Humanitarian emergencies leave people in life-changing situations, and access to healthcare is one of the most important and urgent needs to support people caught up in them.  

Last week the International Pharmaceutical Federation (FIP) released new resources to support pharmacists working in crisis zones. 

But how do pharmacists end up working in these humanitarian emergencies? C+D spoke with Washington DC-based Dr. Mohammed Zurga about his work as director of global pharmaceutical services for humanitarian charity International Medical Corps. 

The first three days 

The charity was founded in 1984 and has since used $4.4 billion in aid to support millions of people in emergency situations across 80 countries worldwide. It works across droughts, famine, war, natural disaster and in countries at risk of diseases. 

Its aim is to establish a presence in an emergency within the first 24 to 72 hours by sending in frontline first responders as well as any technical or logistical staff needed to rapidly deal with an emergency. 

While Dr Zurga is a medical doctor by trade, he has worked with the International Medical Corps for a “fulfilling” 12 years and spent time deployed in the Middle East. 

Read more: Beirut: a pharmacy during conflict

Currently, it’s working across Ukraine, Lebanon, Gaza, Somalia, South Sudan, Yemen, DRC Goma, and under the global pharmaceutical services part of the charity he runs, he says there are a small number of pharmacists in the staff located strategically in places across Africa. 

Whether in field hospitals, mobile medical units or in tents, Zurga says the health professionals are ready to work with the resources they have to start services as soon as possible. 

Read more: Fasting pharmacist raises money for Gaza during Ramadan with a 450km bike challenge

“Services start, then we coordinate with the host country’s ministry of health, and as we establish full operations, we will have stationary clinics, health facilities and warehouses to integrate with existing infrastructure of the country,” he says. 

The charity has worked in places like South Sudan, Yemen and Gaza for several decades as these emergencies “tend to be chronic in nature, so we continue to strengthen existing health systems and not divert into development”. 

Initially, the International Medical Corps will contact anyone it knows on the ground to do preliminary assessments which help to build an idea of the scale of support needed initially.  

It then sends its staff with emergency health kits standardised by the World Health Organization (WHO) which contain basic surgical and clinical equipment, alongside pain medication and anaesthesia, for its first response. The scale and need of the emergency will determine how many pharmacists it sends out. 

“If it is wide scale and the country lacks trained professionals, we tend to send volunteer pharmacists, nurses and doctors to start the initial phase but as we settle down, we focus on training local staff,” he says. “We help strengthen their capacity.” 

Read more: Pharmacist raises almost £90,000 for Gaza humanitarian aid

The International Medical Corps employs over 8,500 staff but says more than 96% of them are local to where the emergencies are, ensuring skills remain with the local communities so they can continue to provide healthcare beyond an emergency. 

Dr Zurga says a couple of pharmacists would come in at the beginning as experts and be responsible for training local pharmacists and pharmacy technicians. “We bring in the medicines, the skills to train them and to provide continual medical education.” 

PIMS and procurement 

After establishing itself in an emergency environment, assessments are done with the local health authorities to look at what vulnerabilities there are in the area, as well as what medication needs to be brought in. 

Medication is bought from humanitarian procurement centres such as the IDA Foundation, and the International Medical Corps uses its logistics and supply chain infrastructure to get it to the emergency areas. 

“You do forecasting and quantification and bring in supplies that match the local need,” Dr Zurga says. “We use our own systems called the Pharmaceutical Information Management System (PIMS) and use consumption and morbidity methods to forecast what we need for the next phase of the project.” 

Read more: PDA launches Medicines to Gaza campaign

The PIMS is in 360 sites in 20 countries as hospitals and clinics can scan and dispense medicines in a way that Dr Zurga says is “modernising existing health systems”. 

“We’re taking PIMS outside of the International Medical Corps to help other NGOs use our digital systems, so we’re expanding our services. Our focus now is modernising the pharmaceutical services in each of the countries we work in.” 

