Safeguarding Health in Conflict Coalition

No Respite: Annual Report Documents Violence Against Health Care in Conflict

kseaton — Wed, 02 Jun 2021 16:34:49 +0000

No Respite: Annual Report Documents Violence Against Health Care in Conflict kseaton June 02, 2021 June 02, 2021

The Safeguarding Health in Conflict Coalition released its eighth annual report on May 24, 2021, documenting the global incidence of attacks and threats against health workers, facilities, and transport around the world. The report cites 806 incidents of violence against or obstruction of health care in 43 countries and territories in ongoing wars and violent conflicts in 2020, ranging from the bombing of hospitals in Yemen to the abduction of doctors in Nigeria. Attacks–including killings, kidnappings, and sexual assaults, as well as destruction and damage of health facilities and transports–compounded the threats to health in every country as health systems struggled to prepare for and respond to the outbreak of the COVID-19 pandemic.

The findings reveal that, on the fifth anniversary of the UN Security Council’s Resolution 2286 on protection of health care in conflict, acts of violence against health care have not been curbed and impunity for those who commit them has remained a constant. In an introduction to the report, Coalition Chair Leonard Rubenstein say, “The reasons for violence are variable and sometimes complex, but the explanation for continuing impunity is not. States have failed to fulfil their commitments to take action–individually or as part of an international effort–to prevent such violence or hold the perpetrators accountable.”

The report, “No Respite: Violence Against Health Care in Conflict,” documents at least 185 health workers killed and 117 kidnapped. Countries sustaining the highest number of attacks included Afghanistan, the Democratic Republic of the Congo (DRC), Libya, the occupied Palestinian territories (oPt), Syria, and Yemen. Although these figures (806) represent a modest decline compared to the overall number of reports identified by the Coalition in 2019 (1,203), the number of killings showed a 25 percent increase, and kidnappings, a 65 percent increase. At the same time, during the COVID-19 pandemic, there were more than 400 acts of violence against health care.

“Violence against health workers has taken many horrific forms: ambulances shot at, hospitals bombed, and even snipers targeting medics,” says Christina Wille, director of Insecurity Insight, who guided the data collection. “The true extent of the violence remains unknown, as many countries, health facilities, and organizations do not report their experiences. Yet we need to remember that each incident is a tragedy in its own right and represents the loss of a family member and a colleague.’

The full 2020 data cited in the report can be accessed via Attacks on Health Care in Countries in Conflict on Insecurity Insight’s page on the Humanitarian Data Exchange (HDX). The data and analyses for 17 countries and territories with the highest numbers of incidents is made available as individual datasets on separate factsheets included in the report.

FULL REPORT AVAILABLE HERE

A related interactive map and report issued by Coalition member Insecurity Insight in March 2021 pinpoints an additional 412 incidents of violence against health, such as attacks on testing facilities and the targeting of health workers directly related to the COVID-19 pandemic.

During the five years since Security Council Resolution 2286 was adopted, people in 14 conflicts have experienced more than 50 reported incidents of violence against health care, eight conflicts have seen more than 100 such incidents, five more than 200, and four more than 300 incidents.

The report notes that states failed to take actions they agreed to in the resolution and were urged by the UN Secretary-General in his recommendations for implementation. They included:

Ensuring that militaries integrate practical measures for the protection of the wounded and sick and medical services into the planning and conduct of their operations;

Adopting domestic legal frameworks to ensure respect for health care, particularly excluding the act of providing impartial health care from punishment under national counterterrorism laws;
Engaging in the collection of data on the obstruction of, threats against, and physical attacks on health care;
Undertaking “prompt, impartial and effective investigations and accountability processes within states’ jurisdictions with respect to violations of international humanitarian law” in connection with health care;
Referral by the Security Council in cases where there is evidence of war crimes in connection with violence against health care, such as in Syria, to the International Criminal Court;
Listing of states found by the Special Representative of the Secretary-General for Children and Armed Conflict to have engaged in violence against hospitals in the annex to the Secretary-General’s annual report on children in armed conflict;
Ceasing the sale of arms that have been used to inflict violence on health care.

