Michael VanRooyen interviewing Darfuri refugees at Kashuni Camp, Chad in 2005.

Michael VanRooyen interviewing Darfuri refugees at Kashuni Camp, Chad in 2005.

When humanitarian aid workers go to an area devastated by war, disease, or natural disaster, they put their own lives in danger. But in recent decades, the risks they face have grown: The leading cause of death for medical humanitarians and other aid workers used to be traffic accidents. Today it’s violent attacks. Now the doctor behind the Harvard Humanitarian Initiative is sounding the alarm. He says our modern age of terror has threatened the principle of neutrality at the heart of humanitarian work, and that formalized training is more essential than ever for those providing aid to people caught in complex conflicts worldwide. Dr. Michael VanRooyen discusses this urgent moment for what he calls “the world’s emergency room”.


  • Dr. Michael VanRooyen Co-founder and director, Harvard Humanitarian Initiative; professor, Harvard Medical School and Harvard School of Public Health; chairman of emergency medicine, Brigham and Women's Hospital, Boston

Read An Excerpt

2016 Michael VanRooyen
Published with permission from St. Martin’s Press


The World's Emergency Room

Photos From The Book


  • 11:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The field of humanitarian aid faces a combination of profound challenges today, lengthy violent conflicts, frequent natural disasters and huge numbers of refugees seeking safety. That's according to a new report from experts who say it's time to build a humanitarian assistance system to meet the challenges of our modern era. Dr. Michael Vanrooyen, director of the Harvard Humanitarian Initiative, has, himself, cared for the wounded all over the world.

  • 11:07:35

    MS. DIANE REHMHe believes formalizing humanitarian aid as a profession is one way to insure help for those suffering due to terror, disaster and disease and to protect aid workers on the front lines. His new book is titled "The World's Emergency Room." He joins me in the studio. I do invite you to, as always, be part of the program. Give us a call, 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or Twitter. And welcome, sir.

  • 11:08:16

    DR. MICHAEL VANROOYENGood morning, Diane. It's a pleasure to be here. I'm a big fan.

  • 11:08:19

    REHMThank you, thank you. Dr. Vanrooyen, it seems to me that the kind of work you do in humanitarian aid has always been dangerous, but somehow it's gotten much, much more so. Talk about why.

  • 11:08:40

    VANROOYENWell, indeed, it has become more dangerous. In the early era of humanitarian aid, there was a sense of neutrality of aid workers so when an aid worker presented themselves in a conflict or a disaster, they were seen as helping the community. But over the last 20 years and certainly in the last 10 years, those aid workers have sort of lost their perception of neutrality and as such, they've become targets so they work in more dangerous environments. There's more of them and there's more likelihood that aid workers will be killed, attacked, abducted compared to years before.

  • 11:09:19

    REHMYou talk about, in your book "The World's Emergency Room," you talk about September 11 being a real turning point.

  • 11:09:32

    VANROOYENIndeed. And even before that time, aid workers were increasingly allowed in more dangerous settings so as the Cold War dissolved, aid workers were increasingly seen as a way to intervene without military intervention.

  • 11:09:52


  • 11:09:52

    VANROOYENAnd so they were increasingly in dangerous positions, like Somalia and Rwanda and all throughout the Middle East, et cetera. After 9/11, there was a bit of a sea change and that sea change was that any Western worker was seen as sort of part and parcel of the U.S. and the Western response to kind of geopolitics.

  • 11:10:16

    REHMBut has the U.S. been the primary source of aid workers in that regard?

  • 11:10:27

    VANROOYENWell, actually, that's changed a lot, too. Certainly, the U.S. has had significant participation in the aid world and has been a significant funder. Many of the big aid agencies that we know, C.A.R.E., Save The Children, Oxfam and others, have large U.S. bases and draw from Western European sources as well. But increasingly over the past years, we've seen many more national aid workers. In other words, because these environments are non permissive, they're difficult to work in, there are more aid workers that are actually national staff.

  • 11:11:01

    VANROOYENSo if you look at Syria today, for example, most of the aid workers are actually Syrian or from the Middle East and not necessarily from the U.S.

  • 11:11:09

    REHMI think of Doctors Without Borders. Now, have those been multinational groups that have been willing to go in and are now saying, we may not go into this particular region because it's too dangerous now?

