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Chapter 3. Organizing medical support for relocation of people in case of

natural disasters or military threat

Carrying out relocation activities is one of the most effective ways of ensuring
protection of population in emergencies.
Relocation activities are carried out in order to ensure safety of population
both in peacetime natural disasters and accidents and when weapons of mass
destruction are used in war time.
Relocation (evacuation) is a set of actions taken in an organized manner to
relocate people to safe areas from the regions where there is a threat to their life
and activity.
Safe area is an area which is safe for the people to be accepted, relocated
and to live far from the ruined areas and other dangerous regions around the cities
and graded sites with the risk of enemy attack.
Relocation activities allow removing in a timely manner people to safe
regions from dangerous areas and destruction sites and minimizing losses which
may arise out of emergencies to the extent possible.
In previous wars, especially during World War II and Karabakh war
relocation processes were widely carried out, also in the manmade accident which
happened in Chernobyl nuclear power plant (April 28, 1986) people were
completely relocated from the 30 km area around this site.
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Relocation activities carried out in past differ from those intended for war
circumstances in modern times. For instance, in World War II the people were
relocated to distant regions in the opposite direction from the enemy. Today,
relocation actions are intended for removing people to safer districts from the cities
and sites which are supposed to be exposed to nuclear attacks of enemy.
Relocation activities should be promptly carried out in case of threat to the
life and health of the people in the areas, where emergencies are supposed to
happen during peace and war times or where the people are directly affected by
disturbing factors.
Relocation activities should be planned by taking into consideration the use of
weapons of mass destruction by enemy, also occurrence of natural disasters and
severe industrial accidents and these measures should be carried out in different
forms depending on the situation.
Depending on the existing situation, the population may be relocated either in
full (general relocation) or part.
In general relocation all people are relocated except the persons holding
mobilization cards (they have to go to recruiting centre), also diseased persons
whose relocation is not possible and medical staff taking care of such diseased
persons.
In partial relocation first of all, children in orphanages, pupils of boarding
schools and secondary schools, higher school students, also teachers of these
schools and their family members, people living in the houses for elderly people
and service staff, also people not engaged in manufacturing and service fields.
In partial relocation certain part of people is removed from big cities to safer
regions and thus, the number of population in big cities is reduced, so it becomes
easier to shelter the people who remain in the cities and work in the important
enterprises and this allows reducing the losses which may arise as a result of use of
modern weapons of destruction to a maximum extent.
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In war times, after the workers and employees who continue working in
dangerous regions are removed and relocated in safe areas, they are taken to the
danger zone to work in shifts and taken back to the safe district after the work.
Relocation district in safe area is appointed for each enterprise, office,
organization and school in the cities from which the people will be removed and
such relocation area may include one or more residential districts depending on the
number of workers, employees and their family members.
Workers and employees of the enterprises which continue operating in the
cities should be relocated at such a distance in the safe area, that their safety is
ensured and minimum time (the most 4 hours) is spent for taking them to the safe
area for working and having a rest.

Safe district should ensure the following:

Reliable protection of population from the impact of modern weapons of
destruction, floods and destructions;
Taking employees to the site from the safe area by spending minimum time
for it;
Grouping of civil defense forces under proper circumstances in order to
take them to the point of destruction;
Availability of the necessary sanitary and hygienic conditions.

The processes for identification, preparation and organization of the regions

and residential areas where the people will be relocated in the safe district start in
advance, in peace times and are completed when there is a risk of occurrence of
emergency.
For this purpose:
Transport roads are improved;
Existing communication lines and means are developed to be used by
management authorities;
Household fund, medical services, public utilities, cultural and educational,
trade enterprises and other facilities are prepared for location and servicing
of the population to be moved;
Organizational works are carried out to establish additional water supply
facilities and carrying out engineering and technical measures.

Relocation of people is carried out upon the industrial and territorial

principle. Industrial principle implies relocation of all workers and employees,
their family members, students of higher educational and professional schools,
secondary schools and specialized schools from dangerous regions to safe areas. In
this case, after the workers and employees who continue working in dangerous
regions are removed and relocated in safe areas, they are taken to the danger zone
to work in shifts and then taken back to the safe district after the work. The
remaining people are removed from their places of residence on the principle of
territory.
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The main method of relocation of population is a combined method. Here,
certain part of population is removed from the dangerous area by the available
transport means and the remaining part on foot.
The main documents for registration of population to be relocated, include
personal identification card and list of people to be relocated made either at the
place of work or residence.
Decisions on relocation of people from the places of residence are taken by
the following officials:
in war times President of the Republic of Azerbaijan, after the referendum
of 26 September 2016, 1 st Vice-President or Prime Minister;
in peaceful times head of the executive authority of the city (region) of
emergency, by providing information to the President of the Republic of
Azerbaijan or 1st Vice-President and Prime Minister.

