By Azir Aliu
The echo of the pain from tragedies with a large number of human casualties and injuries continues to be heard long after the day on which they occurred has faded into dusk. It keeps resonating in the memories of families who have lost their closest loved ones, in a society that confronts these losses in silence, and in institutions that must ask themselves whether they were sufficiently prepared.
These were the Laskarci Bus Crash on February 13, 2019; the Tetovo Modular Hospital Fire on September 8, 2021; the bus that burned in Bulgaria on November 23, 2021; and, later, the tragedy in Kocani on March 16, 2025. These events were not identical in cause or in the contexts in which they occurred, but they share one common and painful point — all of them confronted us with the question of how prepared the state truly is when it must save many lives in a very short period of time.
That is precisely why, when we speak today about the National Plan for Action in Events with Mass Casualties, we move beyond the administrative and bureaucratic expectation that this is merely another document. The plan represents a determined attempt to transform painful memory into institutional maturity. It is a decision not to wait for the next disaster to rediscover what we lack, where we are delayed, and who is insufficiently connected within the institutional network. Instead, we are establishing systemic frameworks for an efficient and effective state response — one that is designed in advance, practiced, and coordinated.
With the adoption of this plan, North Macedonia has, for the first time, established a comprehensive framework for coordinated action during mass-casualty events, addressing risks arising from natural disasters, traffic accidents, industrial incidents, fires, and other emergencies. The plan was adopted by the Government on March 10, 2026, following a proposal by the Ministry of Health of North Macedonia, with the support of the World Health Organization, and in alignment with the recommendations of NATO and international health regulations.
Many institutions and services participated in its preparation — from the healthcare sector and emergency centers to the Crisis Management Center, the Ministry of Internal Affairs, the Ministry of Defence, the Protection and Rescue Directorate, the Red Cross, and the country’s medical faculties.
The institutional value of this plan lies in the fact that it establishes a clear architecture of response. It defines how the system is activated, who makes decisions, how institutions coordinate, how triage is conducted, how patients are distributed, how limited resources are used, and how continuity of healthcare services is ensured even in the most difficult conditions. In other words, the plan goes beyond good intentions and seeks to bring order to the hours when tragedies introduce chaos into institutions and attempt to undermine the state’s response.
When the number of injured people exceeds normal capacities within a short time, every minute depends on whether we already know what the first step is, where patients should be directed, how hospitals communicate with one another, and how decisions are made without parallel processes and institutional noise.
This is precisely where the essence of the National Plan lies — in organizing the response on three levels.
At the strategic level, centralized management and inter-sector coordination are ensured.
At the healthcare institution level, the organization of admission, treatment, personnel mobilization, and the use of equipment is determined.
At the pre-hospital level, field triage, emergency medical assistance, evacuation, transport, and the establishment of forward medical stations are regulated.
This interconnection is crucial because the cracks between what happens at the accident site, the hospital response, and institutional leadership are often what make a crisis more difficult than it needs to be.
Europe learned long ago that preparedness for responding to mass-casualty events must not be based on improvisation. In France, for example, ORSAN (Organisation de la Réponse du Système de Santé en Situations Sanitaires Exceptionnelles) is a national framework for organizing the health system’s response in exceptional health situations, including the mass influx of injured patients.
At the level of the European Union, the European Union Civil Protection Mechanism and its Emergency Response Coordination Centre operate on precisely this logic of pre-prepared coordination, functioning 24 hours a day with the ability to rapidly mobilize assistance when the capacities of a single country become overwhelmed.
The systemic lesson is clear: mature systems do not wait for a crisis to begin organizing themselves — they organize before the crisis.
For me, therefore, this plan carries broader significance. It is a test of whether the state is capable of learning from its past mistakes and shortcomings. It asks whether each tragedy can produce a systemic lesson and build institutional memory — while also demonstrating that the solidarity of citizens, the dedication of doctors, and the support of international partners will be strengthened through systemic improvements.
In Laskarci, Tetovo, Bulgaria, and Kocani, we witnessed something that must never be forgotten: the immense human dedication that emerges when the system faces its most difficult test. Yet we also saw that sacrifice alone must never be the sole pillar of national preparedness.
It is neither fair to healthcare workers nor to citizens for the state to expect that courage will always compensate for systemic unpreparedness. The obligation of institutions is to support that courage with a structured and timely response.
For this reason, the National Plan for Action in Events with Mass Casualties should be understood as a beginning rather than a finished task. Its true value will be confirmed only when it is translated into regular training, simulation scenarios, verification of hospital capacities, interoperability among institutions, and a culture of preparedness that does not depend on who holds office but on the kind of system we have built.
The state cannot promise its citizens that tragedies will never happen again. But it must promise them something else: that it will never enter them unprepared.
That is the least we owe to the victims of Laskarci, Tetovo, Bulgaria, and Kocani. And it is the least we owe to all future generations.
The author is the Minister of Health of the Republic of North Macedonia.