Please enable javascript in your browser to view this site!

Inside Disaster

Hossam Elsharkawi, Field Hospital Coordinator in Haiti

Hossam Elsharkawi

Q: Where were you when the earthquake struck?

When the earthquake hit in Haiti, I was sleeping at my home in Oslo, Norway. It was about 11:30 at night. As part of the Global Alert System for Disasters and the Red Cross world, I get these alerts on my mobile phone. My mobile phone started to buzz. I looked at it and it said, “Red alert major earthquake in Haiti, this magnitude, many casualties expected.” So I knew that this would be a big one very early the next morning for us at the Norwegian Red Cross. Maybe twenty minutes later another message came, because there were actually two earthquakes back to back in Haiti. Same thing and I thought, “Uh oh, ok.”

So very early the next morning—six o’clock—most of us were [at the headquarters], trying to follow up and see what response we could put in place. We knew from past experience that this would be big and would require a massive response of some sort. Although we typically wait for assessments and the trigger mechanisms in the Red Cross to say what is needed by whom, and by which country, in this case we felt confident that we would be deployed with the hospital and the teams.

Q: How did you know it would be such a large-scale disaster?

After a few years, you develop a sense for these things and you know that when the big one hits, you will all need to mobilize. I mean all the different Red Crosses and Red Crescents of the world.

Q: Were you able to sleep after the alert came?

Yes and no. The mind begins to race, but actually the part of me that knows, that has done this before, knows, “OK, I need to get my rest, this is probably the last sleep I will get for some time to come.” And in fact that was precisely the case. The next night’s sleep has probably not happened yet, but it’s—I’m getting there. You manage.

Q: When did you arrive in Haiti?

Two days after the earthquake, I went as part of an advanced team to prepare the ground to receive the Canadian, Norwegian, and Israeli medical teams that were to join us in the field hospital that was to be deployed to Port-au-Prince. The earthquake happened on January 12th. At night Norwegian time on the 14th, I was on a plane heading to Santo Domingo. Then at six o’clock in the morning, I rented a taxi and headed into Port-au-Prince.

Q: While en route to Haiti you were in touch with Field Assessment and Coordination Teams (FACT) Health Delegate, Panu Saaristo?

Yes absolutely. We were in touch with Panu throughout. He was the focal point for health and he was part of the FACT team, which does rapid assessment. We rely on these teams to help us initially decide where to place the hospital. That is critical, we want to save as much time as possible, so, with his knowledge of Haiti, we were already exploring possibilities with him, before the earthquake. With the news … coming already through mainstream media channels, that these various hospitals have collapsed. We had already begun to narrow it down to University Hospital. In fact, this is where we ended up deploying.

Q: How do you choose where to set up an emergency field hospital?

Typically, we want to place field hospitals as close as possible to the pre-earthquake or the pre-disaster medical facility. That’s because people know that is where to go if they need medical attention. Secondly, sometimes you can salvage some of the supplies, equipment or building spaces to use. Thirdly, this is where the local medical staff, who we want to have quickly join us, are.

Q: Ten Emergency Response Units (ERUs) were on the way to Port-au-Prince even before the FACT team began an assessment. Is that unusual?

Yes, absolutely. It is. Normally we would wait for an assessment—at least maybe a 24-to-48-hour rapid assessment. But in this case, many experienced in disaster response globally rightly decided that we didn’t need an assessment in this case. We had the tools to respond. Life saving interventions needed to be immediate. We felt if we lost two or three days to the FACT team [to tell us] that the hospital had collapsed, that yes we’re needed, we would have in fact not have been there to assist those who needed us.

And that has happened sometimes in the past. We saw this happen in the tsunami, we saw this happen in Bam, Iran, during the 2003 earthquake. And then the FACT team takes on a different role, which is part of their role. They focus less on the assessment and more on the coordination of the arriving teams, and that’s fully acceptable, that’s OK. And then, once we are there and set up, the FACT team continues reassessing. They go into more detail concerning the needs and the evolving needs. That is not possible in the first 48 to 72 hours.

Q: Is healthcare the most critical response following an earthquake?

Critical, yes healthcare is critical. In acute onsite disasters, which are rapid, where people don’t have time to prepare and escape — like for example in a hurricane where you know 2-3 days before that it is coming — the casualties are immediate and they are high in number, especially with these big earthquakes and they need us now.

