Best-laid plans: Failed states and medical evacuation

The evacuation of sick or injured patients across international borders is fraught with difficulties at the best of times.

Unforeseen medical complications, bureaucratic hurdles and volatile political landscapes can all disrupt the best laid plans – testing the capabilities of even the most experienced of Tangiers International’s medical professionals.

When the injured party is stranded in a fragile or failed state, however, these complications take on a whole other dimension.

Failed states are countries where the basic functions of a state have broken down, where crime and corruption are widespread and where violence is a part of everyday life. Insurgent groups may be vying for control of certain territories or may even have taken the reins of power in the capital.

For Tangiers, these are all factors which may play into the logistics of a medevac operation. The company operates in some of the world’s most dangerous or politically unstable regions, utilising local knowledge and networks in order to recover patients as safely and efficiently as possible.

Dr John Quinn, Tangiers International’s medical director, explained that entering a failed or fragile state by air presented a unique set of problems.

He said: “You’ve got a crew of five to six people who are landing in the country and need permission to land. Just securing this can require quite extreme measures.

“We may be communicating directly with the minister for aviation or transportation, for instance, because the normal infrastructure you would expect has broken down entirely.

“On top of bureaucratic difficulties, you may have rebels who would love to shoot down any aircraft which is landing. The logistics are insane.”

Even when permission to enter a country has been obtained, imminent plans can be stymied by political developments on the ground.

“It’s entirely possible that they decide to close the airport mid-evacuation,” said Dr Quinn. “You have everything in place with a medevac crew coming in from France or Germany or wherever and all of a sudden that’s all off because everything has been shut down.”

This unpredictability means Tangiers needs access to the latest and most reliable information throughout an evacuation operation. Fortunately, its network of local agents are able to deliver this.

By working with local agents, Tangiers International has eyes and ears on the ground, ensuring it can react to rapidly-developing situations with the upmost efficiency.

When a patient’s health is at risk, this ability to be flexible can make a profound difference. When an evacuation by air ceases to be feasible, alternatives such as overland travel can be put in place in an instant – ensuring the patient can reach adequate medical facilities in the shortest time possible.

Dr Quinn said: “Tangiers International focuses on the places which are very difficult to work in, meaning that we’re acutely aware of how things can go wrong and have systems in place to overcome difficulties.

“When they decide to close the airport, for instance, we have solutions, we have ways to work around it. Having that local knowledge and being able to be very flexible is really our strong suit.”