Professor Gerard Bury:

Perhaps I will start by asking my colleagues to introduce themselves briefly.

Professor Christopher Fitzpatrick:

I am a clinical professor in UCD school of medicine and a retired obstetrician and gynaecologist.

Mr. Shane Leahy:

I am a businessman and a founder of the charity One4Humanity.

Professor Gerard Bury:

I thank the committee members for the opportunity to tell them a little about our work and what drives it.

The UCD Ukraine Trauma Project has delivered almost 500 emergency medical kits and four training programmes in Ukraine since late 2022. The equipment, drugs and training in advanced pre-hospital care techniques reflect best practice by Irish emergency services but are largely unavailable to the majority of emergency carers in Ukraine. Almost 30 former and serving volunteer doctors and paramedic staff from Ireland’s health services have trained and equipped approximately 400 Ukrainian doctors, nurses, paramedics and combat medics, based on our experience in day-to-day use of these interventions in Ireland. I acknowledge some of those clinicians, such as Professor Fitzpatrick, who is a wonderful example of a medical colleague who has delivered all that work, Mr. Ben Heron, an advanced paramedic supervisor with the National Ambulance Service who has delivered an enormous amount of work in each one of those training missions, and Dr. Cathal Berry of this parish who helped us to deliver one of the key programmes earlier this year. That work is greatly appreciated by our Ukrainian colleagues. We welcome the opportunity to outline the project and tell the committee about our plans for the future.

At the outset, we would like to acknowledge the extraordinary work of individuals and groups from Ireland with whom we have met in Ukraine such as One4Humanity, with whom we have developed a very good working relationship. We thank the people of Ireland, the HSE and the Irish Red Cross for their great generosity.An Tánaiste, Deputy Micheál Martin, and the Minister for Health, Deputy Stephen Donnelly, have also provided very valuable support and the Departments of Health and Foreign Affairs and Defence have made key contributions to our work.

I will provide some background now. The impact of the war on people in Ukraine has been appalling. In May 2024, the office of the UN High Commissioner for Human Rights, UNCHR, published an estimate of almost 32,000 Ukrainian civilian casualties, with 11,000 civilians killed. UK Defence Intelligence estimated 500,000 Russian military casualties up to May 2024 and in February 2024, President Zelensky said that 31,000 Ukrainian soldiers had been killed. All of these figures are likely to be underestimates.

Deaths and injuries caused by military weapons result in massive bleeding. Control of severe bleeding in the minutes after injury makes the difference between life and death. Dressings and tourniquets are essential but very early administration of drugs such as Tranexamic Acid, TXA, may save up to one in six lives that would otherwise be lost. TXA works best if given into the bloodstream within an hour of injury. Injection into a vein is effective but requires extensive training. Insertion of a needle into a bone, intraosseous access, is equally effective, straightforward to teach and carry out, but requires more complex and expensive equipment. The UCD Ukraine Trauma Project focuses on this key aspect of advanced pre-hospital emergency care.

The UCD Centre for Emergency Medical Science, UCD CEMS, has been responsible for training advanced paramedics in the statutory emergency services and our Defence Forces in advanced pre-hospital emergency interventions since 2004. We build on that experience in this project. In 2022, UCD CEMS agreed a programme with our Ukrainian pre-hospital care colleagues focused on massive bleeding and the evidence based, life-saving interventions which are largely unavailable in Ukraine but which are widely available in Ireland.

Those woundedon or near the front lines in Ukraine often wait for many hours for evacuation to so-called "stabilisation centres". If TXA is to be of value, it must be given within a maximum of three hours. In Ireland in 2021, 87% of patients with major trauma received TXA within this critical three-hour window.

Four training missions have now visited Ukraine to train almost 400 emergency medical staff with 500 kits supplied. Irish Government rules in relation to neutrality are complied with throughout our work. Each kit contains core materials to control bleeding and cater for intraosseous and intravenous access in order to deliver TXA. Our most recent visit was on 24 April for ten days and included eight doctors and paramedics from Ireland working with Ukrainian medical trainers and interpreters. The team delivered three two-day courses to 136 candidates. Each course teaches the knowledge and skills needed to deliver TXA, as well as reinforcing the fundamentals of whole-patient care in major trauma, with plenty of time to maximise skillsets.

We have also developed a cascade component to our training. Candidates are trained to teach these skills to a colleague. The design and production of 3D simulated training materials in UCD has greatly helped in the dissemination of local training. All training staff are volunteers associated with UCD CEMS with medical and teaching expertise which enables delivery of course components to similar standards as those used in Ireland.

