Masters of immediate response: the role of supply chain processes in disaster relief

Inside the tented supply warehouse of the MSF hospital in Guiuan, the Philippines. Image copyright: P K Lee / MSF

Gay Sutton goes behind the scenes at Médecins Sans Frontières and finds out from Stefaan Philips, Site Director, MSF Supply, how the organisation has honed its supply chain processes and warehousing to respond quickly to emergencies and disaster relief in some of the most inhospitable locations around the globe.

When a natural disaster or humanitarian emergency strikes anywhere in the world, the first international relief organisation on the ground during the critical early moments is very often Médecins Sans Frontières (MSF). Behind the scenes there is a well-oiled supply chain process, with a logistics and warehousing machine that swings into action to get medical staff, equipment and supplies to the needy as quickly as possible.

The challenge is that emergencies are exactly that: urgent situations that require an instantaneous response. The vast majority can’t be predicted or tied down and conditions on the ground are often extremely difficult. In recent years, the organisation has responded to earthquakes in Haiti and Nepal, floods in Pakistan, the Ebola outbreak in West Africa, the typhoon in the Philippines, refugee influxes, and conflicts in many locations.

At the heart of MSF’s ability to respond lies an efficient, well-organised and intelligently stocked global logistics and warehousing operation.

Emergency supplies for the Philippines awaits in the cargo area

Cargo for the Philippines, Ostend Airport, Belgium. Cargo includes medical kits, material for medical consultations, tetanus vaccines, water and sanitation equipment, and relief items such as tents and hygiene kits. Image copyright: Bruno De Cock / MSF


An overview of warehousing

MSF’s supply chain operates on two levels. For ongoing projects – missions located all around the world where medical help is being provided day in, day out – each region or country has its own warehouse stocked for the project’s requirements. Each also holds a certain amount of emergency stock for situations that might occur such as an outbreak of cholera, but if an emergency escalates then these stocks can rapidly be exhausted. Supporting this is a powerful global logistics and supply chain organisation, MSF Global Supply, which is powered by an ERP system that includes a strong warehouse management module. The Global Supply division not only provides regular supplies to the missions, but is what Stefaan Philips called e-prepared – ready to respond immediately to major emergencies.

Based at the supply headquarters in Brussels, Stefaan is in charge of MSF Global Supply, which is literally the backbone of the organisation. “Our main warehouses use forecasting, order planning, transport planning etc. for our regular programmes which account for 60 to 70 per cent of our activity. But the warehouses also stock emergency supplies and these are reserved for, and only ever made available to, emergencies.”


The MSF supply warehouse in Brussels. Image copyright: Ikram N'gadi

The secret is in the planning

MSF has developed a highly efficient approach to preparing for emergencies, and this is now being replicated by other relief organisations. Pre-packed emergency kits have been designed for a whole range of emergency and disaster scenarios. The majority are assembled in the international warehouses in Bordeaux and Brussels, and are held in stock there as well as at the missions where they’re likely to be required.

Each is for a specific emergency scenario and contains the appropriate medical supplies and items needed for treating a defined number of people for a fixed period of time. Some are also designed to provide practical necessities such as water treatment stations, shelters, inflatable hospitals, transport vehicles and autoclaves. Many also include vital information on emergency management. “The scenarios are larger than just a list of equipment,” Philips explained. “The scenarios even specify the profile of human resources you will need for the emergency.” All of this increases the efficiency and speed with which MSF can respond.

All e-kits are continuously monitored via the warehouse management system, and when any components approach six months of their shelf life, the kit is unpacked and the older components replaced with new ones.

The range of scenarios they cater for is comprehensive. Ebola, for example, is a haemorrhagic fever – as is Lhasa Fever. When the Ebola outbreak took hold in sub-Saharan Africa MSF already held haemorrhagic fever kits in Democratic Republic of Congo (DRC) and Uganda, and further emergency kits in the European supply centres, each providing a 20-bed treatment centre for two weeks. “In normal circumstances a 20-bed treatment centre would quarantine an outbreak and get it under control. We knew this from previous outbreaks in Uganda and DRC,” Stefaan explained. However, systems are never set in stone, and MSF is quick to respond to changing situations. “After a few weeks we recognised this outbreak was not the same. So we shifted our strategy and passed on a supply of loose items as the volumes required were unprecedented.”


MSF staff collecting a suspected Ebola patient from the ambulance. Image copyright: Anna Surinyach

“For every item in the catalogue we have at least three different suppliers so we can accelerate supplies when we need to.”

Managing the supply chain

Managing the supply chain so that deliveries can increase significantly when an emergency escalates into a disaster of this magnitude is also a slick process. “We use multi-vendor management,” Stefaan explained. “For every item in the catalogue we have at least three different suppliers – eitherdistributors or manufacturers – so we can accelerate supplies when we need to. And on occasions where MSF gets the feeling that a situation might escalate, we can overshoot the quantities and volumes at the start to create a buffer on site, and to give the supply chain some time to gear up. We know it’s a risk, but it’s a measured risk. At the end of the crisis we can reverse logistics if we need to and take back stocks that are no longer needed in the field.”

