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MEDICAL EVACUATION (MEDEVAC)

TABLE OF CONTENTS
Page

I. General..........................................................................................................................................1
Purpose...........................................................................................................................................1
Eligibility .......................................................................................................................................1
Escorts............................................................................................................................................1
Donor .............................................................................................................................................2
Duration .........................................................................................................................................2
Destination and Costs.....................................................................................................................2
Children born while Mother is on MEDEVAC ............................................................................3
Repatriation of Mortal Remains.....................................................................................................3

II. Mode of Transportation ..............................................................................................................4


Travel by Air..................................................................................................................................4

III. Daily Subsistence Allowance (DSA) ...........................................................................................4


Recognized Regional Medical Centre of MEDEVAC ..................................................................5
Place of Home Leave or Within Country of Recruitment for Locally Recruited Staff..................5
Place of Staff Member's Choice ....................................................................................................5

IV. Terminal and Other Expenses ....................................................................................................7

V. Related Entitlements....................................................................................................................7
Leave Status ..................................................................................................................................7
Special Leave Without Pay (SLWOP)...........................................................................................7
Annual Leave / Home Leave .........................................................................................................7

VI. Procedure......................................................................................................................................7
Approving Authority .....................................................................................................................7
Medical Evacuation Requests .......................................................................................................8
Availability of the UNHCR Medical Service ...............................................................................8
Confidentiality of Medical Information ........................................................................................8
Practical Measures .........................................................................................................................8
Visas...............................................................................................................................................9
Travel Authorization (PT-8) .........................................................................................................9
Purchase of Tickets .......................................................................................................................9
DSA Advances ............................................................................................................................10
Travel Claim ...............................................................................................................................11
Payment of Advances in Order to Settle Medical Bills ..............................................................12
Recovery of Salary Advances for Medical Expenses ..................................................................12
Record-Keeping ..........................................................................................................................13
Annexes

A. Summary table: DSA payable on MEDEVAC ...........................................................................14

B. Recognized Regional Medical Centre of MEDEVAC ................................................................15

C. Emergency Chartered Medical Evacuation Services (International SOS) ..................................17

D. Guidelines for Physicians Advising on Medical Evacuation ......................................................19

E. Contact Information for Medical Service UNHCR Geneva ....................................................20

F. Medical Evacuation Request Form (to be completed by Head of Office) ...................................21

G. Medical Evacuation Request Form (to be completed by the attending physician) .....................22

H. Medical Evacuation Report Form (to be completed by the staff member) .................................25

I. Medical Evacuation Final Medical Report (to be completed by the attending physician) ..........26

J. Sample Authorization for MEDEVAC ........................................................................................28

K. Control Sheet for Audit purposes ................................................................................................29

L. Checklist to be attached to Payment Voucher for Settlement of MEDEVAC Travel Claim ......30
I. General

Purpose

1. The purpose of a medical evacuation (MEDEVAC) is to allow staff members and eligible
dependants the opportunity to secure essential medical care or treatment for a severe illness or
injury requiring medical intervention that is locally unavailable or inadequate.

Eligibility

2. Internationally Recruited Staff Members. Internationally recruited staff members, their


spouses and dependent children residing at the duty station, as well as internationally recruited
consultants (for service-incurred accidents only), may be evacuated in case of an acute illness or
injury for the purpose of securing essential medical care or treatment which cannot be secured
locally because of inadequate medical facilities.

3. Internationally recruited staff members, their spouses and dependent children should plan all
elective surgical, medical or dental procedures in conjunction with their home leave or family
visit travel.

4. Locally Recruited Staff Members. Locally recruited staff members, their spouses and
dependent children, for whom the organization has not assumed a responsibility for relocation
to or from the duty station, will normally be expected to avail themselves of the facilities
available locally1. However, when an acute life-threatening medical emergency has occurred,
MEDEVAC will be considered when the available local facilities offer an inadequate response.

5. Staff on Mission and/or in Receipt of SOLAR 2: Staff members on mission status are eligible
for MEDEVAC as per paragraphs 2 to 4 above.

6. Entry/Periodic/Exit Medical Examinations are not covered by MEDEVAC. Where


adequate medical facilities are not available at the duty station, staff members may be
authorized to travel to the nearest city where adequate medical facilities exist for the purpose of
undergoing the required medical examination. Such travel will be authorized locally. DSA and
travel entitlements will be covered under Account 621250 Medical examinations.

7. United Nations Volunteers and any other category of staff not specifically mentioned above are
not covered by the provisions of this IOM/FOM.

Escorts

8. Medical Escort. A physician or a nurse may be authorized to escort the evacuee only when
medical attention is required during travel.

9. Family Member Escort. A family member may be authorized to travel with the evacuee under
the following circumstances:
a) in psychiatric cases;
b) for children under 18 years of age;

1
As per IOM 48/98- FOM 52/98 of 1 July 1998 Redeployment of locally recruited staff between duty
stations in the same country, a redeployed staff member and his/her eligible dependants will be entitled to
MEDEVAC within-country in accordance with local conditions and subject to the approval of JMS.
2
See IOM 91/2000 FOM 93/2000 dated 28 December 2000: Special Operations Approach

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c) for evacuees who cannot look after themselves (e.g. stretcher or paralytic cases).

Donor

10. In cases of transplant or other medical intervention, the travel of a donor may be authorized.
The Head of Office should consult with PAPS for DSA and travel entitlements for the donor.

Duration

11. As payment of DSA should normally not exceed 45 days, maximum care should be exercised in
determining the place of evacuation based on the expected duration. When MEDEVAC is
expected to exceed this period, or for any extension of MEDEVAC beyond 45 days,
authorization must be obtained from UNHCR Medical Service. For this purpose, all relevant
medical documentation must be forwarded to Medical Service.

12. Once authorized, normally not more than one follow-up MEDEVAC will be approved for the
same condition or in respect of surgical procedures (e.g. removal of stitches, etc). Medical
Service should be contacted when further follow-up evacuations are required.

Destination and Costs

Recognized Regional Medical Centre:

13. The list of Recognized Regional Medical Centers, in line with ST/IC/2000/70, is provided in
Annex B. Any departures from the ST/IC list will be noted and filed as exception by the
Medical Service. Medical Service is aware that exceptions have to be justified for reason of
inadequacy of medical treatment of the particular medical condition at the point of origin and
the adequacy or otherwise at the nearest recognized centre, the latter will prompt an exceptional
authorization to a third point. Urgent life threatening situations will be dealt, as always, as per
the determination by the Medical Service.

