Filippo Gatti is Chief Nurse of the International Committee of the Red Cross (ICRC), based in Geneva, Switzerland. His responsibilities include policy, planning and coordination with the International Federation of the Red Cross and Red Crescent (IFRC) and the many national Red Cross / Red Crescent societies. He is also part of the ICRC’s Rapid Deployment Unit, which is first on the ground in any conflict emergency, and remains in place until additional relief efforts can be resourced—about six to eight weeks. Gatti’s nursing career began in pediatric ICU in his native Bergamo, Italy. His first humanitarian healthcare mission was in Afghanistan in 2006 and he has since worked all over the world.
In Geneva, we’re in support. We always say in the office, “We’re not saving lives.” It’s different when we’re in the field. The proportion of time I’m in Geneva depends on how many needs and clashes there might be in the world.
The ICRC helps and protects the victims of war and armed violence. We act as guardians of international humanitarian law, a complex role that is linked to our history and has been formally entrusted to us by the international community. The IFRC’s focus is on assistance before, during and after natural disasters and health emergencies.
I prefer to be early in the office, about 7:00 or 7:30am, but it can be 5-6am if I need to talk to Asia or until 8pm if I talk to Latin America. There is recruitment, briefing and debriefing with nurses at the beginning and end of missions, and scheduled regular meetings—weekly, two weekly—several days a week. We discuss drugs and equipment; we revise the approach to critical incidents based on the data we receive from the field.
I have a pool of about 400 nurses, with about 80 in the field at any one time. I am the person who knows the nurses according to their competencies and deciding who is going where. You may have good experience as a nurse, but have you been in austere environments? Have you lived with other people? On a mission, you might not have comforts or privacy. There is hardship. You need to be flexible. The challenges are tough.
Notice for the Rapid Deployment Unit might be a weekend. There’s some flexibility; you might need a visa, that takes time. I had two days’ notice for Gaza. I was in Azerbaijan, I came back and my boss said, “We’re opening a crisis cell for Gaza, are you ready?” I said, “Let me wash what’s in my luggage.”
When I’m in the field, I try to forget about my work in Geneva. Sometimes a colleague can cover, but there are meetings that can’t happen if I’m not there. My emails pile up like pancakes.
When you arrive, you get in contact with the authorities, find out what’s available. You meet the local healthcare team, get given an operating theatre, a ward. You check stock, check medications, run around like a headless chicken doing your job as manager for the team. You check infection prevention control measures are respected. We have to organize deep cleaning, we do it, we do whatever is needed. You have to activate the logistics machine, the economic machine. Can the kitchen provide? Nutrition is part of the therapy for the patient. Where do you stay? There’s no hotel! We cannot have a half-hour trip to the hospital each day—it’s not safe. In Gaza, there was a nursing school next to the hospital so we set up there to sleep.
You have to look after your team. You need to understand their coping mechanisms. Some people need time alone, they’re not being rude. Someone might like running to de-stress but you can’t run outside—it’s dangerous. Can you set up a tent where people can exercise? Can you borrow a TV and have a movie night—why not? If there’s a bad apple, you have to get them out, quick. Sometimes you have to laugh, you do babysitting: “Yes my dear, we are in South Sudan, we don’t have Nutella.”
My stress release is cooking. People say, “Really, after 14 hours of work you have the energy to make homemade gnocchi?” But sometimes if I don’t do this, tomorrow my head will blow up.
I am Italian, I always have my coffee maker. I have my headtorch, power bank, sleeping bag maybe or sheets, in some places it’s gum boots. My phone and laptop, of course. You always have your Decathlon package that you know you need: your water bottle, plastic cutlery, because you don’t know what you can find when you get there. You don’t take your favorite T-shirt. Your emergency bag is maximum 15kg for airlift—in that case, you leave everything else behind.
I was in South Sudan in 2013, the start of the civil war. We were 12 people in the healthcare team. In the morning we were told to evacuate to the UN base, emergency luggage only. The UN said, “We can accommodate you in your tents, if you have tents, but we have nothing else for you. We’re waiting on shipments and our supplies are only for the military.” Everyone said, “We have nothing to eat!” and I said, “No, I have food.” My 15kg luggage was 10kg food: pasta, tomato sauce, parmigiano cheese, canned tuna… and COFFEE. Of course! I can live for two weeks in the same underpants and T-shirt if I have to, but we need to eat. For two days, we all ate my food, and we survived. Some of my colleagues who were on that mission are still telling that story.
I don’t compare patients. But on my first humanitarian mission in Afghanistan, we drove two hours and then walked two more hours to a clinic in the middle of the mountains. The welcome we received…the food, the smiles. People who really don’t have anything still give with such an open heart.
Talking about the patients makes me emotional. Weapon wounded stay in hospital longer. Their wounds are dirty, they can get infected, unfortunately at times they may need an amputation and they can stay for months. I have real friendships with patients. To see them healing, standing for the first time, to see them walk, and then they smile —it’s everything.
