Doctors Without Borders' innovative mobile hospital on a trailer

There is no more noble organisation than Médecins Sans Frontières (Doctors Without Borders), which works tirelessly to provide medical care where it is most needed, irrespective of race, religion, creed or political affiliation. Médecins Sans Frontières (MSF) does its work almost exclusively in the world's most dangerous places, administering aid in countries ravaged by war, disease and humanitarian disasters.

Last year, MSF fielded more than 30,000 personnel in over 70 countries, with its US$1.6 billion annual budget funded entirely by donations, 90 percent of which come from private donors and 10 percent from corporate donors. Hence, just as Ernest Rutherford reflected on his team's quest to split the atom, "we didn't have any money, so we had to think" ... so does MSF.

Each year, MSF attempts to do more with less, and this year that enforced ingenuity has spawned a truly remarkable concept – the Mobile Unit Surgical Trailer (MUST).

"The MUST is a complete mobile hospital on trailers," MSF Project Manager Arnaud Bardinier told New Atlas. "It's an operating theater, recovery ICU and sterilization room, with triage possible within the tents we carry, plus it carries all the medical supplies and logistics stock we need for a week of autonomous operation. We have been using it for the first time in south Mosul in Iraq, where it has allowed MSF teams to conduct lifesaving war trauma surgery in hygienic and temperature-controlled conditions.

"It's what we call 'the kit' because it is everything we need in one one discrete mobile unit. So we have the capacity to move everything quickly and efficiently to go anywhere we need to go, and we can be set up and operational within three hours."

Getting an operating theater to the front line is only one of the advantages of the MUST, because the front line can move in both directions.

"In the case of a threat to our security, the MUST also gives us the ability to quickly step back from the front line," says Bardinier. "Just as it can be operational within three hours, we can pack up and leave within three hours. When security is re-established, we are then able to return to where we are needed just as quickly ... all without losing any capacity to do what we're there for. Previously, we often spent days unpacking and setting up operating facilities, and we couldn't operate as close to the front line because it required just as much time to pack up."

"It's important to realise that more than half of what we do at MSF is in the logistical area," Bardinier continues. "Doctors and nurses cannot work in isolation. They need more than just patients. We need to provide support ... sterile buildings to work in, maintenance, technology, water, food and sanitation for our staff, transport, mechanics, construction ... much more than half MSF's work is providing what the doctors and nurses need. That's the true beauty of the MUST - it combines everything into one portable unit."

So where did the idea come from?

"For many years we have had it in mind that MSF had to be able to get as close as possible to where the wounded were, where the population in need was ... our place is invariably on the front line. We tried to work out what we could do to achieve that, but the main issue was security. We don't have an army to keep us safe.

"So mobility was the answer. We thought about helicopters but we didn't have the infrastructure and resources to do that. When the fighting in Mosul (Iraq) started last year, we again looked at the problem and we knew that because of the nature of that conflict, that the front line would be constantly moving and we would need to follow that front line, to be where we were needed.

"As we are always trying to get better at what we do, and our logistics area in particular has been evolving and improving, the emergency pool challenged the logistics area and said, 'can you do this?' and we had been working on ideas like this already, so we went to one of our suppliers and we came up with the MUST."

Only one MUST has been built so far, but the experiences of using it in Iraq suggest it offers a quantum improvement in medical care in conflict and disaster zones. One more MUST is under construction, and three subsequent units are planned when finances allow.

"Each Mobile Unit Surgical Trailer costs €1.0 million (US$1.14 million), so they are not cheap, but they offer a major leap forward in saving lives", says Bardinier. "The MUST gives us the flexibility to be where we are most needed."

In 1999, Médecins Sans Frontières won the Nobel Peace Prize and the acceptance speech of then MSF President James Orbinski is worth reading to appreciate the challenges of the organization.

If you would like to assist Médecins Sans Frontières in its humanitarian heroism, the organization only accepts general donations, not donations for specific projects, which can be made here.

The video below gives an overview of the MUST.