  • 11:11:29

    VANROOYENThat's always been the calculus for many of those organizations. MSF is a premier non government organization that accesses some of the most difficult environments and increasingly, they have to judge whether they can be in a place because of the safety or threats to the safety of their staff and increasingly, they have to work through remotely, as it were, remotely through other organizations that can actually assist them. So many organizations, again, like C.A.R.E and Save and Oxfam and others, have to work with local counterparts in order to gain access to communities.

  • 11:12:03

    REHMAnd what kind of protection are those doctors guaranteed, if any?

  • 11:12:10

    VANROOYENYou know, that's interesting. The protection of an aid worker really revolves around the community. In other words, you can't get security of an aid worker by a gun or by guards or by protection with military forces. Actually, that undermines their security.

  • 11:12:28


  • 11:12:28

    VANROOYENYeah. What really creates security for an aid worker is actually the degree to which the community has adopted them and keeps them safe and understands that they are there for appropriate reasons and are neutral. So if that becomes eroded or undermined, then aid workers are in grave threat.

  • 11:12:49

    REHMWhy do you do what you do?

  • 11:12:54

    VANROOYENYou know, I've always been drawn to the issues that face the most needy. So in other words, people that need a safety net. It's why I became an emergency physician because it seemed to be the most basic form of creating a social safety net, at least at home. And in the humanitarian aid environment, it seemed to be that there were many global developmental needs. There's a huge global development agenda. But the most stressed populations, the people that needed it the most, the people that needed the most acute care, whether it's medical or even public healthcare, are those that are struggling under conflict, war and disaster.

  • 11:13:34

    REHMWhat about your parents and the manner in which their lives perhaps influenced yours?

  • 11:13:41

    VANROOYENYeah. I mean, I talk about that in the work because -- or in the book, I'm sorry, because it is, I guess, has a lot to do with it. My father was a concentration camp survivor and was imprisoned for many years in a concentration camp and was liberated immediately after World War II.

  • 11:14:00

    REHMIn Nazi Germany.

  • 11:14:01

    VANROOYENIn Nazi Germany. He was in a refugee -- or eventually in the death camp in Bergen-Belsen and he immigrated to the United States. And even in the early years when he didn't talk about it much, we talked about his sort of global view and his view of war and conflict and vulnerability and it really lead me to, I guess, develop a world view.

  • 11:14:23

    REHMAnd what about your mother?

  • 11:14:26

    VANROOYENWell, my mother died young so she died when I was just 8 years old of melanoma and she affected really my interest in the domestic healthcare system because as she was struggling with cancer, I was a little kid and didn't understand much of anything. And I saw her struggling and my father struggling with the healthcare system and accessing it. And as she got sicker and sicker, I became kind of more part of hospital life, as it were. So I saw the way the healthcare worked a little bit and I guess I became interested because of that.

  • 11:15:04

    REHMSo what was your first experience outside this country?

  • 11:15:13

    VANROOYENThe first was actually to follow a mentor of mine named Charlie Clements who'd worked in El Salvador during the war and as I traced his steps, essentially, and went to El Salvador during the civil war because I wanted to understand the effect of war on just the population. And this was as a medical student so I didn't really understand much about the effect of the conflict on civilian populations, the threat that it caused or the insecurity that it caused a society. So I worked in El Salvador for a little bit.

  • 11:15:45

    VANROOYENAnd then, secondly, and probably most foundationally, I worked in Somalia after I was a physician and that one really galvanized my interest in working in conflict areas with vulnerable populations.

  • 11:15:58

    REHMThat was at the time of Black Hawk Down?

  • 11:16:01

    VANROOYENRight. It was right around the time and just before the era of Black Hawk Down when, you know, in Somalia, you could see this erosion of neutrality before our eyes. We arrived as -- and I would say, me in particular -- as a naive humanitarian seeking to work in this really difficult, hostile, tough environment.

  • 11:16:20

    REHMOh, boy, yeah.

  • 11:16:20

    VANROOYENIt was tough. And still being accepted by the community, but part of something that was a lot more sort of dynamic and changing all the time. And with the arrival of U.S. and multinational forces in Somalia, our identity as humanitarians changed nearly overnight and we were seen as part of that and part of that Western wave and therefore became increasingly under threat.

  • 11:16:47

    REHMAnd therefore, totally mistrusted. How could you do that work in that kind of atmosphere?

