed about the sociopolitical landscape across Africa. Our robust safety and quality culture is further augmented by substantial investments in real-time information gathering, leveraging both technology and a network of local contacts who provide crucial insights into the current security conditions. This multifaceted strategy ensures we are prepared for the unpredictable nature of conflict zones.
“Through strategic planning, continuous training, and an uncompromising safety culture, we navigate the myriad challenges of these operations, ensuring the highest standards of care and security for our clients and staff alike,” Gitau concluded.
In-depth local knowledge is a must-have
Lara Helmi, Managing Director of CONNEX Assistance, said areas of active unrest and fighting, road closures, and curfews were potential obstacles for assistance companies when organising evacuations from conflict zones. She emphasised that CONNEX employs vital strategies that help successfully navigate challenges, such as establishing a strong network within countries and ensuring effective communication with local authorities.
“In-depth local knowledge of the situation is critical, as the on-ground security situation can be fluid and change quickly,” Helmi said. “To ensure the safety of our staff and patients, we always ensure we have a deep understanding of the local geography, as well as of our own network capabilities, which may not be operating as efficiently in a conflict situation as usual. Medical transport may require additional permits for patients and personnel to move freely and this also requires coordination with the local authorities. If commercial flights are no longer an option, our local knowledge can facilitate repatriation by cross-border road transportation, or by sea, to safer countries where a more typical repatriation by air can take place.
“Our network in countries we operate in always covers cities all over the country,” she continued. “This ensures our personnel and policyholders can be transported to safe zones if ever needed. In the event of a conflict, we have a crisis management procedure we follow to identify the strengths and weaknesses within our network and explore avenues for evacuation,” she said. “We also are in close contact with authorities, including the military in the countries we work with, to ensure diplomatic red tape can be overcome when there is a medical emergency. This includes landing permits for military airports if ever needed.”
Through strategic planning, continuous training, and an uncompromising safety culture, we navigate the myriad challenges of these operations
Safety takes precedence
The experts unanimously agreed that ensuring the safety of staff and clients is the top priority during operations. Risk management, thorough planning, and increased security measures were highlighted as being indispensable.
Helmi told ITIJ that, at CONNEX Assistance, “safety is our prime concern, and we are constantly monitoring the security situation with local and international authorities to ensure we can mitigate risk and still provide assistance to our clients”.
The directors at Hotspot Cover, which specialises in ‘high hazard’ travel and medical insurance, described safety as “paramount”. They added: “Collaboration, communication, and proactive risk management are essential components of successful evacuation operations in challenging and volatile situations.”
They highlighted the importance of incorporating additional security measures and expanding the security team when organising evacuations from particularly high-risk areas.
“Ensuring the safety and security of evacuees, as well as the personnel involved in the evacuation process, requires significant security measures,” they said. “This can include hiring security personnel, securing transportation routes, and establishing safe zones or checkpoints.
“Ideally, your security and risk advisory partner has ‘boots on the ground’ and can implement with local expertise quickly and effectively,” explained the directors. “Knowing the local language and landscape can be a major factor.”
Gitau agreed that enhanced security measures are essential. He said that, at AMREF Flying Doctors, “we implement meticulous planning and team briefings, coordinate to ensure patients are promptly at the airport, and employ strict security measures, including onboard metal detectors for luggage screening. Our operations are carefully timed, with strict adherence to daylight-only missions into conflict areas and minimised ground time to reduce exposure to risks. Additionally, we enhance ground security with extra personnel whenever feasible.”
Constant communication
The directors of Hotspot Cover also drew on the importance of maintaining constant communication with staff throughout the mission. They explained how establishing dependable and secure communication channels is imperative to enable ongoing monitoring of the mission’s advancement, allowing any changes or emerging threats to be reported swiftly. This guarantees a rapid response and efficient adjustment of the evacuation plan as necessary.
They also emphasised the importance of having “contingency plans for alternative transportation options and evacuation routes in case of unforeseen obstacles or emergencies”.
The directors concluded that flexibility and adaptability are key to managing changing risks and guaranteeing the safety of both staff and clients during the entire evacuation process.
Navigating the financial landscape
The directors at Hotspot Cover also shed light on the significant financial implications associated with evacuations from conflict zones. They explained that expenses escalate during these missions due to increased costs of transportation, security, healthcare, and medical services, as well as legal and administrative fees.
“One of the most immediate financial burdens is the cost of transportation,” they said. “This includes the expenses associated with chartering planes, buses, land ambulances, or other vehicles to move individuals out of the conflict zone to safer locations, and often requiring the deployment of specialist security and medical teams to escort the individuals or rendezvous with them at the nearest place of safety and to the nearest medical facility. Depending on the distance and logistics involved, these costs can be substantial.”