When procuring medicine, the charity uses the pull model, so the specific medication needed for the emergency is requested, rather than just relying on the push model, where leftover medicines are sent to an emergency without there necessarily being the need for it. 

“The need of the clinics and hospitals pull from our central warehouses in each country where we keep our medicines and medical supplies. But in the early phases of the emergencies, we can also use push systems.” 

“We use the host country’s treatment protocols to diagnose disease and follow the essential medicines list (EML). In some countries, you cannot import some medicines because it’s outside of their EML so we stick to their local rules.” 

Read more: Russia-Ukraine war: UK pharmacies and wholesalers mobilise to aid civilians

But Dr Zurga says the logistics of getting medication requested by local staff through PIMS to them arriving from the warehouse is a “challenge” and “emergencies make it worse”. 

“Weather can affect you. Sometimes you have to shift medicines ahead of the flood season and use kayaks and boats, so the clinics don’t run out of medicine. 

“You might have a security or transportation issues. You might have to use helicopters or small planes to take medicines to remote places. We have our own security teams that give us a good mapping of the ground to bring in these supplies in due time.” 

Safety and wastage 

Working in vulnerable settings like an emergency exposes safety risks for both the medication and staff. 

“Conflict zones or natural disasters can create a security vacuum, and people might not feel safe,” Dr Zurga says. “But we have a team of security experts advising our teams wherever we go to minimise any impact to our staff or our supplies. 

Read more: A group of influential pharmacists travel overseas for charity

“Whenever we transport medicines from a warehouse to the clinic, there is coordination taking place between supply chain experts, logisticians and security staff to make sure supplies reach their destination safely. 

“But over the years, we have seen instances where warehouses have been looted, or trucks have been stopped on the road. But we’re ready for it and we do have a good team of security experts and when we work with local staff, it makes the whole thing easier.” 

Medicine wastage is common in places where no emergency is happening, so how easy is it to mitigate in humanitarian crises? 

Dr Zurga estimates around 5% of medication used by the International Medical Corps is wasted, and says this low rate of wastage is because of how PIMS tracks medicine from the warehouse to clinic and to the “last mile” where a patient receives the medicine. 

“It’s a real game changer to see the pill moving throughout, and it’s created 100% visibility for us to see the entire supply chain, so we avoid a lot of waste and make sure all materials are used.” 

Read more: How can pharmacists and pharmacy teams help refugees from Ukraine?

He explains PIMS works out how long a clinic’s stock may last based off its demand and can suggest redistributing it to other clinics to use the medication, far different from when the whole process was done manually and followed a paper trail. 

“We have mission pharmacists who manage the whole supply chain with logisticians. It manages drug to drug interaction, and we counsel patients within the system. We also put in proactive alerts in the system where warehouse workers or pharmacists will see a possible expiry.” 

When does it end? 

Dr Zurga says the cost for each emergency operation can vary a lot depending on where the International Medical Corps is working. 

“The response in Ukraine might have taken more money because you have large hospitals and you support an already developed health system,” he says. “When you go to Somalia, you have mobile medical units working under a tree so it’s totally different to a surgical warden in Kyiv.  

Read more: Pharmacist raises over £8k through charity trainee webinars

“I was deployed in Nepal for a couple of weeks in 2015 to assess the earthquake situation and bring in supplies. Every day our supplies depended on how much the helicopter can take, because they have to go through these rugged mountains and drop the medicines. So the factors can be really different from one place to another.” 

He says the charity only stays as long as it needs to but is always ready to come back to help. 

“The tsunamis in Japan and Indonesia, people have been flooded, and you service those people then the local authorities will take over. We pull out and hand over whatever is left of our supplies to local authorities. 

Read more: Community pharmacy is challenging - especially when the community is in the Himalayas

“But in places like Yemen or South Sudan, these emergencies are a vicious cycle. You open your clinics and hand over responsibility to the ministry of health supporting them with medicines. Then, all of a sudden, another cycle of war breaks out and people will be displaced internally and you expand services again. 

“We are first responders. In some cases, the emergency lasts days, or weeks. Or it might last decades.”