14. MEDEVAC is normally authorized to the Recognized Regional Medical Centre. All
authorizations, from Medical Service, for medical evacuations will carry a sequential medevac
authorization number YY/MS/0XX; any extensions thereof will also carry the same
authorization number YY/MS/0XX add.1. All travels under medevac must be fully
documented for audit purposes.

15. Travel costs to the nearest Recognized Regional Medical Centre are borne by the organization
in respect of the evacuee and any authorized escort.

16. If difficulties arise in obtaining an entry visa to the Recognized Regional Medical Centre (see
paragraph 54), an alternative destination within the region will be authorized.

Country of Home Leave:


17. In the case of internationally recruited staff members, MEDEVAC may be authorized to the
country of home leave in cases of:
a) high-risk pregnancies;
b) psychiatric conditions;
c) illnesses requiring a long period of convalescence.

18. Travel costs are borne by the organization in the cases mentioned in paragraph 17 in respect of
the evacuee and any authorized escort, and covered under Account 621710 (i.e. travel on

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MEDEVAC will not be offset against the staff members home leave or family leave
entitlement).

Place of Staff Members Choice:

19. A patient may choose to be evacuated to:


a) the country of home leave (if the case is not covered under paragraph 17); or
b) any country of the staff members choice, subject to approval by Medical Service.

20. The staff member will be required to produce satisfactory medical evidence of proper medical
care or treatment received at the chosen place.

21. Travel costs for the staff member and any eligible family member to the country of home leave,
or the country of family visit, or the alternate country of home leave, may be paid in the form of
advance home leave or family visit, provided all applicable requirements for either of those
entitlements are met. Travel costs in excess of those required for evacuation to the Recognized
Regional Medical Centre will be borne by the staff member when the staff member has
already exhausted his or her home leave or family visit entitlement.

22. When travel is to a country of the staff members choice, UNHCR will only pay whichever of
the following two costs is lower and the staff member will be responsible for any difference:

a) from the duty station to the place of the staff members choice, and return;
b) from the duty station to the Recognized Regional Medical Centre of MEDEVAC, and
return.

23. Emergency Medical Evacuation. For emergency medical evacuations, the Head of Office, in
consultation with UNHCR Medical Centre determines the place of evacuation, which should
normally be the nearest Recognized Regional Medical Centre. In addition, a separate
arrangement exists with International SOS for MEDEVAC in extreme emergencies. The
procedures for MEDEVAC by International SOS are summarized in Annex C.

Children Born while Mother is on MEDEVAC

24. In the case of a child born during MEDEVAC, UNHCR will pay, in respect of the new-born
child, whichever of the following two costs is lower:
a) travel from the Recognized Regional Medical Centre of MEDEVAC to the duty
station; or
b) travel from the place where the mother exercised MEDEVAC to the duty station.

Repatriation of Mortal Remains

25. In the unfortunate event of the patients death during MEDEVAC, UNHCR will cover the costs
of transportation from the place of death:
a) for an international staff member, spouse or dependent child:
to the staff members place of home leave
to the duty station
to any other place, provided the cost of transportation does not exceed from place
of death to place of home leave, in which case the extra costs will be paid by the
surviving family members;

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b) for a local staff member, spouse or dependent child, to the duty station.

II. Mode of Transportation

Travel by Air

26. The mode of travel, irrespective of the duration of the flight, will normally be in economy class
in accordance with the least costly airfare structure regularly available or its equivalent. The
class immediately below first class may be authorized by the Head of Office (see paragraph 42),
when medically recommended.

27. Chartered Transportation. In extreme emergencies, and when traditional commercial or


other UN means of transportation and facilities cannot be used or are inappropriate given the
seriousness of the case (e.g. in field duty stations where commercial airline schedules are
infrequent or unreliable), chartered air transportation may be used. This may be done by
requesting the services of:

a) local/regional companies specializing in emergency chartered medical evacuations, as set


out in the local MEDEVAC plan; or
b) International SOS [See Annex C Emergency Chartered Medical Evacuation Services].

28. Chartered air transportation services should be used very cautiously, as they are very costly.

III. Daily Subsistence Allowance (DSA)


See Annex A DSA payable on Medical Evacuation (Summary table)

29. In all cases of MEDEVAC, payment of subsistence allowance will be subject to the
provision of receipts for a hotel/commercially registered accommodation in order to
determine the appropriate rate.

30. Staff members in receipt of SOLAR3: No DSA will be paid to staff members in receipt of
SOLAR, who travel on MEDEVAC to their administrative place of assignment (APA) in view
of the fact that they are deemed to have been installed at these locations. Staff members
traveling on MEDEVAC to a place other than the APA will continue to receive SOLAR plus
any applicable DSA for up to a maximum of 15 continuous nights of absence from the duty
station. SOLAR will cease to be paid from the 16th night until the staff member returns to
his/her duty station, or to another location where SOLAR is applicable. Any applicable DSA
will be paid in lieu of SOLAR.

31. However, if the evacuation is expected to last 15 days or more, SOLAR will be discontinued
effective from the date of departure on MEDEVAC, and any applicable DSA will be paid.

3
See IOM 91/2000 FOM 93/2000 of 28 December 2000, Special Operations Approach.

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Recognized Regional Medical Centre of MEDEVAC

32. When MEDEVAC is authorized to the nearest Recognized Regional Medical Centre which is
not the staff members place of home leave, DSA may be paid, upon presentation of hotel
receipts, at the rates shown below. Without receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, actual expenses for hotel may be reimbursed on
the basis of receipts up to 50 per cent of the standard DSA rate applicable to the
authorized place of evacuation;
b) for the evacuee when hospitalized, one third of the standard DSA rate applicable to the
authorized place of evacuation;
c) for the family member escort authorized to accompany the evacuee,
if the patient is not hospitalized, up to 50 per cent of the standard DSA rate
applicable to the authorized place of evacuation; and
if the patient is hospitalized, up to 100 per cent of the standard DSA rate applicable
to the authorized place of evacuation;

d) for the medical escort authorized to accompany the evacuee, 100 per cent of the
standard DSA rate applicable to the authorized place of evacuation, limited to two to
three days depending on travel time.