Those who are directly impacted and can be saved, who are not killed directly by the earthquake, need us to be there in those first 72 hours, or else it’s too late. Or else they will die because they don’t get medical attention, or they will suffer long-term consequences and disabilities because medical attention was not provided in that phase. So yes, it’s critical. It’s difficult to get into a country from all the way across the Atlantic. We had the entire Norwegian hospital, field hospital [shipped] into Haiti. The airport was not functional. Many of the roads and also the road network was damaged. Often we would like to get in there early, but it may not be doable. In this case I think we managed a little bit. I still consider our response a bit delayed, but there was not much we could do about that.

Q: You were one of the first medical units on the ground, but surgery was delayed by one day. Why?

Yes. Essentially the logistics: getting the flights, our hospital. The main cargo plane had to land in Santo Domingo, things had to be offloaded into trucks and moved by land from Santo Domingo into Port au Prince. It was a twelve-hour trip. It took all day. The trucks were parked over night until we could off-load them the next day and begin to set up. So we lost time. But the medical teams were in place, and some of the equipment had arrived before the actual main cargo. So in fact, we were able to do something as we waited for the rest of the equipment to come. We worked with the local Haitian medical staff and other medical volunteers (they came primarily from the US) to provide as much as we could during that phase.

Q: What are the emotional challenges of your job?

It is extremely stressful while you are waiting for your cargo, and you’re trying to set up as quickly as possible. Physically you see it, I mean we were seeing people alive one hour, dead the next hour in our larger hospital compound. And we were fairly helpless with some of those cases. Some needed major interventions that were just not possible in that context and we knew they would die. In a medical triage, medical people have to make those decisions. This person can be saved and that person we will just let die peacefully. Those are tough calls because many of the medical teams we deploy from Western countries, in their own countries, their own hospitals, have all the resources to save that one case and they can in fact dedicate it and call on more medical teams from other parts of the hospital or neighbouring facilities, if need be.

If there were a mass casualty situation in the West, like a big bus crash or something … when you’re in these types of situations in Haiti, those types of patients that may be salvageable in the West are not. Many medical people have a real hard time with that.

In our type of hospitals for example, we don’t do blood transfusions. That automatically means that there is a group that you will lose. But that’s the way it functions. So you can imagine the impact on the teams, the impact on their ability to function can be extreme. And it does take a special kind of person—not everybody is cut out for this kind of work.

Q: Why don’t you offer blood transfusions?

Because we cannot guarantee the safety of the blood we give. We may be saving a life because of post-surgical or surgical need for blood unit, and then that person ends up with HIV for the rest of their lives. So, for those reasons it’s very, very difficult. Blood also needs special refrigeration that we cannot sustain in those phases of operation.

Q: How do you cope with the pressure?

The stress in the initial days or in the initial weeks of setting up a field hospital is extreme, but I think the teams end up dealing with it very well. I do by just being focused. You know you have a job to do, and we know that every hour makes a difference, every half hour sometimes makes a difference on what services we’re able to bring online throughout the day. And that, in itself, is extremely rewarding. Sometimes it’s not even a medical intervention. Sometimes, as you observed in Haiti, tents were being put up that actually saved people’s lives, by just moving the patients under some sort of shelter.

And providing them with a blanket for that night means the difference between life and death. So it goes beyond just providing surgery. I know surgery’s sexy, I know the media likes to focus on it, and of course it is important. But it’s also a series of other things that have to be put in place that are just as important and life-saving as the rest of the medical operation.

Q: How can a blanket save a person’s life?

Well, in the context that we were in in Haiti, many of the patients and many of the casualties that had not even been seen yet by physicians were out in the open in the streets, under trees and so on. In the heat, in the sun, and then the temperatures dropping at night … for somebody who is, or has been bleeding, and is approaching shock, those mild fluctuations of temperature can mean life and death. Absolutely. We had very young children, mothers and so on that simply needed a blanket. Even though it was maybe 18 or 20 degrees at night, it was still cold enough to kill a person who is susceptible.

Q: Why was the earthquake in Haiti so disastrous?

I think there were many factors that contributed to the catastrophic level of devastation caused by this earthquake in Haiti. One, it was a rapid onset or acute onset disaster. With no forewarning, like in a hurricane, people cannot seek shelter, cannot make plans to be out of the path of the disaster. Secondly, the fact that it was the capital, and that so many of the government bodies and authorities that normally would be the first to respond before international aid arrives, were themselves severely disabled. Ministries collapsed, police stations collapsed, the UN—an operation that was in fact there to provide some sort of services and security to Haiti—had its entire command and control structure and headquarters collapse.

