Terms of Reference - Consultancy for an assessment of the Emergency Medical Service of the Palestine Red Crescent Society, including operational planning support

COUNTRY OF ASSIGNMENT: Occupied Palestinian Territories (OPT) and remote work

LOCATION IN OPT: West Bank, Ramallah

START DATE: January 2026

APPLICATION DEADLINE: 12 November 2025

ORGANISATIONAL BACKGROUND

French Red Cross (FRC):
Founded in 1864, the FRC provides emergency relief, first aid, health, training, social action, and international humanitarian support. It manages over 600 health, medico-social, and educational establishments in France, employing more than 18,000 staff. Internationally, the FRC works alongside national partners to strengthen health systems and emergency response capacities.

The FRC has been present in Palestine since November 2022, based in Ramallah within the offices of PRCS (Palestine Red Crescent Society). Together, PRCS and FRC have already implemented projects to strengthen Emergency Medical Services (EMS) and First Aid capacities, through a first phase of a CDCS-funded project. This consultancy will directly contribute to activities under the second phase, supporting PRCS in developing an evidence-based EMS Operational Plan for 2027.

Palestine Red Crescent Society (PRCS):
The PRCS operates extensively in the health, emergency response, and social services sectors in Palestine. As an auxiliary to the Palestinian public authorities, PRCS is dedicated to providing comprehensive interventions to enhance the well-being of the Palestinian population. It has a significant presence across Palestine, with a robust network of volunteers and professionals committed to delivering essential services. PRCS is at the heart of the challenges facing society, developing new projects and working on innovative solutions.

The PRCS is the primary provider of EMS in the occupied Palestinian territory. It delivers life-saving pre-hospital care through a network that includes 11 EMS stations and 21 sub-stations in the West Bank, and a significant though gravely constrained presence in Gaza. Across these branches, PRCS operates a fleet of ambulances in the West Bank- of which many are at risk of going out of service- and ambulances in Gaza, out of wich only a limited number of vehicles can be deployed daily due to fuel shortages, lack of spare parts, and restrictions on imports. Complementing this fleet, community-based First Aid Posts and quad-bikes extend reach to areas where ambulances are blocked or delayed, while volunteers play a critical role in providing immediate stabilization.

This service operates in one of the most hostile and unpredictable environments in the world. Since October 2023, PRCS medical missions have been subjected to repeated violations of humanitarian law which resulted in the killing of 31 PRCS staff members in line of duty. In the West Bank, intensified military operations, settler violence, and movement restrictions severely impede EMS access to patients. In Gaza, where the health system has largely collapsed and where hospitals and clinics are either destroyed or operating only partially, PRCS ambulances and facilities remain among the very few functioning providers of urgent pre-hospital care. Yet they do so under bombardment, with limited fuel, minimal equipment, and dwindling human resources.

Despite these pressures, PRCS maintains an extensive operational footprint, attending thousands of cases every month. The backbone of this system is its cadre of Emergency Medical Technicians (EMTs) and Emergency Medical Responders (EMRs). However, the organization faces acute structural challenges: recruitment of new EMTs has stalled due to the scarcity of graduates and the dangerous conditions of the job, while retention is undermined by the context/working environment as well as burnout. As a result, PRCS increasingly relies on EMRs- trained volunteers who can provide basic stabilization but are not authorized to perform advanced procedures. This creates uneven service delivery and places enormous strain on the limited number of professional EMTs.

Training and capacity building have been areas of recent progress. With technical support, PRCS has updated its first aid manuals, trained a cohort of trainers, and committed itself to achieving International First Aid Attestation (IFAA) by 2026. Plans are underway to expand advanced life support training, both through American Heart Association-certified ACLS modules and European Resuscitation Council-accredited ALS courses. These efforts signal a strong institutional commitment to aligning PRCS training with international standards, even while day-to-day operations remain underfunded and overstretched.

The EMS system itself has not undergone a comprehensive assessment since before the COVID-19 pandemic. The environment, however, has changed dramatically: escalating violence, repeated access restrictions, systemic collapse in Gaza, and chronic shortages of resources have reshaped the operational realities. Against this backdrop, PRCS has identified the urgent need for a new, in-depth assessment. This will not only document the technical and operational state of the EMS system- its staffing, fleet, dispatch and communications, training, and protocols- but also provide strategic guidance to inform PRCS’s 2027 Operational Plan and longer-term Emergency Master Plan.

OBJECTIVES OF THE CONSULTANCY

The consultant’s mission is to carry out a comprehensive assessment of the PRCS Emergency Medical Services (EMS), at a moment when the system is under unprecedented pressure yet remains indispensable for the Palestinian population. This task goes well beyond a technical review: it requires capturing the operational realities of EMS provision under conflict and systemic collapse, while at the same time identifying pragmatic, evidence-based recommendations that can guide PRCS’s future operational planning. The consultancy will be carried out through both remote and in-person support (travel will be only to the West Bank, not to the Gaza strip - please see below sections).

