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  • Nicholas Mellor

Bridging Healthcare Gaps through Mobile Clinics: Step In's Journey from Iraq to Ukraine

Updated: Apr 26

This is a story not just about the crucial role that Mobile clinics are playing in the liberated areas in Ukraine, but also the story of its founders who created the organisation, learning from other organisations and adapting to the challenges of working first in Iraq and then in Ukraine.

The founding of STEP IN

STEP IN was co-founded by Zuzana Ulman, a physician from the infectious diseases department in the Czech Republic. Zuzana was deeply moved by the destruction and suffering caused by the emergence of ISIS in the Middle East. This led her to volunteer for three months with Church in Need.

Inspired by her experiences and the support of Professor Vladimír Krčméry, a renowned Slovak doctor and scientist, Zuzana launched STEP IN over eight years ago. Initially, it started as a project of Saint Elizabeth University and later became an independent organization.

STEP IN’s journey began in Iraq, where they provided primary healthcare through mobile clinics.

These mobile clinics visited villages that had found themselves cut off from healthcare centres. Mobile clinics, involving teams of 5-8 people agile enough to work in areas where healthcare services had broken down – or where the physicians that had served those communities had fled. The vehicles needed to be compact and small enough so they could get through to hard-to-reach communities, and where supplies could be offloaded at night to keep them safe and properly stored.

Stationary clinics were set up to serve camps for internally displaced people. Over six years, STEP IN treated over 150,000 patients, employed over a hundred individuals, and trained an even larger number of healthcare professionals and civilians in delivering life-saving aid.

During its healthcare operations in Iraq, STEP IN began to recruit more and more Ukrainians. After the full-scale invasion of Ukraine on February 24, 2022, STEP IN began operating in Ukraine working with its own team members back in their own country, as they built on their expertise: mobile clinics and training programs to build local capacity in critical skills. The map below shows the scope of their work in Ukraine and the essential role of mobile clinics in the areas close to the front line.

STEP IN’s co-founders, Zuzana and her husband Przemek, along with Matej Palencar, have always prioritized the quality of their services.

They have managed to grow STEP IN into an organization able to deliver a growing range of health-related services, meet the requirements of an increasing number of donors, and train its own staff so they grow personally and professionally, while at the same time retaining a patient centric approach and family-like team spirit, something which is often associated with new humanitarian initiatives, and harder to sustain in larger institutions.

STEP IN has built partnerships and gained trust and funds of donors including governments of Slovakia, Poland, United States, Belgium, and Italy. Currently, their biggest source of funding in Ukraine is the Japan Platform, which is partially funded by their government. Other institutional donors include Knights of Columbus.

Lessons from STEP IN’s Mobile Clinics

STEP IN’s mobile clinics have been a beacon of hope in regions devastated by conflict, from Iraq to Ukraine. Mobile clinics in Ukraine use roughly the same approach as that developed in Iraq. A small team travels in a normal vehicle (a minibus or even an SUV, instead of a 5-tonne “proper” mobile clinic) carrying everything they need, neatly packed. One upgrade, forced by the circumstances, is that they now also have tents, which we can set up quickly in locations where there is no facility to accommodate our team. Their experience from Iraq to Ukraine offers valuable lessons on agility, resilience, the power of community-centred healthcare and constant adaptation.

Agility in Healthcare Delivery

STEP IN’s mobile clinics exemplify agility in healthcare delivery. They operate in areas where healthcare services have broken down, reaching communities that would otherwise be left behind. The compact and small vehicles can navigate through challenging terrains, ensuring that medical aid reaches the most remote and hard-to-reach communities.

Picture of a mobile clinic in the liberated areas of Ukraine

The agility of these mobile clinics also extends to their operational model. They can swiftly adapt to changing circumstances and shifting needs, ensuring that healthcare services are always delivered where they are most needed. This agility has proven to be crucial in conflict-ridden regions like Iraq and Ukraine, where the healthcare landscape can change rapidly and unpredictably.

Cost-Effective Healthcare Solutions

Mobile clinics often provide a particularly cost-effective solution to healthcare delivery in regions where traditional healthcare facilities have been destroyed. They require minimal infrastructure and their operational costs are significantly lower than rebuilding or maintaining brick-and-mortar facilities serving smaller communities. This cost-effectiveness allows organizations like STEP IN to deliver essential healthcare services to communities in need, even in the face of limited resources.

Beyond Basic Health Services

STEP IN’s mobile clinics go beyond providing basic health services. They serve as platforms for specialized care, addressing critical gaps left by destroyed hospitals. For instance, they provide support for amputees, offering prosthetic fittings, physiotherapy, and emotional support. They can also be used to support mental health services, providing counselling, trauma-informed care, and coping strategies to individuals suffering from PTSD, anxiety, and depression.

Building Local Capacity

STEP IN’s work is not just about delivering healthcare services; it’s also about building local capacity. They train local healthcare professionals and civilians in delivering life-saving aid, ensuring that communities are equipped to take care of their own health needs. This focus on capacity building ensures the sustainability of their interventions and empowers communities to take charge of their own health.

Leveraging Technology

STEP IN leverages technology to enhance their healthcare delivery. They use Starlink to stay connected even in the most challenging circumstances, ensuring that they can keep working and monitor security developments. They also use telehealth to bridge geographical gaps, connecting patients with specialists miles away.

Conclusion and relevance to the crisis in Gaza

STEP IN’s mobile clinics offer valuable lessons on delivering healthcare in conflict-ridden regions. Their agility, cost-effectiveness, focus on specialized care, commitment to capacity building, and effective use of technology all contribute to their success in bridging healthcare gaps. Their work serves as a powerful reminder that even in the face of adversity, it is possible to deliver compassionate, high-quality healthcare to those who need it most, and potentially serves as a model for how health services could be rapidly deployed in Gaza following a truce or ceasefire.

Step-In’s work has been supported by a charitable donation from Sir Tim Rice with the additional support of the Guildford Chantries Rotary Club.


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