Israel’s military field hospital, regularly dispatched to disaster zones to provide humanitarian relief — and to win the Jewish state some rare international brownie points — may soon be awarded the World Health Organization’s highest ranking, which would make it the first in the world to be so recognized.
In 2013, the United Nation’s WHO created a set of criteria to classify foreign medical teams in sudden onset disasters, on a scale from one to three. No country has yet to receive the top mark and “only a handful in the world could even think of” doing so, according to the lead author of the classification system, Dr. Ian Norton.
Last month, a WHO delegation visited Israel to assess the IDF Medical Corps’ field hospital, a sprawling 26-tent structure, during a large-scale exercise in northern Israel to determine if Israel would indeed be the first to score a “Type 3,” Lt. Col. (res.) Dr. Ofer Merin, commander of the field hospital, told The Times of Israel.
The field hospital is “not just some medics and doctors spread out in the field,” but is a “national treasure” that has the capabilities of an advanced, permanent hospital, but can be set up almost anywhere in under 12 hours, Merin said.
Israeli disaster relief delegations — some of them led by Merin — have been some of the first and largest to arrive at the scenes of natural disasters. Teams from the IDF Medical Corps and Home Front Command provided rescue and medical services after an earthquake in Turkey in 1999, an earthquake in Haiti in 2010, a typhoon in The Philippines in 2013 and, most recently, an earthquake in Nepal in 2015.
A Type 3 classification would cement Israel’s position as a world leader in emergency medicine and prove to both friends and foes that the Jewish state knows how to handle catastrophes.
The classification could also allow Jerusalem to continue to be among the first in line to respond to disasters in the future, a position its diplomats and other politicians relish, but one which has drawn accusations of “rubble-washing” — or using its disaster relief effort to boost its international standing.
Helping other countries in need is “the most effective kind of diplomacy,” then-foreign minister Avigdor Liberman said in 2015, after Israel sent a team to Nepal. “In crafting a country’s image, nothing is more effective than providing aid.”
However, diplomats insist the drive is mostly altruistic.
“If we’re sending aid to Haiti, the Philippines and Nepal, we’re obviously not looking to reap great diplomatic benefits from these countries, which I might be allowed to describe as not superpowers,” said a former senior diplomat in 2015, responding to a question about Liberman’s comment.
Following his visit to Israel, Norton, who was part of the WHO delegation, backed up Merin’s boast, applauding both the field hospital itself and the immersive exercise being conducted inside it at the time.
“We saw a part, just six of the 26 tents, but even just those six tents were impressive,” Norton told The Times of Israel, over the phone from the WHO headquarters in Geneva.
‘I am very confident that Israel will do a good job and get through this process’
The final decision regarding Israel’s qualification will be taken next month, but according to Norton, it appears Israel stands a good chance of receiving Type 3 status.
“I am very confident that Israel will do a good job and get through this process,” Norton said, citing Israel’s vast experience in international disaster relief efforts.
“But the official peer review will happen on November 8 and 9, so the announcement will only come then. Hopefully, you’ll see then Israel being able to declare itself a ‘quality assured’ or ‘classified’ team and wear a ‘classified’ badge on their shoulder,” he said.
Merin, who in civilian life serves as the director of the trauma center in Jerusalem’s Shaare Zedek Medical Center, was wary of counting his chickens before they hatched.
“I’d say that we’re in the process of being recognized by the WHO, but not that we’re accredited this way or that until we actually get it,” Merin told The Time of Israel.
The process to get recognition can take from three months to a full year, and demands considerable effort from the team being inspected, which accounts for Merin’s trepidation towards any premature celebration.
“I’ve personally put hundreds of hours into this process,” Merin said.
Type 1, Type 2, Type 3
For many years there was no internationally recognized system of categorizing emergency response teams — which could operate independently, which needed assistance from the local government in order to function, what services could they offer, etc. — information that can be crucial in a disaster situation.
Rescue workers need to know where they can take patients. When deciding which teams can come in as part of the relief effort, local governments need to know which foreign field hospitals are entirely self-sufficient and which require resources like fuel, oxygen and medications that are often scarce after a disaster.
