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Evacuation of Swedes from Lebanon 2006 – KAMEDO-report 92

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

Summary

Hazard (Risks, Threats and Vulnerability)

Relations in the Middle East have been tense for many years, including those between Israel and groups in Lebanon. There is an almost constant risk of terrorist acts or the outbreak of war in the region. A large-scale armed conflict between Hizbollah and Israel was triggered on 12 July 2006 and lasted for 34 days.
At the time of the conflict there were many foreign citizens in Lebanon, among them a large number of Swedish citizens and others living in Sweden.

Background, Including Preparedness

Experience from the 2004 tsunami disaster in south-east Asia indicated that Sweden needed to be more prepared in several areas and at most levels in society in order to better handle events abroad that could affect many people living in Sweden. The Ministry for Foreign Affairs, the National Police Board, the Swedish Rescue Services Agency and the National Board of Health and Welfare have in different ways prepared for a similar event, both individually and jointly. Among other things, a joint response team (the Swedish Response Team, SRT) has been established by the Swedish Rescue Services Agency which will operate across authorities. The SRT consists of an assessment team that can leave for a disaster area within six hours of a decision to assess the need for possible action, and support teams with emergency services personnel that can leave for the disaster area within 12 hours of a decision.
The Church of Sweden has extensive emergency preparedness, both nationally and internationally.
There is preparedness for disaster medicine in the county councils, and in the three municipalities with major airports preparedness is linked with the major airports and their preparedness (Swedish Civil Aviation Administration) in close cooperation with each county council.

Events

On 12 July 2006 eight Israeli soldiers were killed and two taken prisoner by Hizbollah in conjunction with an attack over the Israeli-Lebanese border. This led to extensive countermeasures by the Israelis and a large-scale armed conflict broke out between Hizbollah and Israel. The conflict continued for 34 days.
The runway at Beirut airport was bombed during the first days and a blockade of Lebanese airspace and territorial waters was introduced. Israeli air attacks were gradually extended, and practically the whole of Lebanon was attacked. Large parts of the country’s infrastructure were destroyed, thus rendering the evacuation of foreign citizens, which had been initiated a few days after the outbreak of war, more difficult.

Damage

The war caused many houses, especially in the southern parts of Lebanon, to be destroyed. Safety in southern Lebanon and in the southern parts of Beirut was poor, and from time to time virtually non-existent.
 

Disturbances

It was difficult or impossible to live a normal life and earn a living.
It transpired that just over 8,400 peopled with residence in Sweden were in Lebanon. At times many people gathered at the Swedish embassy in Beirut, where there was a state of chaos. There arose a great need of evacuation of people with their residence in Sweden from Beirut and other areas.
The evacuation mainly went to Damascus in Syria and to Larnaca on Cyprus for onward transportation to Sweden. In Damascus, and to an even greater extent Cyprus, the conditions were chaotic at times.
Evacuation flights arrived at the three major airports of Sweden: Arlanda airport in Sigtuna municipality, Landvetter in Härryda municipality and Malmö airport in Svedala municipality. Many people gathered at the airports and needed help with onward transportation to other municipalities since that was where they lived or wished to go for other reasons. Many of them lacked true residence in Sweden since they had returned to Lebanon many years previously and no longer had a home in Sweden.

Responses

(Refer also to the Appendix, which includes tables giving a chronological perspective of some important parts of the sequence of events and measures that were taken.)

Crisis management in Sweden

The development of events in Lebanon in July 2006 caused the evacuation of a large number of people with their residence in Sweden. As well as problems with the coordination and transportation of such a large number of people within an extremely limited time period, the work was complicated by damage to infrastructure; airports and land routes within Lebanon and to Syria, had been bombed. In addition, the situation arose during the peak of the holiday season. The Ministry for Foreign Affairs evacuated approximately 8,400 people between 16 July and 16 August in cooperation with the Swedish Response Team and other players. The evacuation was carried out with the aid of 53 chartered flights, three ships (that made seven journeys) and approximately 15 buses.
On Thursday 13 July more and more people started to contact the Ministry for Foreign Affairs’ telephone switchboard and the consular unit called in the consular emergency unit to respond to telephone calls. The Ministry for Foreign Affairs’ Emergency Management Group was called in on 14 July, and this group operated on a daily basis until 31 July. On Friday 14 July the Swedish Rescue Services Agency decided as a first measure to send an eight-man assessment team with representatives from the Swedish Rescue Services Agency, the National Board of Health and Welfare and the National Police Board to Cyprus. It was there that the majority of fleeing people were being sent, for onward transportation home to Sweden. The assessment team also judged the need for reinforcements in the area. On the same day, an emergency management staff was established at the National Board of Health and Welfare. Personnel from this staff participated in all meetings that were held by the emergency group at the Ministry for Foreign Affairs. The medical incident commander of the emergency management staff informed the three major city regions’ TiBs – officials on call – about the situation. A list was also drawn up of available personnel with suitable training for foreign missions.
The Swedish Rescue Services Agency decided, on commission from the Ministry for Foreign Affairs, to fully activate the Swedish Response Team as a complement to the Ministry for Foreign Affairs personnel already in place. Initially there were 55 people from all cooperating organisations (the Swedish Rescue Services Agency, the National Board of Health and Welfare and the National Police Board), and the SRT was to have its base on Cyprus.

