Healthcare providers and patients have suffered thousands of attacks on healthcare systems in the roughly five years since the United Nations Security Council demanded an end to impunity for such attacks, according to data recorded by the International Committee of the Red Cross (ICRC). in countries affected by conflict and other emergencies.
Attacks faced by health workers, the injured and sick included killings, rapes, physical abuse, looting and destruction of medical facilities and medical transport vehicles. Barriers to health services – such as a vaccination campaign prevented from doing its job or an ambulance prevented from passing a checkpoint – were also compiled.
The ICRC counted 3,780 attacks in 33 countries on average per year between 2016 and 2020, two thirds of the attacks and incidents recorded in Africa and the Middle East. The countries with the most incidents recorded by the ICRC are Afghanistan, the Democratic Republic of the Congo, Israel and the occupied territories, and Syria. Due to the challenge of collecting this data in conflict zones, the ICRC’s overall figure probably represents an undercount of the actual number of attacks.
“The world has not made protecting the sick, dying and injured a priority. Health care is at the forefront of current global attention, but not enough is being done to protect health workers and medical facilities, ”said ICRC President Peter Maurer. “Unfortunately, with each attack, more people are prevented from seeking the health care they desperately need. Arms bearers must respect universal value and the right to health care enshrined in international humanitarian law. “
On May 3, 2016, the United Nations Security Council adopted its first resolution on the protection of healthcare in times of conflict. Resolution 2286, supported by 80 states, included steps states could take to mitigate these attacks. Five years later, access to health care continues to be hampered due to non-compliance with international humanitarian law and the obstruction or criminalization of the provision of health care in some cases. In addition, the implementation of the measures set out in the resolution has been weak.
“There is a lack of political will and a crisis of imagination when it comes to protecting healthcare providers and patients. States wishing to see this agenda progress must lead by example, ”said Maciej Polkowski, head of the ICRC’s Health Care in Danger Initiative, which aims to ensure safe access to health care in armed conflict and other emergency situations.
Efforts to reduce violence in health facilities are working. The ICRC has partnered with hospital administrators in a South Asian country to reduce the number of firearms transported to emergency rooms. After five months of implementing the program, the number of firearms intercepted before being brought into the service increased from two to 42 per month, reducing the risk to staff and patients.
Other positive examples include:
In El Salvador: The ICRC and the Salvadoran Red Cross have brought together actors involved in the emergency medical response to victims of armed violence, which has enabled better coordination and an increase in the level of competence of health workers.
In Lebanon: In Ein el Helweh, a densely populated Palestinian refugee camp where several armed groups operate, the ICRC was able to get several armed actors to sign unilateral declarations of respect for health systems and practitioners. The text of the statements was developed jointly with the groups based on an ICRC template and some positive changes were immediately noticed.
Over the past year, the COVID-19 pandemic has further underscored the importance of protecting health care and health workers, both due to the importance of health workers to societies, but also because new models of violence and stigmatization have emerged. From February to July 2020, the ICRC recorded 611 violent incidents against health workers, patients and medical facilities associated with the COVID-19 response, around 50% more than average.
To share just one example, in a rural health center in southeastern Colombia, an armed group threatened a doctor who treated a deceased COVID-19 patient. These threats forced the doctor to relocate areas, depriving residents of care.
Violent attacks are painful for both patients and staff. Filippo Gatti was working as a pediatric nurse in an ICRC medical team in South Sudan when a fighter broke into the operating room and pointed an AK-47 assault rifle in his face, demanding to know if a fighter enemy was helped.
“I took him to the door and showed him a woman on the operating table, a stroke of luck,” said Mr. Gatti, now the ICRC’s chief nurse. “And he said, ‘You have to go. We come back and kill everyone. We moved and fired as many people as we could, but in fact they came back and killed 12 bedridden patients, one of the most horrific cases of violence you can imagine.
“This group didn’t really think about the fact that we were there to treat everyone and anyone, white, red, blue, government or non-government. At some point, it will also be your turn to need medical attention. “
About ICRC data on attacks on healthcare: Data concerning events affecting the provision of health care were collected from January 2016 to December 2020 by ICRC teams in an average of 33 countries per year where the ICRC has an operational presence, i.e. in a situation of conflict or violence. The data is not intended to be exhaustive, but rather representative of what the ICRC sees in the places where it works. Because such data collection is often quite difficult, the data is likely an undercount of the actual number of attacks and obstruction cases.
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