  • 11:16:54

    VANROOYENIncreasingly, it became what we say, non permissive. In other words, at first, NGOs, non government organizations, and UN agencies had a sort of, oh, I guess a relationship with security forces and clans in Somalia to be able to get where we needed to go to distribute food and it was imperfect and corrupt and somewhat dangerous, but once the U.S. military came, it changed the complexion of that relationship. So it was no longer safe to go anywhere and most organizations had to fairly abruptly leave, particularly the Black Hawk Down era.

  • 11:17:30

    REHMMichael Vanrooyen. He's director of the Harvard Humanitarian Initiative. He's chair of Emergency Medicine at Brigham and Women's Hospital on Boston. His new book is titled, "The World's Emergency Room." Short break here. Your calls, comments when we come back. Stay with us.

  • 11:20:01

    REHMWelcome back. Michael VanRooyen is my guest. He's director of the Harvard Humanitarian Initiative, chair of emergency medicine at Brigham and Women's Hospital in Boston and author of a new book, "The World's Emergency Room: The Growing Threat to Doctors, Nurses and Humanitarian Workers." Before the break, Dr. VanRooyen, you were talking about your experiences in El Salvador and Somalia. Many people are wondering about legal protection, worldwide legal protection, and you go back to the Geneva Convention of 1864, but now advancing, you know, 75 years, 100 years, 200 years, talking about what's happening in Syria and the total lack of any legal protection.

  • 11:21:19

    VANROOYENIndeed. I mean, the protection for civilians the protection for aid workers comes essentially from the same Geneva Conventions and additional protocols of 1977. And that is our -- the foundation for the protection under humanitarian law. That being the case, there is little respect for international humanitarian law in places like Syria and conflicted areas and Islamic State-affected areas. Increasingly, kind of on the other side of it, that aid workers and health care workers are being seen as part and party to the conflict. They're being attacked directly. Hospitals are being attacked directly, and aid workers are being obstructed from managing the health of populations actively.

  • 11:22:11

    REHMHow do they protect themselves? How do they live?

  • 11:22:14

    VANROOYENIt is very interesting in that aid organizations have to use sort of two levels of protection. One is negotiated access, say, from the UN or UN bodies as they negotiate access on a larger scale, with combatants or armed actors. And then many times, actually, aid workers have to individually negotiate access. Right, they have to know how to talk to militia, how to talk to combatants, how to stand at the doorway of their hospital and negotiate how to keep that a civilian institution, for example.

  • 11:22:51

    VANROOYENSo much of diplomacy and much of the, I guess, articulation of humanitarian law is done on the ground and by individuals who work for aid agencies to assure their neutrality.

  • 11:23:05

    REHMAnd give me an idea of how in a conflict zone like Syria or Somalia, that you find a place of safety to live. Give me an idea of the conditions under which you might sort of have time on your own.

  • 11:23:29

    VANROOYENDepending on the location, it is again really dependent on the adoption of you and your organization by the local community. So you can have a compound where you live and work, and you park your vehicles, and you are behind gates, and there are guards, but at the end that is never sufficient to ensure the security of your team and your staff because you're going out on the road and on the streets and managing groups of people and getting access to populations all the time and without arms and without protection otherwise.

  • 11:24:06

    VANROOYENYour protection is actually the identity of your organization, the perceived neutrality of you as an NGO or a UN worker and the degree to which the community supports your work.

  • 11:24:19

    REHMYou write about your experiences in Bosnia. Tell us about that.

  • 11:24:25

    VANROOYENBosnia was fortunate to work in an enclave, a Croatian enclave. So I came in with armored personnel carrier -- through an armored personnel carrier into a Croatian-held enclave of about 60,000 people that was surrounded in all sides by Muslim forces. And there was no easy way in or out, and I got there through an escort from the UN. In this hospital, called the Nova Bila Hospital for the War Wounded, it was actually a church, and the church was converted to a hospital, and planking was placed over the sides so that snipers couldn't shoot inside the sanctuary.

  • 11:25:04

    VANROOYENIt was a unique facility because it operated to sort of care for the individuals in the enclave, as well as any other war wounded. So it was a struggle for that institution and that hospital to I guess be perceived as neutral. So it was a civilian facility that also had to take care of war wounded, as well.

  • 11:25:25

    REHMHow many personnel were there with you operating in that way?