Add to that the pre-earthquake condition of Haiti, which was extremely fragile as a country, a country with 80% poverty levels and so on. So all of these combinations I think, put together, compounded the affect on the population, never mind the housing, the types of housing, the crowding. The lack of infrastructure, streets, lack of electricity, made it completely impossible to access people we knew, communities that we knew needed assistance in that village on that particular hilltop, or in that collapsed building. But they were not reachable.

Q: How can we mitigate disasters, and reduce loss and suffering?

That’s the 10 million dollar question, I mean that’s constantly in mitigation and disaster mitigation: how do we better prepare communities to be able to absorb the initial shock, and then respond with some level of efficiency, effectiveness initially, is something many in the Red Cross, the non-governmental organizations, development organizations globally, are trying to do in many countries.

The realities are just more complex than that. After the big earthquakes—as we have seen in China and we have seen in Pakistan and Iran, we put out these slogans in the humanitarian world, ‘let’s build back better’, for example. Means – in the context of earthquake prevention or prevention of the effect of an earthquake, it means good earthquake resistant buildings, proper building codes and so on. And of course we know that the technology exists for this, except given the cost implications, the organizational implications, the level of commitments not only at governments in the centre, in the capitals, but cascading down to the community level—it’s just not happening.

I remember in the Pakistan earthquake, ‘building back better’ in fact meant that you had to really bulldoze major big roads down a number of cities. Well those roads, in fact, had been these people’s livelihoods—their shops, their shopkeepers along those roads, for decades. And making the road wider meant that you had to do something for the livelihoods of those shopkeepers. To get into that type of discussion, and to resolve it in the community proved impossible. I think in the humanitarian world, in the development world, we’re doing our best but it is very, very challenging.

We have certainly learned that it is most efficient to invest in local community response: local volunteers, local organizations. Be it the local hospital or the civil service or the civil defense, and so on. The more those are empowered to respond, the better the outcome in terms of survivability will be. There’s some good success, there’s some good stories and there’s some not so good stories along those lines. And I’m not sure if we’ll ever get there.

Hossam Elsharkawi

Q: Is it political will that stops us from successfully mitigating disasters?

On one level, it is political will that is sometimes lacking. Sometimes when political will is there, yes it is too complex to tackle or too expensive to tackle, or both. And we see this, elements of this sometimes even in the well-developed nations that to invest in preparedness is not so sexy. Resources become available when fpsya disaster strikes, and then everybody wants to donate. And we know it’s too late. In the context of hospital care and hospital emergency care and disaster care, we know that the most cost efficient way is to in fact invest so the hospitals do not collapse because of earthquakes. This is the cheapest way to do it. Hospitals—even existing facilities—the technology exists now from an engineering perspective, to strengthen them with beams and so on so that they won’t collapse.

But it’s impossible to get money to do this before [disaster strikes]. But everybody will rush in with millions of dollars worth of field hospitals and so on that could have probably, pre-earthquake or pre-disaster, built two or three solid facilities in the country. But this is the dilemma we are in.

Q: Often natural disasters destroy communications systems. How does this impact your work?

In the context of disaster, during the early phase, communications are critical to getting a good and solid coordinated response. It’s critical for the security of the team to have, and it’s critical to also communicate with all the incoming assistance to help guide it, customize it to the needs … in Haiti for almost a week, the communications were almost minimum and that is the most critical week, immediately after the disaster. But essentially we had to cope. The field hospital goes with its own communication network, which is VHF radio based, and it gives us some sort of mechanism to communicate with. We go out with satellite phones, we go out also prepared to set up this network, but even then we were challenged because with the satellite phones, signals were often not working or seemed to be jammed or seemed to be absolutely overused.

The local mobile network was not accessible. Even sending text messages was almost impossible for days. But I think overall the team coped well. Often to attend even those coordination meetings, to pass a message to another team half an hour away required that we send a driver and a vehicle and sometimes the doctor or the nurse goes. It takes time. It maybe reduces the efficiency of the response, but it worked.

Q: You sent doctors carrying messages?

Absolutely. In the first phase we had to. We had to get the message across and it meant sending the driver, sometimes with a note and a car and saying go and coming back with another note, and so on.

Q: The first day you were setting up the hospital, and one of the Haitian volunteers reported a shooting.

There were several shootings in the context that we are in, around the hospital compound. Often we would hear gunshots at night in particular. The Haiti disaster, also, the earthquake resulted in the collapse of the main jail detention centre in Haiti, and we’re told 4-5,000 prisoners had escaped. This was very much in our minds from a security perspective—for the safety of our team and our patients. We, we also had to put in place plans to make sure that we knew what we would we do if we’ were confronted with a situation.

