Only a month into 2026 and the world already looks a different place than it did just at the end of last year.
This volatility and uncertainty creates greater risk for gloablly mobile individuals and workforces and this is breeding demand for emergency and evacuation cover.
Notably, reasons for use are growing and becoming more diverse than just when medical emergencies hit, with social unrest being a particularly high profile and increasingly common need for evacuation.
And with costs rapidly escalate and regularly reaching in neighbourhood of half a million dollars, having the right plan in place is particularly important.
Violent unrest
“Many of the general trends and reasons to evacuate remain extant, such as in response to the outbreak of war or in the aftermath of natural disasters – especially for island nations where there are limited opportunities to evacuate at scale,” Mark Overington, head of intelligence at Solace Global Risk, tells Health & Protection.
“Demand for the Middle East has naturally increased in the last couple of years for obvious reasons, and currently contingency plans are in full motion.”
But Overington also points to one emerging trend Solace has noticed – the demand for evacuation services in response to violent unrest.
“While protests are by no means a new phenomenon, the largely Gen Z-led and technologically driven protests have resulted in more dynamic and reactive protests, which makes it harder to assess the nature and scale of protest activity,” Overington continues.
“Before protests were easy to organise in near-real time on social media, there were often fairly obvious focal points, such as outside key government buildings, diplomatic quarters, and arterial roads or major avenues.
“However, social media has made them far more dispersed and decentralised, leading to more dynamic and reactive operating environments.”
Near real time mobilisation
Overington maintains social media has also enabled near-real-time mobilisation, without central leadership, with protests increasingly being formed in response to specific government or security forces actions such as the killing of a protester, as with the recent demonstrations taking place in the US over migration policy.
“This has created a sort of escalation cycle that can help sustain protest activity, and at times provoke violence,” Overington continues.
“Protest tactics have also become more disruptive, with recent examples such as in New Caledonia, featuring widespread road blockades and blocking access to the airport, hugely curtailing options to evacuate from the island nation.”
Diverse risks
Underlining the importance of this kind of support, Dr Mauro Zambon, regional medical director at International SOS, adds: “When a medical emergency occurs during an international assignment, the stakes are high.
“We need rapid medical assessment, logistical support, and safe transport, while international health insurance ensures access to quality treatment and financial protection throughout recovery.
“Given the diverse risks worldwide, from remote regions and natural disasters to geopolitical instability, organisations must proactively prepare their global workforce with robust, integrated protection.
“This not only safeguards employee wellbeing but also mitigates substantial financial and operational risks when the unexpected occurs.”
Risk to expats
Of course when it comes to business travel, expats are at greatest medical risk when they venture to locations which have hospital facilities far below international standards.
According to Dr Finn Morgan, group medical director at Healix International, these risks are amplified when travellers have significant pre-existing medical issues or if they intend to take part in activities which carry a high risk of injury.
“But when it comes to financial risk, travellers can find themselves exposed to significant costs without having to go anywhere adventurous,” Morgan maintains.
“Patients in need of hospital care in the United States can quickly find that they have incurred huge medical expenses,” he continues.
“In these circumstances insurance is of course indispensable.”
Medical evacuation cover is generally included as standard within international medical insurance and a business travel policies and is rarely removed, Linda Beavis, global leader – mobility, global benefits at Aon, points out.
“Therefore the majority, if not all, of the cost is covered by an insurance programme,” Beavis continues.
“It depends on the policy as to whether that cost is then included in the claims experience or not.”
Wider benefits
This cover often comes with additional features – as Kevin Melton, global head of IPMI at IMG, explains.
“The following benefits are also included following evacuation – hotel accommodation for escort and insured person when required pre and post hospital admission and a return air flight for the insured person and their escort,” Melton says.
“Our services also apply for returning the mortal remains of any insured person to their home country.”
Dr Ulrike Sucher, medical director at Allianz Partners, Health, notes the provider’s evacuation and repatriation services are fully integrated into international health plans when appropriate care is not available locally.
Dr Sucher adds demand for this cover closely mirrors where international assignments are most common and where local medical infrastructure may not meet Western clinical standards.
“This is particularly in more remote or geographically isolated locations,” she continues.
”The key drivers are not only medical capability on the ground, but also distance to centres of excellence, availability of specialist care, and logistical challenges in emergencies.”
According to Sucher, the overall risk profile of customers has remained “broadly consistent” compared to pre-pandemic levels.