  • 11:25:29

    VANROOYENSo I added on to the real dedicated Croatian staff, who lived and worked there, and I was, you know, a brief part of their life, and they really were the heroes of this conflict, at least to this community. And there were probably eight physicians, probably two dozen nurse, and they cared for 150 or more patients at any given time. And those patients were those people who were shot and wounded or injured by snipers but also sort of people that didn't have access to any form of health care, who had pneumonia and who had other medical problems. So they were the health care for the community.

  • 11:26:13

    REHMYou write in the book about a very important turning point for you when you started out in the field. It was in Somalia. Tell us about that.

  • 11:26:28

    VANROOYENSo it was, Diane, a really interesting turning point for me because it -- it was a moment that I realized how naïve I was, I suppose. So as I was a young physician, emergency physician, and I started working in the relief environment, I was in a refugee camp just within Mogadishu, so it was a crowded, urban area, and there were encampments all over the place and these tents full of blue, UN sheeting and burlap.

  • 11:26:54

    VANROOYENAnd I was doing essentially a scabies clinic and a clinic to sort of measure for malnutrition. So we had a lineup of kids that were getting measured, and the atmosphere was almost fun because there was -- these kids were all lined up, and we were trying to...

  • 11:27:07

    REHMHow old were these children?

  • 11:27:11

    VANROOYENYou know, they were anywhere from two to 10 or 11 or so. We were trying to measure rates of malnutrition. And I noticed one child who was clearly far worse than the others. She was probably six, although she looked like a toddler. She had a big, bloated belly and puffy arms, and her hair was crackling and brittle and red, and she suffered from, you know, severe protein malnutrition and vitamin malnutrition.

  • 11:27:41

    VANROOYENAnd so she needed actually real therapeutic feeding and need to go to a center for therapeutic feeding. So I asked where her mother was, and nobody answered, and I asked, you know, who -- where's her mother, and they said that she's an orphan, through a translator said she's an orphan, and nobody takes care of her. I said, well, somebody must take of this child. Here's a child in your village, in your camp. And one of the women shrugged and said nobody took care of her.

  • 11:28:09

    VANROOYENAnd I got a bit indignant. I said, you know, how can nobody take care of a child that is here in this camp. And the Somali woman grabbed my sleeve, and Somali women are, you know, they're tough, they're brightly colored hijab, and they're beautiful, and they're really tough, though. And she grabbed me by the arm and pulled me along through the areas of where the refugee camp is, and she pointed to her tent, which was no more than probably five by five and a little sort of burlap hut, and she pulled back the opening and pointed.

  • 11:28:43

    VANROOYENAnd she showed me that she had three kids in there and a small bag of rice and a few pots, and her kids were coughing and skinny, and she just raised her palms in sort of a gesture of helplessness. And I realized that I had no business questioning her motives, I had no idea what I was doing, and I, you know, could always retreat. I had a passport, and I could leave anytime I wanted to, right. But she was making the sort of most terrible of all choices, to care for her own children and to leave this other kid outside of her tent.

  • 11:29:17

    VANROOYENAnd so I was humbled and embarrassed, and I felt that I really needed to learn the field better. I was committed to it, but I needed to go and learn more about Somalia, know more about the aid world and know more about how to do it better. I was convinced that I didn't know what I was doing. I was pretty convinced that a lot of the aid world didn't know what it was doing. And so I wanted to learn more about it and make it a profession.

  • 11:29:43

    REHMDo you have any idea what happened to that young child?

  • 11:29:50

    VANROOYENWe brought her to an ICRC camp for therapeutic feeding. So she was admitted to the hospital, and we brought her to a hospital. I don't know what happened to her afterwards in Somalia.

  • 11:30:02

    REHMBut at least she did get some care.

  • 11:30:04

    VANROOYENShe did indeed, and the ICRC had a really terrific facility to help kids like this.

  • 11:30:12

    REHMAll right, here is an email from Alan in Virginia. He says, humanitarian aid workers need to be non-political. If they are not, if they take sides as these days they often do, they make targets of themselves. Recent events with MSF make that abundantly clear. They need to resist taking sides.

  • 11:30:44

    VANROOYENAlan's point is a good one, and it is fundamental to the philosophies as they relate to aid workers. The split of MSF after Biafra occurred because ICRC, the International Committee of the Red Cross, was observing crimes and war crimes but was silent in order to gain access, essentially. MSF made that split because they wanted to witness and to call attention to the world of what was going on in Biafra and in other conflicts.

