Michael VanRooyen has spent decades responding to emergencies around the world, with no choice but to confront suffering, destruction, and death. These experiences have taught him how to ease pain amid chaos, forced him to navigate moments of intense fear and danger, and given him the technical and emotional depth to support war-torn communities in their efforts to heal and rebuild.
“It’s a gift to work in a place where you truly feel like you are helping people,” he said.
VanRooyen is the Harvard Medical School J. Stephen Bohan Professor of Emergency Medicine at Brigham and Women’s Hospital and the Lavine Family Professor of Humanitarian Studies at the Harvard T.H. Chan School of Public Health. In 2005, he helped found the Harvard Humanitarian Initiative, which has sought to strengthen aid programs through education and research.
In a conversation with the Harvard Gazette, he reflects on the challenges and rewards of a calling that has taken him from big-city U.S. hospitals to global disaster zones and back again.
Where did you grow up?
VanRooyen: A small town of about 7,000 people in Michigan called St. John’s. There were four of us — my father, my mother, my older brother Rick, and me.
When I was 5, my mom was diagnosed with melanoma; she passed away on my eighth birthday. Three years later, my father married a woman with eight children, and suddenly I had five new sisters and three new brothers. It was quite an adjustment to suddenly be part of this big family, but it was great.
To get out of the house, I joined the Boy Scouts. When I was 14, I was with my scoutmaster when we witnessed a tractor crash. We called the paramedics and watched them in action. I was so impressed. I thought, “I have to do something like that.”
You were at Wayne State University for medical school. What do you remember most from those years?
VanRooyen: As a small-town kid, the urban environment of Detroit was an adjustment. But Detroit was an amazing place for clinical medicine because of the size and complexity of the big hospitals. It was my first real exposure to emergency medicine. When I did my first rotation in the ER at Detroit Receiving Hospital — a massive department compared to anything I had experienced — there were sick patients everywhere. I watched the ER doctors and, just like the first responders I witnessed when I was a kid, they were all so professional and composed. The crazier it got, the more focused they became. On my first day in the ER, I thought, “This is it. This is exactly what I want to do.”
When did humanitarian response come into the picture?
VanRooyen: I was a third-year student, bleary-eyed at three in the morning with a new admission. I was sitting next to the patient, asking him questions, when we both realized that we were falling asleep on the spot. We laughed about it and finished, but I remember walking out, looking out the window over the city and wondering what I wanted to do with my career. I was drawn to medicine to help people on their worst day and I wondered if it was possible to help people on a much larger scale.
I eventually decided to be a humanitarian doctor. I had no mentors and no experience. I had a lot of exploring to do, so I took three months off in my fourth year of medical school to work in El Salvador during the civil war. I returned to the United States with a new conviction to be a global doctor. I had found my calling.
What happened next?
VanRooyen: I moved to Chicago, became an intern, and then did my residency in emergency medicine at the University of Illinois there. Back then, there was no flexibility for travel abroad, so I went straight through residency — intense, but great — and graduated in 1991, a newly minted emergency physician. After working a year to pay off my student loans, I quit and headed abroad to explore global medicine. I spent the next year working in various international settings and eventually landed a position as a humanitarian doctor in Somalia. It was a seminal moment for my career.
This was during the country’s civil war. What do you remember?
VanRooyen: Rival clans fought for territory and the country was pushed into famine. Food relief shipments were being stolen by militias and sold for weapons. It was a very dangerous time for humanitarian organizations, which were trying to access the interior of the country to deliver food aid. Nongovernmental organizations had to adapt to the militarized context by paying for armed protection, so there were militias and weapons everywhere.
I worked in Somalia over the course of 1992 and ’93, supporting medical care for refugees. Shortly thereafter, I was called to work in Bosnia in the former Yugoslavia to work in a war hospital. From there, I joined NGOs in a series of relief missions, managing teams in Rwanda after the genocide and then Sudan and other crises. I spent much of the 1990s back and forth between the United States and several humanitarian emergencies.
Were you an ER doctor doing humanitarian work on the side or the other way around?
VanRooyen: Working in humanitarian crises and returning home to work in emergency medicine led to parallel careers. Although the environments were completely different, I was able to leverage my experience from one with the other. I was a full-time emergency doc and director of an ER in Chicago at the same time as I was a relief doc with humanitarian organizations. I continued to grow my experience base, working with relief organizations in Bosnia, Kosovo, Iraq, and North Korea. Then I’d come home and resume my life as an ER doctor and professor.
When you’re training tomorrow’s humanitarian workers, how do you prepare them?
VanRooyen: One of the reasons I started the humanitarian simulation training program 20 years ago was because of the gap between the classroom and the field. We would teach issues of humanitarian principles and access and negotiation, but these concepts lacked the reality that aid workers face in the field. It’s hard for anybody sitting in class to think, “Am I really going to be at a roadblock and have to negotiate access with a gun in my mouth?” The simulation provides practical training. I wanted to give them the feeling of stress and to help them understand the reality of what working in a conflict zone looks like. It has become the premier civilian humanitarian simulation in the world.
The Harvard Humanitarian Initiative’s goal is to conduct research and develop tools that improve humanitarian work, addressing problems you saw in the field. What was wrong with humanitarian aid before?
VanRooyen: When I worked in Somalia, I realized that good intentions are not enough. Most people showing up to work had little experience and no training. As a Western emergency medicine doctor, I was entirely unprepared to work in a war zone. I didn’t know the culture, I didn’t know the context, I didn’t know a lot of the conditions I was treating. It was a feature of the rapid growth of the aid industry. More conflicts, more crises, and more civilian aid agencies, with more people arriving without experience or training.
It occurred to me that there was no professional pathway to train humanitarians. I felt like the system needed a connection to research and education and a professional pathway for leadership development and mentoring, similar to what we have in medicine. The vision was that HHI would be among the very first organizations that aimed to professionalize the aid community at a time when it was growing rapidly and getting more dangerous.
Is the field better today?
VanRooyen: The humanitarian sector has grown and advanced in its complexity, its use of evidence, and its impact. It has grown to meet the needs of hundreds of millions and is a lifeline for people around the world.
But the humanitarian sector is facing its own crisis. The elimination of USAID and its mandate sent shock waves across the humanitarian world, forcing many organizations to radically downsize. It has also created a narrative that the vital humanitarian work that we do is somehow less important. Many NGOs and U.N. agencies have had to reduce their efforts. As the humanitarian sector adapts, there will be many unmet needs. At HHI we have to rethink our next steps and see how we are going to contribute to the future of global aid.
This interview was edited for length and clarity.