One important aspect of supply chain purchasing, after the initial disaster response, is to reduce the length of the supply chain and procure locally where possible. Following the typhoon in the Philippines, for example, once the local market began to function properly again, logistics staff were flown in to synchronise local, regional and international supplies. A considerable amount of purchasing was done in Manila which had access to many of the supplies MSF needed.


Distributing non-food items by boat around Panay island, Philippines. Image copyright: Laurence Hoenig / MSF

Responding to a major disaster

When a major disaster or catastrophe strikes in a location that has no existing MSF mission, clearly defined protocols fall into place, and this ensures a speedy response. One of several specialist exploration teams, always on standby around the world, is immediately flown in to assess the situation. Experts in logistics, medicine and management, they hit the ground running – assessing the nature and extent of the emergency and the materials and personnel MSF should despatch. They then send a detailed proposal back to head office. “In an emergency the decision lines are very short and can take just a few phone calls,” Stefaan said. “Our ability to respond so quickly is closely linked to the fact that MSF is independent.”

By this, he means that there are no outside funding agencies with the power to influence or slow down the decision-making process. Over 90 per cent of MSF’s money comes from individual independent donors (see box), most of whom give small amounts of money, freeing the organisation to make decisions based on the situation on the ground.

The organisation works closely with a wide range of contractors and the military, but also has all manner of transport options ready and waiting in its warehouse.

Pulling out all the stops

As soon as a project is approved the supply chain is activated. The logistics teams on the ground and at head office get to work organising material resources and funding, assessing routes into the emergency area, and chartering planes to fly the cargo in.

On the ground, warehousing space along with materials handling and manpower have to be ready for the first deliveries which usually arrive within 24 hours of the alert. A suitable space has to be identified or created for the location of the medical treatment centre and staff accommodation. This could mean using existing local accommodation and equipment or flying in tents and inflatable hospitals.

In parallel with this, negotiations are made with the country’s government to obtain permission to bring goods into the country and fly in the doctors and nurses – a task that is far easier in an emergency than in a mission situation.

Where MSF already has a mission, of course, the organisation, staff, regular supplies and a range of emergency kits are already on the ground and timescales are much shorter. When the earthquake struck Haiti in 2010, for example, nurses and doctors were deployed and providing medical within three minutes. The logistics teams were also in situ, and instantly began assessing needs and stepping up supplies to cope with the extent and nature of the disaster.


Money is collected worldwide through personal donations and fundraising schemes, then pooled to fund actions across the globe. Over 87 per cent of funds go directly to field projects, just 3 per cent is spent on admin and staff, and the rest goes into fundraising. Of the global income, 25 per cent of funds are retained as cash, so that the organisation can respond appropriately and quickly to emergencies.

The last half mile

One of the inevitable results of a major emergency or natural disaster is the sheer chaos and congestion on the ground and in the air as aid organisations mobilise to fly goods and personnel in, at a time when the local infrastructure has often been devastated. “This is when we have to be creative. And it’s the last mile or so that is often the issue,” Stefaan said, “not the logistics.”

In the Philippines it was only possible to take medical assistance and supplies to the many islands by boat, while after the Nepal earthquake communities in high altitude areas could only be reached by helicopter. In Haiti MSF flew supplies to Santo Domingo and then trucked them up to Port-au-Prince.

The organisation works closely with a wide range of contractors and the military, but also has all manner of transport options ready and waiting in its warehouse. “We stock many transport vehicles. For example we have a fleet of 4×4 hardtop pickups we can fly out to where they’re needed. We have boats for areas that are only reachable by water, and even a small Zodiac kit which is an eight-person intervention boat that can be used as an ambulance, and can carry people and goods.”

There are countries like Syria where MSF is simply not permitted to operate. For an organisation whose ethos is to help the suffering wherever they may be it can be a difficult waiting game as its staff watch from the borders and wait for the refugees to arrive.

Medical team in disaster area

A medical team doing the rounds in the high-risk area, the Ebola treatment centre in Kailahun, Sierra Leone. Image copyright: Sylvain Cherkaoui / Cosmosh


There are two major international warehouse facilities in Europe: at Brussels and Bordeaux. There is also a consolidation platform in Amsterdam largely for Dutch projects.

A large international warehouse is located in Dubai, and holds enough emergency stocks of non-food items (NFI) for 10,000 families. These are distributed around the world purely for emergencies, and include items such as tents and hygiene kits, blankets etc.

MSF is currently working in countries around the globe supplied by approximately 250 local warehouses (numbers are constantly fluctuating). Nairobi, for example, is MSF’s entry point into East Africa and has 1,300m2 of warehousing space. Kinshasa in DRC has 1,500m2 of warehousing. Kabul in Afghanistan has 1,200m2 and so on. They enable the missions to respond to local emergencies. In Haiti, for example, MSF staff were treating the injured within three minutes of the earthquake.


After forty four years of responding to emergencies and disasters MSF has honed its operation to react extremely quickly and efficiently. For the human victim of disaster, hours can make the difference between life and death, a return to health or lifelong disablement, and it’s the logistics and supply chain function – the organisation’s backbone – that enables this rapid response to take place.



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