North Macedonia has adopted its first National Mass Casualty Management (MCM) Plan, one year after a fire at the nightclub in Kočani, on 16 March 2025, killed 63 people and injured 193.
During this complex Mass Casualty Incident (MCI), which took place in a heavily populated neighbourhood, multiple injured people needed immediate triage, rapid transport and specialized burn and trauma care, requiring real-time coordination between ambulance services, hospitals, police, fire and other responders.
Such situations can overwhelm even the most well-resourced emergency services, since clinical decisions must be made under intense time pressure, information is incomplete and the consequences of delayed coordination can be fatal.
The new National MCM Plan provides a national framework to organize and standardize how the health system and partner services prepare for and respond to such events, including fires and transport crashes, industrial incidents, natural hazards and other large-scale emergencies, which generate large numbers of casualties.
“Before this plan, efforts were often fragmented. Now, we have a unified framework that aligns institutions, strengthens capacities and ensures that our health system can respond effectively to any crisis. Now our focus is on the implementation of the action plan, to enable the Mass Casualty Plan to become fully operational,” said Angel Mitevski, State Advisor for Crisis Management and Health System Resilience, Ministry of Health of North Macedonia.
Scenarios that test emergency response
MCIs are among the most demanding scenarios for emergency response. They test surge capacity, logistics, referral pathways, hospital readiness and clinical protocols all at once. They also require clear leadership and shared operating procedures across agencies that do not work together every day. Without an agreed national plan, different institutions may apply different triage approaches, compete for limited resources or struggle to maintain a common operational picture during the first critical hours.
The new National MCM Plan aims to reduce those risks by strengthening preparedness, defining coordination arrangements and supporting faster, more consistent decision-making when multiple people are injured at the same time.
North Macedonia’s plan was developed with technical support from WHO/Europe and the WHO Country Office in North Macedonia. A workshop in December 2024 launched this initiative and focused on building a comprehensive, practical approach that can be applied across the entire emergency response chain.
“The adoption of North Macedonia’s first National Mass Casualty Management Plan marks a critical step in strengthening the country’s ability to respond to complex emergencies. One year after the tragic fire in Kočani, this plan reflects a clear commitment to learning from the past and translating those lessons into practical systems that save lives. WHO is proud to have supported this effort to build a more resilient and responsive health emergency system in North Macedonia,” said Dr Ihor Perehinets, Health Security and Regional Emergency Director at WHO/Europe.
Planning for better preparedness
The plan supports national authorities and partners to assess existing capacities, gaps and resources for MCM, ensuring that preparedness efforts are grounded in a realistic understanding of what is available and what needs strengthening. It also helps establish a multidisciplinary task force to guide implementation and ongoing improvement, bringing together the expertise required for effective preparedness and response.
A core element of the plan is the development of standardized protocols for triage, treatment and referral of mass casualty victims. Standardization is essential in MCIs: it enables responders from different services and facilities to apply the same principles under pressure, and it improves continuity of care as patients move from the scene to ambulances and onward to hospitals.
The plan also defines clear roles and responsibilities for all stakeholders involved in emergency response, helping avoid duplication and delays, and supporting coordinated use of limited staff, equipment and hospital beds. In addition, it includes a communication strategy to strengthen information-sharing during emergencies, supporting timely alerts, coordinated public messaging and effective operational reporting between institutions.
“The strength of this plan lies in its multisectoral foundation. Moving forward, we will focus on operationalizing it through joint exercises, clear accountability and sustained collaboration across all sectors involved,” said Stevko Stefanovskii, Crisis Management Centre of North Macedonia.
This adoption marks a significant step within WHO’s broader work to strengthen health security by boosting national capacities to respond to emergency situations across the WHO European Region. By establishing a shared framework for preparedness and response, the plan will help North Macedonia improve operational readiness, enhance inter-institutional coordination and optimize the use of resources when lives are at stake.