Analysis: International PMI and the Arab Spring

International PMI

Peter Pallot reports on how iPMI providers helped expats in a crisis

The recent political upheaval across the Middle East and Arab states has had a huge impact on the many expatriates that live in the troubled states. Peter Pallot finds out how international insurers and assistance providers came to their rescue.

Wherever it ends up, the Arab Spring keeps rollin’. Uprisings that started six months ago in Tunisia and flowed through to half a dozen countries (with variable unforeseeable outcomes) are still being compared to the collapse of the Berlin Wall.

A crucial difference was that thousands of foreign nationals were and are potentially at some risk in the Arab revolution. By contrast, Westerners living in the East Berlin’s expat compound in 1989 joined in the celebrations.

There is an opportunity here for those modelling international medical insurance plans and intermediaries selling them.

When serious civil unrest breaks out, expatriates first look to their governments for help. This is of variable quality. A source of extra reassurance is to have an assistance company, operating either directly to help you as an insured, or through a “political evacuation” benefit bolted on to an international insurance plan.

One such is the emergency political evacuation cover offered by Interglobal.  Three years ago the insurer arranged for security group red24 to provide all its members with security advice as appropriate. Much of this is similar to that given by official sources. But those on InterGlobal’s top plans are entitled to actual “hands-on” help in a hazardous situation.

Stephen Hartigan, the insurer’s chief executive, says: “It’s worked for us. We’ve had inquiries from our competitors as to the scheme and we say ‘it’s good but we should say it’s an exclusive arrangement we have with red24.

“It’s of value to our customers as we’ve shown in Libya, Yemen, Egypt and Japan – Japan because it’s not just designed for civil unrest, but for natural disasters as well.”

Political emergency evacuation cover, whether of the Interglobal/red24 type or through direct provision by a security firm, is clearly in demand. Revolution popping up like wildfire is one reason.  Employers ever more anxious about the expanding duty-of-care framework is another.

Just how much assistance companies, security firms and insurance companies directly and indirectly helped expats caught in Middle East turmoil is difficult to gauge.  There are hundreds of assistance companies worldwide, mainly small, and scores of ex-SAS types working as security advisers.

But a good idea can be gleamed from International SOS, the world’s biggest assistance company by some margin and genuinely global, while the minnows stick to countries, regions or continents.

The organisation acts for 66% of Fortune Global 500 companies.  It employs 8,000 people including 970 full time doctors and 200 security specialists, has offices in 70 countries and a network of 32 clinics in very remote areas where even basic medical care is nonexistent.

In addition it runs 500 remote-site security projects, for example, catering for oil workers in far-flung spots.

There is a fleet of 10 air ambulances and hire access to other aircraft in case of mass medical evacuations, as occurred in the infamous 2002 Bali bombing, which killed more than 200 people. International SOS hired a passenger jet, appropriately equipped and staffed by doctors, to fly scores of injured Australians and others to centres of medical excellence in the region. It also acted for foreign governments in moving the injured to other destinations.

Even allowing for the assistance company being in a dominant market position, the numbers of expats pulled out of troubled territory is impressive. 

In Libya, thousands of oil workers were relying on governments or assistance companies to get them home. Talk of the imposition of a no-fly zone added to the urgency. On February 19, almost four weeks before the no-fly zone was imposed, International SOS determined it had responsibility for 760 individuals employed by 40 different corporations across a wide area – in Tripoli, Benghazi and the oil fields in the south.

Airspace over Benghazi, the rebel stronghold, was shut. Landing rights and airspace in Tripoli was tightly restricted, with violence and looting adding to the frenzied atmosphere. Civil war was threatening and was shortly to become reality.

The assistance company decided it was wiser to instruct those in remote desert regions to keep station. Hundreds of seats were booked on Air Malta, one of very few airlines operating out of Tripoli. Between February 23 and 28, most of the 760 were extracted, including those in the desert. They were instructed to go to various airports or ports.

International SOS says it supported 1,500 evacuations, issuing 835 air tickets, on 11 flights, including eight commercial and three charter flights; 96 people were evacuated by ferry. (Also at this time the company arranged for 400 expats to leave Japan, mainly worried well, but some directly suffering the effects of the earthquake and tsunami).

The decisions fell ultimately to Scott Gilbert, head of security operations at International SOS and Control Risk, security specialists working jointly with the assistance company.

Gilbert is a 38-year-old Australian who joined the British Army, served in Iraq and Kosovo and left with the rank of Major. So how do you know when to extract people from a zone of civil unrest when a no-fly zone is about to be imposed?

“It’s difficult,” he said. “In some cases during an evacuation, although it’s the least palatable for a client, the safest thing may be to advise them to stand fast until a window becomes available.

“In Libya, there was that window at the beginning before the no-fly zone was applied, where commercial flights were still running out of Tripoli. That’s when we got most people out.”

Before Libya, attention focused on Egypt, where International SOS evacuated 1,250 clients, 420 through a specially charted aircraft. Another flight went to Dubai while a flight to Paris from Cairo took another 114 clients, two dogs and a cat.

As Gilbert is the first to acknowledge, evacuations from Arab Spring countries could have been far, far worse.

“In the Middle East crisis – Tunisia, Bahrain, Libya and Egypt – there wasn’t any direct targeting of foreigners, but we did find people with pre-existing conditions who were running out of medication and two women in Egypt, both 36 weeks pregnant we looked after.”

Airlines will not carry heavily pregnant women but one of the women was taken by commercial flight accompanied by a nurse and the other was air-ambulanced to Europe.

International SOS is so dominant among assistance companies – it is contracted to Bupa International and almost every other UK-based insurance provider except AXA PPP International, which runs its own operation – that it has the hallmarks of a monopoly provider.

However, the business of genuinely worldwide assistance is bound to boil down to a very small number of major providers – just as with telephone networks, for example.

Gilbert attributes the rise and rise International SOS over some 25 years to its early start and “medico-centric” ethos, which has driven professional standards. To employ nearly 1,000 doctors full time puts it way beyond the competition.

However, even the biggest assistance companies cannot always reach the most distant corners of the globe at short notice. Tasks may be delegated to trusted, smaller assistance companies. Building these liaisons takes time.

Gilbert explains: “That in itself is a sort of barrier to entry. A lot of companies that would have wanted to get into the game lack the local networks to treat people.  To have that infrastructure, to send air ambulances or see people at clinics – doctors and nurses for instance on mining sites – those things require a really big investment at the beginning to be credible.

“You are not ringing International SOS to sort a problem with your hire car, you’re in medical or security distress. To be able to respond to that really does require a very good global network.”

For the international medical insurance industry, the picture is fast changing. Gilbert comments: “There’s a lot more single trip business travel these days. Ten years ago there was a small core of business people who travelled a lot. Now there’s a much broader audience of people travelling who are probably travelling a little bit less in terms of number of trips.

“So you’ve got a lot of people travelling to even further flung destinations, seeking competitive advantage in developing markets. It’s one thing to say, ‘Yes, we can cover you business travel’ but another thing to be able to do it in such a wide variety of locations.”

Revolution is a challenge for politicians. For international insurers, opportunities present.

Peter Pallot is a freelance journalist and writes regularly about expat issues in the Daily Telegraph

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