Global Crisis of Attacks on Health Care in 2020 – Related to both COVID-19 and to Armed Conflicts – Caused Grave Harms and Impaired Global Pandemic Response
The following resources from a range of organizations and authors are freely available. Please note that they do not necessarily represent the views of the Safeguarding Health in Conflict Coalition. If you would like to suggest a resource not listed here, please contact us.
Three and a half years of conflict in Yemen have led to the near total collapse of the country’s health system. More than half of health facilities are no longer functional and 16.4 million people do not have access to adequate health services.This brief by the Safeguarding Health in Conflict Coalition focuses on how attacks on health workers, facilities, and infrastructure—at least 40 this year—have contributed to the cholera outbreak and famine-like conditions and provides recommendations for the parties to conflict, the UN Security Council, and others to avert humanitarian and health catastrophe.
This report from the International Peace Institute demonstrates how, in the past decade, counterterrorism measures have had an increasingly adverse impact on the provision of medical care and the conduct of principled humanitarian action in armed conflict settings. Whether inadvertently or not, they have impeded, and at times prevented, the provision of essential and lifesaving aid, often in violation of international humanitarian law (IHL).
Three and a half years of conflict in Yemen have led to the near total collapse of the country’s health system. More than half of health facilities are no longer functional and 16.4 million people do not have access to adequate health services.This brief by the Safeguarding Health in Conflict Coalition focuses on how attacks on health workers, facilities, and infrastructure—at least 40 this year—have contributed to the cholera outbreak and famine-like conditions and provides recommendations for the parties to conflict, the UN Security Council, and others to avert humanitarian and health catastrophe.
This report by Médecins du Monde France (MDM) delves into the unprecedented large number of incidents affecting health workers, facilities, and ambulances in Gaza since March 30, 2018. MDM's report presents insight into the violence health workers have suffered during the seven weeks between March 30 and May 15, based on the information provided by Palestinian health NGOs and their staff. The intention is to offer a better understanding of the incidents occurred along the border area, to frame these incidents within the different applicable legal frameworks, and to portray the consequences they have had on the overall provision of health services. Simultaneously, this report also stresses the importance of improving the safety protocols of health professionals working in Gaza and the responsibilities each actor has.
Health workers are being killed and injured with impunity in the "Great March of Return" protests in Gaza. Medical Aid for Palestinians implores the UK authorities to do much more to ensure better protection and support for Palestinian healthcare which is under attack, under blockade and under occupation.
This report by the University of Essex Human Rights Centre, the Center for Public Health and Human Rights at the John Hopkins Bloomberg School of Public Health, and the Safeguarding Health in Conflict Coalition, is the first of its kind to review laws, prosecutions, and other forms of state-inflicted violence in multiple countries against health workers for treating alleged terrorists or enemies. Of 16 countries reviewed, at least ten have laws that have been or could be used to prosecute the provision of health care to people in need as a form of supporting terrorism. The research was requested by the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras.
In Health in Exile: Barriers to the Health and Dignity of Palestinian Refugees in Lebanon, MAP shows not only how dismal socioeconomic conditions impact their health and dignity, but how a chronically under-resourced and jumbled system of healthcare is struggling to deliver adequate services.
In this new article, Rohini Haar and colleagues describe an extraordinary field-based data collection effort conducted amidst the ongoing war in Syria, spearheaded by the Syrian American Medical Society (SAMS) and supported by a team of mainly United States-based researchers. The resulting database records the deaths of 112 health workers and 185 patients that occurred as part of more than 200 attacks on healthcare facilities and transport vehicles in the governorates of Aleppo, Idlib, Hama, and Homs in 2016. The paper also matches the SAMS-documented events against those recorded in a separate but similar database maintained by Physicians for Human Rights (PHR) using open-source methods. The SAMS–PHR overlap is substantial but not complete, suggesting that there are further events not captured by either data-gathering project.
Watchlist found that during the reporting period of January 2016 to December 2017, parties to the conflict carried out at least 50 attacks on medical facilities and personnel, and at least 750 denials of humanitarian access. Attacks include arson and looting; occupation of medical facilities; and threatening, intimidating, detaining, abducting, or killing medical personnel. Denials of access include denying passage at checkpoints to humanitarian convoys filled with lifesaving medicines and nutrition supplements and the imposition of a range of bureaucratic impediments, for example escalating fees for work permits required for foreign staff and demands that humanitarian organizations pay for the release of humanitarian aid. Watchlist also found that attacks on medical facilities and personnel and denials of humanitarian access have compounded challenges to children’s health, already exacerbated by years of armed conflict that has targeted civilians.
In recognition of the brutality of today’s armed conflicts and the lack of respect for the fundamental rules of international humanitarian law, the Agenda for Humanity presented at the World Humanitarian Summit called for greater commitment and action to ensure the essential needs of affected populations are met and for full respect and protection of humanitarian and medical missions. This analytical paper prepared by the Safeguarding Health in Conflict Coalition summarizes progress by 45 stakeholders on more than 180 commitments made at the summit. Despite positive examples, many challenges remain to ensure people in need have access to—and there is protection of—humanitarian and medical missions.
