Christopher Catrambone is the founder of Migrant Offshore Aid Station (MOAS), a Malta-based global humanitarian organization dedicated to responding quickly and efficiently to emerging crises. MOAS is the only NGO in Ukraine providing safe evacuations for critically wounded military and civilians from the frontlines to hospitals for onward care and rehabilitation. In March 2022, after Russia launched its illegal full-scale invasion of Ukraine, MOAS operations started in Ukraine and began medical evacuations of injured soldiers on the frontline. With a fleet of 51 ambulances, every day, the medics treat mostly young men suffering from critical trauma injuries caused by shrapnel, mines, artillery fire, small arms, rocket systems, and other battlefield injuries. More than 45,000 lives have been saved - 72% of critical casualties evacuated - and counting. “What we are doing in Ukraine is new, but it’s not rocket science. It’s basic mathematics. Saving Ukrainian soldiers’ lives helps Ukraine stay in the war. It’s as simple as that.” Christopher said. A video on MOAS’ work in Ukraine is here. Donate to support the critical MOAS mission in Ukraine.

He has received numerous awards, including the Minister of Defense of Ukraine's "Cross of Honor" distinction and acknowledgment from the Commander-in-Chief of the Armed Forces of Ukraine, Alexander Sirsky, recognizing the critical importance of the existence and activity of the MOAS mission in Ukraine.

Due to the sensitivities of his location and communication challenges at the frontlines in Ukraine, Christopher Catrambone received the questions via email and responded to them on July 16, 2024. This ‘interview’ has been edited for clarity.

JT: When you hear the word "Ukraine" what do you think of?

A single word could never do it justice, and I’ve always been a rule breaker, so I’ll give you two; resilience and urgency. 

Ukrainians exemplify strength and resilience in the face of violence and persecution. More than two years after the full-scale Russian invasion, the people of Ukraine continue to fight for their country. Many of them have left their jobs, hopes, and lives behind. Families have been torn apart. But the spirit of Ukrainians is indomitable.

That said, there’s a feeling of urgency embedded into life here. I think the rest of the world does not fully understand what is at stake and how important it is to equip Ukraine with what it needs to push back on Russia’s advances. Ukraine has invested all its own resources into this fight. The war they are fighting is not theirs alone- it is a war for Europe and the world order. We cannot leave Ukraine alone. And yet, two years after the full-scale Russian invasion, the world’s attention has started to wane. 

We cannot let this happen. 

JT: What is MOAS and why was it created? How has it evolved since its founding? 

This year MOAS is celebrating its 10th anniversary. It was initially founded in 2014 to save migrants at sea at the height of the migration crisis using drone technology to rescue people. It was the first ever NGO to provide search and rescue services in the Mediterranean.  

Since those days, the portfolio of projects has continued to expand and diversify worldwide. MOAS specializes in Maritime Search and Rescue, Emergency Response Preparedness, field hospital implementation, logistically challenging aid delivery, and, most recently, critical care evacuation and point-of-injury care. 

These programs all have one thing in common: they fill a very specific gap in the crisis response in areas such as the Mediterranean/Aegean seas, Bangladesh, Somalia, Yemen, Sudan, and Ukraine. 

MOAS staff go where others are afraid to go. Driven by innovation and efficiency, MOAS creates models for work considered to be impossible, we access areas other organizations consider too risky. We strive to prove that the impossible is possible in the worst of conditions by designing highly innovative and technological solutions to logistical and implementation challenges other organizations struggle to solve. We foster strong relationships with partner organizations and relevant state actors and use all the technical and HR resources at our disposal. 

MOAS evolves with every new mission. Like with other missions, with the Ukraine program, we started from scratch. 

I have been based in Ukraine since the start of the war. I considered it my personal responsibility to ensure this sensitive program was developed and implemented according to my exacting standards and be here to troubleshoot in real-time to keep up the efficiency and efficacy of the activities. 

Critical steps were taken to establish relationships with new donors, register MOAS in Ukraine to facilitate in-country relationships, open new procurement channels for specially adapted ambulances, and recruit a team of over 150 medics and drivers who were able and willing to do this front-line work. Today MOAS is responsible for evacuating 72% of the most critical casualties off the front line. We have saved over 45,000 soldiers and treated an additional 25,000 civilians in the community, without losing a single life. At the end of the day, our goal is to say, “We did absolutely everything we could to save lives. We used every connection and tool at our disposal, and we didn’t leave a single stone unturned.”

