Embark on the heartwarming humanitarian journey of Dr. Hareen De Silva, a British GP whose overseas volunteering experiences sparked a passion for global health. From working in refugee camps to teaching humanitarian medicine, Hareen’s path has led him from the hills of South Yorkshire to some of the world’s most vulnerable communities.
Initially inspired by his former partner’s aid missions, Hareen’s love for rambling opened his eyes to expedition medicine. But it was COVID-19 that unexpectedly set him on a course to the frontlines of emergency response. For his efforts, he was honored by the Queen.
Now a faculty member with World Extreme Medicine, Hareen shares hard-won lessons from managing medical operations in conflict zones. His accounts from the field reveal the courage and conviction it takes to deliver care when resources are limited. But most of all, they uncover a calling to serve others no matter where that might take him.
Hareen’s story will motivate any healthcare professional feeling drawn to humanitarian pursuits abroad. It carries lessons in resilience, adaptability, and staying true to one’s compassionate purpose.
The first spark
Back in 2015, the year I finished training as a GP, my then-partner was working abroad delivering humanitarian aid. She loved going on overseas missions and would return feeling that she had contributed something worthwhile. It first sparked my interest in Global Health.
I started to practice as a GP in South Yorkshire and got into hill walking. That made me think about branching out into expedition medicine, so I did a course and then signed up with Operation Wallacea, a biodiversity and climate research organisation. I went to Dominica a few times with them and really enjoyed going to a new country and looking after people in a completely different environment. It made me re-evaluate how I would manage certain cases without the resources available to me in the UK as a GP.
Although my partner and I split up, I still felt inspired to continue the path I had embarked on as a volunteer overseas. For two years I studied part-time for a Masters in Public Health at the University of Sheffield while continuing in General Practice. In 2019, I quit my GP job with the intention of doing more expedition work. Then Covid hit and all my plans were scuppered!
In the strange way that things sometimes turn out, the pandemic led to new and different healthcare roles for me. Without being tied to a regular GP job, I was available to take on face-to-face locum shifts and then signed up for the NHS Track & Trace System before going to work on the front line of the NHS response to Covid-19 at London’s Nightingale Hospital.
As I result of this work, I was nominated for a British Empire Medal in the late Queen’s Birthday Honours. On 6 May 2023, I was – amazingly – among the 450 BEM recipients invited to attend the King’s Coronation in Westminster Abbey.
My first involvement with World Extreme Medicine came about after I responded to an Instagram post in search of new Faculty members. I was delighted to be accepted in January 2023 and taught on WEM’s first Humanitarian Medicine course. I lecture on the Humanitarian Aid module for both the Masters and the general courses.
I’m grateful for my involvement with WEM. When I applied, I honestly didn’t expect them to take me! When you see the calibre of other people, you think there’s no way they’ll call me up, but it was amazing that they did. WEM is a community of like-minded people whom you can look to for inspiration and call on for advice. It’s a real micro-community of experienced professionals, wonderful people to hang out with and learn from, and it reinvigorates me when I see medics in the early stages of their careers who want to become the next generation of Global Health practitioners. I’ve stayed in the WhatsApp group with the participants of the first course I taught on. It’s heartwarming to see people chatting to each other about taking up new positions and jobs because of the training they’ve received.
I’ve taught three courses now for WEM. I love being able to impart what I’ve learned working in humanitarian aid; it’s a challenge to make things appealing and relatable. I teach what might be considered the ‘drier’ stuff – admin, management and logistics – but I’m passionate about the importance of getting the basics right because, if they’re not, everything else falls down! I hope to be part of the ‘WEM family’ for as long as possible. Everyone has something of value to contribute.
Lighting up new worlds
Working in humanitarian medicine has allowed me to experience very different worlds. In 2020, I worked as a volunteer for six weeks at Kara Tepe 2, a refugee camp in Greece. Hundreds of people would queue every day in the hope of getting treatment. Many had conditions caused by poor sanitation and overcrowding, while others had pre-existing long-term conditions. The most difficult thing was overcoming the mental drain and guilt of having to tell patients they would have to continue to wait, as all appointments were gone when they’d already queued for so long.
After Greece, I worked for four months as a clinical doctor in the Al-Hol refugee camp in Northeast Syria, close to the Iraqi border. It allowed me to finally use the skills I’d learnt during my Masters in the context of delivering humanitarian aid. The hospital was looking after 60,000 people and was one of the only 24/7 inpatient facilities with only 24 beds. I’d do ward rounds and some bedside teaching for the doctors. One day there was a mass casualty incident and a huge fire resulting in more than twenty casualties, which I had to manage over the phone at night.
Working clinically in refugee camps has been exhilarating and yet sobering. It makes you so grateful for what you have back in the UK. You have limited resources, and you have to manage them without ‘overtreating’ patients because you need to move on quickly to the next person needing your care.
Too hot to handle?
Morally it’s difficult because you’re basically giving sub-standard treatment and you must reconcile yourself with that and see it as being ‘for the greater good’; if you weren’t there, no one would be providing medical care at all. So, although you can’t deliver best practice, you are giving the best possible practice within the demands of the setting. You have to be able to accept that.
When I returned to the same Syrian refugee camp in 2022 for the second time with the same organisation (CADUS), but as a medical coordinator, I found it much more difficult because I was the budget holder for the medical side of the project. It was stressful overseeing $50,000 every three months for repeat equipment and medication procurement. The doctors and nurses would tell me they needed this, that and the other. I had to weigh up all their requests because if I had bought everything they asked for, I would have burnt through my whole yearly budget within a couple of months.
Suddenly, I was in a position where I was having to say no to people. It makes you feel morally injured. You can only justify it by recognising that it’s for the ‘greater good – you have to order supplies needed by the mass majority of patients. You also have to consider what other organisations are there and what services they offer to make sure you don’t waste or duplicate resources.
Everyone is working in difficult and dangerous conditions as well, which adds an extra level of stress. Al-Hol was the world’s most dangerous refugee camp, and still is, I believe. In 2021, there was a murder every 1.3 days – shootings, stabbings, beheadings and security raids to rout out improvised explosive devices. You never knew what would happen in the camp or in the safe house where we lived. I don’t see myself taking on such dangerous deployments when I eventually have my own family. That’s why I’m keen to do this kind of work now.
On WEM’s Humanitarian Medicine course, we talk about emotional resilience and the mental attitude you need when working in austere and challenging environments. I’ve had a few flashbacks after Ukraine and Syria and I’ve used post-deployment counselling services and I also find journaling helps – setting aside time for myself without a phone or other distractions, just me walking in nature and trying to ground myself. It is really important to be honest with yourself and others about your mental health after working in these challenging environments.
Despite the risks, I feel privileged to be able to travel the world doing what I do. It makes you appreciate what we have in the UK: it can be frustrating when patients here are unaware of how lucky they are, even though the NHS isn’t what it was or what we want it to be.
Catch-up on our other ‘Stories that Spark’ feature pieces here: