The role of human rights in the protection of the medical mission


Side event at 36th session of HRC
12 September 2017, 12:00-13:15

Remarks by the Special Rapporteur for the right to health for the Office of the United Nations High Commissioner for Human Rights (OHCHR) follow:

Ladies and gentlemen, Excellencies, dear colleagues,

Let me start by saying that it is a real pleasure to be with you today, even if virtually, to participate in this side-event about the role of human rights in protecting and promoting the provision healthcare in times of armed conflict or civil unrest

I would like to thank organizers, the Permanent Missions of Switzerland and Colombia and the NGO Coalition Safeguarding Health in Conflict, for inviting me to take part in this important and timely discussion

As Special Rapporteur on the right to health, and within the purview of my mandate, I would like to emphasize that attacks on and interference with health care constitute one of the primary impediments to the realization of the right to health. 

According to international humanitarian and human rights law, in situations of conflict States are required to ensure the availability, accessibility and acceptability of good quality health facilities, goods and services, especially to groups rendered most vulnerable by conflict.  Situations of violence and conflict are one of the socioeconomic aspects or underlying determinants comprised in the framework of the right to health

My predecessor, Anand Grover, dedicated a thematic report to the issue in which he explained that attacks on and interference with health care infringe upon the right to health, including discriminatory practices which go against medical ethics, legal barriers against the provision of healthcare, attacks against health facilities and workers, and the military use and militarization of health facilities

Destruction of health infrastructure by States, or failure to protect against such destruction by third parties, impairs the availability and accessibility of quality health facilities, goods and services. Under international law, States have an immediate obligation to provide health-care workers and humanitarian organizations with adequate protection.

States are under the obligation to ensure that health facilities are not harmed and health workers are not a target as a consequence of situations of conflict. However, over the past few years, we have witnessed how access to healthcare has become a weapon of war, a strategy used openly, in total disregard of international law, and in almost absolute impunity

Many of us have raised our voices expressing disgust and extreme concern about such practices but they continue

The Independent Commission of Inquiry on the Syrian Arab Republic, established by the Council, has frequently reported on the horrific dimensions of the bombing of hospitals and attacks on health workers in Syria. And we know from the work of Physicians for Human Rights that hospitals in Syria have been bombed more than 450 times since the war began.  Hundreds of health workers have been killed, with devastating consequences for patients

I have been particularly vocal about the situation in Syria.  But Syria is not the only case. The Safeguarding Health in Conflict Coalition has reported that in 2016 attacks on health care took place in at least 23 countries. Hundreds of hospitals and clinics were bombed or shelled in Yemen, Iraq, Libya, South Sudan and other countries in 2016.  Health workers were arrested or assaulted in 20 countries.  And this year, the assaults on health continue with no end in sight

These attacks have not profound impacts on the ability of people to access health care, both in the immediate aftermath of an attack but also much later, when facilities and staff for childbirth, vaccinations, and treatment of chronic and infectious disease are not available. We see this now in Yemen, where a massive cholera epidemic is taking place and facilities and staff to treat it are in short supply because of the attacks

Accountability for these attacks has been absent, and impunity continues. The Safeguarding Health in Conflict Coalition reviewed 25 incidents between 2013 and 2016, in which a total of more than 230 died and six hospitals were forced to close, and where accountability was sought.  It is extremely shocking that only for five of them were any proceedings initiated and in the remainder the results of proceedings were flawed or inadequate

Two years after the first-ever UN General Assembly Resolution on protecting health facilities and personnel in both conflict and non-conflict situations, the UN Security Council adopted a landmark resolution in 2016 (SC Res 22 86) that condemned attacks on health care and laid out steps member states should take to prevent attacks and advance accountability

The Secretary General followed with a report and detailed recommendations to implement the resolution, including taking concrete steps to prevent attacks and end impunity.  His proposals included reform laws to end criminal or other penalties for health professionals who adhere to their ethical obligation to provide impartial medical care; to address military doctrine, rules of engagement and standard operating procedures to ensure that forces adhered to the requirements of international humanitarian law regarding protection of and respect for health services; to train militaries in the rules and hold violators to account; to strengthen their investigations of alleged violations; and to ensure accountability

The Secretary General also recommended that member States report on their actions.  His recommendations have been widely praised as key steps to prevent attacks and end impunity

The Security Council, however, has yet to take action on the recommendations by the Secretary-General.   Moreover, the report the Secretary General submitted to the Security Council in May this year on protection of civilians showed that only few, if any States, had taken the proactive steps as the Secretary General recommended

In my view, the Human Rights Council, OHCHR and Special Procedures could fill this gap in ensuring that member States take the steps outlined by the Secretary General and that could be instrumental in preventing attacks and holding perpetrators accountable 

Many member States have been vocal in condemning attacks, but they must do more – particularly follow the Secretary General’s recommendations.  And they should be accountable for taking those steps

I would like to take this opportunity to state that I am fully committed, through the mandate entrusted to me by the Human Rights Council, to work with member States and other key actors, and contribute to the implementation of  recommendations by the Secretary-General and the Security Council

And, as a first step, I will contribute by examining the problem of criminalization of the provision of health care which infringes upon medical ethics and impartiality, and by issuing practical recommendations for action

I would like to conclude by commending NGOs and other partners, including my colleague from Physicians for Human Rights, that continue to bring this crisis to our attention and who press for governments to ensure better data collection and prevention measures, including through accountability for violations of the fundamental rights to health and security of the person

Thank you for your attention