the last four years, the Palestine Red Crescent Society has
provided emergency medical services in a very precarious environment.
thousands of their peers around the world, emergency medical
technicians (EMTs) from the Palestine Red Crescent Society
(PRCS) are used to saving lives, but also used to waiting
at the station, talking about previous operations they have
done, or simply about the weather, politics and family matters.
Until the phone rings. When the call for assistance comes
in, the crews respond quickly, changing from a state of friendly
camaraderie to a rapid response by trained and prepared pre-hospital
care professionals, as they obtain the call details and hurry
to their ambulance to go to the aid of the person in need.
The difference between the PRCS emergency medical service
(EMS) crews and most others around the world is that they
are working in a context of occupation and conflict. After
arriving at the scene of the incident, although they can see
a wounded child lying on the ground or a woman calling for
them to help her husband who is having a heart attack, they
cannot provide aid immediately.
order to access the patient safely, the EMT crew frequently
has to make a request for "coordination". This process
requires the involvement of the ICRC, which contacts the Israeli
Defence Forces (IDF) to obtain permission for the PRCS ambulance,
on a humanitarian basis, to enter the area. It means that
the EMTs have to watch and wait until the "green light"
is granted. Psychologically, this is a very challenging position
for someone who has entered the profession to help those in
urgent need of care and transportation. Even with such coordination,
and after permission has been granted to enter the area, soldiers
have sometimes opened fi re on the EMTs, leading to injuries
and even deaths of those attempting to carry out their humanitarian
medical mission. Such are the conditions under which the PRCS
has provided its EMS during the past four years of the second
In addition to frequent military operations, there are hundreds
of checkpoints, barriers and earth mounds, as well as the
West Bank barrier, that interfere with the ability of the
PRCS EMTs to provide their services to the Palestinian population.
To overcome these obstacles, assistance, in the form of coordination
from the ICRC, is often — although not always —
required. However, this takes time and delays a rapid response,
sometimes leading to the deterioration of the health of the
patient who has called for their assistance.
PRCS became the main EMS provider to the public of the West
Bank and Gaza Strip in 1996, when it was given the mandate
by the Palestine National Authority to provide ambulance services
throughout the Territories. Having a well-established network
of branches and already providing a number of social and emergency
humanitarian services, including ambulance services, the PRCS
was able to support the Palestinian people. Since then it
has carried out its mandate, often under very difficult circumstances,
with an exceptional degree of professionalism and dedication.
Beyond the difficulties created by the occupation and military
operations, the context in which the PRCS provides its EMS
is further complicated by the fact that a number of other
non-governmental organizations, hospitals, private operators
and the Ministry of Health also operate "ambulance"
services. The majority of these operators use vehicles identified
as ambulances, often including a Red Crescent, Red Cross or
a combination of both. These vehicles are not used mainly
for the care and transportation of the seriously ill and injured,
but to transport medical personnel, medical supplies, patients
in a stable condition or the dead. The plethora of these other
“ambulance” service providers makes it difficult
for the public and the IDF to differentiate their role and
function from that of the PRCS EMS, thereby further reducing
the access and safety of their operations. Advocacy for and
adoption of a draft law are needed to help reduce abuses of
the emblem. In addition to these efforts towards proper identification
of the PRCS as the future National Society of the Red Cross
and Red Crescent Movement in the Palestinian Territories,
the PRCS is encouraging the establishment of an EMS commission
to better regulate the provision of ambulance services.
facts and figures
• National “101” telephone number
• Headquarters, 7 main stations and 23 substations in
the West Bank; 6 main stations and 1 substation in the Gaza
• Minimum of 44 vehicles staffed and on duty 24 hours
• Responds to an average of 7,200 calls per month
PRCS has taken significant steps to establish a professional
EMS operation, in spite of a lack of legislation, so that
those who require its services know that the care provided
is in keeping with international best practices of pre-hospital
care. The PRCS has established an EMS education centre, to
train EMTs, at both basic and intermediate levels, as well
as drivers and dispatchers. The centre’s curriculum
is currently under review, not only to ensure that the courses
currently offered are up to date, but include an EMT paramedic-level
curriculum. The PRCS has also set standards for its vehicles
and the equipment they carry.
But it is not the system that gives the PRCS EMS department
its strength, it is the staff and volunteers who answer the
phone and respond. People like Luay Radad, 30, who began as
a volunteer in 1997, progressed through the service to become
a station director in Ramallah and later Jericho, and is now
a member of the EMS education centre, passing along the knowledge
and skills that he has learned to another generation. Luay
initially wanted to pursue a career in medicine. However,
the restrictions placed on the movement of Palestinians prevented
his attendance at an appropriate university. He learned in
1996 that the PRCS was setting up an EMS department and decided
to train as an EMT. Luay, like many other EMTs, has not been
deterred by the situation under which the department currently
operates. Instead, he says that it has given him and his colleagues
the desire to reach higher levels of proficiency and training
to ensure that the people who need their services receive
professional, high-quality care. Luay is as dedicated to the
PRCS as he is to the EMT profession, and looks forward to
future opportunities to assist in the continuing improvements
of the service.
Dana Banke is ICRC communications officer in Ramallah.
with Younis Al-Khatib, President of the PRCS
What advice would you give to other National Societies
about operating an EMS in conflict areas?
It goes without saying that in times of conflict, adherence
to the Fundamental Principles is given greater impetus. In
the area of emergency service provision, protection and respect
for the work of medical missions in conflict areas is crucial
in order for these missions to be able to alleviate suffering
and save lives. It is also important for National Societies
working in conflict zones to share their experiences and to
identify areas where mutual cooperation can be initiated and
What, in your view, are the main obstacles the PRCS
EMS has to face every day in the field?
The main impediment to PRCS work during the current situation
is access. Access not only for our emergency medical services,
but for the other humanitarian services we provide such as
primary health care, rehabilitation and social welfare services.
Why has the EMS become so emblematic of the PRCS
and the Palestinian people outside the Palestinian Territories?
As the national emergency service provider, the PRCS has over
30 stations and substations throughout the West Bank and Gaza.
Our EMS teams can be dispatched to provide assistance to even
the most remote areas. The PRCS has been particularly visible
since the conflict began in September 2000. It has increased
the number of trained EMTs and ambulances, in addition to
establishing substations in remote areas. Emergency mobile
teams and the 101 hotline have also been part of this expansion
in response to the needs of the population. The professionalism
of the medical crews in the field and their commitment and
sacrifice to save lives embody the humanitarian mission of
What lessons have been learned since the launching
of the EMS?
Crews’ safety and commitment to work according to protocols
and regulations are high on our priority list, in addition
to proper planning and monitoring. Providing continuous training
and refresher courses for the EMS teams are also very important.