Medical Tourism in Conflict Zones: The Importance of Safety, Communication, and Backup Plans

Medical tourism is a growing industry that offers patients access to medical procedures at competitive prices, often in appealing destinations known for their healthcare expertise. However, some regions known for offering high-quality medical care may also face political instability, military conflict, or sudden insurgencies. For medical tourism facilitators, navigating the risks associated with sending patients to destinations involved in active conflict zones requires a proactive, safety-conscious approach. In these situations, safety, backup planning, and solid communication tools are paramount.

And...the way one of the candidates in the USA is talking... if they don't win the election, they are promising more civil unrest so if you are planning to come to the USA for care, you and your facilitator must be vigilant to watch for signs of problems in fewer than 40 days.

Then there's the entire weather disruption for storms and earthquakes. In the USA, just last week, storm damage means that the minute they declare that the hospital is in the pathway of the storm, elective cases get cancelled and they empty out hospitals and send people elsewhere if needed, or home.

The Risks of Medical Tourism in Conflict Zones

Medical tourism involves not only accessing healthcare in a foreign country but also coordinating travel, lodging, and post-surgical care, often in a region unfamiliar to the patient. When that destination is in the midst of a war or experiencing active military action, the stakes are heightened. Patients are vulnerable during their recovery, and any disruption—such as an attack, insurgency, or sudden closure of borders—can compromise their well-being.

Some risks include:

• Disruption of medical services: Hospitals and clinics may be overwhelmed, shut down, or damaged, limiting access to care.
• Travel risks: Airspace closures, canceled flights, and limited ground transportation can leave patients stranded. Higher security staffing is also quite off putting as a visitor just landing at an airport or railway station.
• Supply shortages: Medical facilities in conflict zones may struggle with supply chain disruptions, affecting the availability of essential medications, equipment, or blood products.
• Security risks: The threat of kidnapping, attacks, or being caught in crossfire is heightened in war-torn areas, which poses a direct threat to patients, caregivers, and staff.

Having worked in Medical Tourism since 1977, I have seen it all, managed through surprise attacks with patients at the destination. It's total chaos. It must be avoided as much as possible.

Backup Strategy: A Necessity for Facilitators

As a medical tourism facilitator, having a reliable backup strategy is essential when dealing with destinations prone to or actively engaged in conflict. This plan should not only focus on the safety of the patient but also ensure continuity of care in case the original destination becomes unsafe. Some strategies include:

1. Alternative Destinations: Facilitators should always have a list of backup destinations offering comparable care. These destinations should have similar specialties, accreditations, and pricing. For instance, if a country known for orthopedic surgeries faces sudden conflict, a facilitator should be ready to pivot to another country offering the same procedures with minimal delay or cost increase to the patient.
2. Flexible Contracts and Refund Policies: Contracts with providers, airlines, and hotels should include clauses for unexpected disruptions due to conflict. A flexible refund or rescheduling policy will make it easier to rebook care in safer areas without significant financial losses to the patient or facilitator.
3. Emergency Evacuation Plans: In the event that a patient is already in a conflict zone and the situation escalates, it’s vital to have an emergency evacuation plan. This might involve coordinating with private security companies, international evacuation services, or foreign embassies to ensure safe passage out of the country.
4. Insurance Considerations: Medical insurance and travel insurance should cover potential risks associated with traveling to conflict areas. Facilitators should guide patients to policies that include evacuation for political or military unrest, medical flight services, and coverage for treatment in alternate countries should the original destination become inaccessible.

I want to say something about this having actually done it. Most of the other bloggers I encounter on LinkedIn and elsewhere have ever "done" medical tourism. They talk about it as if... but they don't have the skills stack to "do" medical tourism. Even some of the ones you see at all the conferences. If they were busy doing medical tourism facilitation as a business instead of talking about branding, patient coordination, and other aspects of the business, I don't believe they would survive on their own advice.

Medical tourism is difficult and challenging on a good day. But in conflict and weather prone areas, multiply that by a factor of 10...or more.

So here is my advice. ONE CANNOT TRANSACT MEDICAL TOURISM without having been to the destination. All the little emails you receive on LinkedIn for opportunities are great. Ask them to fly you in and back, host you and give you a tour of the facility(ies), meet the surgeons, meet the coordinators, tour the hotels, eat in the restaurants, and pretend you are a patient. Then turn up the challenge. Pretend the order to SHELTER IN PLACE has just occurred. Or pretend that the state department has called for all citizens to get out and get home. I've been in this situation live. I've had patients where this happened in real time. This is called "red teaming". Coordinate the drill with the local authorities and administrators.