If commercial flights are still operating, it may take days to organise the evacuation of policyholders as airports experience much fewer flights and a huge surge in travellers attempting to leave the country
Long-term support after the evacuation
Beyond immediate expenses, the directors stressed the importance of offering long-term support and assistance to customers post-evacuation, which comes with additional financial implications.
“Providing long-term support and rehabilitation services to evacuees requires sustained financial investment,” they said. “A lot of policies do now have PTSD-type benefits that can assist with counselling costs or rebuild benefits to meet the additional cost of having to make alterations to your car or home in the event of impairment or disability.”
Helmi added that as a result of the heightened operational costs, insurance policies that cover medical evacuations from conflict zones can be pricey. “In addition to potentially increased prices due to forces of supply and demand, insurance for medical evacuation can become extremely expensive,” she said. “This will limit the availability for air ambulance providers trying to access airports in a conflict zone. In these situations, it helps to have the relationships we have with government and military institutions who are able to undertake the missions and repatriate our clients.”
Gitau also acknowledged that insurance policies for these evacuations tend to be more expensive. “These missions entail significantly higher insurance charges for flights into conflict areas,” he said. “Additionally, the necessity for longer flight routings and the provision of extra allowances for staff embarking on missions to more dangerous areas contribute to increased operational costs. These factors collectively result in higher charges for our clients, reflecting the complex interplay between safety, quality, and financial considerations in conflict zone evacuations,” he concluded.
They have to be able to answer the phone within a few rings and be able to deploy someone to the nearest rendezvous point of safety within 30 minutes to one hour
Reducing costs for customers
With operational costs soaring high, how can insurance and assistance companies offer comprehensive coverage at an affordable price?
The directors at Hotspot Cover pinpointed strategies for effectively managing expenses to offer extensive coverage to customers while limiting policy costs.
“While providing cover in war zones can be expensive, we believe in looking at a conflict zone in parts as there are safer areas – or what we call green zones – within each country,” they said. “Therefore, we look to mitigate costs where we can, and charge insureds appropriately based on their travel and how much time is actually spent in more ‘risky’ areas.”
They outlined transparency as being key. “Evacuation costs from war zones can be high but Hotspot Cover ensures that we partner with assistance companies that do not split the difference on claims,” they continued. “Costs must be fully transparent. Air ambulances are costly, but transparency as to case fees ensures that premiums and renewals don’t get overpriced due to not paying more than you have to at the claims stage through hidden add-ons.”
Meeting customer needs and expectations
The strategies employed by industry experts play a pivotal role in ensuring the safety and satisfaction of clients during evacuations from high-risk areas. We asked the experts how insurance providers and assistance companies strive to meet the expectations and needs of customers while navigating such a complex, ever-changing landscape. Effective communication surfaced as a vital element, encompassing interactions among clients, insurance providers, assistance companies, air ambulance services, on-the-ground staff, local authorities, and any other relevant entities.
Helmi told us that, at CONNEX Assistance, “we become our client’s eyes and ears on the ground, providing them with as much up-to-date information as possible. This allows them to stay informed, and also manage their expectations of service delivery,” she said. “For example, a simple service such as delivering essential medication in a city that has become a conflict zone may take much longer to organise in a way where the personnel undertaking the mission are safe. There may also be additional costs as we explore multiple options to complete the mission. Additionally, if commercial flights are still operating, it may take days to organise the evacuation of policyholders as airports experience much fewer flights and a huge surge in travellers attempting to leave the country.”
The Hotspot Cover directors emphasised the importance of communicating with customers. They informed us that they incorporate mitigation protocols into premiums at no extra cost. These protocols include comprehensive pre-travel safety briefings for first-time travellers to conflict zones. Their approach involves the maintenance of a live risk register and travel tracking, facilitating daily safety checks and alerts for areas of heightened risk. They explained that this enables efficient itinerary tracking and communication with on-the-ground personnel as well as rapid resource deployment.
These protocols and strategies allow insurers “to operate strict standard operating procedures and service level agreements with assistance providers and hold them accountable to high standards,” they said. “They have to be able to answer the phone within a few rings and be able to deploy someone to the nearest rendezvous point of safety within 30 minutes to one hour.”
Summary
In conclusion, conducting evacuations from zones of conflict is a complex process that requires a strategic and comprehensive approach as well as flexibility and adaptability. Communication is paramount to a successful mission, where the safety of staff and clients is always the number one priority. Ongoing collaboration between insurance providers, assistance companies, air ambulance services, and local authorities plays a crucial role in meeting the expectations and needs of clients in challenging and unpredictable situations.