Intended for healthcare professionals

Feature Humanitarian Aid

Reporting adverse events in a war zone

BMJ 2018; 361 doi: (Published 07 June 2018) Cite this as: BMJ 2018;361:k2286
  1. Sophie Arie, freelance journalist, London, UK
  1. sophiearie{at}

How much harm does humanitarian healthcare cause patients by mistake? Medical aid agencies and others are increasingly aiming to improve the quality and safety of healthcare they deliver, finds Sophie Arie

In 2014, in the midst of the Syrian conflict, aid workers vaccinating children against measles killed 15 infants when they injected them with the muscle relaxant atracurium by mistake. The Syrian team could not read the English labels on the ampoules of the drug, which they mistook for the diluent used for mixing the measles vaccine.1

The World Health Organization, which was coordinating the vaccination campaign with the United Nations children’s agency Unicef, said that it was the biggest such tragedy in memory.

“The circumstances in which we work make it harder [than it is for Western health services] to avoid medical errors or pre-empt them,” says Tammam Aloudat, deputy medical director for the humanitarian charity Médecins Sans Frontières (MSF) Switzerland, which was not involved in the Syria incident.

Extremely difficult and dangerous situations

The nature of aid agencies’ work means they often have a high turnover of staff, and many are posted to places where they do not speak the language of the health workers or patients. They care for particularly vulnerable patients, working in extremely difficult and dangerous situations, under intense pressure and for long hours in makeshift or poorly equipped facilities. Their work takes them to remote or dangerous places where populations are on the move, communications are poor, and where it can be hard to keep drugs cold, replenish stocks, or win the trust of local communities.

Simultaneously, donors want them to minimise administrative costs and maximise the number of people helped. The result is that aid agencies know little about adverse incidents among the millions of patients they treat. MSF, which provided over 10 million consultations worldwide in …

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