In issuing the report, the Coalition called on the UN Secretary-General to report on the actions and inactions of member states with respect to the commitments made five years ago and recommended the appointment of a special rapporteur or special representative to report on countries and themes as a step toward accountability, to ensure that protection of health in conflict is more than hollow words.

“As if the COVID-19 pandemic and other health threats are not enough, every day, health workers face the risk of violent attack,” says Joe Amon, director of Global Health at Drexel University’s Dornsife School of Public Health, a Coalition partner. “We need an emergency response that targets not a virus but our collective failure to protect workers, facilities, and ambulances and ensure that no matter the context, access to health care, and all health workers, is protected from harm.”

"No patient should worry about safety when seeking care or have to live with fear on top of the vulnerability imposed by illness. Health care providers should never have to put their lives on the line while fulfilling their moral obligations. Violations of the right to safe access to health care cannot continue to be the norm, and violators should be held accountable for these crimes," says Houssam al-Nahhas, a medical doctor from Syria who is Middle East and North Africa researcher at Physicians for Human Rights.

“This report is a clear indictment that the global effort to protect our health care workers on the front lines of care in conflict zones is falling far short," International Council of Nurses CEO Howard Catton says. "The violation of health worker rights is both a health and humanitarian crisis. Our nurses, whether in conflict areas or on the global COVID-19 frontline are particularly at risk of violence. International humanitarian law must not only be respected but applied on the ground to protect nurses and other health workers at the heart of our health systems. The World Health Organization has designated 2021 as the Year of the Health and Care Worker, and the protection of our health workers must be top of the agenda.”

METHODS: The report implemented an event-based approach to documenting attacks on health care and used multiple, cross-checked sources. The information was consolidated into a single dataset of recorded incidents that were coded using standard definitions, which is available on the Humanitarian Data Exchange. The data was compiled and analyzed by Insecurity Insight. Coalition member organizations contributed additional material from their respective areas of focus and research.

The Safeguarding Health in Conflict Coalition (SHCC) is a group of international nongovernmental organizations working to protect health workers, services, and infrastructure.

IntraHealth International is a member of the SHCC Steering Committee with other organizations including: Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, Human Rights Watch, Insecurity Insight, International Council of Nurses, International Federation of Medical Students’ Associations, Johns Hopkins Center for Humanitarian Health, Management Sciences for Health, Medact, Office of Global Health, Drexel Dornsife School of Public Health, Physicians for Human Rights, Syrian American Medical Society, Watchlist on Children and Armed Conflict, and Human Rights Center, University of California, Berkeley School of Law.

Safety and Conflict Health Workers Safeguarding Health in Conflict Coalition

Despite Peace Agreement, Violence Takes a Toll on Health in the Central African Republic

cbishopp — Thu, 11 Jun 2020 18:54:57 +0000

Despite Peace Agreement, Violence Takes a Toll on Health in the Central African Republic cbishopp June 11, 2020

June 11, 2020

Safeguarding Health in Conflict Coalition Chair Leonard Rubenstein discusses the effect of conflict in the country.

For people living in the Central African Republic, life since 2012 has been defined by civil war, violence against civilians, an overwhelming need for humanitarian aid, and persistent attacks on clinics, health workers, and patients.

Given the hundreds of thousands of displaced civilians, rampant murder and sexual assault, consistent impunity of human rights violations, and little leverage by the government and international peacekeeping organizations, the United Nations has deemed the situation a large-scale humanitarian crisis.

Fourteen armed groups signed a Political Agreement for Peace and Reconciliation more than a year ago, and a new special criminal court was established to seek to end impunity. Still, peace in the country remains uncertain.

Over the past three years, there have been well over 100 incidents of violence against health, including assaults, lootings, the destruction of health facilities and more—though the actual number may be much higher, as the World Health Organization’s reporting system deteriorated significantly in 2019 in many countries and specifically in the Central African Republic. The targets included clinics, international nongovernmental organization (NGO) health workers, and patients, as well as supplies at medical warehouses, health facilities, and international NGO compounds.

