**2.2 Location of the FFH**

*Military Engineering*

and Nepal).

**2. Background**

further develop this field of study.

hospital deployment are described.

specific irradiation risks [6].

**2.1 Mission definition and timing of deployment**

(FFH) is one type of medical relief system. The World Health Organization/Pan-American Health Organization defines a field hospital as "a mobile, self-contained, self-sufficient healthcare facility capable of rapid deployment and expansion or contraction to meet emergency requirement for a specified period of time [3]." The Israeli Defense Force (IDF) Medical Corps developed a model of airborne FFH [4]. This model was structured to deal with disaster settings, requiring selfsufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions deployed in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines,

The rest of the study is organized as follows. We provide a literature review of healthcare humanitarian aid to disaster areas and a formal definition of a foreign field hospital. The methodology being used is case study. Data was collected by interviews conducted in Israel with senior military staff who actively commanded the humanitarian missions in the disaster areas. Supplemental information was gathered from secondary sources cited in paper. We analyze a series of ten case studies over time period of three decades that provide insights in regards to FFHs deployed by the Israel Defense Forces (IDF) to assist in different types of disasters around the world such as Haiti, Turkey, India, Rwanda, Armenia, and the Philippines. We conclude by sketching future research opportunities that can

A field hospital is an independent health care facility, which is deployed rapidly for emergency purposes, following the request of the affected country. It is important that delegation and recipient countries clarify in advance the details on responsibilities, chain of command, working protocol with authorities and law enforcement agencies, facilities, installation, and operational process of the FFH in order to avoid any misunderstanding. Both parties need to know the details on the date when the FFH will be operational on site, the FFH equipment and services to be provided, the number of medical staff and their qualifications and experiences, the location of the FFH, and its duration of stay. Next, the components of field

Disasters around the world with the potential for the need of international medical assistance are assessed by Israeli governmental bureaus (Ministries of Foreign Affairs, Health, National Security and others), as well as by military offices and local non-governmental organizations. Sending a preliminary assessment team is important. This was the case, for instance, in the pre-FFH era, during the ongoing Cambodian disaster in 1979, were prior assessment of needs, combined with fund raising, led to an incorporation of a drafted team into a Red Cross field hospital in Sakeo, Thailand. More recently, for example, a special assessment team was en route to Haiti 11 h after news of the earthquake reached Israel [5]. An assessing advancing team to Japan evaluated the need for a full scale functional FFH, given the damage to local healthcare system and the medical needs at the disaster zone, coordinated the efforts with the local authorities and regional healthcare providers, defined the required location of the operation, and assessed

**58**

Since swift air deployment is essential to operate expeditiously, missions were airborne, deployed usually in military Hercules airplanes (that enable transportation of vehicles) and occasionally in commercial aircrafts for long-distance missions such as in Haiti/Japan/Nepal. Location of the medical relief operation was usually decided before arrival, and coordinated by pre-assessment team based on dialogs with local health care system and logistic headquarters. Issues taken into account were accessibility to patients, safety (regarding aftershocks in earthquake scenarios, or appropriate safe surroundings in a war zone), and proximity to air fields (for supplies and evacuation in case of emergency). For instance, an intact, roofed municipal sports center provided an adequate shelter and convenient location for the FFH in the snowy Kirovakan. The gymnastic stadium was divided into four functional areas by stretched cables from which black polyethylene sheets were hung, while supplies and surgical rooms were placed on the podium. In Zaire, sleeping quarters were located within an unfinished, fenced, and easily protected private house adjacent to the field hospital. In the missions to Bhuj, India and to Port-Au-Prince, Haiti, soccer fields were chosen as the operation site, because it's a well confined area, usually with one/two entrances, has walls (protection), and its size is adequate [8, 9].

## **2.3 Communication systems**

In a chaotic post-disaster environment, there is a need to utilize both long-range systems to communicate with the delegation's country of origin, and short-range systems to enable communication between site of field hospital home base and local authorities, ambulances, helicopters, as well as delegations from other countries deployed in disaster area. It includes standard walkie-talkie (130–170 MHz), loudspeakers, telephony, fax, internet, email and video conference. Range, spectrum of radio frequencies, bandwidth, weight, size, ease of usage, reliability, batteries life, and cost are important factors in determining which systems the delegation should bring to disaster area. Caution should be taken when patrolling in disaster area with long antenna near collapsed wiring in an earthquake setting. Standard military VHF radio (30–75 MHz) that are non-dependent on local network, proved to be useful in IDF missions for communication with neighboring military units from various countries.

In IDF mission to Rwanda, military VHF systems were utilized for communication with vehicles moving at the range of up to 30 km from the headquarters at the field hospital, which also covered mobile short-distance communication

between the hospital and the sleeping quarters. In 1999, at Adapazri, Turkey, short wave communication (telephone and Internet) relied on a high frequency (HF) radio transceiver in the range of 3–30 MHz; in 2010 at Port-Au-Prince, Haiti, a direct satellite channel was established with an 8 GB bandwidth; and in 2011, at Minanisanriku, Japan, broadband global area satellite internet network (BGAN inmarsat) enabled Wi-Fi communication [6].