The criminality element is always present in many countries and in many cities. In that particular context of a shooting, we were told of a patient that maybe was lying near the hospital, it was not the mandate of the foreign medical staff that we brought, or the Red Cross delegates to go out and do these medical evacuations, because we hand this type of medical evacuation over to the Haitian Red Cross. They know the road network, the places where to go and where not to go better. They know the addresses, and they’re able to do it far more efficiently than we could have by going out ourselves.

The patient did end up coming to the Red Cross field hospital, and being successfully operated on. He survived.

Q: Do many people volunteer to help?

Often we will see many people in that early phase try to be helpful, to be useful. I recall in the early days, an American volunteer who said she was a massage therapist came and said, “I’m here because I saw the news and I’m here to help, what can I do?” Of course, everybody on the team wanted a massage immediately. Ok, we did not go for that but yes, I mean people try to be useful. […]

Q: Was this your first time in Haiti?

It was my first time in Haiti, yeah.

Q: What do you think of the country?

Extremely positive. I had been warned that Haiti is a very complex country, with high levels of poverty, and that I should expect to be challenged. In fact, my experience immediately after this disaster, and in many other disasters that I’ve been present at globally, disasters tend to bring out the best in people. People are helpful. And our Haitian counterpart, be it the doctors and the nurses at the hospital, other officials and the Haitian Red Cross that we interacted with, or the volunteers of the Haitian Red Cross were absolutely positive in an odd sense because I mean every single one of them was affected by this disaster. Their family, their loved ones, their friends; they lost somebody. But somehow, they were also focused on the assistance and dealing with and addressing what needed to be done as a medical service provision.

I’ll also never forget at one point this hospital director we were dealing with from day one who was incredibly supportive, and wanted us to set up as quickly as possible. He had provided us with space and support, even the diesel that we needed to get the generators going for the field hospital. About a week into the operation, he came up to me and he said “Hosham, I’d like a private word with you.” He said, “you know my family has been out in the open for the last eight days. I have no tents, no blankets, no plastic sheeting. Can you please help me with something?” And this is a person who spent 24 hours of his time with us prioritizing the medical care and not his family.

It’s these stories that are, that are incredible, that come out.

Q: Was security a concern for you?

Sadly there often tends to be sensationalism that the media picks up on—incidents of looting or violence or things going the wrong way in humanitarian assistance. And of course, sometimes they do. And in every emergency major disaster I have been to, I have seen elements of that. It is never representative of the vast good will that you see in any operation as well. Maybe it makes good media stories, but it is never… We teach in disaster response and management and the Red Cross world that these stories of looting are often exaggerated, a myth. I mean don’t think that everybody’s out to get us, because we bring in these goods. It’s never the case.

People are often offering us protection if they think we need it. Offering help, offering assistance. I remember in responding to the China earthquake a year ago or so, when we desperately needed translators in the first phase. In fact, none of us were Mandarin or Cantonese speakers, and all we had to do was ask. My translator, who walked around with me during the entire mission was a professor of English at the University in Shangdu, in the province that was affected. She refused any type of assistance or support or money or allowance. She said, “I’m doing this for my people.” And so we do get this, and to me this is more representative of the people that face us and deal with us, and help us in disaster response because every success story of these field hospitals, I say, should be dedicated in fact to the local volunteers who come and help us, medical and non-medical people.

I know often the media likes to make us the heroes. We’re not. They are because they actually suffer through it, they work through it, and we leave and they continue to go through it.

Q: How important is psychological care during the emergency phase of disaster response?

Psychosocial support in the early phase of an operation in the form of basic psychological support for people is absolutely critical, and I led efforts – along with other colleagues in the Red Cross, to make sure that we bring it with us in the form of trained people that can launch this just as we launch surgery. It’s as important to launch this type of assistance for what we call ‘the invisible ones’. And to provide this team of a few delegates who will launch this with a necessary kit, and tools, and so on, just like the surgeons have their instruments, to launch this.

And in fact Haiti was the first time we deployed this. We have been working on this particular psychosocial support module for two years now, including the training of the right type of personnel. And it was deployed, in my view, very successfully, and they have done a fantastic job of providing support initially within the context of the university hospital compound which had 1200 patients and their families and staff, to the families and patients and to the staff working through local Red Cross volunteers from the Haitian RC. It worked to a level I think even beyond my expectations. And much of the positive feedback we received as a medical unit set up in that hospital had to do, not with the 300 hundred surgeries that we were able to do quickly, but in fact with these teams going around and talking to the local nurse or to the patient or the doctor, just to say how are you doing? How is your family? Is there something we can do for you? Do you want to be in contact with somebody? People appreciated that tremendously.