We have had the privilege of working with wonderful colleagues in Ireland and Ukraine. Around 50 volunteers have repeatedly prepared and packaged our kits for delivery to Ukraine. Our partners in Ukraine, Serhi Prytula Charity Foundation, has hosted our training missions and supplied excellent interpreters and facilities for each course. Medical colleagues from Ukraine who have attended previous courses have become tutors on our subsequent courses as well as running their own courses locally, often close to the front line.

All of our kits have now been dispatched to pre-hospital care staff and we have daily requests for more. The greatest impact on all of us has been made by those we have trained. Doctors, dentists, nurses and professional paramedics are familiar colleagues but the extraordinary people we have met include vets, medical researchers, lawyers, hotel workers, teachers, recent college graduates and retired people who are all now volunteering as combat medics. All are caring for terribly injured patients on a daily or weekly basis. Their commitment to their patients and their country is very striking. We have met those moving directly to or from the front line and those who have lost loved ones to the war only days previously. All are fiercely committed to learning what we have to teach, putting it into action and teaching their colleagues.

Many Irish agencies and individuals do amazing work in Ukraine and it has been our privilege to meet some of them. An example of these would be former and current members of Dublin Fire Brigade and the National Ambulance Service who are among a group which has driven eight emergency ambulances, five donated by Dublin Fire Brigade, and 40 4x4 vehicles purchased by themselves and their friends and families, to Ukraine. Mr. Tony McEvoy who is with us today is one of those extraordinary people.

Through our courses we have made important contacts with colleagues in Odessa National Medical University which have generated a recent memorandum of agreement between UCD and that university and we hope to see academic developments focused on emergency care. Working with colleagues in Odessa led us to develop a great working relationship with Mr. Shane Leahy of One4Humanity in order to obtain a bespoke maternity Hospitainer, which we will hear a little more about later, for Mykolaiv in southern Ukraine where the hospital unit had been destroyed. Shane and his colleagues subsequently transported a large consignment of our equipment to Kyiv.

One4Humanity was founded by Shane Leahy and Norman Sheehan in 2023 and provides humanitarian emergency response assistance by tapping into the founders’ business knowledge and contacts to provide essential assistance such as medical aid. Their team has delivered 16 self-contained hospital units right across Ukraine, including to Kherson, Kharkiv and Kramatorsk. These units are predominantly trauma units but also include maternity and laboratory units. One4Humanity, working with Cemark, a CRH company, has delivered more than $80 million worth of medicines and medical aid donated by their key partners: Heart to Heart International, a US charity. They currently have a large consignment en routeto Ukraine containing 25 pallets or 6,500 kg of medicines for hypertension, anxiety, asthma and other conditions.

One4Humanity's Project Conor in Odessa supports more than 380 families raising children with severe disabilities, mental disorders, autism and genetic diseases.

Our project has had the privilege of offering some medical advice and support to the project. One4Humanity is in advanced talks with Suhaila Tarazi, director general of Al-Ahli Hospital in Gaza City with a view to providing them with a Hospitainer starter hospital: operating theatre and recovery rooms. One4Humanity is working closely with Hospitainer, WHO and the International Medical Corps, IMC, which have already delivered Hospitainer units in Gaza.

The Al-Ahli Hospital is run by the Anglican Church in Jerusalem and is strongly supported by the Anglican Archbishop of Dublin, Michael Jackson. Once the first unit is delivered, One4Humanity will look to scale up.

The important opportunity today for us is to be able to say some thank yous. We have raised not €900,000, as I reported in the opening statement I submitted, but in fact we have hit the €1 million mark thanks to the Irish Red Cross which donated a further €100,000 to our Ukraine trauma project yesterday. That adds to the €300,000 we already had raised from the Irish Red Cross, to the €400,000 from HSE global health engagement on behalf of Government Departments, €60,000 from UCD and the remainder from the generous donations of Irish people. All of this money has been spent on purchase of emergency and training kits, including all equipment and drugs, and travel for teaching teams. We thank many individuals - ambassadors Larysa Gerasko and Therese Healy for their warm support and hospitality; the Tánaiste, Deputy Micheál Martin, and the Minister for Health, Deputy Donnelly, and their staff; Ms Liz McMahon and Ms Anna Marie Carroll and their colleagues in Irish Red Cross; Ms Ciara Norton and Dr. David Weakliam of HSE Global Health; Deputy Cathal Berry for his enormous support; all of our colleagues at UCD; and the many volunteers who have worked very hard to make each mission happen.