  • 11:31:21

    VANROOYENSo that fundamental split exists. How do you maintain access and neutrality and at the same time speak out when you see horrific abuses? So it's -- that question is a key to a fundamental I guess debate that still goes on in the aid community. How do you...

  • 11:31:41

    REHMBut that's got to be part of the training, as well, I would think.

  • 11:31:45

    VANROOYENIt is, and fundamental to the aid worker, every aid worker, every professional aid workers, is the notion of neutrality and independence and impartiality and the notion that we have to stay neutral. That is not always possible, especially when we're sort of lumped with military efforts or other efforts.

  • 11:32:09

    REHMI think of the sighting of Osama bin Laden and the identification of his location by individuals who purported to inoculate individuals within that region. Did that charade, as it were, hurt the cause of aid workers and their ability to move freely?

  • 11:32:47

    VANROOYENDiane, it did, and that sham vaccination campaign to seek and to try to locate Osama bin Laden in the era leading up to his assassination damaged the sense of neutrality of aid workers significantly because it -- once it was noted that a physician was posing as a vaccinator and was actually working for the CIA, there were -- was an escalation of attacks on all manner of aid workers, in particular vaccination workers. So women vaccinators in Pakistan and all around the Middle East were being targeted and killed, execution-style, because they were simply giving immunizations. So that was a real step back in the sort of battle for understanding the neutrality of aid workers.

  • 11:33:43

    REHMAnd you're listening to the Diane Rehm Show. Before we open the phones, Dr. VanRooyen, I'd like to know how, given the experiences you have abroad, how do you come back, how do you reintegrate yourself with family, with friends, with colleagues? I mean, in your mind in your heart, I would think these images of these children, of these human beings who are suffering through war, must be pretty indelible.

  • 11:34:25

    VANROOYENYeah, and indeed it is, and I wanted to personalize that aspect when I wrote the book, to talk a little bit about how that is, because I have a lot of colleagues that are aid workers and come back and have to struggle with sort of reintegration and kind of making sense of what they've seen. And I couple things really helped me to do that. one is diving right back into my field in emergency medicine, which in and of itself is an intense field.

  • 11:34:52

    REHMOf course.

  • 11:34:54

    VANROOYENAnd -- but the -- in emergency medicine and even in the aid world, part of the thing that actually helped me was the sense that I was doing something, that I could do something instead of being helpless. So the idea that I was actually there and being able to do something, however small and in my limited way, actually gave me some, I guess, satisfaction. And then secondly, it was important for me to have ways of kind of processing it, right, and so having family members and friends and colleagues I could talk to is one thing.

  • 11:35:27

    VANROOYENWhat helped me a lot, actually, is teaching. So when I took a -- started teaching classes in humanitarian aid at School of Public Health, or at -- now I teach one at Harvard for the undergrads, telling those stories actually kind of helps you process it. You know, you look at ways to look at the background and how your experience was something that was bigger, and you talk about it, and it allowed me to make sense of the experiences I was having.

  • 11:35:56

    REHMGive me an example of one of the stories you tell.

  • 11:36:01

    VANROOYENWell, I'll give you an example of one way that I involved my students that I thought was really interesting. So I was back and forth in the Balkans quite a lot during -- in Bosnia and then eventually in Kosovo during the Kosovo crisis. There was a large movement of the Kosovar refugees into Albania, and I was called to go design a refugee camp. And the refugee camp was essentially to look at designing health care services for a large, new refugee population.

  • 11:36:32

    VANROOYENI was teaching a class at the time, and so I had to leave within 72 hours and ditch my class and get somebody else to cover it, but I had my students actually design it with me. So I brought all of my students together, and I said, look, this is -- you know, you can either write a paper for the class, or you can help me design a real refugee health center. And all of them did. We worked late into the night, kind of three days, and we designed this sort of health care system, really looking at the specific needs that those populations would face.

  • 11:37:03

    VANROOYENAnd I've got to tell you, it was really fun to go into Kosovo to design this refugee health program and almost...

  • 11:37:11

    REHMThat the students and you had created together.

  • 11:37:15

    VANROOYENAnd they did it in a way where they looked at the expected mortality and the expected problems that would specifically face those refugees, and they did I think a tremendous job. So it was really interesting.