There has been a tendency in the past for these field hospitals to be exclusively clinical. There has been an attitude that if it doesn’t bleed I don’t want deal with it. It has taken a number of years to go past that. And in fact, create something we call now the psychosocial support module, with trained teams, and to get it to operate. For future deployments, I would never go out to the field hospital without this particular unit on the first days as well.

Q: Most of the places you deploy to don’t have counseling per se in their culture?

It is psychological trauma post-disasters: loss of livelihoods, loss of homes, loss of family, loss of loved ones, loss of limbs affects people for a life time. You can heal a fracture, you can heal a wound for people, and they will quickly recover. These other types of emotional, psychological trauma often never heal. What we know for sure from our experience is that to start people on this healing process, is you have to treat them with dignity from day one. You have to treat them as active survivors of a disaster and get them busy helping themselves, and not as passive victims that are just helpless and there and to receive aid. People, it has been proven, recover much more quickly if they are actually doing something for themselves and for their communities and for their families.

So, this psychosocial support module in fact is tasked primarily with activating many of those mechanisms in the community. It could be a women’s group, it could be a small tent for children to play in, or a combination of the both, to get people busy. And it works. It absolutely works.

Q: How do you make psychological help relevant to the population?

The challenge with doing psychosocial support in any country is that you have to embed it in the culture. Whatever mechanisms exist—every community has its own coping mechanisms and the trick for us is to activate those as quickly as possible immediately after the disaster. And to know what those are, we have to quickly link up with the local community, the local Red Cross, the local leaders who tell us. In many places where we have been, it’s the religious communities, the religious leaders. It’s the mosques and the churches and so on that people seek for some sort of closure, healing, support. And if we know that, then in fact we can create that. We have done that in the past within even the context of a tented hospital, where we set up a tent and we call it the prayer tent for the patients and their families.

That in itself is providing tremendously in terms of psychological healing and coping for that population. So it could be simple interventions like this that go a long way. And yes, we’re not talking about individual counseling. This is the last thing you want to do in the context of an earthquake. We don’t have the resources, and there might not even cultural acceptance of that. Unless it’s clearly a medical, clinical psychiatric illness, this is not what we are talking about here.

Q: Can you tell me about the baby that was transferred from the base camp to your hospital?

Often we’re presented with many of these very critical cases that somebody finds somewhere in the context of these disasters and wishes, of course, to transfer them immediately to the next available facility. The day we got this call about this baby who was ventilated, meaning the baby could not breath on it’s own (severe lung problems of some sort, pneumonia perhaps), and it was decided to send this child to our field hospital. Our field hospital is also challenged in providing care for those types of cases, those critically ill cases. For example, we don’t have ventilators that help people breath in the context of a field hospital, because we know those types of patients require intensive care units that we don’t have with us.

So, my initial thinking was, let’s have the case. I was very doubtful if we could save that child, that baby – I think it was a six-month old baby. And but we were able to, because of our relationship with the Swiss, who had specialized pediatricians. Luckily at the time the American hospital ship, who started even I think that day, to evacuate patients, had all of the advanced technology to take care of that. It worked. We were able to take this case, transfer it and treat it at the hospital ship.

If that hospital ship had not been there, I don’t think that child would have survived. Actually, I’m not sure if the child survived now, but at least it was provided with the best possible care in that context.

Q: Can you explain the organizational and command structure of the ERUs? Because you seem to operate fairly independently.

We need to operate, in the context of these disasters, fairly organically, flexibly. And devolve the decision-making to the lowest common denominator. Emergency Response Units, of which the field hospital is one type of unit, are designed philosophically, to operate autonomously.

In the context of Haiti, we happen to be all deployed within reach of each other, I mean within one city largely. On other operations, we have been 800 km apart, and you cannot meet and so on. So you have to ensure that in that context, you are fully autonomous, self-sustaining and have all of the mechanisms and support services that you need to operate. And often we find ourselves acting as the assessors, the providers, the administrators, and as representatives of the organizations in that context. Attending meetings and coordinating—it could be one or two people responsible for all of that.

Sometimes when there are more of us in an operation, then we say, “Ok, I will cover this and you cover that.”

Q: How big was the Haiti response compared to other disasters?

This is easily one of the top three operations I would say in the numbers, in terms of the numbers of ER used, numbers of delegates deployed, and in terms of the scope of destruction and need on the ground.

Q: Are there too many NGOs responding to large-scale disasters?