Turning to our plans for next steps, the recent surge in attacks on Ukraine has created a constant demand for new supplies from our partners there. We plan a further ten-day training mission in autumn 2024, aiming at up to 150 further participants who will receive emergency kits. The recent generous contribution from HSE and the Irish Red Cross, taken with charitable donations, will fund those missions and perhaps some additional work. We have requested further funds from other agencies but at the moment the funds we have should enable us to accomplish some significant work later this year.

Having described our work, we have some things to ask of this committee. Our work has shown us the great needs that exist for specialist medical support in Ukraine. Our team remains committed to making our contribution and we ask for the support of the joint committee in a number of ways to progress that work: first, to support the continuing work of our project and for our further efforts to fund training and equipment; second, given the scale of current crises in Ukraine and Gaza, to support the work of other voluntary and charity agencies such as One4Humanity. Mechanisms to allow for the transfer of suitable vehicles would be a measure of immediate assistance in Ukraine; and finally, to consider the establishment of formal mechanisms for Irish medical professionals who wish to volunteer their time and skills in major medical emergencies overseas. Those mechanisms might then allow our colleagues to contribute as part of the Irish Government’s response to requests for emergency assistance in humanitarian crises. Our experience suggests that such an interest exists and that there are specialist areas in which the expertise of Irish clinicians can be of great value.

I thank everyone for the opportunity to make this presentation.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Tá fáilte romhaibh go léir. I thank Professor Bury, Mr. Leahy and Professor Fitzpatrick for being here today. As a starting point, we would all want to be associated with commending all those involved in this project who have contributed to the humanitarian efforts which are the saving lives in civilian populations who have no responsibility for a barbaric war that is being unleashed on them by the illegal Russian invasion of Ukraine. It is the broad view of the committee that we would be eager to assist in the project’s work in whatever way is practical and feasible.

I welcome the indication from the opening statement that was submitted that the request to the Red Cross was pre-empted. The written statement mentioned that there had been a request for €150,000 but the oral statement said that €100,000 was received. Professor Bury said the project had also contacted other agencies for some additional funding. If I heard Professor Bury correctly, he said the next mission is okay but he rightly has an eye to the next ones. Can he clarify precisely what he would like to have in place to be able to proceed as he would wish and what logistical arrangements would need to be sorted out as early as possible? He also mentioned mechanisms to allow for the transfer of suitable vehicles as something that would be of immediate assistance. What does that mean? Are the challenges logistical or are there administrative issues? Is something else causing the blockage? What kinds of vehicles are we talking about? Is it ambulances, civil defence or something else?

Interestingly, Professor Bury called for the establishment of a formal mechanism for Irish medical professionals to volunteer their time. We have seen right across the world, no matter where you go, that when there is a crisis of any kind, there will be an Irish person stuck in the middle, providing front-line support. Very often they will just randomly appear but especially in regions such as Ukraine and Gaza. The real power of Ireland is generally that we have Irish people on the ground operating and supporting people in need and communities in distress as a result of either conflict or natural disaster. I really like this notion of having a formal structure whereby there would be a one-stop shop for those who wish to participate. Should the Government establish such an arrangement through a Government agency or is it that the Government should support such a mechanism for that to happen? How would that be operationalised? What support, if any, can this committee provide? Can Professor Bury give examples of templates that have been used by other states or regions where such a mechanism has been brought to fruition?

Professor Gerard Bury:

I thank the Deputy for a comprehensive set of questions. I will ask Professor Fitzpatrick to talk about future funding frameworks and the issues we need to look at going forward in a moment.

We do not at all want to look ungracious. The Irish Red Cross has been superb in its support. We always over ask in terms of what we expect. The offer of €100,000 yesterday from the Irish Red Cross, in addition to the €300,000 it has already donated to us, is hugely appreciated. Clearly any further funds from either the HSE, on behalf of Departments, or the Irish Red Cross, on behalf of the Irish people, in terms of the funds it has collected, would be very welcome but we very much wish to acknowledge the generosity and the kindness of those agencies.

The very practical clinical issue we have been addressing in our project is that of pre-hospital emergency care, the sharp stuff, right up at the point where people are injured or killed. The care of those people in the first hour or so after they have suffered a major issue is critical to their survival. Irish emergency services or colleagues in the statutory emergency service in this country deliver a superb standard of care to those patients. There are approximately 5,000 major trauma victims in this country who benefit from a well-established system of care.