During relocation, every person must take with himself/herself the most
necessary belongings: clothing, shoes, underwear, bedding, personal ID card,
military card, work record book, pension card, certificate of education,
marriage certificate and birth certificates of children.

When selecting clothing for children, protective properties of such clothing

and season of the year should be considered. Powdered milk, baby food, cookies,
canned juices, etc. should be taken for children under 3 years old.
In order to carry out relocation of population directly, assembly and relocation
points (ARP) are created by the forces of relocation commissions. These points are
usually created in the buildings of schools, clubs and other public buildings near
the grounds and roads.
The people arriving at the assembly and relocation points are registered there
and grouped: those who will be carried by transport means are grouped by the
types of transport means and those who will go on foot are included into pedestrian
groups.
If the regions to which pedestrians will be removed are located at a long
distance, an intermediate relocation points may be organized for them.
People who are removed by transport means are taken to the stations or points
where they get off the transport means in the safe area. The staff of the reception
point organizes meeting, registration and location of the persons taken there.
Food supply for relocated people is provided on the base of catering
organizations. When necessary, additional catering points (canteens) are opened.
General settlements are carried out on all relocation activities in the Republic,
cities and regions. In case any emergency risk or emergency itself arises, the
resources and forces needed for relocation processes are calculated.
In case of accident in the areas of chemical hazard, also in case of radioactive
contamination, relocation processes are carried out in two steps. Here, also
protective measures are taken against radiation and chemical contamination.
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The territory of the accident-affected district is strictly controlled by police
and relocation of population from the accident-hit zone is regulated by traffic
police on the established route.
In big cities relocation of workers and employees of the facilities which have
stopped production operations or shifted operations to the suburbs, also people not
involved in industrial operations is carried out by combined method, which implies
relocation of these people to the suburbs of the city both on foot and by transport
means.
In order to carry out registration of the people to be relocated, registration
points are established for refugees (those who are relocated) upon the decision of
the head of executive authority.

Medical services for population during relocation are provided by the

healthcare facilities of the country. At the assembly points of the people to be
relocated permanent medical facilities are created and on the pedestrian relocation
routes mobile medical points are established on special vehicles (image 1).

Image 1.Mobile medical points

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Organizing medical provision for relocation of people
in case of military threat

Such risk also exists in modern times and organizations which are responsible
for safety of population should always be prepared. In order to ensure safety of
population, the number of people is reduced, their evacuation is organized and they
are relocated to a predefined area. According to the resolution of the Cabinet of
Ministers of the Republic of Azerbaijan passed in 1993 on the basis of relocation
of population (resolution No 438, dated August 6, 1993), only 3 organizations, i.e.
the relevant district or city executive authority, Ministry of Defence and Ministry
of Emergency Situations may apply to the government for relocation. After
permission is given at the governmental level, Emergencies Commission for the
relevant district and city will organize reducing the number of population and their
evacuation according to the predefined plan (Chart 1). One of the members of the
Emergencies Commission is a head of the medical service of the district or city.
Head of Civil Defence Medical Service should clarify the following issues in
advance for the organization of evacuation process:
Number of people to be relocated
Accurate information on the number and specialization of medical
specialists among the people to be moved who are not employed;
Route of relocation;
Medical facilities located on the route of relocation;
Relocating medical facilities and creating medical centers on the basis of
such facilities;
Creating medical centers on the basis of hospitals;
Organizing medical provision for patients whose transportation is not
possible;
Sanitary and epidemiological condition in the region where hospital base
is opened and geographical pathology of the area;
Information on drinking water supply of the new area;
Organizing hospital base at a distance from the areas which may attract
enemy.

When organizing medical provision, head of Civil Defense Medical Service

should know the location and number of assembly and relocation points,
acceptance and relocation points and intermediate relocation points. This is
because, medical facilities should be established in those points for medical
provision of population.
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ARP assembly & relocation point

MF medical facility
PGON point for getting on
PGOFF point for getting off
IRP intermediate relocation point
RRP reception relocation point

Chart 1. Chart of organizing medical provision when reducing the number of

population and during evacuation

Medical staff will carry out the following duties in the opened medical
facilities:
To identify patients and send them to hospital;
To identify and isolate infectious diseases;
- To use medical specialists among the people to be relocated;
To control sanitary and epidemiological situation at all points which
organize relocation.