Place of Home Leave, or Country of Recruitment for Locally Recruited Staff

33. When MEDEVAC is authorized to the staff members place of home leave, or within country
for locally recruited staff, actual expenses for hotel or other commercially registered
accommodation may be reimbursed on the basis of receipts at the rates shown below. Without
receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, up to 50 per cent of the standard DSA rate
applicable to (i) the staff members place of home leave, or (ii) the actual place of
evacuation within country for locally recruited staff;
b) for the evacuee when hospitalized, no DSA is paid;
c) for the family member authorized to accompany the evacuee:
if the patient is not hospitalized, up to 25 per cent of the standard DSA rate
applicable to (i) the staff members place of home leave, or (ii) the actual place of
evacuation within country for locally recruited staff; and
if the patient is hospitalized, up to 50 per cent of the standard DSA rate applicable
to (i) the staff members place of home leave, or (ii) the actual place of evacuation
within country for locally recruited staff.
d) for the medical escort authorized to accompany the evacuee, 100 per cent of the
standard DSA rate applicable to the authorized place of evacuation is paid, limited to two
to three days depending on travel time.

Place of Staff Members Choice

34. When advance home leave or family visit is authorized instead of MEDEVAC, normally no
DSA is paid except to the medical escort who receives 100 per cent of the standard DSA rate
applicable to the place of evacuation, limited to two to three days depending on travel time.

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35. Actual expenses for hotel or other commercially registered accommodation may be reimbursed
on the basis of receipts at the rates shown below. Without receipts, no reimbursement will be
made.

a) for the evacuee when not hospitalized, whichever of the following two costs is lower:
up to 50 per cent of the DSA rate applicable at the place of home leave; or
up to 50 per cent of the DSA rate applicable at the nearest Recognized Regional
Medical Centre of MEDEVAC.
b) for the evacuee when hospitalized, no DSA is paid;
c) for the family member authorized to accompany the evacuee,

if the patient is not hospitalized, up to 25 per cent of the standard DSA rate
applicable at the staff members place of home leave or 50 per cent of the rate
applicable at the Recognized Regional Medical Centre of MEDEVAC,
whichever is the lower; or
if the patient is hospitalized, up to 50 per cent of the standard DSA rate applicable
at the staff members place of home leave or 100 per cent the rate applicable at the
Recognized Regional Medical Centre of MEDEVAC, whichever is the lower;
d) for the medical escort authorized to accompany the evacuee, 100 per cent of the
standard DSA rate applicable to the authorized place of evacuation, limited to two to
three days depending on travel time.

36. When MEDEVAC is authorized to the place of the staff members choice, which is not the staff
members place of home leave, DSA may be paid, upon presentation of hotel receipts, at the
rates shown below. Without receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, actual expenses for hotel may be reimbursed on
the basis of receipts up to 50 per cent of whichever of the following two costs is lower:
the standard DSA rate applicable at the place of the staff members choice; or
the standard DSA rate applicable at the Recognized Regional Medical Centre;
b) for the evacuee when hospitalized, one third of whichever of the following two costs is
lower:
the standard DSA rate applicable at the place of the staff members choice; or
the standard DSA rate applicable at the Recognized Regional Medical Centre;
c) for the family member authorized to accompany the evacuee,
if the patient is not hospitalized, up 50 per cent of the standard DSA rate applicable
at the place of the staff members choice or the Recognized Regional Medical
Centre, whichever is the lower; or
if the patient is hospitalized, up to 100 per cent of the standard DSA rate applicable
at the place of the staff members choice or the Recognized Regional Medical
Centre whichever is the lower;
d) for the medical escort authorized to accompany the evacuee, 100 per cent of the
standard DSA rate applicable to the authorized place of evacuation, limited to two to
three days depending on travel time.

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IV. Terminal and Other Expenses

37. Terminal and other expenses shall be paid in accordance with SAMM chapter VII.

V. Related Entitlements

Leave Status

38. Based on the medical certificate to be submitted by the staff member and duly certified by
Medical Service, absence on MEDEVAC will be charged to sick leave.

39. If a staff member accompanies a family member on MEDEVAC, the absence will be charged to
annual leave. At the staff members request, the absence may be charged to family leave4 and/or
taken as Special Leave Without Pay (SLWOP), as appropriate (see SAMM chapter VI and
procedure 6.2.).

Special Leave Without Pay (SLWOP)

40. No MEDEVAC will be authorized during SLWOP. It is the responsibility of the staff member
to take out adequate insurance coverage during SLWOP.

Annual Leave

41. No MEDEVAC will be authorized during annual leave when the staff member is away from the
duty station or place of mission. It is the responsibility of the staff member to take out adequate
insurance coverage during annual leave.

VI. Procedure
(Initiate Medical Evacuation Checklist See Annex L)

Approving Authority

42. Authority to approve MEDEVAC to the Recognized Regional Medical Centre within the
region (see Annex B) or to the country of home leave, on the recommendation of the UN
designated physician, is delegated to the Heads of Offices, in consultation with UNHCR
Medical Service. The information which is forwarded to UNHCR Medical Service is
confidential, and should under no circumstances be filed in a staff members file
(PER/IND).

43. Guidelines for physicians advising on MEDEVAC are outlined in Annex D.

44. MEDEVAC to any other place will require the prior approval of UNHCR Medical
Service.

4
See IOM/FOM 08/98-10/98 dated 1 February 1998 Introduction of a Family Leave Option

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Medical Evacuation Requests

45. In cases where the prior approval of UNHCR Medical Service is required, the Medical
Evacuation Request Forms (attached as Annex F and G) should be completed and
submitted to UNHCR Medical Service. It should contain the following information:
a) staff members name, employment status (local or international), duty station, and index
number;
b) patients name (if not the staff member) with relationship to staff member;
c) Nearest Recognized Regional Medical Centre of MEDEVAC;
d) requested place of evacuation;
e) proposed date of evacuation and expected duration;
f) patients current clinical condition;
g) tentative diagnosis by the treating physician;
h) laboratory tests;
i) treatment initiated;
j) specific purpose of the evacuation; and
k) recommendation of the local UN designated Physician.