Implementing Red Teaming in Medical Tourism for Conflict Preparedness

In the context of medical tourism, especially in destinations that may face risks due to wars, insurgencies, weather problems, or active military actions, red teaming is an invaluable method to proactively assess and enhance safety protocols. Red teaming involves simulating potential threats and vulnerabilities from the perspective of an adversary or system failure to test how well a medical tourism destination, and its associated services, can withstand and respond to emergencies.

This is some of what I do as a consultant when I am called to "develop" a medical tourism program and product at a destination.

Red teaming is a form of adversarial testing in which a group, the "red team," plays the role of potential attackers, disruptors, or system stressors, while the "blue team" represents the defenders or those trying to ensure the smooth functioning of the system. The red team's job is to exploit weaknesses, simulate potential crises, or otherwise cause disruptions to stress-test the system's resilience.

In a medical tourism setting, the goal of red teaming is not only to find weaknesses but also to improve coordination between all parties involved in patient care, travel, and logistics. It is an ongoing process to assess preparedness for emergencies, whether they stem from conflict, infrastructure failure, or other crises.

In fact, if you are interviewing potential destination partners, ask when their last red teaming drill was conducted and what the results were.

How Red Teaming Works in Medical Tourism

Red teaming exercises are conducted by assembling a group of experts who simulate a series of realistic threats that could disrupt a patient's medical tourism journey. Involving multiple stakeholders—airlines, airports, hotels, hospitals, clinics, and ancillary services (such as transport providers, interpreters, and concierge services)—the exercise runs through a series of scenarios to determine how each part of the system reacts.

For instance, the red team might simulate a military conflict erupting nearby, border closures, or cyber-attacks on the hospital’s infrastructure. They could also mimic logistical challenges such as airline cancellations or supply chain disruptions that affect the delivery of medical supplies. Each scenario is designed to push the medical tourism destination’s operations to the limit and evaluate its readiness.

How I have Organized Red Teaming Drills for Medical Tourism Destinations

1. Stakeholder Involvement: I begin by engaging every key stakeholder in the medical tourism process: National, regional and local public administration authorities, hospital executives, nursing directors, airport directors, hotel executives, and more.
2. Scenario Design: I create a series of realistic, layered scenarios that could potentially impact patient care, travel, or safety. Some examples include: bombings, bomb threats, political insurgences, hurricane, typhoon, earthquakes, tornadoes, work strikes, and more. Having been a firefighter, EMT and police dispatcher, and being FEMA certified in disaster management and recovery in healthcare sets me light years apart from my consultant competitors. It's second nature to me.
3. Coordination with Security Forces and Embassies: Include local security forces and foreign embassies in the red teaming exercise. Testing how effectively these organizations can collaborate with healthcare providers and tourism services is critical for ensuring the safety and quick evacuation of patients if needed. This includes making sure patients have access to secure communication channels with their home country's embassy. Know exactly how patients and surgery buddies get help and get to safety at the embassy. Know the routes. Know the maps. Know the obstacles.
4. Testing Emergency Communication Protocols: A key part of my red teaming drills is testing the communication protocols between different stakeholders, especially during crisis situations. Facilitators should ensure that communication lines between hospitals, airlines, hotels, and the patient remain open and secure at all times. This can include encrypted messaging systems, and a centralized emergency command center to coordinate responses in real time. Is the command center your cell phone? You better never run out of battery! I carry two cell phones. One for my personal communication and one for patients to call.
5. Post-Drill Review and Improvement: After the red teaming exercise is completed, hold a comprehensive After-Action review with all participants. Identify weaknesses or gaps in the response and work to develop improved protocols. This might include better staff training, creating more detailed emergency plans, or upgrading communication infrastructure.

Benefits of Red Teaming in Medical Tourism

• Enhanced Readiness: Red teaming allows facilitators and medical tourism destinations to identify vulnerabilities and fix them before real-life crises occur. It forces stakeholders to think critically and prepare for worst-case scenarios. This is a requirement of ISO-9001-2015. It is not a requirement of JCI or most other healthcare accreditation schemes. It is a tick in a box that they have done it and have a paper or electronic document set about it. What if there's no power?
• Improved Coordination: I run drills that involve EVERY PART of the patient’s medical tourism experience, from departure and the airline to the hospital, and return. Red teaming improves overall coordination between stakeholders. This ensures that, in the event of a crisis, all parties are aligned in their responses. And if the staff changes, the drills must be repeated for the new staff.
• Increased Patient Confidence: Knowing that a destination has undergone rigorous testing -- and that you were there while it happened -- to ensure their safety will boost patient confidence, especially in areas that may be prone to conflict. Patients will be more likely to trust facilitators who can provide a clear backup strategy and demonstrate proactive risk management.
• Operational Resilience: By identifying potential bottlenecks and weak points in the medical tourism process, red teaming builds a more resilient and adaptable system capable of handling unexpected disruptions without compromising patient care.
• This is not "just" a retrofit of what they do for local patients with a few additions. If your medical tourism partners have launched their medical tourism program as a copy paste of what they do for locals with the addition of a hotel room and flights...RUN! Too many medical tourism programs are just that and only that.

