Intrusion into a Health Facility: Health Workers and Health Facilities Must Be Protected in Afghanistan


Since January 2014, 140 security incidents have directly harmed NGOs. ACBAR calls upon all parties to the Afghan conflict to end all forms of violence against humanitarian actors—including NGOs and their employees.

ACBAR—the Agency Coordinating Body of Afghan Relief & Development—has been aggrieved to hear of the intrusion into a health facility providing essential assistance to patients.

ACBAR would like to reflect that Afghanistan is facing an armed conflict, and that the security situation has been gradually degrading over the past few years. In 2013 NGOs were impacted by 228 violent incidents, the highest number since 2011 and the worst year on record.

Most of the NGOs under the umbrella of ACBAR have been operating in the country for more than 10 years, and have vast experience in dealing with Afghanistan’s volatile environment and specific security incidents. Afghanistan is a complex country with 34 provinces and 358 districts affected by more than 30 years of almost-constant armed conflict.

Currently a domestic armed conflict continues between the Government of Afghanistan and numerous, disparate armed opposition groups. The impact of this conflict on the delivery of, and access to, health care, is varied, and the barriers to access of health care are huge. Not only does the ongoing conflict limit very seriously the population’s access to health care, but the public health system has been modified by Tokyo agreements in 2011.

The military operation on the ground is using, from time to time, health facilities as backup.

ACBAR would like to reiterate that according to international humanitarian law, health care facilities retain their protected status as long as they are exclusively devoted to the care of the wounded and the sick and are not used to advance military goals. Designating health facilities as a rest point would thus put the patients and the staff working in these facilities at risks of attacks.

This protected status is what allows health care providers to operate in conflict situations, which is at the heart of their mission to save lives. It is by operating as neutral, impartial actors that health care providers are able to gain access and respect from all parties to a conflict. In the current context, using health care facilities as a political space would severely alter the perception that other actors and the population have of them.

Lack of access to health care remains a key problem. There are, more or less, 58 districts that health providers are unable to access—either permanently or temporarily. In 2014, 7 provinces out of 34 were experiencing high levels of insecurity, plus 3 provinces with really limited access. These provinces are also under NGO implementations’ responsibilities.

All parties to the conflict, whether armed opposition groups or pro-government forces, also need to be sensitized to the protection of civilians, of health facilities, and of health workers, in accordance with international law and other relevant normative frameworks.

To conclude, ACBAR wants to insist on the fact that the situation in Afghanistan is complex—the impact of the conflict does not affect all areas equally. Clearly, though, the risks to the delivery of adequate health and aid services are very high.