46. It is essential that correct and complete information be communicated to UNHCR Medical
Service to avoid unnecessary delays. Each request for MEDEVAC will be reviewed
individually, taking into consideration the recommendation of the UN-designated physician and
any other medical information at hand.

Availability of UNHCR Medical Service

47. UNHCR Medical Service or the designated Duty Officer at Headquarters is available for
consultation and assistance in all cases, 24 hours a day, and may be reached by telephone, fax,
telex, or e-mail (see Annex E).

Confidentiality of Medical Information

48. Medical information is confidential and should be treated as such, whether within offices or in
the transmission to UNHCR Medical Service, other offices or medical facilities.

Practical measures

49. Once MEDEVAC has been approved, the Human Resources/Administrative Officer at the staff
members duty station must send the following information/documentation to the Human
Resources/Administrative Officer in the receiving country:

a) staff members name; employment status (local or international), duty station, and index
number;
b) if applicable, name of accompanying family member and/or medical escort;
c) date of arrival, name of airline, flight number, and estimated time of arrival for patient
and, if applicable, accompanying family member and/or medical escort;

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d) estimated date of departure, name of airline, flight number and estimated time of
departure for patient and, if applicable, accompanying family member and/or medical
escort;
e) whether hotel accommodation arrangements are required for the patient and, if applicable,
accompanying family member and/or medical escort;
f) whether transportation arrangements to and from airport are required for the patient and,
if applicable, accompanying family member and/or medical escort; and
g) whether patient is covered under UNSMIS or MIP. UNSMIS or MIP can issue a letter of
guarantee in case medical centres request a guarantee of payment in advance.

50. The Human Resources/Administrative Officer at the staff members duty station must remind
the staff member to retain all receipts for accommodation, for submission with the Travel
Claim.

51. In addition, a copy of the Travel Authorization (PT-8) reflecting travel advances granted,
must be faxed to the Human Resources/Administrative Officer in the receiving country
(see paragraph 55).

52. In non-emergency cases, travel should not commence until the appointment with the pertinent
specialist has been made. As far as possible, evacuation should be avoided on weekends and
holidays when, as a rule, only emergency services are available in many hospitals.

53. The patient should have with him/her all necessary medical documents and records.

Visas

54. Prior to departure on MEDEVAC, the Human Resources/Administrative Officer should ensure
that any required visas have been obtained.

Travel Authorization (PT-8)

55. The Human Resources/Administrative Officer is responsible for issuing the travel authorization
(PT-8) in respect of MEDEVAC travel, based on the authorization received from UNHCR
Medical Service. Evacuees and accompanying family members and/or medical escorts must be
in possession of a signed PT-8 prior to undertaking MEDEVAC. Travel that has been
undertaken on oral instructions should be confirmed as soon as possible by the issuance of a
PT-8. For account codes, please refer to paragraph 66 below.

56. If the conditions of travel necessitate a deviation from the authorized route and if such a change
results in a higher cost, the traveler should contact and obtain prior authorization from the Head
of Office/Human Resources/Administrative Officer.

57. When travel on home leave or family visit is authorized in order to allow the patient to undergo
medical treatment, the authorization to travel will be given by Personnel Administration &
Payroll Section (PAPS) in the normal way.

Purchase of Tickets

58. Unless staff members are specifically authorized to make other arrangements, all tickets for
transportation involving MEDEVAC will be purchased by UNHCR, directly through its
authorized agents, in advance of the actual travel.

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59. When a staff member requests a standard of accommodation in excess of his/her entitlement, or
is authorized to travel for reasons of personal preference or convenience, by other than the
approved route or mode of transportation, the staff member will be required to pay, directly to
the Travel Agent, any additional costs in advance of travel.

DSA Advances

60. The maximum initial DSA that may be authorized by Field Offices is limited to 15 days.
However, the initial advance against DSA should never be more than the number of days of the
expected duration of the evacuation, as certified by the treating physician. An advance of 100
per cent against the estimated entitlement to DSA may be made to the traveler and recorded on
the original PT-8. No extension of DSA payments beyond 15 days may be authorized, nor any
advances made, without the prior approval of Personnel Administration & Payroll Section
(PAPS).

61. If the MEDEVAC period is extended, the staff members Human Resources/ Administrative
Officer may request UNHCRs office at the place of evacuation to provide an additional travel
advance which must be recorded on the travelers PT-8.

62. The Human Resources/Administrative Officer should inform staff members of any restrictions
on travelers cheques and credit cards at their destination.

63. Travelers who encounter personal emergencies or extraordinary expenses may contact the
UNHCR Head of Office at the place of evacuation. Staff members should not contact UNDP
offices except in extreme emergencies and may do so only where there is no UNHCR office.

64. Advances made by Field Offices in respect of medical evacuation travel or DSA should be
charged as follows:

a) Staff assigned to posts and local temporary assistance (including staff members in
receipt of SOLAR): All advances should be debited using the following chartfields when
payments are made to him/her either at their duty station or outside his/her duty station:

Cost Center - (Duty Station)


Programme - VF
Account - 240018
Open Item - Staff Member's last name.

(Please note when travel ticket has been purchased by the Office, then that cost need not
be charged as an advance but should be treated as expenditure)

b) UNHCR staff on mission status, internationally recruited staff on temporary


assistance and consultants: all advances charged to the pertaining cost centre on the
relevant PT-8.

65. Where the advance is made by the UNHCR office at the place of evacuation, the appropriate
country and location code of the duty station of the staff member should also be quoted in the
payment voucher. Copies of any payment voucher should be forwarded to the staff members
duty station to ensure recovery. All advances should be recorded on the original of the PT-8,
and a copy of any payment voucher given to the staff member.

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Travel Claim

66. Travel expenses should be charged directly to the appropriate account code as follows:

a) Staff assigned to posts: Pertaining cost centre, using 621710 as Account.


b) Staff on mission:

(1) Headquarters PT8: An addendum to the mission PT8 authorizing travel to the
mission area, charging the pertaining cost centre with Account 621710 should be
issued. The third and fourth copies should be forwarded to Travel and Visa Unit
(HQAU01), with box 18 fully completed and the amount of the advance received
indicated in box 13.
(2) Local PT8:
(2.1.) Missions lasting 1-60 days: Pertaining cost centre of the staff member,
using 621710 as Account.
(2.2.) Missions of 61 days or more:
(2.2.1.) If in receipt of SOLAR, charge the same account code as SOLAR
using 621710 as Account.
(2.2.2) If not in receipt of SOLAR, charge the pertaining cost centre for
the staff members salary5 using 621710 as Account.
c) Local staff on temporary assistance: Charge Account 620320.
d) Internationally recruited staff on temporary assistance and consultants:
Authorization issued as an addendum to the mission PT-8 covering travel to the mission
area, charging the pertaining cost centre as indicated on the original.