The consultant will be expected to approach the assignment in three complementary dimensions:

1. Operational and logistic review
   • Assess the current EMS structures in the West Bank, including emergency stations, sub-stations, ambulance fleet, dispatch and communication systems, and First Aid Posts.
   • Evaluate the availability, condition, functionality, and sustainability of PRCS’s fleet and medical equipment.
   • Assess the quality of the daily operations, including case loads, response times, patient outcomes, and logistical constraints.
2. Human resources and training
   • Analyze PRCS’s staffing structure, with a focus on EMTs, paramedics, and volunteers, and identify critical gaps in recruitment, retention, and deployment to provide sustainable and practical recommendations.
   • Examine the balance between professional EMTs and volunteer Emergency Medical Responders, noting the implications for quality of care.
   • Map current training systems, curricula, and partnerships (e.g. ACLS, ALS, IFAA process) and provide recommendations to harmonize the competencies and consolidate a sustainable, internationally recognized training pathway.
3. Strategic and institutional alignment
   • Provide recommendations to strengthen the EMS component within the broader PRCS mandate as auxiliary to public authorities and leading health actor in Palestine.
   • Ensure the assessment directly informs PRCS’s 2027 Operational Plan, while aligning with the Society’s Emergency Master Plan (2025–2027) and Strategic Plan (2024–2027).
   • Develop a prioritized recommendations matrix, specifying feasible measures, responsible actors, timelines, and resource needs.

The consultant’s methodology should be participatory and grounded in dialogue. It will involve:

• Consultations with PRCS leadership, EMS management, and frontline staff at station level.
• Engagement with volunteers and Community Awareness Committees to capture community-level realities.
• Interviews with external stakeholders, including the Ministry of Health, UN agencies, and Movement partners, to effectively articulate PRCS EMS within the wider humanitarian response.
• Validation workshops with PRCS leadership to collectively analyze findings and refine the recommendations.

Ultimately, the consultant is not only tasked with producing a technical report. He or she is expected to deliver a strategic tool that strengthens PRCS’s capacity to plan, adapt, and sustain its life-saving EMS operations in the face of violence, restrictions, and chronic resource gaps. The outcome of this work will shape PRCS’s ability to continue fulfilling its humanitarian mandate in both the West Bank and Gaza, and will provide Movement partners with a common framework for a coordinated support.

SCOPE OF WORK

1. Assess the EMS System

The consultant will carry out a full review of the technical and operational components of the PRCS EMS, including:

• Organizational structure and staffing: Analyze the workforce composition (EMTs, paramedics, volunteers/EMRs), recruitment and retention challenges, and management capacity.
• Fleet and equipment: Assess the functionality, maintenance, and sustainability of EMS fleet and infrastructures as well as medical equipment and consumables.
• Dispatch and communications: Review existing systems for case allocation, coordination between stations, and links to external actors.
• Training and protocols: Examine current training curricula (e.g. ACLS, ALS, EMR), career pathways, clinical guidelines, and their alignment with international standards.
• Coordination mechanisms: Review how PRCS EMS complement with the Ministry of Health, UN agencies, Movement partners, and other emergency service providers, including the private sector..

The assessment will include an analysis of performance data- such as response times, case mix, patient outcomes, and quality indicators- in order to provide a measurable baseline for future planning.

2. Engage Stakeholders

Recognizing that EMS operates in a highly politicized and constrained environment, the consultant will adopt a participatory methodology. This will include:

• Consultations with PRCS leadership, EMS management, and frontline staff across stations and sub-stations.
• Engagement with volunteers and community representatives (e.g. Community Awareness Committees) to capture perspectives on access barriers and the role of first aid at community level.
• Dialogue with external stakeholders, including the Ministry of Health, international partners, and, where relevant, private sector providers.

These consultations will ensure the assessment reflects both internal operational realities and the broader humanitarian and health ecosystem in which PRCS operates.

3. Formulate Actionable Recommendations

The consultant will produce a prioritized recommendations matrix that translates findings into clear, actionable measures. Recommendations should be practical, context-appropriate, and directly linked to PRCS’s strategic frameworks (Strategy 2024–2027 and Emergency Master Plan 2025–2027). Each recommendation must specify:

• The responsible actor (e.g. PRCS HQ, branch management, external partner).
• A realistic timeline for implementation.
• The resource implications (financial, human, material).

The recommendations will cover, at a minimum, those core areas:

1. Workforce and Leadership Development
   Workforce development and training (technical and managerial skills).
   Performance monitoring and accountability mechanisms for station managers.
2. Systems and Operations Optimization
   Actionable measures to improve dispatch and communications systems.
   Optimization of fleet and equipment use, maintenance, and replacement.
3. Quality of care and Technical Governance
   Enhance the quality and accountability through the establishment of a clear clinical governance, including quality assurance and data systems.
4. Partnerships and Resource Mobilization
   Strengthening partnerships and resources mobilization.
   Before finalization, recommendations will be presented and validated with PRCS leadership to ensure alignment with the Society’s humanitarian mandate, Palestinian national health strategies, and international standards.

