Roads that had been open just moments earlier were suddenly made impassable by wildfires. Smoke was reducing visibility and winds were changing the direction of the flames. Patients dependent on treatment at home were at risk because electricity had failed and smoke was affecting air quality.
A hospital treating vulnerable patients lay in the potential path of the fire.
For the emergency teams responding to the wildfires that swept through Muğla, Türkiye, in July, evacuation was not simply about getting people out of danger. It was about making sure patients, whether cared for at home or in hospital, could continue receiving the care they depended on. Their experience shows why protecting health during wildfires starts long before the flames arrive.
Decision-making under rapidly changing conditions
Serkan Atila is the Provincial Coordinator for UMKE, the abbreviated name for the Turkish National Medical Rescue Team, under the Muğla Provincial Health Directorate. His team’s responsibilities include providing medical rescue and emergency health services and establishing and operating emergency response units or even field hospitals in safe areas nearest to the incident site. UMKE also supports the health of rescue teams, volunteers and the civilian population and ensures the safe evacuation of the sick and injured.
In July, faced with an unpredicatable and fast-moving wildfire, UMKE’s response plans had to flex quickly.
“Dense smoke reduced visibility, while shifting winds could alter the fire’s path of progression within minutes. Since a route previously deemed safe could quickly become blocked, it was necessary to keep alternatives ready rather than relying on a single path,” says Serkan.
At times, medical teams were at risk.
“While we were providing medical supply support to the firefighting personnel, the wind suddenly shifted direction, and the flames rapidly advanced toward our location. At that point, the safety of both the firefighting and UMKE teams was prioritized, and we executed a controlled withdrawal from the area to a safe zone. This experience clearly demonstrated that the continuity of health-care delivery in disaster settings depends, first and foremost, on ensuring the safety of the team itself.”
Assessing the need for evacuation
Using 4x4 vehicles, the teams reached hard-to-access areas that were difficult for standard ambulances to enter and encountered cases involving smoke exposure and the direct effects of the fire. Still battling volatile conditions, the team assessed the medical needs of residents, administered care if needed and organized the transport of cases requiring further evaluation to appropriate health-care facilities.
Caption: An UMKE team member responds during the Muğla wildfire. Credit: UMKE.
Serkan’s teams maintained a constant exchange of information with Turkey’s Disaster and Emergency Management Authority (AFAD), Ministry of Agriculture and Forestry, fire departments and law enforcement agencies. As they approached dwellings, evacuations were carried out based on risk assessments that prioritized the needs of the elderly, individuals with limited mobility and those undergoing ongoing medical treatment.
“We reached patients at risk of treatment interruption or failure of medical devices due to power outages; in these cases, we assessed not only the direct impact of the fire but also the secondary clinical risks associated with the disruption of care. We avoided unnecessary evacuations by ensuring that treatment could be safely continued on-site for clinically suitable patients, while planning for the continuity of care for those who required evacuation,” says Serkan.
Across the 6 affected neighbourhoods in Muğla Province, 703 people along with around 100 animals from 408 homes were evacuated and moved to safety. Fifty-five buildings were damaged, some of which were completely destroyed.
Activating emergency evacuation plans
Hospital evacuation is a last resort because moving patients can itself put lives at risk, particularly for those with serious health conditions. WHO nonetheless recognizes that precautionary evacuation may be necessary when a risk assessment indicates that a hospital cannot continue operating safely. Decisions must consider both the evolving threat and the risks associated with moving patients and interrupting care.
As wildfires approached Seydikemer State Hospital, in southeast Muğla Province, the hospital’s emergency and evacuation plans were activated. Patients were rapidly assessed and categorized based on their clinical status, mobility, ongoing treatments and the medical support they would require during transport. Planning for ambulances and destination health-care facilities – covering intensive care and palliative care patients as well as general ward patients – was carried out in coordination with the 112 Emergency Operations Center (SKKM/EOC).
“Our primary objectives during the transfer process were to ensure no interruption to ongoing treatment, transport necessary medications and medical devices alongside the patient, maintain oxygen supply and monitoring throughout the transfer, and fully convey clinical information to the receiving team,” says Serkan.
Safe evacuation also requires reliable patient identification and tracking, with essential clinical information accompanying each patient. Receiving facilities must be able to provide the care patients need, and clear handovers must support the continuation of treatment on arrival.
Field information from firefighting agencies, law enforcement, AFAD and other stakeholders helped shape health operations decisions. While the Provincial Health Directorate ensured the overall coordination of health services, SKKM/EOC handled ambulance and hospital planning, hospitals managed patient intake capacities and preparations, and UMKE teams supported the evacuation process by conducting medical assessments of patients in high-risk groups. Forty-five patients were evacuated safely and transferred to nearby facilities. Fortunately, the hospital did not sustain any damage.
Coordination, communication and preparedness
Pre-prepared and field-feasible plans, strong and seamless inter-agency communication, adequate equipment capacity and trained personnel capable of maintaining their composure under stress all contributed to the success of the emergency response to the Muğla wildfires. The experience also underscores an important lesson – that coordination is the invisible infrastructure of emergency response.
“The greatest contribution came from pre-disaster planning efforts and the teams’ level of preparedness for various scenarios,” says Serkan. “Keeping vehicles and teams mission-ready, establishing communication channels in advance and clearly defining personnel roles and responsibilities significantly reduced our response time.”