On the morning of September 27, 2024, North Carolinians were bracing for a hit. The National Hurricane Center had been tracking a storm—christened Helene on September 24—for more than a week. What started as a low-pressure weather system was headed for the US Gulf Coast as a life-threatening hurricane, and a state of emergency had been declared. Helene slammed into Florida as a Category 4 hurricane, with winds up to 137 mph. But it wasn’t the wind that devastated the Appalachian Mountains of western North Carolina. It was the rain.
As Helene weakened into a tropical storm over the Tennessee Valley, it stalled above western North Carolina, dumping record-breaking amounts of rain on small mountain towns, many with populations well under 1,000 people. Rivers overflowed with lethal force, sending walls of water, mud and debris crashing down the mountains. Homes were swallowed, power and communications were knocked out, bridges and roads that connected the little towns to larger population centers were demolished and entire communities were swept away. Residents had little time to escape—and some did not.
“This was, by far, more devastating than anything any of us alive have ever seen in this area,” says Jennifer Mullendore, Medical Director for Buncombe County Health and Human Services. “While we have plans—preparedness plans—to respond to an event like this, this was so much more than we had ever planned for.”
Most national, state and local governments plan for large-scale disasters—floods, fires, earthquakes, tornadoes—but preparing for a once-in-a-lifetime storm like this can be challenging, especially for smaller communities.
As a global first responder, much of the work that International Medical Corps does happens in unpredictable scenarios—the “edge cases” that even the most robust plans may not anticipate, such as large-scale sudden-onset disasters, and outbreaks of conflict or infectious disease. Because many of the places where we work are experiencing extreme situations—for example, war, drought and economic collapse—we know how to be resourceful and efficient in low-resource settings, where relying on traditional infrastructure isn’t an option. We’re also able to provide resources—funds, equipment, supplies and even temporary medical staff—to supplement what is available locally. And with more than 40 years of experience responding to humanitarian crises and disaster, there are few obstacles that we haven’t confronted before.
Even before Hurricane Helene struck, when it was clear that the storm had the potential to be a mass-casualty event, our Emergency Response Unit communicated with local partners in the Southeastern US and prepared to respond. In the aftermath of the storm, our team provided primary medical care and mental health services at shelter sites, working closely with the local Department of Health and other local, state, federal and nonprofit partners. We helped to ensure continuity of care by providing local health facilities with alternate power sources, coolers for medicines that require refrigeration and portable health units. And we brought in portable showers and washing machines for health workers, enabling them to take care of their personal needs and return to work. Measures like these are critically important when local first responders are themselves affected by a disaster and need to deal with their own losses as they help others.
“Having had zero experience with anything like this, I was eager to meet with people who had experience. [And] having an experienced group who came with everything they needed—staff, supplies, knowledge—being able to step in and help out has been great,” Mullendore says. “It’s one less thing I had to worry about.”
“There were a lot of grassroots organizations coming together for Helene,” remembers Erika Czerwinski, a clinical psychologist from Asheville who volunteered with our mental health team in North Carolina. “If we didn’t have the structure that International Medical Corps provides—in knowing we’ve got a medical team, we’ve got a mental health aspect and we’re working with local partners to provide shelter and housing—there would be a lot of chaos. There would be a lot more people on the street. There would be a lot more illness.”
International Medical Corps helps to move people from relief to self-reliance. Building resilience is part of everything we do. This means that, in a crisis where local resources remain, our job is not to set up a new, separate health system. Instead, we help the existing health system get back on its feet and recover. Ideally, after we respond to a crisis, the support and knowledge sharing we provided leaves a health system stronger than it was before.
In the US, there is already a lot of local capacity—meaning that there are usually plenty of hospitals, plenty of health workers and robust infrastructure. But what happens when an entire community is affected by disaster—for example, when Puerto Rico was devastated in 2017 by Category 4 Hurricane Maria? In situations like that, where damage is widespread, local emergency response can be temporarily incapacitated. Hospitals and pharmacies can be flooded or without power. Doctors, nurses and support staff can be displaced from severely damaged or destroyed homes.