JT: How do you find staff?

MOAS is staffed exclusively by Ukrainians. It started with a mixed team, but the complicated logistics of bringing internationals in and out or registering their credentials, etc was prohibitive and resource-heavy. Over time we built relationships with the Ministry of Health and Ministry of Defense, which improved our recruitment system for local medics, anesthesiologists, and tactical drivers. 

Working with local staff is not only logistically easier but also, the dedication and discipline of the Ukrainian teams are unmatched. They have a vested interest in the outcomes, feel a personal connection to our patients, and have an innate respect for the military and state actors we navigate daily. Add to this their ability to communicate and navigate easily and freely and you’ll find that our staff is incredibly effective and motivated.

We have very solid retention with our local teams, we pay well and the work we do is incredibly rewarding. As such, we don’t need to push for recruitment as hard as we did previously, only needing to recruit new teams when old teams rotate out. We have a rigorous screening process, including a qualification and accreditation review, an extensive interview, a field test, and then quarterly upskilling, training, and testing. It keeps the teams fresh and focused and ensures we are providing the best possible service to the servicemen and women who rely on us in their time of greatest need.

JT: Can international staff work with MOAS in Ukraine?

At the moment we are not recruiting international medics or drivers, but should that change we’d advertise it on our channels. We are always looking for support in PR and Fundraising, which are vital components of maintaining this incredibly resource-hungry operation. Anyone interested in working, volunteering, or donating to MOAS can contact us at dev@moas.eu.destroyed.

JT: Where in Ukraine do you work? Which hospitals do you evacuate the wounded to?

We have 14 bases all along the front line, between 10 and 50km (6-31 miles) from the action. These bases coordinate with military hospitals and stabilization points to receive referrals of critically ill, ventilated, and life-support-reliant patients. When a patient like this is received by the front-line military hospitals or stabilization points, they know they will need a MOAS evacuation, so they contact us directly to request support.

We mobilize our teams from the base and travel as far as needed to collect patients, receiving a comprehensive handover from the retrieval sites. These sites are pretty basic, lacking the kind of technology or resources they need for comprehensive trauma care. They’re not signposted, for security reasons, and only collaborate with extensively vetted and pre-approved organizations. The staff at these front-line sites are incredible in what they’re able to achieve in such stressful and resource-poor conditions. They provide the initial trauma care and any emergency surgery necessary to stabilize the patient for transport.

We are one of the only organizations, be that NGO, state or private, that is equipped and has the personnel able to transport ventilated and 

critical patients for the hours it takes to arrive at the drop-off facility. The referral site is coordinated by our pickup location, so we are advised of what team is waiting for the patient and which hospital when the case is referred to us. We liaise with them throughout the journey to ensure that when we arrive, they are ready and waiting, with a comprehensive understanding of the patient’s status, to facilitate smooth and efficient hand-over. 

Our units are also in constant contact with our logisticians and team leaders at their base, communicating the use of consumables that need replacing, reporting on the status of the patient, coordinating routes, and navigating any emergency issues. Following patient transfer the units immediately disinfect and return to base to restock the vehicles ready for the next deployment.

JT: You’ve said that other organizations, such as the Red Cross and Doctors Without Borders, are either unable or unwilling to do the work MOAS performs on the frontlines. Why is that?

There are two main reasons for this. One is the expense and procurement challenge of equipping an ambulance with the equipment and expertise needed to transport intubated, ventilated and critical patients for the 5 hours required. We have an anesthetist in every unit, ventilators, defibrillators, and infusers in every vehicle, and a supply of IV medications necessary to treat unconscious patients. 

The second is that this kind of specialized evacuation service is most needed at the front for patients who are members of the military or civil defense. Of course, as a humanitarian organization, we follow the Geneva Convention, and all our patients are unarmed well before our teams interact with them, but the complexities of working so closely with the Ministry of Defense and the military hospitals is something most NGOs are too risk-averse to navigate. 

We strongly believe that everyone has the right to the highest standard of medical care, regardless of who they are. It is a tenet of humanitarian intervention and we are determined to provide services wherever they’re most needed, and in the form they are least available.