The multiplicity of providers and non-governmental organizations and so on can be good, and can be bad. There are many that come that are ill-prepared to cope with the reality of an earthquake. And we had that in Haiti. Many teams had just never been outside of their country. Had never responded to a disaster beyond what may be considered a disaster in their hospital, which could be a multiple casualty car crash. And then they’re faced with Haiti. So, they were unable to cope. They came ill-prepared; whether it’s their own water, food, place to sleep, or medical supplies to do something.

Others were good and they knew what they were doing. To ensure that this is well-coordinated, and to make sure that we don’t all provide services in one neighbourhood while another neighbourhood is completely neglected is a challenge always, and it requires somebody to have a holistic helicopter view of the operation, in terms of if we’re talking health care, medical needs, medical priorities, and not just in a capital where everybody wants to be sometimes, but even in the greater disaster-affected area.

The coordination mechanisms were put in place in Haiti in what we call these ‘cluster meetings’. They were held daily, chaired by the World Health Organization. But these were non-binding meetings, I mean the World Health Organization cannot tell somebody or order somebody to go some place or not to go some place. So we rely a lot on the good will and the understanding of people and the willingness to coordinate, not to duplicate, and to be of added value. Generally, it works. We’ve had challenges sometimes. In the hospital itself, we had a microcosm of this where we worked, because we had in fact about fifteen different groups as it turned out. We did meet daily, but the issues were so many and so varied, and the teams initially rotated very quickly. The faces changed, you were not guaranteed that a decision made at noon today is what was understood the next morning by the same organization’s team coming in the next, at six in the morning, because the teams changed.

So, there were a lot of repeated coordination mechanisms. Generally at that hospital, it worked well, and it worked well because the hospital management itself, the Haitian hospital management was very keen at making sure that they progressively or incrementally improved the situation. And they were firm on which organizations they wanted in and which ones they did not necessarily want to cooperate with. But they were also very open with us from the beginning. I remember my first meeting with the hospital director in Haiti, and he said “Hosham, I’ve never been in an earthquake or major disaster like this. I’m not sure what we have to do. Can you assist us?” And that’s exactly what we did. Aside from setting up our own ERU, and field hospital in their compound, we acted as a technical support and material support provider for the hospital, because of our past experience with earthquakes.

And that was invaluable for them to make sense of the operation.

Q: How would you characterize the level of professionalism of humanitarian organizations?

I think there are many mediocre organizations globally that provide or pretend to provide humanitarian assistance. Sometimes it’s individuals. Sometimes it’s groups. It’s fantastic that people engage in humanitarian activities and after having done this for about twenty years, I don’t pretend to know what the right reasons are, what drives somebody to do this. There are many reasons and we’re all different beings and we all have different value systems and motivations that drive us. But I have also learned what the wrong reasons are for doing this kind of work. And some of those wrong reasons, for me, have to do with the type of person that goes out, if in fact they’re just escaping problems at home. They’re not really going to help. Yes, they will help, but they’re escaping relationship problems or financial problems, and they think somehow this will go away if they are out there in the middle of a disaster.

It doesn’t. And sooner or later, it catches up with them and they end up being a burden to the operation. The second wrong reason, I feel, is the type of person who goes out and thinks they will help everybody and they have the big heart and they want to. And you can’t. Given the scale and scope of these types of disasters, priorities have to be set and in the Red Cross world, we do target what we call for example, the vulnerable groups: children under five, the chronically ill, the disabled, pregnant women. Because we know those are more likely to suffer and have long-term consequences and possibly die than others.

So we say this is the group we will target. Going in and pretending that we will help everybody, no matter what the media wishes to take as a message, is not doable. The third group that typically also I feel goes for the wrong reasons is the ones that go out and thinking they’re the expert, that they know everything. You know, they’re the best surgeon, maybe they are the hot shot surgeon in their hospital, or the best doctor, or the best nurse. But they end up in the field and they realize without the infrastructure and the supporting systems and the team that they may have in their home country, that they are in fact not productive in the field.

So all of these come together, too. People have to balance that, and in Haiti I have seen people make all the wrong decisions on all of the three points, and fail in the medical mission if we’re going to look at the medical mission.

Q: Was this particular to Haiti?

No, it’s not particular to Haiti, we see it in most disasters.

Q: What do you think motivates people to do disaster relief work?

