Today we are joined by Mary Ana McGlasson. Mary Ana holds dual Masters degrees in public policy and nursing from Princeton University and the University of Washington. She is the Director of the Center for Humanitarian Leadership, and an Associate Professor, with almost 20 years of experience as a Family Nurse Practitioner and a decade of international-based roles designing, implementing and overseeing humanitarian and development programs.
Mary Ana’s humanitarian experience covers a wide range of contexts in Africa, Asia-Pacific and the Middle East, in roles including Country Director, Global Emergency Response Coordinator and Global Health Advisor. She has designed and managed humanitarian programs across a wide range of disciplines including epidemic response; conflict, post-conflict and refugee health systems; emergency WASH-related services for refugees and IDPs; microfinance and women’s empowerment; natural disaster response; and community-based peacebuilding.
Mary Anna’s poster for The Graduate Certificate of Humanitarian Leadership
We first started working together when you were leading efforts to support hospitals in eastern Syria after ISIS declared the caliphate and a really interesting times perhaps could you explain the environments? Well, listeners, what was it like?
At the time, I was working as a relief International’s global emergency response coordinator. And I had been sent to Turkey in early 2013, to kind of do a scoping mission. At that time, lots of NGOs 10 to 15, had sort of clustered around the border between Turkey and Syria, primarily around Untuckit in the border, which has become a little bit more famous in the last few years. And what I noticed immediately was that literally, no one was really trying to work in the east of Syria. It’s impossible. It’s too hard. It’s too far, which is exactly the kind of challenge I like as a nurse and a nurse practitioner, when I hear that their health needs, and there’s no one meeting them. So that was my first place we started, there was a community that we identified and east of Syria, a small community in this further area of Arizona, which is closer to the Iraqi border. And by the time 2014 rolled around, we had a handful, three, four hospitals and health facilities that we were supporting with medical supplies, salary support, or incentives for doctors and nurses and other stuff. And we really were coming alongside a community that was already working very, very hard in the middle of a warzone. Despite having no supplies and no support for a few years. At that point. We just came along and supplied some of the missing ingredients and really allowed them to define what was needed if they said we need women’s health, we do that. If we need primary health, we do that village was actually the epicentre of the polio outbreak that happened in mid-2013, which carried on for years. And so we were just really helping them as best we could at the centre of a crisis on top of the crisis. And just when we thought things couldn’t get more complicated, already before 2014 just to get a supply truck of medical supplies from procuring them in Turkey, getting them across the border and then navigating the multitude of armed groups at that time in the northwest of Syria. Some hostile some quite friendly, I guess you could say. But negotiating humanitarian access across no fewer than 25 separate checkpoints and armed groups to get to the east of syria then the caliphate was declared seemingly from nowhere to the rest of the world although we’ve been hearing whispers the different donors for years were really concerned about this quote rising terrorist group that was seemingly very threatening and al qaeda spin off java till muestro which i think now in security circles is somewhat of a household name that was perceived as the big threat but when we spoke to people in the community even as far back as mid 2013 they said you don’t need to worry about those guys those guys are just you know people from our community and you know they’ve always been a little bit more extreme but we’re not worried about them we’re really worried about this other group and that was the first time i heard the term isis dash as it was referred to at that time and still is today and i think that was my first clue that we as analysts or the international community were focusing on what we thought was one problem and there was something else much darker rising and of course mid 2014 probably anyone listening to this podcast will know that the caliphate was declared taking over a huge swath of iraq and syria and in the wake of that at that time we had seven or eight i think maybe nine even hospitals and health facilities scattered throughout that whole area that were the primary or only healthcare service providers for probably around 1.5 to 2 million people and all i could think about was the people and the communities and the faces and the doctors that had traveled all the way to turkey for the previous year to convince us to come along and support them and of course my first thoughts were while most of this funding is us government and eu funding what are the implications going to be politically but no matter what happens we have to advocate for this humanitarian support to continue in these areas because it’s not the fault of those communities that they happen to be living in the crossfires of a caliphate.
