Projection of educational needs for European personnel going outside Europe

During the acute phase which at most lasts for a few weeks there is an immediate need for personnel who have considerable training and experience in the assessment of health priorities and planning interventions: they also need special skills such as survey techniques, provision of water supplies, sanitation, implementation of feeding programmes, and the treatment of war injuries where relevant.

Ideally multidisciplinary teams, who have been trained together, should be sent and include an administrator, water engineer, nutritionist etc as well as nurses and doctors.

While ideally the need of this phase should be met by local health services, they are usually already overstretched and so it is likely that their role will be limited to general supervision by senior health administrators, who may or may not be trained in the general principles of disaster management.

Europeans already involved in long-term health work in third world countries may make major contributions during a refugee crisis and should also receive modules of training, even in Europe.

Although the situations are often initially envisaged as short-term emergencies they usually continue for a year or more: there is therefore a need for a steady flow of European personnel who have attended short courses.

In practice it is not realistic to provide manpower norms as the number required will depend on the severity of the situation and the local resources of both manpower and supplies. Generally it is important not to create an artificially high staffing ratio which cannot be maintained once relief teams leave.

The quality of health personnel sent is as important as quantity. There is a need for a greater emphasis of community health skills. In particular staff capable of training refugee and local people have a vital role both in promoting self reliance and in reducing the number of overseas personnel needed.

In view of the longer term commitment in these situations, it is essential that overseas personnel have the skills to co-ordinate the work with the host government’s health plans. From this it is clear that the training of European workers should include a discussion of transcultural problems.

European health workers who become involved in short-term assignments to refugee situations overseas present peculiar problems. Firstly, it is difficult to identify them prior to their becoming involved overseas and secondly, it is often difficult to obtain release of the workers from their permanent post once they have been trained. Nevertheless experience in several countries has shown that there is a large demand from potential volunteers for short courses. Government and health authority views on releasing staff can also be changed. Agencies concerned with refugee relief may also consider maintaining an expert team with good experience, to help plan, evaluate and take a leading part in field work.