Delivering Aid to Conflict Zones

Roibeárd O’hÉineacháin reports.

The successful delivery of medical aid to conflict zones requires adaptability to local conditions and a trustworthy and efficient distribution network. However, it always remains a learning process because each conflict zone is different, stresses Dr Tom Ogilvie-Graham.

“You meet a lot of people with a lot of experience in delivering medical aid in different places,” he said, “And there is a danger that you draw too much on your experience and lose that adaptability to the particular circumstances.”

He noted his involvement in bringing medical aid to conflict zones or immediately post-conflict zones in about 12 different areas. For approximately five years, he was in Palestine as the CEO of the Order of St John’s Eye Hospital Group—based in Jerusalem, where it has been since 1882. The hospital also had clinics in Hebron and Gaza and has provided remote villages with mobile outreach clinics.

“Although the distances are not that great on the West Bank, the problems of getting access are pretty severe, which also involves ferrying more difficult cases to Jerusalem for definitive treatment,” he said.

Working with a disrupted system

While Palestine presents difficulties with delivering medical aid, it has a well-established home base that has been there year on year, decade after decade. In Ukraine, by contrast, there is a disrupted economy and healthcare system, with a disappearance of nearly 200 clinics and the loss of staff.

Dr Ogilvie-Graham noted healthcare systems in conflict zones are often broken or inherently corrupt. Ukraine’s corruption prevention agency is currently dealing with 78 incidents of attempted profiteering from humanitarian aid since February 2022. Medical aid is particularly vulnerable to corruption because of its high value. He cited an instance in Iraq where he found the material they delivered to a medical facility only two days earlier was now on sale in the local bazaar.

Working through well-established, international medical aid NGOs will provide safeguards against corruption, he said. However, in conflict zones, they are often incapable of delivering specialist support where and when it is most needed. Currently, 80% of medical supplies to Ukraine come from small organisations such as ESCRS, 17% from individuals, and only 3% from international organisations such as the Red Cross.

Dr Ogilvie-Graham noted that at an early stage of its involvement, ESCRS had the good fortune to team up with Lyubomyr Lytvynchuk MD, PhD, a vitreoretinal surgeon based in Giessen, Germany. He has provided ESCRS with a well-established network for the distribution of medical aid in Ukraine. And since he is based in the EU, he has been able to reduce the difficulties involved in importing medical materials.

“I am 100% pleased with Lyubomyr, and I believe we have made the right choice. We want to continue working with him as well as our sister society in Ukraine, of course,” he said. “ESCRS has also invited the European Society of Reconstructive Surgeons (ESOPRS), the world society of oculoplastic reconstructive surgeons (WSOPRS), and EURETINA to join in this initiative so we can provide ophthalmic support beyond anterior segment surgery.”

Acquiring funding and resources

Dr Ogilvie-Graham noted ESCRS’s industry partners responded very generously to its specific requests, with more than €1 million worth of equipment distributed so far. ESCRS set up a fund in March 2022 and allocated €100,000 from its own reserves towards Ukrainian support. Many sister societies and some ESCRS members have also contributed to this fund. ESCRS has also absorbed all related administration costs into its overall budget.

Future ESCRS strategies in Ukraine may include initiatives such as telemedicine and an international trauma consultancy network. Telemedicine is unlikely to be of much value right now because the physicians in Ukraine’s remaining medical facilities have been dealing with the conflict since 2014. However, in the longer term, establishing a worldwide network of consultants could be useful—particularly in areas such as reconstructive surgery where improvement is necessary.

In the meantime, the ESCRS is contributing to Ukrainian ophthalmic surgeon training by offering 20 observerships in host institutions across Europe, the United States, and New Zealand. It gave travel grants of €1,000 each to observership candidates to attend the 40th ESCRS Congress in Milan. The ESCRS also offered free Congress registration to 600 Ukrainian surgeons, and 300 attended in person.

“One should never underestimate the effect of morale,” he observed. “The fact that a European organisation is doing something practical has an enormous effect, and the word goes around that our colleagues in Ukraine are not on their own.”

Dr Ogilvie-Graham is the managing director of ESCRS and is based in Rome. He delivered his talk at the ORBIS symposium at the 40^th Congress of the ESCRS in Milan. tog@md.escrs.org