Evacu0ation Work 16 July – 16 August

The evacuation started in earnest on 16 July. Personnel from the Ministry for Foreign Affairs and the Swedish Rescue Services Agency were flown to Aleppo in northern Syria to prepare for the reception for those who would be evacuated by bus. The eight personnel from the assessment team arrived on Cyprus. One of the doctors chose to travel on to Beirut after a request from the Ministry for Foreign Affairs, and arrived there the following day. On the same day as the assessment team arrived on Cyprus, the other parts of the SRT also arrived and the Swedish Rescue Services Agency established its staff on the island with good support from the Cypriot civil defence. Personnel already in place at Aleppo received reinforcements of 11 people from the support team of the Swedish Rescue Services Agency.
The National Board of Health and Welfare had then been put into reinforcement status and the work with recruitment of personnel continued after signals from the Ministry for Foreign Affairs that this would probably be a long-term commission. The National Board of Health and Welfare was responsible for receiving evacuees in Sweden. Västra Götaland Region was given the task of collecting patient information to be forwarded to the correct medical care principal and to plan for possible secondary transportation.
Region Skåne, Stockholm County Council and Västra Götaland Region strengthened their disaster management organisations and prepared to mobilise personnel for the Swedish Response Team (SRT). In close cooperation with each municipality (Svedala, Sigtuna and Härryda), reception at the three major airports was also prepared. From Tuesday 18 July, work was concentrated on evacuating Swedes by ship to Cyprus, but many people travelled independently to Damascus in Syria.
All Swedes who were evacuated to Damascus and Cyprus continued to Sweden using either regular or chartered flights. On Monday 17 July the first flight with evacuees landed at Arlanda airport. Starting with the second chartered aircraft, most aircraft were provided with medical personnel mainly from the Swedish National Air Medevac (SNAM).
The last meeting of the emergency group was held on 31 July, the same day that the final chartered aircraft took off from Cyprus. Subsequently all work was carried out within the ordinary operations of the Ministry for Foreign Affairs, and on 16 August the evacuation work was completely finished.

Evacuation Work in Place

The central staff of the SRT was established on Cyprus, where the majority of evacuees arrived by ship before they were flown home to Sweden. Personnel from the SRT, from the Ministry for Foreign Affairs and embassy employees were also on the ground in Aleppo and Damascus in Syria, Mersin in Turkey and in Beirut.
Initially it was the person appointed medical care coordinator by the medical personnel on Cyprus who was given the commission of coordinating all actions to be taken. When operations expanded, a common decision was taken that the medical care coordinator on Cyprus would also be responsible for Lebanon and Cyprus, while operations in Turkey and Syria would be coordinated by the National Board of Health and Welfare in Stockholm.

Lebanon

On Thursday 13 July a Ministry for Foreign Affairs official, who was on holiday in Lebanon during the initial stages of the crisis, took over the management of the consulate-general in Beirut. Thanks to this, work in organising the first evacuation transportation started at an early stage.
On Sunday 16 July the evacuation by bus was started that came to transport a total of about 1,100 people out of Lebanon. Most of them were evacuated during the first day.
On Monday 17 July about 15 people came from Sweden as reinforcements. The doctor from the assessment team who had initially been sent to Cyprus, but after a strong request from the Ministry for Foreign Affairs had chosen to travel on to Beirut, arrived there on Monday and stayed there on commission of the National Board of Health and Welfare.
From Tuesday 18 July evacuation took place mainly by sea and primarily to Cyprus; evacuation by road to Syria continued but to a lesser degree than during the first days as the buses were needed instead for transportation from hotels to the harbour in Beirut.
The doctor’s presence in Beirut was perceived as extremely valuable, even though the number of medical measures was limited. Through his presence alone, the doctor had a calming effect on those who were fleeing the country as well as the team working with the evacuation. In addition, the doctor could deal with the medical and psychological problems that were difficult for others to assess, and could also make a medical assessment of whether patients could undertake a long and strenuous journey.
On 25 July, after ten days of intensive work, almost 7,500 people had been successfully evacuated, which was the majority of those who wished to receive help in getting to Sweden.