For medical center of each assembly and relocation point (ARP) 1-2 medium
level medical staff is appointed and the duration of each work shift is 12 hours.
Medical staff is selected from polyclinics or medical-sanitary division. Sanitary
transport mean should be allocated for sending of patients to the treatment facility
for the medical facility of the assembly and relocation point (ARP). Medical
facility of ARP should be evacuated to the area in the suburbs of the city in the
end. At the stations and other parking points medical facilities are created with 12
hour working schedule. 1 doctor and 2 medium medical staff are allocated for the
medical facility. Medical staff is selected from nearby polyclinics or medical-
sanitary division.
Medical provision for people on the route of relocation is carried out by
medical and sanitary division. 1-2 medical assistants or nurses are allocated for
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moving sections, ships or vehicle groups. Medical staff should provide the
necessary medical assistance to injured persons.
On the route of relocation in the intermediate relocation point mobile medical
centers are operated in the vehicle for medical provision of pedestrians. These
vehicles deliver patients or injured persons to the nearby hospitals or intermediate
relocation points by overcoming any natural obstacles. 1-2 sanitary teams supplied
with sanitary bags are appointed for each 500-1000 people moving in pedestrian
groups. After provision of first aid to the injured person, he/she must be delivered
to the predefined place.
In order to organize medical provision for people moving in pedestrian
groups, medical facilities are created on the basis of rural treatment and preventive
facilities located near the intermediate relocation points. 1 doctor, 2 medium
medical staff, transport mean and medical items are allocated for such medical
facility. 12 hour working schedule is set.
At the stations or parking points medical facilities are created on the basis of
Civil defense medical service (CDMS). They operate on 12 hour working schedule
and 1-2 medical staff is allocated for them. Medical center is created at each
reception and relocation point (RRP). They operate on 12 hour working schedule
and 2 medium medical staff is allocated for them. Such medical points are supplied
with the necessary medical property and sanitary transport mean.
Medical provision of relocated people is carried out by the principle of district
and territory. In these cases, as the number of people on the area serviced by
district doctors is increased, resources and forces of treatment and prophylactics
facilities of the relocated regions should be used. CDMS should control sanitary
and epidemiological conditions in the fields of catering, trade, public utility
services. Identification and isolation of infectious diseases should be ensured at
ARP, IRP and RRP. Therefore, isolation points should be established at these
facilities.
Along with minimization and evacuation measures, sanitary and awareness
raising activities should also be carried out in the period of enemy invasion risk.

Relocation of medical facilities

Relocation of medical facilities is a very hard and difficult task. To settle this
problem, managers of all medical facilities should have an accurate action plan in
peaceful period. The plan should describe preparation rules and purpose of
evacuation according to the condition of each patient.
Guided by the practice in this field, in the period of enemy invasion risk 50%
of patients are discharged from the treatment and prophylactics facility. For
instance, patients who are not in the chronic or complication period. If necessary,
these patients are supplied with medicines for 2-3 days period. They have to come
to the assembly and relocation point, get registered there and moved to the suburbs
of the city with general population.
45% of the patients under in-hospital treatment should be evacuated under the
control of the medical staff and relocation to the suburbs of the city should not
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affect their health negatively. Also, they may not be out of doctor control. For
instance: patients with abdominal stitches, injuries in the state of hemi- and
tetraparesis. These patients are sent to the suburbs of the city together with the
medical staff of treatment and prophylactics facilities.
5% of the patients may not be transported, which means their relocation may
cause health problems. Therefore, a responsible person is appointed for the patients
whose relocation is not possible and a shelter is organized in the city which is
equipped with all equipment. Medicines, medical supplies, food and water is
provided according to the number of patients. Head of medical service allocates
medical and technical staff for protected hospital. Head of the treatment and
prophylactics facility should work out all matters concerning evacuation.
After starting usual work process on the area, the head of the medical facility
will report to the head of higher medical service.

Medical provision for the workers and employees of the facilities which
continue operating

In case of enemy invasion risk, some state organizations of strategic

importance should continue operating. For instance, military factories and plants,
power stations, nuclear stations (NS), oil refineries, etc. Medical provision of
workers and employees in these facilities is carried out by medical and sanitary
divisions of these facilities. Such medical and sanitary divisions are evacuated to
the suburbs of the city and provide services to the people there and their family
members. But medical centers are opened for the workers and employees working
in shifts. Medical centers for providing services to diseased or injured persons
should be opened in shelters. Medical center is opened in each organization with
the staff of 2500. 1 doctor, 2 medium medical staff, 1 sanitary transport is allocated
for medical centers and 12 hour work schedule is fixed. The staff of each shift
accompanies the shift to the suburbs of the city.
For the facilities with the staff less than 2500 only 1-2 medium medical staff
is allocated.
In the facilities located near each other and with little staff number one
medical center is created upon the order of CDMS and medical staff, medical
supplies and sanitary transport is allocated. The main duties of medical centers are
as follows:
Providing first aid to the persons having industrial injury;
Identifying and isolating patients with infectious diseases;
Exercising control over sanitary and epidemiological conditions, food and
water supply;
Sanitary posts and sanitary teams are organized for each work shift for
providing first aid to injured persons in case of mass destruction weapons
are applied by the enemy.