Yeah, it certainly was the epicentre of simply challenges and I remember you being a big advocate for humanitarian support in Der er Zor or around that time when the epicentre of a polio outbreak in any situation is a huge task but then as you said it was a crisis on top of a crisis and getting supplies and working your supply chains through as you said 25 hostile and non-hostile groups and then isis declaring a caliphate that’s extremely challenging, to say the least, and the potential risks impacting your operation are huge in an environment that’s dominated by so many different groups and has so many different influences how do you conduct a robust context analysis and risk assessment.
and as a great question so again just to remind listeners my background is not as a security specialist my background is as a nurse practitioner and thankfully the heart of nurse and nurse practitioner training is really about critical thinking and good analysis looking at a community or situation and gathering massive amounts of data and consolidating that into top priorities which could be you know when you’re looking from a community health lens at the macro level you’re looking at policing and security and access to services and roads and all of these things that play a role in people’s overall health and well being and somehow i think instinctively i think i didn’t have a training in safety and security or risk management but i had a lot of instinct and i really reached into my nursing toolkit i’d done some work internationally before the serious response but i wouldn’t consider any of those super high risk settings compared to this i guess nothing is more complicated than this was for me but early in our setup of the very first health facility which was in a very tiny town of about 80,000 people i insisted in our first funding proposal that we put in place the infrastructure that my nursing brain which always thinks about 25 steps ahead of all the things that can go wrong in the human body when you’re trying to keep someone alive that same instinct i fought through the process of yeah everything could go find this work it in tomorrow but probably it’s not going to and here all the other things that could go wrong so what do we need in place we need reliable interlocutors we need a wide net real work of people who can tell me what’s really happening on the ground i need people on my team who are from that area originally who can cut through some of the other regional perceptions or misperceptions I need people who understand these community Days who know the roads between the communities who are sitting in my office, these are, you know, displaced Syrians who were at that time living in Turkey. And we built this pretty broad network of reliable counterparts, community members who had demonstrated to us a lot of goodwill for their communities, they were already doing the work long before we came along. And we then sort of built a multitude of different people that we could speak to just to cross-check and triangulate the information we were getting, even from the very beginning in 2013, there had been a couple of very high profit, kidnappings of international stuff in that very area and other areas of Syria. And I’ll just tell everyone, I have worked on this year response for the better part of six, seven years, and I’ve never put my foot in the country, which is, for me a great sadness and tragedy. Because this country that I’ve worked in and around for so many years at this intensity, it was unsafe and so unsafe from 2013, that we were relying on this network of reliable people. And we did find a lot of bad eggs, and that people always say, Well, everyone couldn’t have been good. Now, that’s the whole point, you have to ask and ask and ask and follow the leads when you get questionable information. And really dig to the bottom of that. The second thing we put in place was that I insisted on making sure we had some sort of internet access and way back at the beginning of the crisis in 2011, considering government cut off access to networks, and, you know, very controlled access to the internet, under a security state anyway, so it was quite easy for them to just cut off entire regions of the country from any sort of internet or phone or other access. And so we invested in relatively affordable satellite connections and hubs that we could put in each of the facilities so that they always had access to be able to contact us whether by site or by email, that was also really critical, not only to keep up the communication to reinforce this network of reliable interlocutors, but also so that we can get the data from the hospitals. Obviously, when you’re analyzing risk, you need information. But you also need to cross check data so that you’re certain that the activities you say you’re doing are really happening, especially when you can’t go and visit a site or confirm, in fact, that the hospital even exists, the bandwidth has to be good enough to receive pretty large files of data, photos, videos. And at that time, a lot of people thought that was overkill. And I just thought this isn’t that expensive. And we’re talking about projects that are worth a minimum of 500,000 up to millions of dollars when you get into these really complex hospital environments. Setting up this kind of internet connection is a few $100 at the end of the day, and then maybe 30 or $40, for data each month on average. So that for me was a no brainer. Even if things never got worse. Those were fairly small investments to be sure that we never lost that connection. And those simple things that well developed, trust based network of humans, who would cross check and triangulate information for the betterment of their communities and to support their communities combined with some fairly low-cost communication tools. When the caliphate was declared in 2014, we didn’t lose connection with our key focal points and our staff at that time in 2014. I believe at that time, we were supporting the monthly salaries of probably 1500, medical staff, vaccination workers and other administrative support to keep these facilities running. You can imagine that practically a lot of cash on a monthly basis. So we had a very elaborate way of getting we were not carrying physical cash. I won’t go into the details of, of how you transfer money in a conflict zone. But I would, from the very beginning, I said no 100% no to the idea of carrying cash. Not only was it firmly illegal, but it was excessively dangerous to the human beings who would ultimately be carrying cash. And so we found workarounds for that way before it got very complicated.