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Medical evacuations

How we organise medevacs in Africa

Emergency medical evacuations (medevacs) are extremely technical. Evacuating a member within Africa complicates things even further. In this guide, we go into full details about how medevacs work, what they means for the member, and how we overcome typical challenges that emergency situations in Africa present.

What is an emergency medical evacuation?

When a member falls ill or suffers an injury, there’s a chance the treatment they need isn’t available locally. In Africa, this chance is much higher. It’s a huge continent and, depending on the severity of the injury or illness, suitable medical facilities may be few and far between. This is where emergency medical evacuation cover comes in. If one of our members suffers a life-threatening of limb-threatening illness or injury, we transport them to the closest hospital for urgent treatment. We handle all aspects of the evacuation, including liaising with medical teams on the ground, logistics, securing admission at the destination hospital, and handling passport/visa issues.

How does a medevac work?

Step 1

Member notifies us of a medical emergency

A member (or their representative) calls our 24/7 emergency medical assistance helpline to notify us of an emergency.

Step 2

We assess the situation

Our operations team assesses the situation on the ground, while our medical team establishes the particulars of the member’s medical condition.

Step 3

We sort the logistics

We organise the evacuation destination and the means of transport that best suit the member’s interests. We take several criteria into account, including severity of the member’s medical condition and air ambulance availability.

Step 4

Transport arrives to pick up member

With the member’s admission secured at a destination hospital, we dispatch transport. We collect the member from their medical team on the ground and get them to an air ambulance.

Medevac Standard vs Medevac Plus

All our health plans come with cover for emergency medical evacuations as standard. But members can optionally upgrade their cover to Medevac Plus for additional benefits.


Medevac Standard

Medevac Plus

Evacuation by road, sea or air to nearest hospital for immediate in-patient treatment for a life/limb threatening condition where treatment cannot be provided locally
24-hour emergency medical helpline
Evacuation cover for advanced diagnostic tests or cancer treatments that cannot be provided locally
Advanced repatriation to your country of residence or nationality (if within your cover area)
Cost for someone to fly from anywhere in the world to be with you, and their hotel expenses (up to US$150 for a maximum of 30 days) if you’re evacuated alone to somewhere other than your country of residence/nationality

How a member initiates a medevac

Notifying CEGA

In most cases, a member (or a relative of the member) contacts our dedicated 24-hour emergency helpline at CEGA. Sometimes, the member’s local medical team call the helpline. In a few cases, the member’s broker has contacted the helpline! It doesn’t really matter how: as long as someone calls the helpline, we can start the medevac process.

Given the emergency situation it is rare that we get calls directly from our member, but it has happened. When this happens, we simply engage CEGA, our emergency assistance partner, on behalf of the member, and ensure that the member and CEGA have open channels of communication as the clinical assessments, and logistical arrangements are made.

Assessing the situation

Two teams at CEGA convene to progress the medevac case. The operations team gathers all relevant information about the member’s situation, while the medical team contacts the patient’s local care providers to establish the member’s medical condition.

If we don’t already know (very unusual), CEGA let us know about the member’s medevac case. We check the member’s policy for eligibility and hand over the management of the case to CEGA. Qian Huang, the Head of Claims at William Russell, keeps the senior leadership team informed about the case.

The operations and medical teams at CEGA work together to form a plan suited to the member’s situation. Here, we take into account several factors (which we explain below).

We handle notifications of medical emergencies with the highest degree of urgency, but that doesn’t always count for much in Africa. Patients may expect that things must happen now, but medevac within the hour is unrealistic. Our medevac protocol takes time to complete. We need to assess the medical situation and the patient’s location so we can make sure the patient is stable enough for transfer.
Qian Huang
Head of Claims

What are the logistics of a medical evacuation?

The decision-making framework at William Russell is solely based on clinical best practice, and the safety and health of our members.

If an evacuation is necessary, our sole aim is to relocate our member to the nearest, and most appropriate medical centre of excellence. The purpose is ensuring the best clinical outcome. We, at all times, liaise with our members and their immediate family, as well as with their appointed representatives (if we’re asked to do so).

There are several factors that need to be considered as we determine both the destination, scheduling and method of evacuation:

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Patient’s medical situation

Is the patient stable enough to evacuate by air or road? In 9 out of 10 cases we evacuate by air ambulance, and a key consideration is whether the route to the airfield facilitates a safe ground transfer.

This is extremely important in cases of head injuries, complex fractures, and/or spinal injuries.

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Patient preference

We take into account the wishes of the patient. For example, we might evacuate the patient to a centre of excellence nearer to their home country.


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Availability of service providers

We have pan African medical evacuation capability provided via a roster of specialist companies. The partners we use are experts in medical evacuations, and aviation medicine, which is a complex area of medicine.

The providers we engage are vetted against a rigid set of criteria that covers both geographical reach, company size, and performance KPI’s.

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International travel means paperwork, even when it’s an emergency.

For example, transferring into South Africa requires a significant amount of paperwork, whereas Kenya is more straightforward and therefore evacuations to Kenya can be expedited compare to South Africa.

Any potential delays in getting our members to a facility does form part of balancing the clinical need of our members, with their preferred destination.

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Time of day

Over the last 30 years we have built extensive knowledge of rural runways across the African continent. Most rural runways have no lighting and so cannot facilitate flights after dusk. If we’re notified of a medical emergency in the afternoon, it is unlikely that we’ll be able to land a plane to evacuate the patient on the same day.

