1. 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
2. 2
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.
3. 3
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
4. 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”
5. 5
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.
7. 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
8. 8
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.
9. 9
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.
10. 10
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.
11. 11
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.
12. 12
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.
14. 14
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.
