Featured Journal Content
May 26, 2018 Volume 391 Number 10135 p2079-2184 e20
Health care in conflict: war still has rules
Denouncing attacks on health-care facilities and personnel in conflict situations, the UN Security Council unanimously adopted resolution 2286 in May, 2016. Addressing the Council, then UN Secretary-General Ban Ki-moon, condemned military actions leading to destruction of health-care facilities as war crimes, and called on Member States to honour their obligations to protect health-care workers and patients in conflict saying “even war has rules”.
But 2 years later, on May 21, a new report from the Safeguarding Health in Conflict Coalition, Violence on the front line: attacks on healthcare in 2017, shows a grim reality of continued attacks on health infrastructures coming from all sides, and which persist with impunity.
In 2017, at least 188 hospitals and clinics were damaged or destroyed, 50 ambulances attacked or stolen, and there were 57 reports of armed groups violently assaulting staff and patients in hospitals—101 health-care workers were killed and 64 kidnapped, 203 patients were killed, and 141 injured. Denial or obstruction of access to health-care facilities was reported 74 times. 57 of these events were in the occupied Palestinian territory. In Turkey, a physician was arrested for providing impartial medical care, and in Afghanistan, female health workers have been threatened for actions deemed inappropriate for a woman. Health facilities in Afghanistan, Burkina Faso, the Central African Republic, Egypt, and Turkey have been forced to close.
When resolution 2286 was adopted, Peter Maurer, President of the International Committee of the Red Cross, urged Member States that “after outrage must come action, not complacency”. But the sheer number of attacks in 2017 demonstrates the international community’s catastrophic failure to uphold its commitment to the resolution. The Coalition makes specific recommendations to the UN High Commission for Human Rights, Security Council, and Secretary-General to ensure that the lives and rights of health-care workers and patients are protected in conflict areas. António Guterres, UN Secretary-General, must continue to condemn these attacks, work proactively to stop them, and hold the perpetrators accountable for their war crimes.
Report: Impunity Reigns as Medical Personnel and Facilities across 23 Conflict-Torn Countries Remain Under Attack
Safeguarding Health in Conflict Coalition
In its fifth annual report released today, the Safeguarding Health in Conflict Coalition warns that attacks on health care in conflict zones around the world are continuing with impunity and may in fact be increasing. The report entitled “Violence on the Front Lines: Attacks on Health Care in 2017” documents more than 700 separate attacks on hospitals, health workers, patients, and ambulances in 23 countries in conflict across the globe. And, as shocking as these numbers are, they are merely a fraction of the real figures: due to under-reporting of attacks and the use of aggregate data by some agencies, the true numbers are undoubtedly higher.
The report was released on the eve of the United Nations Security Council’s review of actions since it adopted resolution 2286 two years ago. The resolution condemned attacks on health facilities and health workers and demanded that governments take concrete actions toward protecting health facilities and medical workers from attack in armed conflict. But since its adoption governments have taken few of the steps needed, such as to reform military practice, investigate and prosecute those responsible for attacks, and stop arms sales to perpetrators. Without such action, the additional decimation of medical infrastructure continues to rob civilians already suffering in war of life-saving treatment.
The report documents more than 700 separate attacks on hospitals, health workers, patients and ambulances in 23 countries in conflict across the globe.
“The world knows about atrocities against health care in Syria – and the report reveals more than 25 acts of violence against health facilities, transport, and personnel there, the most in the world – but Syria is hardly alone: governments and armed groups inflict violence against health care with impunity in conflicts across the globe,” said Leonard Rubenstein, chair of the coalition and senior scientist at Johns Hopkins Bloomberg School of Public Health.
“Numbers don’t tell the full story of the violence inflicted on patients and the doctors, nurses, lab technicians, and ambulance drivers who have made it their life’s mission to provide crucial care services to people in need,” said Rubenstein. “In one incident in the Democratic Republic of Congo, a militia allied with the Congolese army attacked a hospital in the town of Cinq in the Kasai region near the Angola border, killing at least 90 medical staff and patients, including pregnant women and other civilians. During the attack, the militia set fire to the operating theater with approximately 35 patients trapped inside. Yet the world pays little attention.”
The report reveals that the ten countries which experienced the most attacks on health in 2017 are Afghanistan, the Central African Republic (CAR), The Democratic Republic of Congo (DRC), Iraq, Nigeria, the occupied Palestinian territory, Pakistan, South Sudan, Syria, and Yemen. Syria continues to experience the highest number, with 252 documented acts of violence against health facilities, transport, and personnel in 2017, amid sustained airstrikes and shelling on hospitals there.
The report defines an attack on health care as any act of verbal or physical violence, obstruction or threat of violence that interferes with the availability, access, and delivery of curative and/or preventive health services in countries experiencing conflict or in situations of severe political volatility. This includes attacks that kill patients, health workers, or others or destroy health facilities, and also includes the looting of medications and other humanitarian supplies.
In 15 countries, some 56 health programs were forced to shut down due to insecurity, leaving citizens without essential services. In Burkina Faso, where three health centers were closed following a terrorist attack, some 38,000 people were deprived of access to crucial treatment. In the occupied Palestinian territory, the Palestine Red Crescent Society reported 33 incidents where Israeli security forces restricted the passage of ambulances.
In 15 countries, some 56 health programs were forced to shut down due to insecurity, leaving citizens without essential services…
The Safeguarding Health in Conflict Coalition, of which IntraHealth is the communications secretariat and a member, consists of more than 35 organizations working to protect health workers and services threatened by war or civil unrest. The coalition raises awareness of global attacks on health and presses governments and United Nations agencies for greater global action to protect the security of health care.