  • 11:37:27

    REHMAnd we will take a short break here. When we come back, we'll open the phones. You'll have your chance. Stay with us.

  • 11:40:01

    REHMAnd welcome back. Time to open the phones for Michael VanRooyen. His new book is titled, "The World's Emergency Room: The Growing Threat to Doctors, Nurses and Humanitarian Workers." First let's go to Meghan, in Gainesville, Fla. You're on the air, Meghan. Go right ahead.

  • 11:40:28

    MEGHANHello. Thank you so much for taking my call.

  • 11:40:30


  • 11:40:32

    MEGHANI was actually just very curious. As a new nurse I have a great desire to do health -- world health medicine. And I was wondering what would be the best way for me to get started in that.

  • 11:40:50

    VANROOYENHi, Meghan. You know, there's a tremendous growth in the number of people that want to do global health work and humanitarian work. And there are increasing number of outlets for it. So I think the system itself is set up to help people who have a clinical skill like you do, to apply those skills to the field. Certainly in the humanitarian world there's a lot of constraints, especially in areas where there's conflict and war and sort of instability. The environments are really constricted and difficult for a Western aid worker to work.

  • 11:41:27

    VANROOYENBut for your interest in global health one of the best ways is to just get started and then look for organizations that you can actually explore the field. And then find out specifically where you want to go. There's many different paths. So good on you. I'm glad you're looking.

  • 11:41:44

    REHMWhat would be a good organization for her to apply to?

  • 11:41:51

    VANROOYENSo there are many of the traditional non-government organizations, like, again, Oxfam, Save The Children, Doctors Without Borders, etcetera. Some require a longer term commitment for clinical work.

  • 11:42:01

    REHMI see.

  • 11:42:03

    VANROOYENSome need clinicians and some don't. But there are many, many other organizations that help encourage placement of people abroad as well. When you think about it there are many hospitals, many health centers, many institutions that would love to have a foreign medical person or somebody from the United States to assist. Certainly there's some licensing challenges and other things. So I would not be discouraged by it. It'll take a while to navigate it 'cause there's no real clear path. But if you keep persisting, you'll find your way.

  • 11:42:38

    REHMAll right. Let's go to Cleveland Heights, Ohio. Kris, you're on the air.

  • 11:42:43

    KRISThank you. Let's see, Population Services International, have you heard of it and what is it, actually? Is it a for-profit or a not-for-profit?

  • 11:42:57

    VANROOYENYou know, I've heard of Population Services International, but I don't know much about the organization, I got to admit. I imagine they probably do a larger developmental activity and not so much working in the relief environment.

  • 11:43:11

    KRISThe reason I ask is that my youngest son works for them, first in Somaliland and now in Kenya. And he's very close-mouthed and I haven't been able to learn very much about it at all.

  • 11:43:23

    VANROOYENWell, you know, he's working in some really interesting areas, I got to say. Because Somaliland and Kenya, in particular, suffer from sort of the effect of having big population movements around them. So these are places where a lot of refugees find their -- to be their destination. And so those countries and those regions in particular are groaning under the burden of increasing burden of refugees. So he's in an interesting area.

  • 11:43:56

    REHMAll right. Here's an email from Alaina. She said, "I'd like Dr. VanRooyen to talk more about the clash of opposite world views in his work. One, that human life is precious, and the other, that human life is expendable. What communication work does he find himself doing to advance his work in the field?"

  • 11:44:29

    VANROOYENWow, well, interesting question. And I wouldn't say that there's probably a world view that human life is expendable, so much.

  • 11:44:36

    REHMSometimes it sounds that way, especially when you hear about what's happening in Syria.

  • 11:44:44

    VANROOYENTruly, I mean, I think that there are forces that certainly show us that human life is expendable. And some of the policy decisions we are making indicate that civilians don't have much of a sort of place in the calculus of what our plans are. I would say that the -- there is a bit of a tension between the utilitarian argument or the argument of how to get help to the most people appropriately, regardless of being sort of individual care.

  • 11:45:18

    VANROOYENAnd that's kind of a public health approach, compared to the individual medical approach of caring for an individual and leveraging resources for an individual. And that's a tension that physician and public health workers that do both sometimes have how to invest into -- in larger public health efforts that can serve a larger population, but not necessarily be attentive to an individual versus individual medical care. And it's a tension that we often have.