“They cannot be a burden on the affected country. In the past, teams arrived with no equipment, and local authorities had to look after them; we found that inappropriate,” Norton said.
A specialist in emergency medicine and former head of his native Australia’s emergence response team, Norton joined the WHO in 2013. That same year, he and a team of other experts developed the WHO’s classification system, which puts foreign medical teams into three groups: Type 1, Type 2 and Type 3.
The document detailing the requirements for these classifications is some 91 pages long, but in short, the types are in ascending order by number of patients that can be treated and level of difficulty of the procedures that are offered.
A Type 1 medical team can offer first aid and other immediate emergency care on an outpatient basis, meaning the victims do not remain in the hospital for extended periods of time; a Type 2 has at least 20 beds for inpatients and can perform 7-15 surgeries per day; and a Type 3 has twice as many inpatient beds, an intensive care unit and can perform 15-30 surgeries per day, as well as provide a host of other services, including rehabilitation.
Israel’s field hospital blows past some of these requirements: A Type 3 field hospital needs 40 inpatient beds, Israel’s has 86. A Type 3 needs two operating rooms, Israel’s has four.
However, some aspects of the classification are not simply an issue of which specialists are on staff or the amount of oxygen the facility can produce per minute, Norton said.
Operating procedures for everything from how medical workers get vaccinated to how medications are stored to how equipment gets shipped overseas also need to be written out and formalized.
Those written procedures then need to be reviewed by three foreign government teams in order for Israel to be “fully classified,” Norton said.
“We also ask them to comply with the principles of being an emergency medical team, which means they will behave ethically in the field, that they will treat anybody no matter race, color or creed and that they will take part in the combined and coordinated effort to do the best for people affected by the disaster,” he said.
To ensure that the IDF team will follow those principles, Norton said, “we look at how they teach the teams, but we also ask the director-general and the chief surgeon to sign on behalf of the organization that they will do their best to comply.”
But to a certain extent, the WHO approval is just a “rubber stamp” on an established fact, he said. For instance, throughout our conversation, Norton referred to Israel’s field hospital as a Type 3, despite it not yet formally receiving the title.
Israel is the sixth foreign medical team to be reviewed by the WHO thus far. Teams from Russia, China and Japan have already been reviewed, and an Australian team is undergoing the process alongside Israel.
Some 75 teams, of various sizes, from around the world have requested the process and another 125 may follow suit in the future, Norton said.
However, most of these are of Type 1 and Type 2 classifications.
“We don’t actually have any other Type 3’s that are in the process of being verified,” Norton said.
Only a pan-European collaboration and a Chinese team stand to receive one in the foreseeable future, he added.
If Israel gets its certification, in addition to being the only Type 3 team in the world, it would also be the only one with a “military component” that has been recognized by the WHO.
“So really there are two firsts, as it were, for Israel,” Norton said.
In addition to a fancy feather in the IDF’s cap, the Type 3 classification would have some real world ramifications.
If Israel receives the designation, it would get “preferential access to disasters in the future,” Norton said.
The concept of “preferred access” to natural disasters may sound strange, until you consider situations like the one in Haiti in 2010, where groups arrived with medical personnel that were not properly trained and supplied, and ended up becoming more of a drag on the local government than a boon to the relief effort, Norton said.
As such, some countries are considering declaring that only recognized and vetted teams will be allowed to join their relief efforts in order to prevent such issues from repeating themselves, Norton said.
‘We can’t become a country that experiences a disaster and finds it doesn’t have tents or food or services’
To Merin, however, that unpreparedness is not just an issue in a foreign disaster site, but represents a greater threat is that emergency response teams wouldn’t be ready if a catastrophe were to strike inside Israel.
“I’ve seen dozens of field hospitals from various countries. There is something unique in our abilities, to get there fast and to be independent. And in our worldview, that’s essential,” he said.
A Type 3 designation would therefore not only be proof that Israel is capable of helping other countries in an emergency, but that it can also help itself in the event of one.
Raphael Ahren contributed to this report