From the central warehouse into the disaster area, all types of transport have to be deployed.
From the central warehouse into the disaster area, all types of transport have to be deployed.

Earthquakes in Nepal, Ebola in Africa, war in Syria, famine in the Sahara: Medecins Sans Frontieres and its aid workers are active everywhere on the front lines. But in order for them to save lives, perfect logistics is a must. A look behind the scene.

Ceiling-high shelves fill a 13,000-square-meter warehouse, stocked with products that save lives around the world. The hall is the epicenter of the newly built logistics center belonging to Medecins Sans Frontieres (MSF), also known as Doctors Without Borders, with good transportation access near Brussels, the Belgian capital. 98 people work here. Together with other centers in Bordeaux and Dubai, as well as a number of local warehouses around the world, the facility is the logistical backbone of a supply chain for an organization that is active wherever medical help is urgently needed. The center is where crucial supplies for missions are sent on their way. Logistics is a high priority. In fact, it is the third pillar of MSF, following human resources, or the medical and medical support personal in disaster zones and within in the organization. Fundraising is the other pillar, as 89 percent of MSF's financing comes from private donations.Logistics is a crucial success factor, even if this aspect is sometimes not apparent in the astonishing photos of missions in crisis zones. Patricia Low, a staff member of the Swiss section, sums it up like this:

Before we can help, our staff must be able to get to the area in the first place. And without the right equipment, they cannot do much! 

It is no wonder that for MSF the logistics staffis just as important as medical personnel.

Logistics personnel are the first aid workers on site

Sometimes even the most rudimentary infrastructure is lacking, whether because it was destroyed by the natural disaster or ongoing war or sometimes because it never existed in the first place. Access to aid supplies, such as medications, injections, bandages and clean water and electricity, can be just as bad. Low says:

That's why every MSF team also includes logistics personnel, who along with the doctors, are the first aid workers on site.

But that is not the only reason why MSF transport and storage is a very special challenge. Jean Pletinckx, in charge of the Brussels center, explains:

Thirty percent of our missions are foreseeable, 70 percent are not.

After all, very few earthquakes, floods, cyclones and epidemics can be planned for, and it is just as difficult to react quickly to such events.

Medecins Sans Frontiers

But that is exactly the task of the Supply Chain, as MSF's logistics section is called. Pletinckx says:

We see it as our responsibility to have all necessary materials ready within 24 hours or to react to two simultaneous crises within 48 hours.

That is avery ambitious goal, but one that is actually achieved in most cases. On the one hand, experience with local conditions makes it all possible. Pletinckx, 47, has been with MSF for over 20 years and is a good example: He has first-hand knowledge of many crisis zones. During his first few years, he was deployed in nearly all the major war zones: the Congo, Zaire, Liberia, Bosnia and Iran. He was then in charge of the Russian MSF headquarters for Eastern Europe, followed by time in Indonesia and eventually in South Africa and the fight against HIV. For four years now, he has been in charge of the central warehouse in Brussels, where the aid transports are coordinated. He is a full-time manager who is confronted with new challenges nearly every minute.

Logistics remains the most complex element within aid organization

Another form of support are the so-called emergency kits, nearly complete pre-packaged kits of materials for all the various types of missions. There some 500 different types of kits, each containing the necessary equipment for a specific crisis situation.

Antoine Delaitre has been in charge of supply for MSF Switzerland in Geneva for already five years, and of course with the corresponding field experience in various crisis regions.

For example, a team will spend two weeks stocking Ebola kits with sufficient materials for the care of Ebola patients. The Surgery 300 Interventions kit enables MSF staff to start performing surgical procedures in areas of conflict and in one month, carry out 300 major interventions in a hospital structure with 100 beds. The kits do not just contain medicines and first-aid equipment. Many also include devices for water treatment, communications or supplying power.

After all, the idea is to alleviate suffering over the long term. While the emergency kits do offer effective support, logistics still remains the most complex element within the aid organization — and in the logistics industry. The reasons are many. One of them is the already described lack of functioning infrastructure in disaster areas. Even if every imaginable form of transport is deployed — trucks, chartered cargo aircraft and helicopters— "we must assume that some shipments can be loaded only by hand." And the next phase of transport is usually very complicated. Often human carriers are the only transport option at the destination.

The next challenge has to do with the amounts and the diversity of the materials that have to be moved in a very short time. "For the crisis in southern Sudan, we had to send 255 kits for 100,000 refugees, containing medicine, tents, water purification equipment," says Pletinckx's colleague Stefaan Phlips, describing a typical task. Flexibility and planning must work in tandem, difficult as that is light of the complex situation.

The unpredictable makes logistics nerve-wracking

Other factors to consider are the specific requirements of the transported goods: Medication that is only non-perishable when cooled, sterile instruments, complex devices, etc. An entire mobile surgery installation, new and specially designed for MSF, is a good example of all the necessary complications involved in conducting an operation a laid effort. Add to that replenishing warehouse supplies on an ongoing basis because certain pharmaceuticals only have a limited shelf life. Or the fact that some proven medications have not been approved for a certain country and a replacement must quickly be procured and substituted into goods being shipped.

And time and again, despite all preparations, there is no way to plan for the unpredictable, which makes the job of MSF logistics personnel nerve-wracking at times. Pletinckx mentions the Ebola epidemic a san example:

It was completely unclear how the disease would spread. Could the epidemic be contained or would it infect other countries? We had to send hundreds of thousands of protective masks, protective suits and medical supplies to West Africa, and of course, all in no time!

The demands were even too much for Medecins Sans Frontieres to handle and Pletinckx asked well-known logistics companies to jump in as sub-contractors. But they had to cancel — they were simply not able to manage the timelines and quantities! Ultimately MSF was able to accomplish the task with its own resources. Pletinckx neatly sums up the motto of MSF Logistics:

The things have to be done. And it is out of the question to not do something because it is far too difficult, too short-notice or too expensive. We have to do it no matter what.

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Médecins Sans Frontières (MSF), or Doctors Without Borders, is a private, independent aid organization founded in 1971 from a merger of two entities: the Groupe d'Intervention Médicale et Chirurgicale en Urgence, founded as a response to the Biafran War; and Secours Médical Français, which was formed in reaction to the devastating Bhola cyclone in Bangladesh. Since then, MSF has delivered medical emergency relief worldwide in catastrophe and war zones. In 1999 MSF was awarded the Nobel Peace Prize.

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