After Hurricane Maria, many health facilities in Puerto Rico were inoperable due to damage, while the entire island was without power and access to clean water. Our team was ready to provide generators, fuel, and water delivery and storage so that local clinics could re-open and serve patients. We also provided grants to help support local health workers who had lost everything, so they could return to work more quickly. Our mobile medical teams conducted home visits to particularly vulnerable neighborhoods. And we helped health facilities prepare for future disasters, providing equipment and funding for upgrades to facilities, and working with local first responders to improve emergency response processes. Because we were able to quickly fill unanticipated gaps, local health workers could quickly get back to the business of providing healthcare.
Much of our work around the world is in support of displaced people—those fleeing violent conflict, famine and other life-threatening circumstances—so we know what it takes to support the health needs of large groups of people who are suddenly living in temporary shelters. We also understand the challenges and risks of those situations, and we bring that expertise to all of our disaster responses.
Experience has taught us that coping with the uncertainty of displacement takes a tremendous toll on people’s mental health, which can diminish their ability to recover. Following the January 2025 wildfires in Los Angeles, California—which decimated two communities and left thousands of people living in temporary shelters—our team stepped in to provide health services and supplies to displaced people. Volunteer doctors, nurses and mental health staff provided care in the principal shelters set up by the city, supporting wildfire survivors as they sorted out where they were going to live and how they were going to recover. And our mobile team provided mental health support to residents waiting at neighborhood re-entry points to visit their burnt homes, helping them prepare for the experience and providing resources they could turn to as they faced days, weeks and months of recovery.
Another area of expertise we bring to our work in the United States is infectious disease prevention and control. Because the health system in the US is so robust, healthcare professionals rarely have to confront an out-of-control or unknown situation. But in February 2020, reports of an unidentified and highly contagious respiratory disease originating in Wuhan, China, quickly erupted into a global pandemic. As a leader of responses to Ebola throughout Africa, International Medical Corps was ready to help manage a large and rapidly spreading outbreak of infectious disease.
Our Emergency Response Unit quickly began working with national and local partners in a handful of countries with limited public health capacity— the Democratic Republic of the Congo, Ethiopia, Nigeria, the Philippines and South Sudan—to help them prepare. We used what we’d learned during the Ebola outbreaks to help health facilities establish processes for identifying and managing patients sick with the virus, to prevent the spread of the disease to other patients and health workers. Our Logistics and Procurement team was able to locate, purchase and deliver large shipments of masks, goggles and other personal protective equipment to health facilities. And we conducted extensive training of local health workers—many of whom had never dealt with a deadly infectious disease outbreak—in infectious disease monitoring, prevention and control.
As COVID continued to spread, we expanded our response to our thousands of staff members around the world, providing them with guidance on how to screen patients for COVID, enhance prevention and control of the virus, and protect health workers—a critical and very vulnerable resource in the rapidly evolving situation.
By mid-March 2020, we were fully involved in the US response, training frontline workers and infectious disease experts on infection prevention and control processes; providing hospitals with temporary medical shelters, equipment and surge staff; and sharing our expertise in infectious disease management, control and prevention with health facilities around the country—including Jamaica and Flushing medical centers, two hospitals at the heart of the outbreak in New York City.
By the end of the COVID-19 pandemic, we had provided 32 hospitals and 51 long-term care facilities with emergency medical tents and equipment, supplies, training and surge staff. Once again, because of our years of experience in global humanitarian relief, we were able to fill critical gaps in local health systems during a time of extreme crisis.
It’s this kind of experience in large-scale emergencies that Jennifer Mullendore appreciated when we provided support to Buncombe County after Hurricane Helene. “Seeing the partnership between International Medical Corps, the local medical provider, our staff and our social workers, and seeing the number of people in the shelter decline drastically because of the coordination of care and everybody bringing their resources and their knowledge and expertise to work collaboratively—it was really great.”
“When you are someone who’s living through a disaster, when it’s happened in your own community, when you have friends and family that you’re worried about, or when you see the devastation in areas that you’ve been to—it’s hard to process while you’re trying to help other people,” Mullendore says quietly. “So, having outside experts come in and be available to meet the community’s needs allows the locals—first responders and healthcare providers—some space to grieve and to take care of themselves. It’s been nice to have all these partners come in and lift some of the load off of us. That’s been very appreciated.”
At International Medical Corps, preparedness and resilience are at the heart of what we do. Preparation is crucial, but sometimes things are so much more than anyone can plan for. During those times, International Medical Corps is there.
To find out more about International Medical Corps’ lifesaving work around the world, visit InternationalMedicalCorps.org.