Operational Hazards

How Iraq's shifting sands will affect the provision of effective medical care for workers

DR. RIKARD MOEN is Regional Medical Director at RMSI Medical Solutions.

Terrorism, explosive/ballistic incidents, kidnappings and political instability. These are just a few of the reasons why Iraq is probably the most challenging arena in the world for the Oil and Gas sector to provide safe, effective and fit-for-purpose medical services.

Following years of deterioration, the local medical infrastructure is not able to provide international standard medical care and foreign companies are required to establish their own services or contract private health care companies.

In addition to the poor facilities and clinical standards available, the security concerns regarding accessing such facilities add a further layer of complexity and risk, particularly for foreign nationals.

Medical evacuations out of Iraq are occurring on a weekly basis and are increasing in frequency.

The risk profile for medical evacuations will only increase as Oil and Gas operations continue to ramp up over the next 3-4 years meaning the need for effective, fully integrated medical services is greater than ever.

Healthcare below par

In the 1970s and 1980s the Iraqi healthcare system was considered to be one of the best in the Middle East. However, since the first Gulf War in 1991, and the subsequent commercial isolation of Iraq, the national healthcare system has waned significantly.

The healthcare system is now a mere shadow of its former self and the quality and capacity of care provided is well below the levels considered to be of international standard.

During the height of the coalition military presence, it was sometimes possible for certain companies, on a case-by-case basis, to access military medical services, particularly for incidents of a life threatening nature. Since the withdrawal of the US military in December 2011, this facility is no longer available.

The resulting lack of reliable and high quality national medical infrastructure in Iraq, coupled with extreme travel security risks, requires companies to be as operationally self-sufficient as possible. This includes the ability to adequately address the primary healthcare needs of its staff alongside robust contingency plans to deal with emergency medical incidents of both a life threatening and non-life threatening nature.

RMSI is the only integrated medical solutions company in Iraq with the resources to deliver from pre-deployment training and medical assessment to medical evacuations should the need arise. They are also called upon when a medical facility does not have the capabilities to continue a patient's treatment or the area is simply too remote or hostile to allow continued care.

With a number of independent, yet fully integrated specialist services, including a 24hr mission response center, remote field clinics and primary emergency retrieval, the Dubai-based medical solutions company offers the complete solution to hostile area medical care.

Under attack

Whether it's language barriers, dust storms or transportation, companies conducing operations within Iraq face myriad problems on a daily basis. But by far the biggest issue is security. Complex arrays of groups have waged an insurgency against US-led coalition forces and the Iraqi government since the end of the full-scale military conflict in Iraq.

Armed opposition groups and trans-national terrorist networks have also targeted diplomatic, commercial and humanitarian personnel and assets, as well as civilians. The security situation has improved since mid-2007; however, foreign personnel continue to face threats from suicide attacks, roadside bombings, shootings and kidnapping.

Violent crime is widespread and includes carjacking, robbery and murder. Although the majority of the multinational companies have strict security procedures and protocols in place to protect their employees from such risks, foreign nationals are still an attractive target for insurgents. Transferring personnel around the country continues to require significant logistical planning and security resources.

Flexibility and experience

Medical and security challenges can frequently combine to create an extremely unpredictable operating environment, in which a minor incident can turn into a major emergency. Even with extensive planning and preparation, it is possible for situations to deteriorate quickly as contingency and response plans become unworkable in a live field incident, requiring a high degree of operational flexibility and local experience.

As is always the case, better planning will yield more robust and consistent results, and companies should fully prepare their medical and security plans and contingencies before entering the country. Medical services provision in Iraq is a highly skilled and high-risk specialty, which should only be practiced by experienced medical organizations, which have extensive experience and knowledge in the remote and hostile medical field.

There is a limited margin of error in these arenas and poor or delayed case management will inevitably result in patient harm or fatality. In light of this, projects need to determine whether they have the capabilities and experience to manage this through their internal medical infrastructure or whether an external medical provider is required.