FROM UNDER THE RUBBLE: A DESCRIPTIVE STUDY ON THE EMERGENCY RESPONSE OF DOCTORS WITHOUT BORDERS POST BEIRUT PORT BLAST ON AUGUST 4, 2020

Abstract

Introduction: A disaster is an occurrence that disrupts the normal conditions of existence and causes a level of suffering that is beyond the capacity of adjustment of the affected population of community (WH0, 2022) on the other hand , emergencies are defined as the quick response to a hazardous event .On August the 4th 2020 , the Lebanese capital of Beirut suffered a disaster like no other when the Beirut Port exploded up in flames. The Beirut Port blast was one of the biggest explosions in history, plunging an already strained country into darkness amid a COVID-19 pandemic and an unprecedented economic crisis. Medicine sans frontier (MSF), also known as Doctors without Borders responded to this humanitarian crisis. The explosion Killed more than 200 individuals and injured more than 6,000 (Shankiti, 2020). Destroyed Residential and commercial infrastructure as well as medical infrastructure three hospitals were rendered unfunctional as well as to the karantina central warehouse. The study was motivated by the request from MSF to do an evaluation of their response, moreover the possibility for improvement of future emergency responses. The main purpose of this study is to evaluate the emergency response conducted by MSF in response to the Beirut Port blast guided by the World Health Organization (WHO) framework for emergency response. Methodology: This study is based on a mixed-method approach where the quantitative is embedded in the qualitative, using secondary data obtained from MSF. Data sources: Secondary data obtained from MSF. The data covered from the time MSF started the emergency response i.e. August 7th until the end of the emergency response on September 30th in the form of emails, minutes of meetings and presentations. As well as quantitative aggregated data. Data management: the data was categorized into emails, presentations and minutes of meeting. Then labeled chronologically. The third step was identifying key actions within the WHO framework and then slating the data from MSF into the corresponding action in the framework. Data analysis We used the framework thematic analytical approach to gather and analyze the qualitative data (Gale, 2013). This approach is particularly important when there is prior conceptual framework to guide the research but also allowing space for additional comments that highlight the difference in operations between the WHO and MSF. Results: The findings are organized into three main categories or key moments of action based on the WHO framework: situational analysis, incident management system, emergency performance standards and key performance indicators (KPIs). For each category, we map and report the actual activity conducted by MSF supported by extract from the secondary data and we identified the gaps in implementation. Situational analysis: Out of the 18 sub-functions that WHO Framework proposes to conduct a situational analysis, we found that MSF reported on 15 of them. The following steps were implemented: 1- scope 2-scale 3-number of people affected 4- size of geographic area affected 5-causative factors 6-ongoing hazards and risk 7-primary and secondary effects 8-refugees complicated by the situation 9- conditions of the effected population 10- extent and type of health consequences 11-vulnerabilities and vulnerable groups, 12-functionality of national health system 13-physical damage to health facilities and other vital infrastructure.14-disruption of health service delivery, including cessation of programmes.15-operational environment 16-response capacity 17-international capacities and response 18-access and gaps. The gaps in MSF situational analysis were: first, delay in initiating the analysis by 24 hours; second, there was no proper systematic documentation of the situational analysis. The WHO had clear details on what to report in the situational analysis. From the email and presentation, the documentation was rather patchy and did not follow the recommended details of the WHO Framework. Especially on the points of international capacity response. The MSF has taken several strides to assess the situation post Beirut Port blast emergency, however a few gaps were identified that need to be addressed in the future. Incident management: The WHO Framework encompasses 26 sub-functions that make up the incident management of the emergency framework. Ranging from activating the emergency Standard of Practices (SOPs) to the day-to-day management of the incident response. Out of the 26 sub-functions, MSF implemented 18; these were 1-ensure the safety and security of all staff 2-activate emergency SOPs 3-establish an initial Incident Management Team 4-establish contact with government officials, partners and other relevant stakeholders 5-determine the need for surge support 6-begin the deployment of surge support 7-elaborate the initial response objectives and action plan, 8-appoint an Emergency Coordinator and Incident Management Support Team 9-field operations 10-operational oversight 11-technical and operational support 12-staff health 13- liaison 14-information and planning 15-monitoring and evaluation 16-strategic and operational planning 17-project management 18-health service delivery 19-techinical expertise 20-training of health staff 21-operational support and logistics 22-supply chain management 23- field support 24- finance and administration 25-health logistics 26-HR. Six sub-functions were found to be unique to the WHO funded NGOs, hence not applicable to MSF. Two sub-functions were meant to be implemented by MSF but not addressed and these were: training of staff & monitoring and evaluation. Key performance indicators were not met according to the data received from MSF. Discussion: We suggest to MSF that having a monitoring and evaluation component in their future responses would be an added value as highlighted by the lessons learnt from implementation of the Pandemic influenza preparedness framework and the joint external evaluation (JEE) both benefited the development of the National Action Plan for Health Security (NAPHS) in Indonesia. This was further enhanced by multisectoral coordination mechanisms and the active engagement of stakeholders, political commitment and authoritative backing through various presidential decrees. Second, in developing countries, governments clearly have neither the financial infrastructure nor the know-how to respond adequately to disaster. As a result, they rely on non-governmental organizations. NGOs with funding and human resources in place are willing to fill the role of the state but are also failing due to lack of coordination, know-how, and governmental support. Given the history and capacities of MSF, we believe if there was systemic and chronological documentation MSF would have been able to identify, coordinate and support other actors. We believe if this was also done in the situational analysis, MSF could have changed their incident management to accommodate. Finally, we believe having a model for key performance indicators such as the WHO have to monitor the standards of the response and evaluate its effectiveness is very important (World Health Organization, 2020). Conclusion: We provided an overview of the emergency response by MSF to the Beirut Port blast and compared to the steps suggested by the WHO framework. The lessons learned: the response was adequate but suboptimal. There are several gaps that MSF need to address to improve its emergency response. First, there is a need to create a systemic chronological documentation and reporting system on the situational analysis. Second, better process for the national and international capacity response. Third, establishing a monitoring and evaluation component as part of the incident management. Finally, MSF needs to consider the key performance indicators for an emergency response as recommended by the WHO guidelines.