67. Where MEDEVAC is within the country of the duty station, settlement will normally be
effected in local currency in accordance with normal procedure. Where travel is outside the
country of the duty station, settlement of the travel claim will normally be made in US dollars.

68. Where travel claims are settled locally, copies of all documents should be retained in the Field
Office for future audit inspections.

69. Travel claims of staff assigned to posts or local temporary assistance should be submitted
immediately upon return to the duty station and settled by the Field Office that issued the
original PT-8.

70. Travel claims for MEDEVAC in respect of internationally recruited staff on temporary
assistance, staff members on mission with Headquarters PT8s and consultants, must be part of
the final travel claim and submitted upon completion of the mission/assignment.

71. The following documents must be attached to all travel claims:

a) medical certificate from the UN designated physician and the approval from UNHCR
Medical Service which should indicate:
(i) exact number of days of sick leave recommended;
(ii) number of days of hospitalization;
(iii) number of days the patient was required to stay at the place of evacuation;

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This would normally be the pertaining cost centre for the mission location, not the staff members own post.

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b) copies of all payment vouchers relating to any advances received or payments made,
whether by the UNHCR office at the place of evacuation or by the duty station of the staff
member, to or on behalf of the patient, in respect of travel, DSA or medical expenses
c) original PT-8
d) ticket stubs and/or any unused airline ticket(s) for immediate refund
e) original hotel receipts (to enable calculation of the DSA rate) and/or declaration of any
free or subsidized accommodation, meals or transportation provided by UNHCR, by
government or a related institution, or by an airline.

72. The payment voucher pertaining to the final settlement should clearly indicate:
a) maximum DSA entitlements;
b) all other related travel expenses;
c) recovery of any advances;
d) full allotment account code.

Payment of Advances in Order to Settle Medical Bills

73. It is the responsibility of the staff member to settle his/her own medical expenses.

74. However, where the medical expenses are expected to be high, Field Offices may be authorized
to settle medical bills charging the suspense account 240006, followed by the staff member's
name and/or employee ID. Payments in this respect will be considered as salary advances, and
authorized as follows:

a) Locally recruited staff members: upon receipt of authorization from the releasing
office;
b) Internationally recruited staff members and consultants: upon receipt of authorization
from Personnel Administration & Payroll Section (PAPS).

75. The UNHCR office at the place of evacuation should send copies of all relevant payment
vouchers reflecting advances, made either to the staff member or on his/her behalf, to the staff
members duty station or Personnel Administration & Payroll Section (PAPS), as applicable, to
ensure reimbursement of the advance(s).

76. When making advances for the purposes of settling medical bills on behalf of locally recruited
staff members or their eligible family members who are covered by the Medical Insurance Plan
(MIP), Field Offices should always bear in mind that reimbursement of medical expenses
during one calendar year is limited to the MIP ceiling.

77. When specifically authorized by Personnel Administration & Payroll Section (PAPS), medical
expenses incurred for service-incurred injuries (see SAMM chapter 6.5), may be charged to
suspense account 240005, pending a final decision from the UN Advisory Board on
Compensation Claims.

Recovery of salary advances for medical expenses

78. In cases where advances have been made in respect of medical bills, the releasing office should
ensure that the staff member submits forthwith a claim for reimbursement of medical expenses
(MIP or UNSMIS). Advances for medical expenses will be recovered as follows:

a) Staff members covered by MIP: Upon settlement of the medical claim;

12
b) Locally recruited staff covered by UNSMIS: Upon receipt of authorization for
reimbursement from UNSMIS Geneva;
c) Internationally recruited staff covered by UNSMIS: In all instances, claims must be
sent to their Human Resources Officer who will request direct reimbursement from
UNSMIS.
d) Medical expenses incurred for potential service-incurred illness or accident: The
staff member should complete and submit, within the four-month time limit, form P.72
rev.4 Claim for Compensation under Appendix D to the Staff Rules, attaching original
medical bills and related payment vouchers. When the illness or accident has been
Recognized by the Advisory Board on Compensation Claims as service-incurred,
advances will be offset accordingly at Headquarters. If the illness or accident is not
Recognized as service-incurred, the supporting documentation will be returned to the
staff member who should proceed as per a) or c) above.

79. Failure by the staff member to submit claims for reimbursement will result in the
deduction of the total amount of all advances from the staff member's salary.

Record-Keeping

80. Within two weeks following the return of the evacuee to the duty station, the staff member
should ensure that a complete medical report delivered by the attending physician at the place of
evacuation is forwarded to UNHCR Medical Service (see Annex I).

81. It is the responsibility of the Head of Office to ensure that the control sheet, which is attached as
Annex K, is kept up to date at all times for audit purposes.

82. Upon completion of the medical evacuation i.e. upon settlement of the travel claim, the Human
Resources/Administrative Officer at the Field Office must send, referring to the MEDEVAC
Authorization Number, scanned copies of the travel claims along with necessary documentation
(excluding medical reports), to the GroupWise mailbox HQMS00@unhcr.org copied to
MEDEVAC@unhcr.org. This information will help PAPS in providing reliable statistics
pertaining to medical evacuations.

