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Back from the edge

A rare glimpse behind the scene of a humanitarian crisis

How does it feel to stand in the face of an international disaster? The University of Manchester has a new role co-ordinating the UK's global humanitarian response. Professor Anthony Redmond OBE shares his own experiences and explains how teams are trained to rebuild lives at a moment's notice.

Imagine being deployed to provide medical support in the aftermath of a devastating earthquake and, a few weeks later, having to identify bodies and human remains in the wake of an air disaster. For Professor Tony Redmond OBE, this was his first experience of responding to a humanitarian crisis back in 1988 – an earthquake in Armenia which killed more than 25,000 people, followed by the infamous Lockerbie bombing which took the lives of all those on board the New York-bound Boeing 747. "The two experiences came one after the other and affected me so so deeply that I thought 'I'll either never do this again or it will have to become my life's work'. It had to be one or the other. And that is how UK-Med was born," recalls Professor Redmond. Professor Redmond has made humanitarian aid his mission.

UK-Med is the University's medical emergency response charity that, this year, won an £8 million grant from the government to become the UK's deployment lead to global humanitarian crises. "In Armenia I'd never seen so much death, with coffins piled up on street corners; I'd never seen destruction as such on this scale – thousands of people with severe crush injuries. It was a challenge working in such difficult circumstances," he remembers. "There was no electricity and, in the dark, I remember falling into a crushed car where the driver was dead at the wheel. It was truly life-changing."

The ability to anticipate how to deliver emergency aid to the highest standard is at the heart of UK-Med's modus operandi.

A national response

Now Head of UK-Med and Deputy Director of the University's Humanitarian and Conflict Response Institute (HCRI), where the charity is based, Professor Redmond's personal mission has extended to the education and training of others as well as the responsibility of a crucial and strategic co-ordinating position in UK disaster response.

The charity has responded to humanitarian crises all over the world, deploying medics to the Philippines (post Typhoon Haiyan), to the Gaza conflict, the Ebola crisis in West Africa and most recently to Nepal in response to last April's devastating earthquake.

Pre and post deployment protocol

  • Teams are dispatched to a UK airport when a country has given an international call for assistance and after the UK government's directive has been issued.
  • Each team's deployment lasts two to three weeks and each person is issued with a personal kit bag and rations.
  • On arrival in a new country, the team registers with the World Health Organization (WHO) Coordination Centre and the Global Health Cluster as an Emergency Medical Team (this helps to coordinate international medical teams and direct the right care to areas of need.)
  • The WHO liaises with the local government so that they know who is physically working in the country and is appropriately authorised.
  • The team may then set up an outreach mobile health clinic, provide assistance to existing clinical teams (e.g. hospitals) or set up a full field hospital.

The £8 million grant from the Department for International Development, awarded in January, cemented the University's status as a centre for expertise in this area and will fund the support, education and training of health care workers on the UK International Emergency Trauma Register and the new UK International Emergency Medical Register.

These national registers, the first of which was set up by UK-Med in 2011, have registered and trained hundreds of volunteers, ensuring the right mix of skills, training and experience to deploy within 12-24 hours of a global disaster.

On call

The ability to anticipate how to deliver emergency aid to the highest standard is at the heart of UK-Med's modus operandi.

Professor Redmond, a consultant in trauma and emergency medicine and Professor of International Emergency Medicine, explains: "A multidisciplinary clinical team is always on standby, working on two-monthly on call cycles. Before being deployed, each team member must be available, released by their employer and appropriately trained."

Professor Tony Redmond OBE treating patients after an earthquake

Professor Tony Redmond OBE treating patients after an earthquake

Karen Livingstone is one of those deployees – a UK-Med medical adviser who completed her nursing degree and MA in Humanitarian and Conflict Response at Manchester. While working as a nurse, she was deployed to the Philippines to help people whose homes and communities were destroyed or severely damaged by Typhoon Haiyan.

She says: "While working on the Islands, I treated people who had wounds from flying debris, injured limbs, broken bones and dehydration. A lasting impression is the resilience of those people. People's belongings were washed from their homes by the sea and the water sources were contaminated but they were determined to get back on their feet. They explained their needs and welcomed our help and support."

"You want to get working as quickly as possible but in reality there may be delays getting to, into and around a country because of the widespread effects of the disaster. During this time, you envisage scenarios that you may face.

Pre-deployment training and team work are fundamental in preparing you for the hard work ahead." Professor Redmond agrees: "You're always anxious when you immediately arrive but once you start working and treating patients you very quickly get into a pattern and the anxieties ease." Conflict zones, though, are very different, he explains. He would sleep fully clothed with a grab bag, head lamp and hand torch by his bed, ready to make a run for it. "The constant, low-grade, unremitting anxiety of a conflict zone is very wearing and at times worse than a sudden stressful event such as being held at checkpoint, or even shot at." For these reasons, mental preparation is a vital part of UK-Med's training.

Normalising the process

"You can't let yourself become a victim," says Professor Redmond. "You have to be able to help people, otherwise you are just adding to the problem. Being properly trained and equipped makes you better prepared and more resilient, allowing you to start work quickly and help people get their lives back together, sometimes literally, by providing life-saving or limb-saving surgery or by getting a health service going again.

"To make this work we have to normalise this process for deployees. We work in highly abnormal circumstances but we still aim to deliver high-quality medicine and health care practice just like any other branch of medicine."

The work of UK-Med is underpinned by HCRI's research which aims to understand and evaluate the quality of aid provided during humanitarian disasters. The Institute is one of the very few World Health Organization Collaborating Centres tasked with undertaking global research on how to improve the effectiveness of international Emergency Medical Teams in a disaster and to develop training to help local teams and doctors improve their response to disasters.

Professor Redmond says: "The need for emergency humanitarian assistance has never been greater and the demands from the public and politicians to spend limited resources effectively have never been louder. The research and teaching carried out by HCRI, in support of the work of UK-Med, helps us ensure that those in the greatest of need get the best of help".

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