“The highest exposure tends to be in regions with limited medical infrastructure, long distances to advanced care facilities, or challenging logistics, such as Sub-Saharan Africa, parts of Southeast and Central Asia, and remote island locations,” she continues.
“In these scenarios, evacuation costs can escalate quickly, particularly when air ambulance services or cross-border transfers are required.”
Best practice
Providing these services tends to come with complications, but while every case is different, established best-practice disciplines guidelines do exist.
According to Claire Hargreaves, managing director at Trawick International EMEAA, these guidelines include an approach where joint insurer and medivac clinical assessment and triage confirm necessity, urgency, and severity and one that is destination selection based on clinical capability, continuity of care, and alignment with insurer hospital networks — not proximity alone.
Hargreaves adds that a good approach should also have clear clinical governance, ensuring medical need always drives decisions over logistics or provider preference and wherever practicable, effective use of both its own and its medivac partners’ assets.
These include contracted hospitals and the sourcing and comparison of multiple transport providers rather than relying on a single supplier.
“Ultimately, success relies on all parties agreeing on transport choices that are proportionate to clinical risk, distance, cost, and patient outcomes — with the patient always at the centre of the decision,” Hargreaves continues.
“Insurer and medivac relationships should not be viewed through a vendor lens, but as true partnerships working together for the benefit of customers.”
Extensive and escalating costs
A further consideration, Hargreaves continues, is that the greatest risks and costs tend to arise in remote or unstable locations where suitable care is unavailable, requiring patients to be moved across borders for treatment that would be routine in more developed medical markets.
“Costs escalate quickly when evacuation options are constrained by security restrictions, airspace or border closures, extreme weather, or slow and unclear decision-making that leads to inappropriate transport or multiple transfers,” Hargreaves explains.
“This can occur on any continent, but the highest cost relative to incidence we see is in and around Africa,” she adds.
“It is also important to note that cost escalation is often driven by poor planning and weak alignment between medical, evacuation, and insurer networks — not just clinical severity.
“Insurers and medivac companies that prepare through clear governance and integrated arrangements are far better positioned to control both outcomes and spend.”
Air ambulance
Evacuation by air ambulance is understandably one of the costliest means of evacuation.
However, it is able to provide the highest level of care in an emergency as these aircraft enable doctor or nurse escorts to bring the necessary equipment and medication to treat the patient throughout the flight.
“If traveling to a developing country and there is limited infrastructure not only in that country, but in that region, then it’s more likely
“For example, if you are on a safari in western Africa and have a medical emergency, an air ambulance to Johannesburg
“It’s important to note that evacuations are not always by air; they could be to another facility within driving distance.
“Air ambulances can cost hundreds of thousands, we have covered up to $500,000 in a single long-haul evacuation.”
And Melton reveals that during 2025 the insurer managed three to five air ambulances per week around the world.
“We have airlifted patients from hospitals in very remote and diverse locations, including Cuba, Kenya, Uganda, Iraq, Senegal, Nepal, Algeria, Easter Island, Mozambique, Ethiopia, Cameroon, Cape Verde, Tajikistan, Jordan, Liberia, Djibouti, Madagascar, Afghanistan, Samoa, Vanuatu, and even Antarctica,” he adds.
IMG has also recently acquired Assist America, a global emergency travel assistance provider, showing the emphasis insurers are putting on this facet of their operations.
Strong demand for evacuation cover
Looking to the future, Peter Lurie director at Proactive Insurance, foresees steady demand for evacuation cover continuing.
“We have definitely seen a steady rise in demand for evacuation cover, particularly over the last few years,” Lurie says.
“Clients are far more switched on to the reality that having medical insurance is not always enough on its own.
“With everything that’s going on globally – political instability, regional conflict, climate events and stretched healthcare systems – people are asking the right questions about what happens if suitable treatment simply isn’t available locally.”
Lurie adds this demand is not slowing down, and is actually becoming more mainstream.
“Global mobility isn’t going away, and neither are geopolitical or environmental pressures,” Lurie continues.
“Employers, families and internationally mobile individuals are becoming far more pragmatic and risk-aware.
“Evacuation cover is moving firmly into the category of something you should have rather than something that’s nice to have, especially for anyone spending time outside well-established healthcare systems.
“The only issue is we don’t do enough of it, more enquiries would be great.”