Time is of the essence. In Ukraine, many civilians and military casualties of the war wait for eight to 12 hours at the spot at which they are injured for evacuation to a hospital or stabilisation centre. Vehicles that can robustly travel to the point of injury and retrieve that person to a stabilisation point are critical. One of the most important pieces of kit from a humanitarian point of view have turned out to be 4x4 jeeps but their life span is very short; only a matter of weeks. This is not a part of our project's work but is a wonderful example of the work that other Irish individuals and small groups have taken on of their own volition. They have identified this niche area. It seems that this State, as a purchaser and disposer of large numbers of vehicles on an annual basis, might consider setting aside some of its suitable vehicles, including 4x4 vehicles, ambulances and other suitable vehicles, or impounded vehicles, for instance, that might meet those criteria. They could be set aside and a mechanism could be created through an appropriate charity for the donation of those vehicles. The Irish Defence Forces have this month contributed some important and well-defined functions through vehicles they have donated to their opposite numbers. The whole range of emergency medical services in Ukraine benefit from such access. If the committee could support, advise or develop a framework in which some of those sorts of vehicles were made available for transport to Ukraine, it would be very much appreciated.

I will ask Professor Fitzpatrick to talk about future funding and we can come back to the formal mechanisms the Deputy mentioned a moment ago.

Professor Christopher Fitzpatrick:

As Professor Bury highlighted, we now have enough funding to undertake a visit to Ukraine in the early autumn to train up to 150 participants and also to provide them with clinical emergency equipment and drugs, and training materials, so that they can cascade the training to colleagues. In addition, we will next week start to requisition emergency materials and drugs to send as a resupply for those who have previously attended our courses. That will bring us up to the end of the year. What we would greatly appreciate from this committee is a recommendation that this model of funding continues into next year and for as long as the conflict continues. We anticipate that funding of up to €1 million will be required next year in order to undertake at least two visits to Ukraine to provide a series of courses on each training mission with up to 150 to 200 participants depending on the demand. It is also important that we continue to supply those who previously attended our courses with clinical equipment and drugs that are difficult to access.

In addition, as Professor Bury highlighted, we have developed an in-house 3D printing system of anatomical models that we use as part of our simulation training. When we visit Ukraine, we bring a significant number of them with us and leave them behind so that course participants can use them to train their colleagues. For the core activity of the UCD Ukraine Trauma Project, we would like the committee's recommendation to be that the funding will continue into next year. We will look to escalate our activity and request funding of up to €1 million. We acknowledge, as Professor Bury said, our main funders who, to date, have been the HSE global health programme and the Irish Red Cross Society. We also acknowledge the support of the Minister for Health, who has taken a special interest in this project.

Professor Gerard Bury:

I will briefly return to the large issue of the establishment of the formal mechanism to perhaps create a framework for the many individuals Deputy Carthy mentioned and who are found all over the world in every crisis. The number of individuals from Ireland contributing at all levels in Ukraine is extraordinary. There is, to the best of my knowledge, no framework at a national level within which medical practitioners and medical staff with specialist expertise can offer those specialist services to areas in which major medical emergencies exist. The HSE has a framework by which staff members who take time off to volunteer on projects may be reimbursed their wages. However, that is not the same as a framework in which a specialist in a hospital discipline, a primary care discipline or a pre-hospital care discipline can offer those specialist services and that expertise to people in need. The NHS has a framework that exists at the moment. To the best of my knowledge, it provides its staff with a framework in which they can offer those skills, experience and expertise to areas in need.

There are, of course, agencies, such as Médecins sans Frontières, MSF, the Irish Red Cross Society and the international Red Cross, the International Federation of Red Cross and Red Crescent Societies, which have superb systems in which emergency assistance can be offered. However, it seems that the resources of this State, specifically in respect of medical, nursing and pre-hospital care assistance, might be marshalled in a way that enables those who are willing to offer their time, interest and expertise to do so. I believe it is necessary to examine the options to implement that. I do not have, and am not offering, a mechanism immediately to do so but it seems to me that this committee might be one of the vehicles through which those options might be explored and some recommendations robustly examined.

Réada Cronin (Kildare North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank everyone for coming in today. Maith sibh go léir. We can be proud of, and grateful for, the expertise they have shared with the world. There is so much war going on at the moment and with the jingoism behind war, it is easy to forget how fragile humanity is and humans are when they are in the firing line of all this weaponry made by the weapons industry. I am glad that the witnesses' expertise and skill is being used for good. It is nice that Ireland plays some part in that regard.

Our witnesses were talking about their plan to send one Hospitainer to Gaza and said they might follow it up. It is an amazing thing that the human spirit keeps going. The hospitals that Gaza already had were deliberately attacked and destroyed and yet people such as our witnesses can say that we will get another hospital in there. That is what keeps the human spirit going.

