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Sreejesh Parajuli, a paramedic with Dhulikhel Hospital carries a Direct Relief Emergency Medical Pack and enters a vehicle to travel to treat survivors of the recent floods in the Himalayan valley along the Nepal-Tibet border, on September 11, 2026 in Dhulikhel, Nepal. (Photo by Abhishek Chinnappa/Getty Images for Direct Relief)
When disaster strikes, we tend to measure response in hours.
How quickly can first responders reach affected communities? How quickly can medicines arrive? How quickly can damaged health facilities begin caring for patients again?
Speed matters enormously; but what we often see is that the ability to move quickly in an emergency is rarely created during the emergency itself.
It is built beforehand.
Mountain Heart Nepal delivers Direct Relief-provided personal care items for displaced people in Bidur Municipality, Nuwakot district, Nepal. (Photo courtesy of Mountain Heart Nepal)
When catastrophic flooding swept through Nepal last month, entire towns were lost in an instant. Roads and bridges were washed away, and communities suddenly became difficult or impossible to reach. Yet within hours, local medical teams supported by Direct Relief were moving up the valley toward affected areas with emergency medical supplies already positioned in the country.
It looked like rapid response. In reality, it reflected decades of preparation.
We often think about disaster preparedness in terms of physical assets: medicines, emergency kits, warehouses, vehicles, and generators.
All are essential. But preparedness also has a less visible architecture.
It is the relationship with a healthcare provider established years before an earthquake. The regulatory knowledge that allows medicines to move quickly. The logistics systems that protect temperature-sensitive products when electricity fails. The information that tells you which facility is functioning and which is not.
And perhaps most importantly, it is trust.
Supplies can be purchased. Trust takes time.
Local organizations bring knowledge, relationships, access, and long-term commitment to their communities that cannot be manufactured after disaster strikes. Those capabilities are humanitarian infrastructure every bit as much as warehouses and supply routes.
Global organizations can bring different capabilities: specialized medical resources, logistics, technology, private-sector partnerships, and flexible philanthropic capital.
The opportunity is not to choose between local and global. It is to connect the two effectively, before they are needed urgently.
We have seen that principle at work repeatedly this year.
Fundación Wayuu Taya provides Direct Relief aid to earthquake-affected communities in La Guaira, Venezuela. (Photos by Maxwell Briceño for Direct Relief)
Following the devastating earthquakes in Venezuela, longstanding relationships allowed Direct Relief and local organizations like Acción Solidaria and the Wayuu Taya Foundation to move quickly from understanding needs to supporting medical care and the movement of requested medicines and supplies.
And in the Democratic Republic of Congo, the recent Ebola outbreak has illustrated another dimension of preparedness: the work of organizations like VillageReach and Jericho Road’s Wellness Center, and the ability of a health system to absorb a crisis without abandoning everything else it is responsible for.
Because disasters do not replace existing health needs. They compound them.
Women still go into labor during floods. Cancer patients still require treatment after earthquakes. People living with diabetes still need insulin when the power goes out.
And the urgency required does not begin with a disaster declaration.
Direct Relief continues to support the Ebola response in the Democratic Republic of the Congo through partners including VillageReach, helping strengthen outbreak detection and patient care. The organization’s response includes ongoing shipments of personal protective equipment, diagnostics, oral rehydration salts, antibiotics, and chronic disease medications. (Photo courtesy of VillageReach)
It has also made me think differently about how we define an emergency. For a patient who urgently needs care, a formal disaster declaration or news coverage does not determine whether that need is real.
Some health emergencies command the world’s attention in mainstream news. Others happen every day, largely unseen. A woman unable to access safe obstetric care, a patient whose dialysis treatment is interrupted, or a clinician without the medicines needed to treat the person in front of them may never make a headline. The consequences are no less real.
A resilient health system must be able to do both: meet essential health needs every day and absorb the additional shock when crisis arrives.
This is why I have come to think deeply about the traditional distinction between emergency response and the work that happens between emergencies. In practice, one determines the effectiveness of the other.
Preparedness is not a separate work stream from response. It is what makes effective response possible.
That principle is core to Direct Relief’s operating model, working to equip healthcare providers 365 days a year. Much of that happens far from the attention that accompanies a major disaster: supplying essential medicines, strengthening logistics and infrastructure, and supporting priorities identified by healthcare providers themselves.
Then something happens.
A devastating earthquake. A catastrophic flood. An outbreak. A fire.
And investments that may have seemed incremental suddenly become consequential.
A relationship becomes a communications channel. A routine shipment establishes a supply route. Resilient power keeps medicines refrigerated and a health facility operating. A stockpile of emergency medical supplies already in-country saves days of transit. Years of collaboration make it possible to act on information with confidence.
That is the leverage of preparedness.
At a moment when humanitarian needs are growing, and the resources available to address them are increasingly constrained, this idea deserves more attention.
In response to the June 2026 earthquakes in Venezuela, Direct Relief supported the deployment of Medical Impact, providing emergency funding and medical backpacks to equip its multidisciplinary medical teams from Mexico and Colombia as they deliver mobile care in affected communities. (Photos by Enrique Polito for Medical Impact)
This moment requires more than doing the same work with less. It requires organizations to be disciplined about where they create distinctive value, to concentrate resources there, and to partner for the rest.
And while this is true in the private sector, I believe it is increasingly important in humanitarian work; our stakes are human.
For Direct Relief, this means understanding where capacity exists, strengthen it before it is tested, and putting specialized global capabilities behind locally identified priorities when circumstances overwhelm it.
Particularly when resources are scarce, effectiveness cannot simply be measured by how much aid is mobilized. It also depends on whether the right resource reaches the right provider at the right time, where it can have the greatest effect.
That is both a question of impact and one of stewardship.
We cannot know where the next earthquake will strike, when the next outbreak will emerge or which community will suddenly find itself cut off from care.
But uncertainty is precisely the reason to prepare.
Our ability to respond on Day Zero is built through the work happening the other 364 days of the year: the relationships established, the supply pathways tested, the resources positioned, the health facilities strengthened and, above all, the trust earned.
Those investments serve people every day. And when the extraordinary happens, they become the foundation on which an emergency response can immediately build.
The work done on ordinary days determines what is possible on extraordinary ones.