EXPECTED RESULTS AND DELIVERABLES

Comprehensive EMS Assessment Report (30–40 pages + annexes)

• A full analysis of PRCS’s EMS system, covering structure, staffing, fleet, equipment, dispatch/communications, training systems, protocols, and coordination mechanisms.
• Integration of performance data (response times, patient outcomes, case mix, quality indicators).
• Contextual analysis of operational challenges, including access constraints, security risks, and resource shortages.
• Annexes may include detailed station-level data, interview summaries, or technical tables for reference.

Recommendations Matrix (10–15 pages)

• A prioritized set of actionable recommendations tailored to PRCS’s operational realities.
• Each recommendation to specify: responsible actor, timeline, and resource implications.
• Recommendations to address workforce development, fleet and equipment management, dispatch systems, clinical governance, quality assurance, partnerships, and resource mobilization.
• Designed as a practical tool for direct integration into PRCS’s 2027 EMS Operational Plan.

Presentation Materials

• A PowerPoint summary of findings, highlighting key evidence, gaps, and recommendations in a visual and accessible format.
• To be used by PRCS leadership for internal decision-making and for sharing with Movement partners and donors.

In-person Validation Workshop (2 days)

• Facilitation of a participatory workshop with PRCS HQ and branch representatives to present and discuss findings.
• Collective validation of the recommendations matrix, ensuring institutional ownership.
• Support to PRCS in refining the draft 2027 EMS Operational Plan based on the validated recommendations.

Final Report and Technical Support Package

• A revised final assessment report, incorporating feedback from PRCS and workshop participants.
• The final package should include:
  • The Assessment Report.
  • The Recommendations Matrix.
  • The PowerPoint summary.
  • Workshop proceedings (agenda, participants, key discussions, validated recommendations).
• Delivery in both electronic and hard-copy formats, ready for operational use by PRCS and for sharing with Movement partners.

Deliverable schedule:

• Inception report and methodology: within 3 weeks of contract start (no later than February 2026).
• Field work and stakeholder consultations (in the West Bank): by May 2026.
• Draft report & recommendations matrix: by July 2026.
• Validation workshop (in the West Bank): October 2026.
• Final report: December 2026.

REPORTING

The consultant will report directly to the Programme Coordinator based in Palestine, who will serve as the primary focal point for day-to-day coordination, logistical arrangements, and liaison with PRCS. Throughout the assignment, the consultant will receive continuous technical and methodological support from the FRC Regional Health and Logistics Advisors. Their role will be to accompany and assist the consultant in ensuring analytical depth, contextual relevance, and consistency with PRCS’s strategies and international EMS standards. They will provide guidance on methodology and data sources, facilitate access to key stakeholders and background materials, offer feedback on draft deliverables, and participate in technical discussions and the validation workshop to help translate findings into practical, actionable recommendations.

CONSULTANT PROFILE

• Senior EMS / health systems expert with international experience in pre-hospital emergency care and operational planning.
• Demonstrated ability to work in fragile, conflict-affected, or resource-limited settings.
• Strong facilitation, stakeholder engagement, and capacity-building skills.
• Previous experience in oPt an asset.
• Fluency in English required and Arabic desirable.
• The consultant must be allowed to enter and remain in Israel to be able to access oPT

TRAVEL AND LOGISTICS

• The consultancy will involve long term field presence in Palestine (2-3 months) followed by remote work for the report drafting and other, shorter field missions for the workshops and support with refining the 2027 Operational Plan.
• The consultancy will involve travel within the West Bank (Ramallah HQ and selected EMS stations/branches).
• The consultant’s financial proposal should include the cost of the deliverables.
• Accomodation in the West Bank, travel in the West Bank, and Entry Visa for the purpose of the consultancy will be organised and covered by FRC (travel from the consultant’s home base to either Tel Aviv or Amman for entry into the West Bank will not be covered)
• The consultant must be allowed to enter and remain in Israel to access oPT

EVALUATION CRITERIA

Applications will be evaluated based on:

• Relevant professional experience and qualifications
• Quality and clarity of the proposed methodology and timeline
• Demonstrated ability to conduct EMS assessments and operational planning in fragile contexts
• Availability for field missions during the proposed timeline (Feb 2026-Oct 2026)
• Financial proposal
• The tenderer must provide proof of a legal consultant status in their country of residence, through the submission of an official document certifying their legal commercial registration

USEFUL RESOURCES

PRCS Emergency Master Plan https://www.palestinercs.org/public/files/image/2025/news/PRCS%20Emergency%20Master%20Plan%202025-2027.pdf

PRCS- 2024-2027 Strategy Framework
https://www.palestinercs.org/public/files/image/2025/who%20we%20are/en_PRCS%20strtegic%20framework.pdf