The witnesses' requests are modest considering the amount of work they do. The Ukrainian ambassador was before the committee last week and I talked to her about the psychological services on offer. The witnesses are here this week. In respect of a formal mechanism for Irish medical professionals, for how long do medical professionals go away? Is it for a month or six months? How do other countries frame that?

I ask the witnesses to give us a bit more detail on what they would like, given that they said this is something the committee could look at. A formal system for medics to volunteer would be a great idea. They would learn a lot from the experience, particularly when working in those kinds of conditions. I ask for more detail on what works in other countries.

Professor Gerard Bury:

I will ask Mr. Leahy to speak about the amazing work his organisation has done, and the plans for Gaza.

Mr. Shane Leahy:

For background, like so many other Irish people, I volunteered with Gorta in the early stages of the war in Ukraine. I found myself on the Ukrainian side of the border, helping refugees coming out, and was touched by the people we met as we set about trying to assist. Luckily, I met a business colleague who happened to be the logistics director of CEMARK CRH. It is the biggest cement company in Ukraine and is owned by CRH. It had warehouses and trucks that were not requisitioned by the government, as a lot of the health service had been. We were able to utilise its infrastructure to deliver aid into the far reaches of Ukraine in the early stages of the war. We first got a Garda Síochána convoy that delivered aid and we were able to deliver that into the far reaches of Ukraine. The National Rehabilitation Hospital also donated its old equipment and another Irish company, the Kirby Group, delivered some generators. We were able to prove the model with that and set up warehouses in Ukraine with CEMARK truck drivers who had been working with the company for more than 20 years to deliver aid.

From that, we developed a partnership with Heart To Heart International, a major US charity. I acknowledge its incredible support of our organisation. We have delivered 16 hospital units into the far reaches of Ukraine. Three of those units have been damaged by Russia but we have managed to repair them and I am glad to say they are up and operating. That is one of the projects that we still work on in Ukraine. We worked with our colleagues here, Professors Bury and Fitzpatrick, to deliver one of those units into Mykolaiv. It is still in operation but we have been requested to move it to a location with even great need, which we will do.

Regarding medicines, we were able to prove the model through working with An Garda Síochána and others, and delivered in excess of $80 million of medicine that Heart To Heart International had donated to us. It is flown to Vienna and we truck it into our warehouse in Ukraine. We then use the distribution within Ukraine to deliver it to its end destination. We have been able to scale that successfully. It is largely self-financed. I acknowledge the contributions of a number of colleagues. The EY Entrepreneur of the Year donated some funds but it is largely self-funded and the warehouses and transportation are largely provided by CEMARK. We are continuing to deliver.

In respect of Gaza, we want to deliver one unit, which would be our first, to prove the model. We would like to then scale it up from there. Ross Kelly, who is a former Entrepreneur of the Year finalist has come on board and is leading that on our behalf. He is sitting in the Gallery today. He has done some phenomenal work laying the ground for getting that hospital unit in.

Réada Cronin (Kildare North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thought I recognised Mr. Kelly. I know who he is now.

Professor Gerard Bury:

I thank Mr. Leahy. That was great. In some ways, my business has been to ensure that our project keeps its focus on the Ukraine pre-hospital scene. If the work that Mr. Leahy has described in Gaza becomes feasible, perhaps some of the kits and materials that we found to be critical at the front line will be provided also. That would require additional funding separate from what we have talked about regarding Ukraine.

I will return briefly to the question about a formal mechanism. My focus, as a former director of the UCD centre for emergency medical science and as someone who has worked in the pre-hospital area in this country for decades, with colleagues whom I admire beyond measure, has been on the pre-hospital element of care. This is probably one of the vital areas in which our expertise can be of use. We have demonstrated some of that in Ukraine.

We must remember that Ireland is a small country. We have our own needs, a small population and limited scope to provide care. When we began our conversation with colleagues in Ukraine in 2022 about what we could do to help, my insistence was on added value. We needed to contribute something that was not already available and that would make a difference over and above what those wonderful colleagues were doing. In the pre-hospital care and early hospital care arenas, as well as the continuing care phase of medical support for large-scale emergencies in other countries, there are areas in which niche and important expertise exist in this country. These could add to the work of bigger, more sophisticated and perhaps more robust agencies and countries, but there are areas in which we can contribute that bring that added value. They are built around planning and preparation. There is no point in simply upping and going. It is important to have these sorts of expertise that we have been able to tap into, through colleagues like Ben Heron and all of the other wonderful paramedic staff in Ireland who have contributed to our project.