13
Annex A

DSA PAYABLE ON MEDICAL EVACUATION


(Upon presentation of hotel receipts Refer to paragraph III of IOM/FOM)

Evacuation to Evacuation to Evacuation to


staff members CHOSEN PLACE (other
RECOGNISED REGIONAL MEDICAL COUNTRY OF HOME LEAVE or
than place of home leave, or outside
CENTRE WITHIN COUNTRY for LOCALLY
country of duty station for locally
or other exceptional destination in RECRUITED STAFF
recruited staff)
EXTREME cases
When evacuee is NOT When evacuee is When evacuee is NOT When evacuee is When evacuee is NOT When evacuee is
hospitalised hospitalised hospitalised hospitalised hospitalised hospitalised
Actual expenses based
Actual expenses for Actual expenses based on 1/3 of lower of:
International on hotel receipts, but
E not to exceed 50% of hotel or other hotel receipts, but not to
exceed 50% of lower of: 1) DSA of chosen
staff and 1/3 of DSA of accommodation based
V DSA of Recognized No DSA place, or
eligible family centre recognised centre on receipts, but not to 1) DSA of chosen place,
2) DSA of recognised
exceed 50% of DSA of or
A members
place of Home Leave 2) DSA of recognised centre
C centre

U If evacuation is to place If evacuation is to place Actual expenses for


Actual expenses based on
hotel receipts, but not to
1/3 of lower of:
Local staff outside country of duty outside country of duty hotel or other
E and eligible
station: Actual station: accommodation based
exceed 50% of lower of:
1) DSA of chosen
expenses based on hotel No DSA 1) DSA of chosen place, place, or
E family receipts, but not to 1/3 of DSA of
on receipts, but not to
or 2) Applicable rate of
exceed 50% of DSA of
members exceed 50% of DSA of recognised centre place of evacuation 2) DSA of recognised DSA of recognised
Recognized centre centre centre

50% of lower of: 100% of lower of:


50% of DSA of
E 50% of DSA of 100% DSA of 25% of DSA of Place place of Home Leave 1) DSA of chosen
of Home Leave place, or 1) DSA of chosen
Family escort place, or of within- place, or
S recognised centre recognised centre of within-country place place, or
country place of 2) Applicable rate of 2) Applicable rate of
of evacuation for locally
C recruited staff
evacuation for DSA of recognised DSA of recognised
locally recruited staff centre centre
O
R Medical
T escort (doctor 100% DSA of authorised place of evacuation up to a maximum of 2-3 days depending on travel time
or nurse)

14
Annex B

Countries with inadequate medical facilities justifying


medical evacuation to recognized regional medical
centres
Countries Recognized regional medical centres

A. Central America
Belize, El Salvador, Honduras, Nicaragua Mexico
B. South America
Bolivia Chile
Guyana Trinidad and Tobago and Venezuela
C. Caribbean
Haiti Dominican Republic
D. Arab States
Iraq Jordan, Lebanon
Libyan Arab Jamahiriya Egypt, Tunisia
Yemen Egypt, Saudi Arabia
E. Africa
Benin
Burkina Faso
Cape Verde
Central African Republic
Chad
Congo
Democratic Republic of the Congo Cameroon
Equatorial Guinea Cte dIvoire
Gambia Gabon
Ghana Senegal
Guinea South Africa
Guinea-Bissau
Liberia
Mali
Mauritania
Nigeria
Niger
Sao Tome and Principe
Sierra Leone
Togo

15
Countries Recognized regional medical centres

Burundi
Djibouti
Eritrea
Ethiopia Egypt
Rwanda Kenya
Somalia South Africa
Sudan
Uganda
United Republic of Tanzania
Angola
Botswana
Lesotho
Malawi South Africa
Mozambique
Swaziland
Zambia
Comoros
le de la Runion
Madagascar
F. Asia
Armenia
Azerbaijan
Turkey
Georgia
Kyrgyzstan
Afghanistan
Bangladesh
Bhutan
Kazakhstan India, Pakistan
Nepal
Turkmenistan
Uzbekistan
Maldives India, Sri Lanka
Cambodia
Lao Peoples Democratic Republic Thailand
Myanmar
Viet Nam
Democratic Peoples Republic of Korea China
Mongolia
G. Micronesia and Melanesia
All countries Australia, New Zealand

16
Annex C

EMERGENCY CHARTERED MEDICAL EVACUATION SERVICES


International SOS

Medical Evacuation Travel in EXTREME emergencies

1. UNHCR has a contract with International SOS, based in Switzerland, which provides air
ambulance services for medical evacuations of extreme urgency. However, in view of the
extremely high costs (minimum US$50,000) of using this service, it should only be resorted to
in very exceptional circumstances. Until further notice therefore, all requests for SOS flights
should continue to be addressed to UNHCR Medical Service who will liaise with CSSS.

2. Wherever possible, evacuation of emergency cases should be carried out through commercial
air services.

3. The Head of Office is authorized, should the need arise, to arrange medical evacuation travel via
International SOS without reference to UNHCR Medical Service in extreme medical emergency
where a life-threatening condition exists, and where an evacuation by normal commercial air-
services cannot be organized in view of the gravity of the illness or injury. The Head of Office
is authorized to request the services of International SOS for the emergency evacuation of the
following categories of staff:
a) Internationally recruited staff members;
b) The recognized spouse and dependent children of staff in a) above who reside at the duty
station and whom the Organization has an obligation to repatriate, i.e. UNHCR paid their
travel expenses to the duty station;
c) Internationally recruited consultants;
d) Locally recruited staff members, provided the illness or injury is established to have been
service-incurred.
e) In all other cases, the prior authorization of UNHCR Medical Service will be required.

4. In summoning International SOS, the following factors must be considered:


a) Gravity of medical risk (e.g. Serious accident, rape, etc.);
b) Speed with which the patient must be evacuated;
c) Costs involved.

5. A password is required before International SOS will take any action. A new password will be
sent shortly to each Head of Office assigned in a representational capacity, who, in his/her
absence, has the authority to provide the password to the Officer-in-Charge.

17
Contacting International SOS (24 hours a day)

6. Telephone: (41) (22) 785 64 64


Fax: (41) (22) 785 64 26
All newly assigned Regional Representatives, Representatives, Chiefs of Mission and Heads of
Liaison Office will have access to the International SOS Directory Listing through the protected
internet website pages of SOS International upon receipt of the password from the SOS
International. Reference is made to IOM/FOM/32/2003.

7. When contacting SOS, the responsible Officer must indicate:


a) the password (as provided to all Heads of Office);
b) the name of the patient;
c) the nature of the problem;
d) the whereabouts and contact number of the patient and attending physician;
e) the contact number of the UN examining physician (if applicable).

Return to duty station

8. Normally the patient should not return to the duty station until the treating physician at the place
of evacuation certifies that he/she is fit to do so. This certificate must, in due course, be
forwarded to UNHCR Medical Service, and a copy should be attached to the travel claim, so
that the appropriate DSA may be calculated. Other normal procedures, as outlined in the
IOM/FOM, apply (including the completion of the Final Checklist).