It is difficult to know what drives people to do humanitarian work, especially consistently and year after year. And that for me is the same. I think I can trace it personally to experiences at a very, very young age where I was, at the age of 4, myself MEDEVACed by the Red Cross because of a war across a war zone, from one country to another. And at the age of four, my grandparents handed my younger brother, who was three, to me and said, “OK, now you’re the big boy, you’re in charge”. So I was, in fact, I feel a Red Cross volunteer at age four. I had to take responsibility for this young kid. I was four, he was three.

And I remember, you know, holding his hand and talking to him and these are my earliest childhood memories. I remember being loaded on the Red Cross plane full of casualties and I remember having conversations with, I now come to realize that they were injured soldiers being evacuated across or MEDEVAC’ed outside of a war zone, who were trying to talk to me as a four year old, and my brother. Landing in another country where our parents were waiting for us, desperately.

And so I have that in my history, and maybe it came back to haunt me later in life and I wanted to be of help. And maybe it’s no surprise I ended up being with the Red Cross for twenty years.

Q: What war were you MEDEVACed from?

This was out of the, I was MEDEVAC’ed out of the ’67 war in Gaza across the Sinai, in fact. And ironically, was it last year? Yes, last year, I ended up on that same border as the medical emergency coordinator for the Red Cross when the whole conflict flared up again, MEDEVACing casualties out of Gaza, and coordinating the arrival of medical assistance into Gaza at that same border. So, some spots are still problematic across this world.

Q: Do many humanitarian workers have personal experiences that have brought them to do this work?

Not necessarily, no. I think people have different reasons for doing this. I think for many individuals that their sense of social responsibility and in a global sense, social responsibility and wanting to be of help is more evolved for some reason. Their value system, how they were raised—many, many factors are at play here. I have no pretence to know or to try and understand what drives people, and I think it’s very difficult to dig deep into the motivations of human beings.

And the ones that last in this for the long term inevitably realize the limitations of the work we do, and the world we operate within and the constraints, and work with that. Yes, sometimes pushing the limits a bit more because we need to develop and do better, but understanding and being pragmatic about what is doable and what is not.

Q: What’s the most rewarding thing about your work?

Satisfaction comes from many different angles in this line of work. It’s clearly rewarding to be on the first phase of a medical mission after a disaster, because you see immediately the consequences of your work. You know, the cliché—saving lives—it really is. The teams are making a difference immediately, and it shows. So, there is tremendous satisfaction in this and undoubtedly, even for the longer term, it has many, many implications. In many places I have been to, five or six months after the disaster, we are in what we call a “hand-over” phase where we feel that we have actually helped create a group of local responders that are capable, willing, perhaps need additional resources to continue with the work, but you feel you really created some capacity in the country that did not exist before your arrival. I also know that we learn as much as we provide in these settings. Every mission I have gone on has been a learning experience, always.

And a critical success factor for any delegate, with Red Cross or not, is their willingness to understand that they need to be constantly learning and relearning many aspects of the work that we do.

Additionally in some contexts we have seen our work translate into real capacity that was actually delivered by the country. Indonesia in particular, after the tsunami, and the hospital that we sent and we handed over and we trained our local counter parts in the Indonesian Red Cross and Ministry of Health, they managed to deploy the hospital we gave them, twice on their own, for domestic disasters that have hit Indonesia, without having to call on international assistance.


And there’s tremendous reward in this as well when you think back, “yes, ok, it doesn’t have to be always us flying in assisting”. If we can build that capacity and they can do it on their own, fantastic. Ok. We will only respond when the local capacity to handle a disaster is overwhelmed. And then we can add that search that is required.

So, these types of success stories happen and they continue on. And we will always be available to provide the surge needed if a country is overwhelmed and requires international assistance. But we don’t need to be there for every disaster of every scale. So yes the rewards come at many levels for this type of work.

Q: Can the earthquake in Haiti become an opportunity to improve the lives of people in that country?

The earthquake in Haiti has generated an incredible amount of international solidarity, support, donations, and sympathy. That provides an opportunity out of this catastrophic event for Haiti to rebuild and to invest and redevelop services, essential services and schools and clinics and social welfare and longer-term rehabilitation and physiotherapy, and the things that we know are needed after a disaster of this scale.

Haiti is at a crossroads – we’ve seen this in many disasters. Right decisions have to be made to ensure that investments are made in the right direction, the right priorities, providing for those directly and indirectly impacted and the wider population.

It is not uncommon—I have gone to some countries ten years ago as a disaster responder. We have set up temporary shelter and I have gone back ten years later to those countries, and the people are still in the types of shelters that we help set up initially that have evolved, a decade later, into slums. So, it shows that it’s not a given that international support will necessarily translate into long-term well-being for the population.