Generally, from being alerted of a potential medical evacuation case, to completing the clinical and logistical assessments, air transfers take place within 24 hours, and, for patient safety, they routinely need to take place during daylight hours.

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Our discretion

Whilst we clearly need to operate within the terms and conditions of the member’s plan, we do routinely exercise discretion and flexibility.

In a recent case, one member suffered burns in Botswana. Our Clinical Team concluded that a satisfactory outcome could be achieved in Botswana. However, the best outcome would be delivered via treatment at a centre in South Africa, and the member was evacuated to South Africa for treatment.

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Patient’s nationality

Nationality affects the destination we select. Certain nationalities might have visa requirements or access difficulties, which are difficult to overcome in an emergency.

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Travel restrictions

Restrictions in international travel as a result of the COVID pandemic, local outbreaks of disease, civil unrest and/or conflict all contribute to our decision making.

At all times in emergencies, expediting a transfer as quickly and safely as possible is at the centre of our thought process.

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Relevant and appropriate costs

When expediting evacuations, we ensure the focus is on looking after members which includes only incurring costs that are relevant and appropriate for their plan level.

Medevacs are complex, so we keep things simple by focusing on the patient’s best interests
Our aim is always the best clinical outcome for the member

Who provides the emergency medical evacuation?

For emergency medical evacuations in Africa, we partner with CEGA. CEGA is one of the world’s leading providers of medical assistance and provide over 500 air evacuations per year. They are EURAMI accredited and part of the Charles Taylor Group.

We work with a number of air ambulances in Africa, on a case-by-case basis, including:

  • Awesome Air
  • Netcare 911
  • Amref Flying Doctors
  • Aspen Medical
  • Okavango Air Rescue
Megan Lewis – Expert on health insurance in Africa
“Emergency medical evacuation is a vital part of any expat’s medical coverage. The sheer size of Africa, and the inevitable variation in the availability and standard of care, does at times necessitate evacuation to a more suitable destination, in order for our members to be seen by the most appropriate specialists, in the right clinical settings, in order to ensure the best clinical outcome.”

What are the typical evacuation routes in Africa?

A number of variables will determine which route is taken, from which air ambulance company is used to medical treatment destination the patient requires. Here are some examples:

Location of patient

Origin of air ambulance

Destination of air ambulance

South Africa
South Africa
South Africa / Europe / Middle East
South Africa
South Africa
Kenya / South Africa
Kenya / South Africa
Nigeria / Spain / Kenya / Germany / South Africa
Kenya / Spain / South Africa / Europe

Frequently asked questions

No. Our medevac service does not include search and/or rescue.

We handle emergency medical evacuations with the highest degree of urgency. We’re very aware of the expectation of our members and their families for instant (or ‘within the hour’ evacuations). However, this is neither medically possible nor safe for any insurance provider with customers in Africa, for legitimate reasons. Below, you’ll find an overview of our process.

Step 1. Our medevac team must undertake a clinical assessment of the member on the ground, and—where necessary—arrange for immediate life-saving medical interventions and care. The aim here is to safeguard the member’s well-being (and sometimes life), while we organise the logistics of the medevac.

Step 2. The medevac team must determine the most clinically appropriate centre of excellence to which we will evacuate the member. We’ll consider:

  • The availability of relevant specialists
  • The medical capabilities of the receiving hospital
  • Whether the hospital has intensive care units

In short, we must undertake a full clinical assessment prior to medevac to ensure the best clinical outcomes for the member.

Step 3. Once we’ve established a suitable receiving hospital, we must work through several logistical issues, including:

  • Securing visas for the member (this depends on the member’s nationality and the destination country)
  • Alerting the receiving hospital and their clinical teams, so the right people are on standby to receive the member
  • Arranging ground transportation both to the departure airfield and from the destination airfield to the receiving hospital
  • Issuing ‘fit to fly certificates’, without which no patient can be evacuated by airplane

These steps forms part of a rigorous process that aims to both safeguard the member’s life and to evacuate the member as quickly as logistically possible to the most appropriate centre of excellence.

We treat each evacuation on a case-by-case basis. We have a roster of companies we work with, and we choose the best one for the situation. For example, the best air ambulance service in Kenya is Amref, however if they are not available we will source an alternative.

Similarly, members in Botswana may expect Netcare911, but CEGA may sometimes pick a different company. We commit to always having our member’s best interests at heart, so will always choose the right company for each evacuation.

Since we started providing health insurance to members in Africa in 1992, we’ve organised 100+ medevacs, 100% of which were successful. We had 12 medevacs in 2022 alone.

It’s hard to give a precise answer because there are so many factors influencing how the medevac unfolds. Some of those factors include:

  • Patient’s medical situation
  • Time of day
  • Availability of service providers
  • Paperwork
  • Patient preference
  • Our discretion
  • Patient’s nationality
  • Travel restrictions

Each medevac case is different from the next. They pose various challenges that our medevac team works through to ensure the best clinical outcomes for the member.

The speed with which we get our members airborne is not necessarily an important measure. After all, it’s worth noting that we only evacuate members in a life- or limb-threatening situation. The processes we adhere to exist to ensure the best clinical outcomes for our members in an emergency medical situation. Undue rush can endanger the patient’s life. In 2022, we completed medevac cases for 22 members: each member was safely evacuated in a timely and straightforward manner, receiving the right level of care at the most appropriate centre of excellence.

Medevac Standard comes, as the benefit’s title suggests, as standard on all health plans. Members can upgrade to Medevac Plus for a fixed cost: US$169 per adult and US$152 per child.

Ready to talk? Schedule a call with our Africa Desk