Syria

Initially the only road out of Lebanon was through Syria. Since the major roads from Beirut to Damascus had been bombed, the alternative was to transport evacuees by road to Aleppo and from there to fly home to Sweden. After Sunday, the road to Damascus was opened again so that evacuation work could be organised using that route instead.

Aleppo

On Sunday 16 July, personnel were flown from the Ministry for Foreign Affairs and the Swedish Rescue Services Agency to Aleppo. During the first 24 hours approximately 750 evacuees left on chartered buses, in addition to those who had been able to leave Lebanon by their own means. After Tuesday 18 July there were certainly some evacuees that continued to go to Aleppo, but considerably fewer than previously. For that reason some of the personnel were moved to Damascus, where more people started to arrive after the road to there was once again passable.

Damascus

During the first days of the evacuation, work was carried out with meager resources. Embassy personnel had to work hard and a large part of their time was spent drawing up manifests and helping people with their passport documents.
On Wednesday 19 July badly needed reinforcements arrived from Aleppo. After 23 July Damascus was almost completely empty of Swedes, but evacuation work continued with registration, passport controls, transportation help and so on. Fewer people needed help now and the situation was more manageable. After 26 July, manning levels were gradually decreased and on Monday 7 August the last medical personnel went home.

Cyprus

On Sunday 16 July the Swedish Rescue Services Agency assessment team, together with people from the Ministry for Foreign Affairs, flew to Cyprus to prepare the evacuation from Lebanon. They also made an assessment on whether there was a need for reinforcements. Soon afterwards the other parts of the SRT arrived on Cyprus. The majority of evacuees travelled via Cyprus and then flew onward to Sweden. At most, the staff had over 40 personnel at their disposal and received good support from the Cypriot civil defence, which lent them small but functional premises for their work.
After Monday 17 July the Swedish personnel were responsible for coordinating the reception of other EU countries’ citizens, since the Swedish personnel were first in place in Larnaca.
The need for medical care was small but various kinds of medical assessments were required the whole time.
On the night of 19 July a huge number of evacuees started arriving on Cyprus, and during the next 72 hours the figure reached about 4,000.
On Wednesday 19 July air transportation from Larnaca to Sweden started up. During the time period 19–23 July, more than 20 flights were made from Larnaca to Sweden, mostly to Arlanda, but also to Landvetter and Malmö. The work in receiving the evacuees in the harbours, transporting them between harbours, assembly points and airports and then organising all the flights home from the airports continued virtually non-stop during these days.
On Friday 21 July more than 1,000 Swedes were evacuated in 24 hours. The situation was particularly chaotic at the airport, where the personnel force at one point consisted of four to five people who were dealing with 750 frustrated Swedes, along with all the others who were there at the same time. Reinforcements arrived in due course in the form of Swedish police, Ministry for Foreign Affairs officials, people from the church and others from the staff unit.
Also after 23 July evacuees continued to arrive on Cyprus, but not in the same numbers as previously. In the night before Tuesday 25 July two aircraft took off with evacuees, this time from Pafos, and on Tuesday evening two aircraft left with Swedes from there. After that there were a few isolated flights home to Sweden from Cyprus every day, and the operation was then gradually scaled down.

Flights to Sweden

Already on Monday 17 July the first planes with evacuees arrived at Arlanda airport. On Tuesday 18 July the staff of the Swedish National Board of Health and Welfare heard that there were cases of illness among the evacuees onboard the aircraft. For this reason the evacuation aircraft were backed up with medical personnel from SNAM (Swedish National Air Medevac). Västerbotten county council was responsible for medical staff specially trained for aviation situations being present on aircraft returning home. Medical staff from SNAM manned 24 of the 53 aircraft chartered by the Ministry for Foreign Affairs. Medical personnel were present on a further ten aircraft, partly personnel from Region Skåne, and partly medical personnel who were on the way home from the SRT.
The medical measures that arose consisted mainly of giving painkilling tablets, in a few cases tranquillizers, inhalers for anti-asthma medicine, intravenous drips and analgesic injections.
The aeromedical measures were led by command and control groups at Arlanda airport and in Umeå.

 

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Year: 2008
Article number: 2008-126-44
Format: POD
Pages: 87
Language: Engelska
Price (VAT included): 76 kr

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