  • 11:45:46

    REHMHere's a tweet from Calliope, who says she's curious about your thoughts on Americans trying to solve these problems abroad, rather than focusing on the great diverse needs here in the U.S.

  • 11:46:04

    VANROOYENThis is a question that I get and think about all the time. And that is the degree to which we're investing in foreign problems and solving foreign problems when we have certainly plenty of domestic problems in the United States with our erosion of our cities, our educational system, our approach to Native American health and many other issues. And I've worked in cities and in Native America health quite a lot.

  • 11:46:32

    VANROOYENAnd I would say it shouldn't be either or. We are a citizen of our country, just like we are a citizen of the world. I think that we have, both for the sake of our own ethical principles, as well as the sake of creating a better world, invest locally and globally.

  • 11:46:53

    REHMTell me about your experiences as an emergency room doctor. How did they compare with what you see out in the field?

  • 11:47:06

    VANROOYENI'll hesitate to compare inner-city emergency medicine to a war zone. Because the intent is not to compare the two. It's actually very different. And the needs and demands are quite different. But the overriding premise is a little bit the same, and that is that as an emergency physician and in emergency medicine, we are that 24/7 safety net for the community. So that when bad things happen to people, when heart attacks and strokes and trauma and gunshot wounds and all of that happen to people, the emergency department stands ready to help those people.

  • 11:47:40

    VANROOYENI sort of feel that the humanitarian aid world is that to global health. In other words, it's not the stuff that will sustain and develop countries. It's not the thing that will actually help increase and improve economy so much. It is a safety net to provide emergency humanitarian aid to stabilize a population and keep them from experiencing severe morbidity and mortality. So in that respect, domestic emergency medicine is the safety net for the United States, and humanitarian assistance is a safety net for the world.

  • 11:48:15

    REHMAnd considering the kinds of dangers that these humanitarian aid workers are confronting, do you see an increase in interest in serving abroad or a diminishment?

  • 11:48:34

    VANROOYENIn the last 10 years even, Diane, I've seen this massive increase in the number of students, like our prior caller for example, and young professionals that want to have a global impact. They are less impressed with what they can buy and more impressed and, you know, I appreciate that, with what they can contribute and what they can do. So there are many more people that want to work in the humanitarian sphere and in the global health sphere, which I think is tremendous.

  • 11:49:08

    VANROOYENI think the thing that I believe we should do is make it a professional pathway. In other words, get these people so that they understand what it is to serve abroad, and particularly in my field, what it is to serve in an humanitarian environment. Bring them along and apprentice them into the field responsibly, so that we build a field of professionals that can actually understand the context in which they're working.

  • 11:49:33

    REHMSo that is what your Harvard initiative is all about.

  • 11:49:38

    VANROOYENIndeed. It's essentially a humanitarian university. And the idea is that we, very much like a school or university, we are not -- we're not a non-government organization. We work with many non-government organizations, like Doctors without Borders and Save and Oxfam and CARE, but we're a place where you do research and translate it to the field. We're a place where we train undergraduates and graduates students an PhDs and bring them as leaders into the field.

  • 11:50:07

    VANROOYENAnd then we take people from the field back and re-educate them as well. So we have a lot of engagement. It's very practical. And it is really trying to build humanitarian assistance as its own unique discipline.

  • 11:50:20

    REHMAnd helping them along the way to understand the differences that they may encounter in the kinds of cultures that they're encountering.

  • 11:50:34

    VANROOYENIndeed. Cultural literacy and the understanding that you'll work in a very different culture, not just linguistically or culturally, but also in a culture that has been affected so much by conflict, for example and by insecurity. It's something that you -- is trainable. It's not something that you just have and can show up and think -- you think that you know. Very much like my appearance in Somalia. I was naïve and I didn't understand the context. I want to be able to build that contest in future humanitarian aid workers.

  • 11:51:08

    REHMHere's an email from Dane, in Roanoke, Va. He says, "Please comment on aid issues involving the latest Ebola outbreak, in particular the killing of aid workers by a mob incited by tribal leaders."

