Sarajevo has many more Irmas: Medical evacuation is a matter of red tape. Jill Rutter calls for it to be cut

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THE BRITISH public has been touched by the generous gesture of the Prime Minister, who cut through red tape and arranged the evacuation of the critically ill Irma Hadzimuratovic. Her case demonstrates that governments can relieve the suffering of Bosnian people if they have the political will do so.

But in Sarajevo today, 41 other adults and children who have been officially approved for medical evacuation lie sick in hospital beds. Patient No 42 died on 6 August. The surviving ones include eight- year-old Denis and 11-year-old Edhem. Denis has a congenital heart defect and his condition is deteriorating. Edhem received shrapnel wounds to his face and arms. His left eye was destroyed, and he requires plastic surgery.

Despite clearing the often complex procedures needed before evacuation, these children have not been given the offer of hospital beds and treatment in host countries. They remain stranded in Sarajevo. In the so-called safe havens of Bosnia many sick children are in the same position. The names of other sick and injured have not even been submitted to the United Nation's medical evacuation committee. These children are quietly dying in the hell of Vitez, Srebenica and Gorazde, without the hope of reaching safety and a well-equipped hospital. As in other conflict-torn regions of the world, such as Afghanistan and Angola, children who could be saved by medical treatment are dying unnecessarily.

Irma's case highlights many issues surrounding the way Western governments treat refugees and victims of conflict. As Irma recovers, maybe our government could reflect on these issues.

The procedure for the medical evacuation of civilians from Bosnia needs to be streamlined. At present in Bosnia, medical evacuations are managed by a joint UN agency committee. A patient's name and medical records can be submitted to a UN agency field office by any doctor. The patient's case is then examined by the UN medical evacuation committee for Bosnia, which will decide whether the patient's case meets certain criteria, namely that his or her life is threatened in the short term and he or she will certainly benefit from evacuation in the long term.

The committee has to decide that there is no local treatment available, and that the patient's condition will not be worsened by a medical evacuation. If a treatment can be organised locally, it has to be argued that the mobilisation of human and material resources for a specific patient would not hamper the treatment of others.

If a patient meets these criteria, UNHCR (for adults) and Unicef (for children) proceed with the logistical arrangements. UN agencies need to consider aspects such as transportation arrangements to Sarajevo airport or a UN airbase, legal authorisation from the Bosnian authorities, transit clearance from any third parties, acceptance of liability from a host government and arrangements for the care of relatives. Negotiations for the safe passage of sick people in a war zone take time.

What takes more time is finding a host country willing to accept a medical evacuee and gaining clearance with government departments in such countries. To be evacuated to Britain, the Home Office and the Department of Health must give permission. Only then can health authorities or hospital trusts be approached to give treatment, and housing be found for relatives. As has happened with Irma's father, it is charities such as the Refugee Council that are usually approached to provide such housing.

There are 17 other armed conflicts that are producing significant numbers of refugees and displaced people. For a sick child in Kabul there is no UN medical evacuation committee, no television crew to publicise the suffering and shame governments into responding. Sick children can usually be treated in the hospitals of neighbouring countries; few need to be transported to Europe. The reality is that most of the world's children who could benefit from medical evacuation are not given the opportunity, and die.

Medical evacuation is always the last resort. More effort should be put into maintaining the supply of medicines and electricity in hospitals in war zones. In Western countries there is a need for better co- ordination of medical evacuation, based on the principle that all countries should be sharing the responsibility for the care of refugees and others affected by conflict. UN medical evacuation committees should be able to remove all the world's sick and injured victims of armed conflicts, and be funded to do so.

Earlier this year, the Danish Presidency of the EC suggested there be a European Refugee Commission. The Danish government proposed that such an EC body would provide for the emergency relief of refugees in their home countries, assist for the settlement of refugees in the EC and act to tackle the root causes of refugee movements: conflict and human rights abuse. Such an organisation would operate on the principle that rich EC countries should share responsibility for supporting refugees. But the tentative Danish proposals were dropped from European political agenda. The Ad Hoc Group on Immigration - the inter-governmental forum for discussing refugee policy - was more concerned with proposals to keep refugees out of the EC.

The Refugee Council believes that Irma's case revives the argument for an EC Refugee Commission. Such a body should be able to respond rapidly to the needs of individuals. It could be given the brief to allocate the evacuation of sick and vulnerable people to EC countries instead of having to wait for 12 individual countries to respond. It could do much to improve housing and education for refugees in many EC countries. It could channel aid more effectively to the vast majority of the world's refugees who remain in the poor countries of Africa and Asia (some 90 per cent of the world's refugees).

Most important, it should act with UN agencies to prevent conflict at source, and ensure that all countries respect human rights. As Peter Kessler, a UNHCR spokesman, said this week: 'If the siege of Sarajevo continues, many of Irma's friends will be injured or killed.'

His message was clear. The world's politicians should act more forcefully to lift the siege of Sarajevo and to promote peace in the region. Prevention is always better than cure, and children such as Irma need peace to grow up healthy and happy. While politicians dither, children in the world's war-torn regions die. John Major has shown he can act with compassion and speed for one child. This magnanimity needs to be extended to support other vulnerable people in Bosnia, Sudan, Afghanistan and many other countries.

The writer works for the information and policy section of the Refugee Council.

(Photograph omitted)