When disaster strikes, Israel’s government, army, and aid agencies are always among the first to send material and expert assistance, whether it’s earthquakes in Haiti and Nepal, tsunamis in Sri Lanka and Japan, typhoon in the Philippines, or other mass disasters in Turkey, India, Mexico, El Salvador, Greece, Rwanda, Armenia, Indonesia and New Guinea.

If local hospitals are out of commission or overwhelmed, the Israel Defense Forces can get a field hospital functioning within 12 hours of arriving at the setup site, an awe-inspiring feat of logistics unmatched by other countries.

ISRAEL21c asked Prof. Kobi Peleg, a world-renowned expert on disaster management and a veteran of numerous Israeli medical aid missions spanning from the Armenian earthquake in 1988 to the Nepal earthquake in 2015, how this became possible.

The short explanation is the IDF’s combination of experience, systematic precision, and extraordinarily motivated and qualified personnel, said Peleg, who directs the Israeli National Center for Trauma and Emergency Medicine Research and chairs Tel Aviv University’s English and Hebrew master’s programs in emergency and disaster management.

Each time Israel completes a medical relief mission, the operation is analyzed and the processes are tweaked so that the next mission can be even more successful.

Peleg has headed the IDF military medical school and the medical branch of the Homefront Command, and was deputy commanding officer of the IDF emergency field hospital in Armenia. UNDAC, the United Nations Disaster Assessment and Coordination agency, counts on his expertise in situations across the globe.

“Some hours before the medical delegation leaves, an advance team of three to six people goes to assess needs and find a site where we can set up,” said Peleg. As soon as the medical and logistics teams touches down, everyone gets to work immediately, even after long and grueling journeys. “Nobody goes to sleep,” he said. “It does not matter if you’re the director general of a hospital; if you’re on the Israeli delegation, you work as hard as the logistics people.”

The team pitches around 20 treatment tents and then unpacks and arranges appropriate equipment for each tent. If the disaster was an earthquake, the largest unit will house trauma and orthopedics. If it’s a pandemic, the main tent will deal with infectious disease treatment and control; if it’s a fire, the burn unit is the main tent.

After disaster victims are treated, the field hospital gets busier with “ordinary” patients while the country’s own healthcare system is in recovery mode.

“Before starting to work, we meet with the commanders and all the people in the field hospital,” Peleg said. “The commander gives an overview of the mission and outlines how he wants everyone to be organized, which is very important. Every evening we summarize the day, discussing if we need to change anything and if there are any special issues to be addressed.”

The Israelis cooperate with local and international officials, hospitals, international relief organizations, and smaller medical delegations. “In Haiti, for example, we had two surgical tents from Colombia as part of the IDF hospital, as well as physicians from the US and nurses from Canada,” he said.

Once the host country accepts an offer of help and Israel’s Foreign Ministry approves sending a delegation, authorities must determine the most urgent type of assistance. It could be search-and-rescue, food, engineering, or medicine. “These are very complicated decisions,” said Peleg. “Ideally you would wait until an assessment is done to determine how many hospitals are damaged, how many and what types of casualties there are, and how many international medical delegations are on the way. But in a large-scale disaster, the communication networks, roads and airports may be damaged, and it’s a mess. Usually we won’t have real answers until 24 to 48 hours later.

“Yet the clock is running against you. People trapped after an earthquake, for example, can survive an average of three days without liquids and five days without food — if the weather isn’t too extreme. Every 24 hours that passes, we have less chance of finding survivors. Also there is usually a lot of logistics and travel time involved, so if you wait for an assessment you won’t even land till three or four days later, and then it takes another 12 hours to set up the field hospital.”

The other option is to respond rapidly and rely on educated guesswork. This is what the Israelis do most often.

“We have enough experience to know approximate needs, so we take a chance and go with what we think we’ll need,” said Peleg.

Decision-makers from governmental and military units – including the Ministry of Defense, which supplies the planes and funds – scramble to organize communications and logistics, manpower and materials from the public and private sectors.

Because the military deals mostly with adult males between the ages of 18 and 40, it does not have medical supplies for pediatrics, obstetrics, and geriatrics. So equipment must be gathered from Israeli hospitals and the Ministry of Health as well as the IDF.

At the airport, the assembled equipment is weighed and then another difficult round of decision-making ensues. “If we need to bring 120 people, every person with his or her personal baggage will have about 100 kilos, so for each person you can take 100 kilos less equipment and vice versa,” explained Peleg. “And if you need to bring drinking water, food and generators, which you often do in large-scale disasters, that’s even more weight. You have to decide at the last minute what not to take, and often you find you need things you chose to leave behind.”

Missing supplies can be sent easily enough if the mission is close to home, but if it’s farther afield – say, Haiti or the Philippines – the delegation has to manage without or ask Israelis coming later to bring lightweight items.

The IDF medical mission to Nepal – deployed within 30 hours of the disaster — was Israel’s largest ever, including about 120 healthcare workers, 45 physicians and 95 tons of equipment including a lab, x-ray machine and medical informatics system.

The staff of the 60-bed IDF field hospital under the direction of Col. Dr. Ofer Merin (who is also the head of the trauma unit at Jerusalem’s Shaare Zedek Medical Center) treated 1,600 patients, performed more than 85 surgeries, and delivered eight babies before folding up the tents on May 11.

The video embedded below shows the Israeli medical team opening a field hospital in the Philippines following Typhoon Haiyan in November 2013.

This time-lapse video shows the activity in the field hospital set up in Nepal after the earthquake in April 2015, giving a scope of what the medical teams accomplish in a single day.

[Photo: Israeli Defense Forces / Flickr ]