Systematic attacks on medical facilities in Syria have driven field hospitals underground, in basements, and into caves. These fortified facilities are saving the lives of health workers and patients.This report from 13 leading Syrian medical organizations, including coalition member Syrian American Medical Society, and The Syria Campaign makes an appeal for protection and support.
This report by coalition member Watchlist on Children and Armed Conflict highlights how the targeting of medical facilities and personnel in 2015 and 2016 has had devastating impacts on children’s health. The report details attacks on medical facilities and personnel by parties to the conflict and describes how these attacks have compounded challenges to children’s health, already exacerbated by the escalation of armed conflict. The report provides policy recommendations to key stakeholders, including the Saudi Arabia-led coalition, the Houthis, humanitarian actors, Member States, and United Nations agencies to strengthen children’s right to health care.
The October 2016 issue of the World of Irish Nursing and Midwifery journal focuses on the delivery of care in conflict zones.
In its 3rd annual report, the Safeguarding Health in Conflict Coalition found that during 2015 and the first three months of 2016, deliberate or indiscriminate strikes on health care have killed medical workers and patients, decimated medical infrastructure, and robbed countless civilians of vital medical care in 19 countries around the world.
Nurses play a crucial role in addressing the needs of people in conflict areas and fleeing from them. This statement by the European Federation of Nurses Associations (EFN) advocates for peaceful conflict resolutions; condemns any attacks on health facilities and personnel, patients, and medical vehicles; and includes specific calls to action for the international community.
Attacks on medical facilities, health workers, and patients have occurred in at least 17 countries undergoing conflict and civil unrest since January 2014, Human Rights Watch and the Safeguarding Health in Conflict Coalition said in a joint report issued today. The report was released at the annual meeting of health ministers from around the world in Geneva from May 18-26, 2015.
This report by the International Committee of the Red Cross is based on 2,398 incidents of violence against health care. The data were collected from various sources in 11 countries between January 2012 and December 2014 and analyzed by the ICRC. This report highlights the urgent need to step up and implement measures. See also the ICRC’s earlier reports, Violent Incidents Affecting Health Care and Health Care in Danger: A Sixteen-Country Study.
This two-page brochure summarizes the mission and activities of the Safeguarding Health in Conflict Coalition.
In its first-ever report on attacks on health care, the World Health Organization compiled and analysed secondary data from open sources on attacks on health care in emergencies. The findings aim to provide a better understanding of the extent and nature of the problem; to inform WHO's priority actions; and to inform the actions of national authorities, decision-makers, health care providers, humanitarian health organizations, and all parties to conflict and affected communities as we work together to ensure that health care is provided universally during emergencies to all those who need it – in safety.Currently there is no publicly available source of consolidated information on attacks on health care in emergencies. While the data are not comprehensive, the WHO found that, from January 2014 to December 2015, there were 594 reported attacks on health care that resulted in 959 deaths and 1,561 injuries in 19 countries.
ACBAR published a special briefing paper to the government of Afghanistan for the protection of aid workers. Since January 2015, 49 aid workers were killed, 38 wounded, and 30 kidnapped in the country. The paper is part of the Brussels Series, in preparation for the Brussels Conference, and it details a set of recommendations to move forward.
This eLearning module from the ICRC is a basic introduction to the legal framework applicable to health care delivery during armed conflict. Through interactive case studies, learning activities, animations, and other media, it guides users through the main legal principles and common dilemmas faced by health care personnel.
The consequences of the international community’s failure to protect Syrians from systematic and repeated violations of both human rights and humanitarian law have been devastating. Yet, one in particular stands out: the erosion of the long-established principle that neither militaries nor armed groups can target medical workers and the health care system for attacks. Since 2011, the Syrian government has systematically violated this principle and is using attacks on medical workers and facilities as a weapon of war.
This report by the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health and the Syrian American Medical Society recounts the experiences of 27 physicians and other health workers in Syria who struggle to provide trauma care and health services to a population under assault. The goal is to offer a ground-level view of the daily experiences and insights of Syrian health workers in opposition-controlled areas. Interviews were conducted with medical personnel currently working or having recently worked in field hospitals in Aleppo, Idlib, Latakia, Hama, and Darayya in rural Damascus.
This paper presents a framework from the lessons distilled from Japanese experiences of supporting health workforce system development in Afghanistan, the Democratic Republic of Congo, and Cambodia.
Patients and health workers face extraordinary risks in today’s armed conflicts and other emergencies. Part I of the International Review of the Red Cross’s thematic issue focuses on patterns of attacks against health care, based on results from health-related data collection and field studies. It also outlines the legal and ethical frameworks applicable to the provision of health care.