9. In cases of serious illness or injury, only the UNHCR Medical Service at HQs has the authority
to approve the return of the patient to the duty station, and he/she may not return to the duty
station before such approval is given.

18
Annex D

Guidelines for Physicians advising on Medical Evacuation

Beyond the typical acute life-threatening illness or injury, medical evacuation may be
considered according to the following guidelines:

A. The following chronic conditions with potential for life-threatening outcomes or


complications may be considered for medical evacuation:
Cancers
Complications of diabetes mellitus
Cardiovascular diseases
Pulmonary diseases
Kidney diseases
Liver diseases
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
Organ and bone marrow transplants
N.B. The above-mentioned conditions may require repeated medical evacuations.

B. The following non-life-threatening chronic conditions are generally not considered for
medical evacuation:
Chronic eye conditions
Chronic ear, nose and throat/allergy conditions
Chronic back pains, osteoarthritis
Chronic gastrointestinal ailments
Chronic urological conditions
Chronic skin conditions
Any request in this category must be submitted for review to UNHCR Medical Service before
any action is taken.

C. The following conditions do not qualify for medical evacuation:


Infertility treatments
Plastic surgeries (unless in the context of disfigurement)
Orthodontic treatments
All chronic/congenital medical conditions that are stable and non-life-threatening

19
Annex E

Address, telephone and fax numbers


of the UNHCR Medical Service
Geneva

as at November 2007

Telephone Telephone after working


Name/Title E-mail during working Fax hours/ mobile telephone
hours
Dr Michel Baduraux baduraux@unhcr.org 41 22 739 8952 41 22 739 7334 41 79 217 31 22
Medical Director

Dr. Pascal Achard achard@unhcr.org +41 22 739 8403 As above 41 79 202 23 19


Medical Officer

Sinead ODonovan- rogerson@unhcr.org 41 22 739 8953 As above 41 79 217 31 21


Rogerson
Nurse

Duty Officer Not applicable 41 22 739 8000 Not applicable 41 22 739 8111

41 22 (0)79 217 3123

If the medical service is closed you should contact the UNHCR Switchboard +41 22 739 8111 who
will be able to give you the contact number of the Duty Officer and/or the External Duty Doctor.

20
Annex F

MEDICAL EVACUATION

Medico-Administrative Request Form

Please send to the UNHCR Medical Service by:

Fax No.: 004122 739-7334


E-mail HQMS00@unhcr.org
Telephone: 004122 739-7010

THIS FORM MUST BE COMPLETED BY THE UNHCR HEAD OF OFFICE REQUESTING THE MEDICAL EVACUATION

Duty Station: Country:


Name of Evacuee (FAMILY NAME, First Name): Date of Birth:

Gender: M F
Name of Staff Member: Job Title of Staff Member:

Index No:

The Medical Evacuation Medical Request Form should be addressed to the Medical Service, as above.
Reasons for the request:

Can the evacuee travel alone? Yes No


If no, who is accompanying the
evacuee? Doctor Nurse Family Member Other (please describe)

Indicate in all instances: Nearest/Recognized place of evacuation (see Annex B):

Indicate if applicable: In case of need to extend evacuation, please indicate staff members place of home leave:

Expected duration of medical evacuation as recommended by the attending physician


(indicate number of days and dates):

Name of Physician who has recommended the evacuation (please print in capitals):

Contact details
Telephone: E-mail:
Fax: Mobile
Name of Head of Office (please print in capitals) Signature of Head of Office

Telephone:
Fax:
Mobile: Date: (dd/mm/y)
E-mail:
Please note this page should be duly completed. Failure to comply will result in request being denied
MS3(a)

21
Annex G
MEDICAL EVACUATIONS
Medical Request Form

To be completed by the attending physician and sent directly to the


UNHCR Medical Service (Geneva), under confidential cover by fax or e-mail

To: UNHCR Medical Service


Fax No.: 004122 739-7334
E-mail: HQMS00@unhcr.org

Concerns: Patient (Family Name, First Name):---------------------------------------------------------------

Date of Birth: -------------------------------------- Gender: ------------------------------------

Staff Members Name: --------------------------------------------------------------------------------

Duty Station: --------------------------------------------------------------------------------------------

Index No:__________________________

The information included below should be relevant to the pathology requiring the medical evacuation.

I. CLINICAL FINDINGS

1. Present complaints:

2. Significant past history:

3. General Appearance:

4. Cardiovascular system:

5. Respiratory system:

Please note this page should be duly completed. Failure to comply will result in request being denied
MS3(b)

22
6. Digestive system:

7. Nervous system:

8. Eyes:

9. Ear, Nose and Throat:

10. Genito-urinary system:

11 Musculo-Skeletal system:

II. LATEST LAB RESULTS (IF ANY)

III. TREATMENT INITIATED (IF ANY)

IV. REASONS FOR JUSTIFICATION OF MEDICAL EVACUATION

MS3(b)

Please note this page should be duly completed. Failure to comply will result in request being denied

23
V. REQUESTED OR SUGGESTED PLACE OF EVACUATION

Name (please print in capitals) ______________________________________

Address in full: _____________________________________________________

__________________________________________________________________

__________________________________________________________________

Tel. No: ________________________________________

Fax No.:________________________________________

E-mail: _________________________________________

Mobile: _________________________________________

Signature of Attending Physician: _______________________________________

Date___________________________________________

Please note this page should be duly completed. Failure to comply will result in request being denied

MS3(b)

24
Annex H
MEDICAL EVACUATIONS

Medical-Administrative Report Form

Please send to the UNHCR Medical Service by:

Fax No. 004122 739-7334


E-mail: HQMS00@unhcr.org
Tel. No. 004122 739-7010

In order to enable the Medical Service to authorize the return to work of the staff member, the following information is
required:

THIS PART IS TO BE COMPLETED BY THE STAFF MEMBER

Name of evacuee Family Name, First Name (please print): _______________________________________________

____________________________________________________________________________________________________________

Date of birth: _____________________________________________________________________________________

Family Name, First Name of staff member (if different from evacuee) (please print):

________________________________________________________________________________________________

____________________________________________________________________________________________________________

Job title of staff member: ____________________________________________________________________________

Duty station: ______________________________________________________________________________________

Place of evacuation: ________________________________________________________________________________