Red teaming is an essential tool for medical tourism facilitators working in or near conflict zones. By regularly running drills that simulate real-world threats, destinations can not only ensure patient safety but also build a robust operational framework that can withstand crises. When combined with solid communication protocols, security measures, and a well-thought-out backup plan, red teaming drills provide facilitators with a comprehensive safety net, ensuring that patients are never left vulnerable, regardless of the external situation.

For facilitators and patients alike, a proactive approach that includes red teaming is a cornerstone of responsible and effective medical tourism in today’s unpredictable world.

Additional Safety Assurances for Patients

To build trust with patients, facilitators need to demonstrate that patient and companion safety is their top priority. This includes:

• Updated Travel Advisories: Facilitators must stay on top of travel advisories from government sources, such as the U.S. Department of State, the U.K. Foreign and Commonwealth Office, or equivalent bodies, and communicate any changes to patients as soon as they arise. Even if patients express a willingness to take risks, facilitators have an ethical obligation to inform them of potential dangers. Stick to official advisories; not rumor mills and gossip and local news channels. Some news channels are directed by the government to water down the reports to save face.
• Secure Communication Channels: If a patient is already in a conflict zone, secure communication tools—like encrypted messaging apps—can help maintain contact and ensure they can reach out for help if needed. Being able to reliably contact local providers, embassies, and security services in real time is critical during a crisis. People write about having a sat phone. They are too expensive to include in a package.

Knowing When to Avoid Certain Destinations

At times, the safest option is to simply avoid destinations that are embroiled in conflict or show signs of impending instability. While a particular destination might be known for affordable, high-quality care, the risks involved in traveling to an unsafe region far outweigh the benefits.

Some key factors to watch for include:

• Political tension: Even if there is no active conflict, facilitators should be wary of destinations where political unrest or protests are common. A peaceful destination can quickly turn into a conflict zone. The US Presidential elections are a prime example this year. Ukraine, Russia, Israel, Gaza, Lebanon. Many of these places have excellent medical facilities that were once medical tourism superstars. That can change in an hour.
• Proximity to conflict zones: Even if a destination is not directly involved in a war, its proximity to conflict areas can increase the risk of spillover violence or refugee crises that strain local healthcare resources. Turkish borders come to mind.
• Fragile infrastructures: Destinations with fragile healthcare and government systems are less equipped to handle sudden conflict or emergencies, which could leave patients in precarious situations. Make sure to enquire about seismic upgrades. I've been in some hospitals in Colombia, Thailand, Turkey, Ukraine, Philippines, and other locations where the hospitals and clinic buildings are 50+ years old. Sorry. Not on my watch.

Communication Tools in Crisis Situations

Having reliable communication tools is crucial in conflict zones. Facilitators and patients should be prepared with:

• Encrypted Messaging Apps: Apps like Signal or WhatsApp provide secure communication, which is especially important in volatile regions. But what if all comm methods are disrupted?
• Local Emergency Numbers and Embassy Contacts: Always provide patients with a list of local emergency services, including police, hospitals, and embassy contacts, as well as a backup contact within your facilitation team.

Medical tourism facilitators play a crucial role in ensuring the safety and well-being of their clients. While some patients may still seek treatment in destinations facing conflict, it’s the facilitator's responsibility to provide clear communication, secure backup plans, and prioritize the safety of patients above all else. In times of war, insurgency, or active military action, the best strategy might simply be to steer patients away from the region altogether, offering safer alternatives that guarantee the same level of care without the added risk. In an industry built on trust, a solid backup strategy, proactive safety measures, and effective communication are the cornerstones of ethical and successful medical tourism facilitation.

Many of these touchpoints are in my Medical Tourism Facilitator Handbook . Amazon sells copies, and so does the publisher. They are available in print and electronic versions.

If you are a public official or a hospital executive, hotelier, or medical tourism association leader and would like me to conduct the red teaming at your location or consult to your project or to speak at your event, there are times when I can break away from my daily responsibilities to travel to your location for these reasons.

Maria Todd PhD MHA

Call my office for an appointment to discuss: +1.800.727.4160