Planning and preparation, the identification of roles, the mechanisms by which people can be seconded or released from their work and supplied with the training, equipment and framework in which they can make that added value contribution are all feasible activities. There are a number of options to explore them and I do not propose to offer my pet choice here. There are many people who could contribute to that discussion and develop some recommendations for implementation.

Réada Cronin (Kildare North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank Professor Bury.

Professor Christopher Fitzpatrick:

I might add to that. In the context of a national response, having it under the aegis of a government, particularly the Irish Government, carries a significant advantage in that the reputation of this country is well respected in Ukraine. Certainly, from the people whom we met, they are well aware of the reception and support Ukrainians have received here since the onset of the war. Our position of neutrality is also well respected. It adds an extra dimension to the work we do in that we look to train clinicians to treat all casualties of the conflict. We have also had the privilege of meeting some Ukrainians in Kiev recently, who we met originally in Dublin and are back working in Kiev. They have carried a very important message regarding how they were looked after in this country. Having something with an Irish stamp on it certainly carries added value in terms of our reputation for hospitality and humanitarian interventions and our neutrality.

Réada Cronin (Kildare North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank Professor Fitzpatrick. I appreciate that.

Professor Gerard Bury:

I thank the Chairman. His own comments fill in the blanks and many of the issues. It seems the Department of Health and the Department of Foreign Affairs are lead agencies in creating such a framework. Clearly at operational levels, the HSE and other parts of the health sector in this country will contribute and will have an important role to play, but there are some principles are important from my experience. One is keeping it tight. Large, bulky administrative organisations that are cumbersome are not going to attract the sort of people or functions we want, nor will they deliver. The second is that there has to be focus and that will differ from one medical emergency to another. It is important to have a range of skills, equipment and preparation.

The pre-hospital, early hospital and continuing care domains seem to me, as a family doctor in my own professional background, to be the main components of care that need to be prepared and delivered. Whether it is a training issue or whether it is a provision of care issue, there are large numbers of people in this country with expertise they are willing to contribute. A lean organisation with clear focus that gives them an opportunity to provide added value is going to attract many of the colleagues I know, under the banner of an Irish national project. For the reasons Professor Fitzpatrick mentioned, the country stands to gain from such an exercise as well.

Volunteerism is extraordinary as a powerful driver for good. We have now raised €1 million, of which we have spent about €700,000. All of that money has been spent on equipment and on travel, not on administration or on any other function. It is an enormous tribute to the people who have volunteered their time, their expertise and their own funds, to a large extent, to get them to a point where they can deliver on their commitments.

The Department of Health and the Department of Foreign Affairs seem to be agencies that might, at an early stage, consider the establishment of such a framework and perhaps consult with some of the other countries at EU level, which have similar frameworks, and examine how best the sort of characteristics I have talked about might fit.

In respect of the hospital and other health services in Ukraine, it goes without saying they are under extraordinary pressure. One of our colleagues who has accompanied virtually every mission that we have delivered in Ukraine, Dr. Lyudmyla Zakharchenko, a consultant neonatologist in the Rotunda hospital, comes from Ukraine and her expertise in liaising with her peers in Ukraine has clearly demonstrated to us that this is an area of care that has been devastated by the war. The care of mothers and neonates, children in their formative weeks and days, has been undermined at many levels and Dr. Zakharchenko's ability to work with her colleagues in some areas that have been battered by artillery and to talk with them about better and more modern techniques to offer care to those neonates has been inspiring. Dr. Zakharchenko has not needed to go and put hands on babies who have just been born, but her expertise and her ability to talk to colleagues and countrymen about how best and how better, perhaps, to offer care to those mothers and babies has made a difference.

Professor Christopher Fitzpatrick:

Professor Bury has spoken about the issue of pre-hospital emergency care of war victims. Perhaps Mr. Leahy would like to illustrate the difficulty that exists with regard to children who have severe disabilities. This is a project Mr. Leahy has been involved with.

Mr. Shane Leahy:

Through Project Conor in Odessa we are working with a local charity to deliver services to families that have severely mentally and physically disabled children. They are forgotten in a time of war. The Ukrainian government has other priorities, unfortunately, in terms of the front-line action and front-line casualties. It is often the weak who are left behind and we are starting a project of supporting them. It is headed by the commercial director of Cemark, who is volunteering all of his time on the ground. We are providing funding directly to him so that he can purchase medicines. Those medicines are overseen by the Odessa university hospital. That relationship was brought about Professor Fitzpatrick and Professor Bury. I am very proud of the work we are doing there and the difference it is making on the ground. It is something I would like to see more co-operation with going forward.