Date of arrival at the place of evacuation: ________________________________________________________________

Date of return to the duty station: ______________________________________________________________________

Date of resumption of duty: ___________________________________________________________________________

Please note this page should be duly completed. Failure to comply will result in request being denied

MS3(c)

25
Annex I
MEDICAL EVACUATIONS

Final Medical Report


To be completed by the attending physician and sent directly to the
UNHCR Medical Service (Geneva), under confidential cover by fax or e-mail

To: UNHCR Medical Service


Fax No. 004122 739-7334
E-mail: HQMS00@unhcr.org
Tel. 004122-739-7110

Concerns: Patient (Family Name, First Name) (please print):__________________________

__________________________________________________________________________

Date of birth: _______________________ Gender: _____________________

Staff Members Name and Relationship: __________________________________

Duty Station: _______________________________________________________

Index No: __________________________________________________________

Signs and symptoms presented by the patient on arrival:

Emergency treatment started:

Results of investigations (if any), please attach:

Evolution of condition post treatment:

Prognosis

Recommendations:

Limitations:

MS3(d)
Please note this page should be duly completed. Failure to comply will result in request being denied

26
Date of first medical consultation: _____________________________________________________________________

Place of hospitalization (if any): _______________________________________________________________________

Dates of hospital admission: _____________ ______________ Date of hospital discharge: ________________________

Dates of consultations as an outpatient:: ________________________________________________________

_________________________________________________________________________________________________

Date of final medical consultation: _____________________________________________________________________

The patient is fit to travel on: __________________________________________________________________________

Sick leave (indicate precise dates) from:: to:

Date of Medical Service e-mail authorization:_____________________________________________________________

Name (Family Name, First Name) (please print):___________________________

__________________________________________________________________

Address in full: _____________________________________________________

__________________________________________________________________

__________________________________________________________________

Tel. No: ________________________________________

Fax No.:________________________________________

E-mail: _________________________________________

Mobile: _________________________________________

Signature of Attending Physician: _______________________________________

Date:___________________________________________

MS3(d)

Please note this page should be duly completed. Failure to comply will result in request being denied

27
MEDICAL SERVICE
Annex J
MEDICAL SERVICE AUTHORIZATION FOR MEDICAL EVACUATION

Authorization References No.07/MS/00_ Date: 12:00:00 AM

Subject: Medical Evacuation Request in respect of:


Mr./Mrs./Ms.

Duty station : /

UNHCR MEDICAL SERVICE FILE NUMBER : HCR/0

I refer to the above mentioned case.

In accordance with the documents in our possession, the evacuation of the following person is authorized as
follows:

1. Name of the patient:

2. Evacuation authorized from:

3. The Evacuation is authorized to up to cost

Is it the place of home leave ?

Is it authorized exceptionally ?

{Note: Any additional cost due to deviation from the up to cost authorized place (as per paragraph 3 above) is to
be borne by the staff member.}

4. The duration of the evacuation is estimated ____0________ days.

5. The following person(s) is/are authorized to accompany the patient. :


SOS used :
Air Ambulance used :

Note for the field:

(a) At the end of medical evacuation, a detailed medical report from the treating physician should be send
under confidential cover only to the Medical Service (by fax 41.22.739.73.34 or e-mail
HQMS00@UNHCR.ORG)
(b) A medical certificate precisely indicating the sick leave period.
(c) Only non-medical administrative documents, including the travel claim settlement form, should be
sent to the GroupWise Mailbox medevac@unhcr.org as scanned attachments, noting the above
authorization number as subject of the e-mail.

Thank you for your kind cooperation in this matter.

UNHCR Medical Service, Headquarters, 94 rue de Montbrillant, cp 2500, 1211 Geneve 2


Tel. : + 41 22 739 70 10 (sec.) Fax : + 41 22 739 73 34 Email : HQMS00@unhcr.org

28
Annex K

CONTROL SHEET FOR MEDICAL EVACUATIONS


INTERNATIONALLY AND LOCALLY RECRUITED STAFF AND DEPENDENTS
(To be completed and retained for Audit purposes by the releasing office)

Country Office:
(City and Country)

Period Covering: 1 January to 31 December

ORG1 SMs Index Status Name of Family Name / Actual MEDEVAC H/L / FVT Auth. No Total Remarks2
Name No. Local / Evacuee relation status of Place of N /E of days Cost of
(last in Intl (Patient) escort MEDEVAC MEDEVAC
CAPS)

1
Organization (UNHCR, UNDP, etc.)
2
Use additional page if necessary
29
Annex L
MEDICAL EVACUATION CHECK-LIST
(To be completed by the releasing Office and attached to the Final Travel Claim)

Staff members name: Index:


Functional Title: Grade/Step:
Patients name: EOD:
Duty station: Nearest Recognized Regional Medical Centre MEDEVAC:
Place of HL (if applicable): Place of s/ms choice:

Action Date Action/Comments/References


1. Recommendation of UN Designated
Physician
2. Approval by Head of Office
3. MEDEVAC Request Forms (Annex F & G)
sent to Medical Service as necessary
4. Approval by Medical Service for
MEDEVAC where required
5. Expected duration of MEDEVAC
REGULAR MEDEVAC
6. Name of traveler
7. Name of accompanying person
8. Visa requested
9. PT8 issued
10. DSA/Advance Given
EMERGENCY MEDEVAC
11. Name of traveler
12. Name of accompanying person
13. Visa requested
14. PT8 issued
15. DSA/Advance Given
16. Invoice forwarded to Chief PAPS
(if applicable)
SERVICE-INCURRED Refer to SAMM procedure 6.5
EXTENSION OF MEDEVAC
17. Interim medical report sent to MS on: (if
applicable)
18. Final medical report sent to MS on:
19 Certified sick leave form received from MS
on:
20. Attendance record card updated on:
21. Authorization by MS for the extension of
MEDEVAC received on:
22. Travel claim (including necessary receipts)
received on:
23. Travel claim settled on:
24 Claim for UNSMISS/MIP submitted:

Scanned copies of travel claim and relevant


25. docs sent electronically to GroupWise
Mailbox HQMS00@unhcr.org copied to
MEDEVAC@unhcr.org

NB: Step 21 must be completed before final payment is made.


MEDEVAC Checklist prepared by:
Signature:
Date:

30