At this point it seems Haiti is getting the right support and advice. I hope it continues and that the right decisions are made.

Q: The Haitian government is struggling with where to locate the million plus Internationally displaced persons (IDPs). What do you think the solution is?

The discussion of where to settle people after an earthquake is a tough one and the best, the most organized of countries have struggled with this one. I mean, even China with all its resources and so on after the massive earthquake of Shangdu in 2008, continues to struggle with this one. The reality is people want to stay where they consider home is. It’s a human instinct, and often authorities, in order to rebuild devastated communities, want the people to move away for some years. And that’s tough for the people and for the authorities, and I am not sure if there are easy answers in this one.

I have heard about those debates, and I don’t know how they will be resolved for Haiti in particular, but clearly, given the scope of devastation and the massive work required to just clear the rubble from those neighbourhoods, those people have to move away. But that’s tough. In every earthquake I have been to, the population who’s had their homes destroyed, they want a tent and a blanket and perhaps some assistance, but they want to take it and set it up exactly where their house collapsed.

And it makes sense, of course. But that makes the roads narrower, the clearing work impossible, and so on. So, it will be a challenge. It’ll require a lot of finesse and diplomacy and understanding and meeting halfway between the population and any local authority.

Q: Were secondary disasters a big concern in Haiti?

The impact of what we call the “secondary disaster” that can be triggered—be it after shocks for sometimes weeks, a month or so after an earthquake, be it the secondary collapse of buildings, be it electrocution, falling objects, the rains, the mudslide, the rock slides are always, of course, there. And they become a reality of any population’s and any government’s daily life after a situation like Haiti. So, preventing those is a priority. Preventing further casualties because of these types of events – falling buildings and debris, and so on, is important and means that people need to move.

Q: Do you think it will be possible for the Haitian government to convince people to relocate?

It’s hard. It’s hard to convince people to move because this is their history, their entire life, their belongings. Everything goes into that building under that rubble, and there are things that they want to salvage from there, still. And sometimes it takes them months or longer to actually get in and get that picture, sometimes, and even get that ID card. And sometimes recover a loved one, or the remains of a loved one. And yes, it’s fully understandable that the human, at the individual or family human level, why people makes those types of decisions and are willing to take those risks.

Q: Looking back, is there anything you would do have done differently in Haiti?

I am reviewing in my mind constantly the Haiti deployment: what we did, what we didn’t do, how things could have been different. Could we have relocated the hospital somewhere else, could we have had different members on the team, could we have had more members on the team? More of this particular type of drug or less of that? More beds, more tents. This is constantly processing in my mind. At this point, it’s still early on to have concluded. By and large, the Red Cross response and the Red Cross teams have really done a fantastic job.

Many countries truly deploy almost the best of the best of their delegates, with experience and resources and so on. And it showed in the Haiti response. It showed the good will and the willingness to go to extremes to deliver a service and as quickly as possible.

Will I change my mind in a month? Probably yeah, probably things will become clearer and now we are engaging some external consultants to go back actually, and look at what we did with fresh eyes, to more objectively tell us and advise us on what we could have done better and what worked and what didn’t. That is critical and that is part of the learning that we hope to go through and improve this whole emergency response unit concept and model.

Hossam Elsharkawi

Q: Will you be returning to Haiti?

I will be back to Haiti closer to what we consider the ‘hand-over phase’. It could be in the next two or three months. Typically at plus three or four months, we begin to look at handing over the medical units that we deployed to a local partner. Usually in the cases of field hospitals, it’s often the ministry of health or a local hospital. And to help negotiate not just the hand-over, but what we associate with the hand-over, which is a longer-term training and capacity development and building.

And it will be wonderful to go back and meet some of the people that we met in the first phase, and that helped us so much get up and running as well, and to touch base again.

Q: Many journalists commented on the resilience of the Haitian people. What was your impression?

The Haitians were extremely resilient, but I must say everywhere I’ve gone humans are resilient. I never underestimate the ability of any community, any nation, any people to cope with adversity. It’s amazing. And at all age groups and so on, absolutely. It’s there and I think it may not be visible in a pre-disaster phase, but I think people do manage somehow to go beyond and continue. I have no doubt the Haitians will as well.

Q: Dozens of people managed to survive several days, even weeks under the rubble. Is that common in earthquakes?

There are always stories of people surviving weeks—it happens. If you have access to water, it’s doable. But, in the greater scheme of things there are very few that have managed to do that. And, it’s always nice and refreshing to hear those stories and it gives hope, sometimes false hope, to the survivors looking still for loved ones. But, they’re always there, absolutely.