To comment on that briefly, we have come across a number of different organisations and, again, even the work that we are doing together came about by a fluke. We have been able to complement each other. We have been able to bring equipment into Kyiv when they have had problems. They have been able to assist us with the project in Odessa by bringing in Odessa university hospital and it has been invaluable to us being able to deliver a service over there. If there was some type of emergency co-ordinator who could bring all of the groups together, hear what they are doing and potentially allocate some resources to some of those, that would be very useful.

Professor Gerard Bury:

In Ireland?

Professor Gerard Bury:

We have had great support from the Department of Health. I have had so many meetings with so many people. The Minister for Health, Deputy Stephen Donnelly, has been very supportive and has regularly made contact with us about our work. The direct face-to-face work though has been with HSE global health, as the vehicle through which funding and other supports are offered. For instance, staff of the HSE who have come on training missions have had their contractual arrangements looked after in terms of our work. We have not directly engaged with the Department of Health on this matter.

Cathal Berry (Kildare South, Independent)
Link to this: Individually | In context | Oireachtas source

I thank Professor Bury and his team for coming in today and for all the great work they are doing. It is fantastic. I have two very brief questions. The first is in relation to the medical specialists and this panel of people the witnesses are looking to put together or is at least suggesting.

The Department of Foreign Affairs has this rapid response corps which the Chair might remember from his days as Minister. Could we include a separate stream in the rapid response corps, which would be medical-specific and for medical specialties? We have a tradition of sending small groups of people abroad for humanitarian reasons and there is a framework already there. We could expand that framework slightly, rather than just having generalists, logisticians, engineers and linguists, we could include a medical specialist stream as well. That was my first question and I wonder what the witnesses' thoughts are.

Second, to back up the Chair, Mr. Leahy is doing great work in Gaza in relation to that containerised hospital. I am not sure what the Department of Foreign Affairs can do. Is there something specific the Department of Foreign Affairs could do? Could it charter a ship, for instance, or provide logistics to help this containerised hospital get to Gaza? I am conscious of the likelihood of conflict spilling over into Lebanon in the next two weeks or slightly longer and Mr. Leahy might required to go to Lebanon as well with a similar concept.

To conclude, I want to acknowledge the support of the Minister for Health, Deputy Stephen Donnelly, who has been very supportive. My two questions are: is the rapid response corps worth exploring and is there anything specific the Department of Foreign Affairs could do to help Mr. Leahy get the equipment to Gaza? I thank the Chair.

Professor Gerard Bury:

I thank the Deputy for all of his support and his work on our project. I am not terribly familiar with the Department of Foreign Affairs' agencies or roles and the rapid response corps Deputy Berry described is an excellent agency to consider as a starting point. The little I know about it suggests it is a non-medical and largely support-based organisation. It might be a good starting point to consider it as a framework for the sort of work that we are talking about. Similarly, the co-ordination role Mr. Leahy mentioned between other agencies might also fall under the ambit of any framework that is created rather than directly being a part of a Department of Foreign Affairs agency, per se. It might need to be broadened just a little bit beyond the current framework that has been described.

Mr. Shane Leahy:

In terms of the provision of the hospital units, there will be significantly more than one required for Gaza. There is obviously significant destruction throughout the strip, so we would look to scale if possible. We want to get one in to prove the model but then scale that. We started in Ukraine with one and we got 16 in. Again, we would be looking for something similar in Gaza, so funding for scaling would be very useful.

Cathal Berry (Kildare South, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Chair and the witnesses.

David Stanton (Cork East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Apologies for being late, but I was speaking in the Dáil Chamber. It is very hard to believe this is happening in 2024 and that such awful wars are occurring on our Continent, in Gaza and in Sudan, which is beyond appalling as well. There is no sign of any of them finishing and they are, in fact, getting worse. A lot of my questions have been asked so I am not going to repeat them. One thing strikes me and that is the long-term psychiatric and psychological trauma that young people and children will endure as a result of the horrors they are experiencing at the moment. Could I get the witnesses' thoughts on that?

A lot of the other questions have been asked and I congratulate the witnesses on the work they are doing. We have to do all we can to support them, Chair, with the three asks they have here. What is the long-term psychological and psychiatric impact of what people are experiencing on the ground out there? I know that sometimes when people from Ireland go abroad and help, they are impacted by what they have seen and they need might support when they come back. That is an issue I wanted to highlight.