This film tells the story of Mirta Nubia Rosero, the only health worker in a remote village in south-western Colombia. After five decades of conflict, unexploded landmines and remnants of war lie hidden in the ground.
This report offers a review of the discussions that took place during a three-day conference in November 2013 that resulted in a call for action, including a global research agenda. The Center for Public Health and Human Rights of the Johns Hopkins Bloomberg School of Public Health convened 19 experts from the fields of humanitarian practice, human rights, human security, academic research, government, and philanthropy, along with UN representatives and leaders from health professional associations, to address the problem of attacks on and interference with health care, particularly in times of armed conflict and internal disturbances. Participants met in Bellagio, Italy, and included eight individuals whose organizations are members of the Safeguarding Health in Conflict Coalition.
Physicians for Human Rights–Israel commissioned a fact-finding mission to investigate the Israeli military offensive in the Gaza Strip that began in July 2014. Eight independent international medical experts gathered evidence on the types, causes, and patterns of injuries and attacks; attacks on medical teams and facilities; evacuation; impact of the conflict on the health care system; and longer-term issues. This report presents their findings, including that medical teams were killed or injured in the course of evacuating the injured and that at least one apparent deliberate attack on a hospital resulted in several people killed and injured.
In times of armed conflict, international humanitarian law provides robust protection to health care services, but it also contains gaps. This paper focuses on the importance of a human rights approach to addressing these challenges.
This report from the Syrian American Medical Society presents volunteer physicians’ insights on the danger they and their colleagues faced while treating patients, performing life-saving surgeries, training personnel, and conducting assessments.
Over the past few years, the frequency and severity of attacks on health workers, patients, hospitals and clinics throughout the world have increased. This report by the Safeguarding Health in Conflict Coalition and Human Rights Watch describes recent examples of attacks on health in order to raise attention to this issue among the global health community, the human rights community, and those responsible for the attacks. The escalating level of attacks targeted against health care must be recognized as a critical human rights issue. Global and national human rights institutions should take action to ensure that practical steps are taken to protect health workers and facilities, and protect access to health care for all who need it.
The Trauma Management Program (TMP) was developed to improve the capacity of local health workers to deliver effective trauma care. This report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries.
This emergency report documents and decries systematic human rights abuses in Bahrain during the February and March 2011 political unrest, and the persecution of health workers based on their knowledge of those abuses.
This report shows the devastation on Bahrain’s health system resulting from the Government of Bahrain’s continued assault on doctors, patients, and the health care system.
This report describes the Syrian forces’ assault on the country’s medical system. The report includes new evidence of government forces denying wounded civilians medical treatment.
This account from one of the nurses and midwives who returned to Somaliland after the civil war relates what has been done to train a new generation, improve standards of care, develop training programs, and foster regulation.
This article discusses the requirements for improving the experience of health workers in fragile states. Efforts are needed to establish performance-management systems, support promotion, and provide opportunities for professional development.
This paper presents findings from a review of three global sources of human rights reports in armed conflicts for 2003–08 and in-depth reports on violations committed in armed conflict during 1989–2008.
This paper captures the professional, personal, and national effects conflict is having on health workers and the inadequate protection they work under, and makes recommendations to ensure health workers can effectively and safely save lives.
This report discusses issues related to violence against health workers, patients, and hospitals during armed conflict and the impact violence has on health workers and the subsequent lack of health care for those in need.
This paper illustrates the process, successes, ongoing challenges, and strategies Liberia has used to increase and improve human resources for health since the end of a 14-year civil war.
This video provides a brief introduction to the principle of medical neutrality, its foundation in medical ethics and international law, violations of medical neutrality, and steps that can be taken to protect and promote the principle.
This video footage shot in Libya reveals the danger that health workers are exposed to as they treat the war-wounded close to the front line.
This article outlines the issue and a new campaign that aims to raise awareness and improve conditions on the ground for health workers and facilities in conflict zones.
This report evaluates the potential strengths and weaknesses of task-shifting in humanitarian relief efforts, and proposes a range of strategies to constructively integrate task-shifting into humanitarian response.
This document outlines the role health workers play in areas suffering from severe crises and makes the case for investing in human resources for health as central to health system recovery and improved health outcomes.
This brief explains how the health sector can contribute by providing essential medical interventions and support for survivors, documentation for legal cases, programs that assist in reducing social stigma, and data for effective programming.
This study looks at how violence affects the delivery of health care including attacks on patients, health workers, and facilities, and on medical vehicles.
Violence against the wounded and the sick, and against health care facilities and personnel, is a crucial yet overlooked humanitarian issue. This brochure provides a brief overview of the reality of violence against health care.
In this issue of the Red Cross Red Crescent Magazine, contributors outline the global challenges of delivering health care during conflict or other situations of violence and health care after natural disasters.
Designed to assist in re-establishing health services in a context of political and economic instability, this guide provides practical information and tools for rebuilding a health workforce.