  • 11:51:32

    VANROOYENThe Ebola crisis was a fascinating new challenge to the aid world because it fell in a place that was really uncomfortable for most aid organizations. Many aid organizations are used to sending large groups of aid workers, hiring people, getting a logistic structure involved. But very few aid organizations -- and Doctors Without Borders and Samaritan's Purse were probably the only two for a while that really understood how to manage this really complex medical environment, the real, really complex infection-control environment.

  • 11:52:09

    VANROOYENI mean, Ebola was killing health care workers and it was really scary. And it was a difficult time for the aid world. And so we can say all we want about mobilizing health care workers to work in Liberia, Sierra Leone and Guinea. But the fact is that it wasn't safe to do so. And so to establish that mechanism for safety, took a lot of doing and a lot of activity and a lot of, sort of, will among a few non-government organizations.

  • 11:52:35

    VANROOYENThe other part that the caller's eluding to is the communication strategy. Ebola was as much a public health emergency and a medical emergency, as it was a communication emergency. And that is the way that aid agencies were able to communicate public health messaging, how to bury your dead appropriately, how to do it in an appropriate fashion, how to reduce fear, how to seek medical care, instead of staying away from it, when you become ill.

  • 11:53:02

    VANROOYENSo the communication issues around Ebola were huge and needed to be addressed. And, you know, the breakdown of that communication resulted in a mob attacking aid workers who were there to help them.

  • 11:53:16

    REHMWow. And you're listening to "The Diane Rehm Show." Was it the entire community that attacked these aid workers?

  • 11:53:29

    VANROOYENNo. And I think it was a rare thing. I think that it happened, but it was not a widespread feature of the response. You know, the news focuses on something like that and we see it in the news and we think that maybe that is symbolic of everything that's happening. But the fact is that we had many organizations, many people that were providing incredibly dedicated support, even at their own risk, to communities and helping them adapt to and adopt new public health sort of procedures that are absolutely safe. So I think it was an aberrancy actually.

  • 11:54:06

    REHMAll right. And to Martin, in Alexandria, Va. You're on the air.

  • 11:54:13


  • 11:54:14

    REHMHi. Go right ahead, sir.

  • 11:54:17

    MARTINOh, thank you. I've been waiting a long time…

  • 11:54:19

    REHMI know you have.

  • 11:54:19

    MARTIN…listening and I'm very fascinated because I worked in the Peace Corps a long time ago. And, you know, I originally called about volunteers and, you know, threats to them, but I also understand that there's a lot more going on in the agency to help people help themselves. So I guess my question would be, you know, from an American point of you -- well, I have several questions. As I keep listening I have several questions.

  • 11:54:54

    REHMJust one, please, sir. We're almost out of time.

  • 11:54:58

    MARTINAll right. The American question is, you know, volunteers and others that are Americans were under a certain amount of threat. That's one thing I would address. And the other thing would be how can we engage other people to engage in their own health and benefit?

  • 11:55:23

    VANROOYENGreat. And, Martin, the latter question is of sentinel importance, I think. And that is the change in philosophy in the way that, even in the humanitarian response environment we need to empower local organizations, national structures and local authorities to actually do their own work. Now, this is difficult in places like Syria, where there's been a complete breakdown of sort of civil structures.

  • 11:55:48

    VANROOYENBut in most places that encounter emergencies, whether they're natural disasters or even political emergencies, there are local organizations, local structures, ministries of health that are all seeking to do this work. And there is a pretty large movement in the international humanitarian architecture to actually engage, promote and empower, as well as fund, local organizations to do their own work, their own planning and their preparation. So it's actually a really important question and a new era in humanitarian relief.

  • 11:56:24

    REHMAnd at the same time, one would hope that there would be greater international agreement about how to protect these workers.

  • 11:56:36

    VANROOYENThere is. There's a big movement sponsored or promoted by the International Committee of the Red Cross and other aid organizations to look at health care and danger and how to promote the safety of health care workers and hospitals and ambulances and all kinds of health structures. And that is done on a policy level, but also, as I mentioned, on a local level.

  • 11:56:58

    REHMMichael VanRooyen, his new book is titled, "The World's Emergency Room: The Growing Threat to Doctors, Nurses and Humanitarian Workers." And, Dr. VanRooyen, I certainly want to thank you for the work you do and continue to do.

  • 11:57:19

    VANROOYENWell, Diane, a pleasure to talk to you today.

  • 11:57:21

    REHMThank you. And thanks, all, for listening. I'm Diane Rehm.

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