Professor Gerard Bury:

I thank the Deputy. I will ask my colleagues to comment because I think they are really important and much broader issues than perhaps the ones we have focused on in our very focused project. What has been inspirational is to meet the colleagues we have encountered on our training programmes and to hear of the circumstances in which they are working and living and to see their genuine robustness and solidarity with each other, as well as their coping abilities under circumstances that theoretically might be expected to damage people immediately. There is no doubt that war and civil disruption, to the extent that it is happening in each of the countries the Deputy described, has devastating effects on the population. We have to acknowledge that people are awfully robust. They look after each other and societies, with the sort of solidarity and the cementing together Ukraine in particular has in terms of the attack it has endured, have been surprisingly robust in my experience.

It is a great example in the longer term perhaps, and in the continuing care phase I mentioned earlier, of how expertise from our country might support colleagues - psychological, psychiatric and mental health specialists - in identifying the areas in which their services in the future are going to have to cope. We cannot deliver that care for ourselves. It is going to be long term and massive in terms of its need but I think there is the expertise in this country to contribute, but perhaps not in the most obvious of ways.

Dr. Chris Fitzpatrick:

I agree with Professor Bury said in that regard and I think there will be long-term consequences. We have been impressed by the resilience those who participated on the course have shown. They have spoken about stress. They said they are in stress so post-traumatic stress disorder will follow later. We have also met many civilians on our travels. We take a 13 hour train from the border to Kyiv and on our last journey we met a group of school children who were coming from Poland having participated in a swimming competition and their resilience was phenomenal. They wanted to speak to us, so they could improve their English while on the journey.

They showed us their medals and spoke about the interruptions at the school because of the air raid alarms going off. Many of them were attending school in underground facilities but they were phenomenally enthusiastic about their competitions and meeting foreigners coming into their country. No doubt there are consequences, but at the present time there is an incredible esprit de corps and incredible patriotism in Ukraine as well as an incredible ability to look after themselves. No doubt, as Professor Bury expressed, there will be consequences in the long term and perhaps some of our work can look into those areas as well.

Mr. Shane Leahy:

I want to echo that in terms of solidarity. The biggest fear is that you are alone in this and the biggest thing that we can do for them is to stand beside them and stand behind them because they are fighting on our behalf. Solidarity is the most important thing.

Professor Gerard Bury:

We received a very small token at the end of our last course which was a spent bullet case that had been carved into the shape of an angel with a map of Ukraine carved on the back. It was a very small token but nonetheless it was extraordinary for the group of 40 or 50 participants in that course to stand and offer us some small tokens of meaning to them. It spoke to the solidarity, the resilience and the courage that people demonstrate.

Réada Cronin (Kildare North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

It shows how the arts can help as well in dealing with trauma, creating something out of something so horrible as a bullet. I agree with the witnesses in that we do have a great tradition in Ireland of volunteerism and the GAA is a huge example. We have the Maynooth community first responders in my own community who are all volunteers. As we use our political capital in the world to speak out about things we believe are wrong, like the war on Gaza, for example, and the war in Ukraine, we can build it up by something like what the witnesses are suggesting.

Everyone knows about Médecins Sans Frontières. There is something we could do with that formal arrangement for medics to volunteer the witnesses are talking about .

In this defence committee, we often deal with the awful side of war so today's meeting was a bit more positive.

Professor Christopher Fitzpatrick:

On the subject of the arts, I had the great privilege of meeting with the young Ukrainian actor who was attacked on the streets of Dublin when they came over here last year to perform Translations, the Brian Friel play they presented in the Abbey in Ukrainian. I met him last October. He is back in Ukraine. I think the then Taoiseach, Deputy Leo Varadkar, met him on a visit to Kyiv subsequent to returning. I went to see him perform on stage in Kyiv, and what he said to me through a translator was that, in fact, the arts are really important. They are a form of defiance and solidarity, and also a form of inspiration to the people of Ukraine.

Life goes on relatively normal. Children go to school, cinemas run and the theatre runs, and it is part of that solidarity and self-healing. The arts are making a hugely important contribution to that.

Professor Gerard Bury:

Thank yous are the most important things I can say. It has been quite a privilege to do this work. It has been a privilege to work with colleagues here whom I have known and worked with in familiar guises over many years but to see those colleagues rise to different challenges and in ways that are inspirational has been a real privilege for me. It has been an honour to do all of those things, and to see other Irish individuals and groups - like Tony and his colleagues, and like Ben and Shane - simply rising to the occasion, and saying, "I cannot sit at home and watch this happening. I will do something but I will do something constructive". They will manifest that political capital that members have described but at a personal level and in the best spirit of the Irish people. I thank all of those people for all of their work and the opportunity to work with them. We have a lot more to do and I very much appreciate the remarks the Chair made, which suggest a follow-on to our presentation.