Also read: Violence against health care in the CAR and 19 other countries or territories in conflict in a new report, Health Workers At Risk: Violence Against Health Care

Leonard Rubenstein, chair and founder of the Safeguarding Health in Conflict Coalition and director of the Program on Human Rights, Health and Conflict at the Johns Hopkins Bloomberg School of Public Health, traveled to the Central African Republic earlier this year and spoke to health workers and the Minister of Health, Dr. Pierre Somse, about the effects of civil war and conflict on health and the country’s health systems.

Rubenstein shared his experience and viewpoints with us in an interview.

How has health been a target in the Central African Republic?

Rubenstein: Health care has been a target from the start of the war, including violence directed at patients from opposing groups inside hospitals and clinics. The victims may be fighters from a different group or people of a different religion or ethnic background.

A second type of violence involves looting, robbery, and kidnapping for ransom by armed groups or criminal gangs. The perpetrators often seek medications, supplies, and other valuable items.

For example, as documented in our Safeguarding Health in Conflict Coalition report on 2019 incidents, medical supplies were taken from warehouses and health facilities, as well as from international NGO compounds. Perpetrators were usually armed and assaulted and threatened health workers.

Listen: Rubenstein discusses violence against health in the CAR and other places in conflict during a briefing about the new report.

How do these incidents affect the health and health system in the Central African Republic?

Rubenstein: These attacks have had profound effects. They often led to suspension of health services and departure of health staff—to the point where many clinics lack any professionals. They also terrify people, leading them to fear coming to clinics for care.

Vaccination campaigns have also been disrupted because there has been violence against vaccinators as well as looting and stealing of supplies. Recently, there was a major measles outbreak, which is likely because violence affected the ability of children to access necessary vaccines.

The decline in utilization is a significant impediment to community health. For example, one major attack that affected the ability of patients to access antiretroviral treatment in a community with a high prevalence of HIV. When there is a loss of access to medication, for an HIV patient, it can be a death sentence.

As the unprecedented pandemic of COVID-19 affects countries around the world, targeted attacks and other incidents of violence impede health workers’ ability to save lives and the country’s ability to address the many repercussions of COVID-19.

What do you think would make a positive impact?

Rubenstein: The country’s Minister of Health, Dr. Somse, is very committed to the protection of health care. He engages with armed groups, supports health workers, and collaborates with humanitarian groups to develop strategies for protection of health care. He’s shown real personal courage and I think will continue to make an impact.

The most positive step would be to successfully implement the 2019 peace agreement. That would require members of the armed groups to come into the government and the government would need to mobilize the troops.

It is also crucial to ensure that the Special Criminal Court receives the support and resources it needs to end impunity. As long as impunity prevails, it is nearly impossible to stop attacks. Improvement of basic policing is also essential for progress.

Read the new report, Health Workers At Risk: Violence Against Health Care.

By Hannah Webster

Former advocacy communications intern, IntraHealth International

Safeguarding Health in Conflict Coalition Global health security Safety and Conflict Health in Conflict Central African Republic

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New Report: 1,200+ Incidents of Violence Against Health Care in 2019

cbishopp — Thu, 11 Jun 2020 12:43:18 +0000

New Report: 1,200+ Incidents of Violence Against Health Care in 2019 cbishopp June 11, 2020 June 10, 2020 Washington, DC

More than 1,200 violent attacks and threats were perpetrated against health workers, medical facilities and transports, and patients in 20 conflict-affected countries in 2019, according to a new report published today by the Safeguarding Health in Conflict Coalition.

The report—the most in-depth assessment of violence and threats to health care in regions experiencing armed conflict and political violence—finds that attacks on health in 2019 continued with impunity, undermined public health, and denied civilians access to life-saving medical services.

The report finds that at least 150 health workers were killed, 90 were kidnapped, and at least 500 more were injured in attacks on health care in 2019.

The 2019 data mark an alarming increase in the number of reported violent incidents compared to 2018, when the Safeguarding Health in Conflict Coalition reported 973 such incidents across 23 countries studied. The true extent of violence against health care in conflict may be much higher due to significant underreporting.

These assaults on health occurred in the months prior to the COVID-19 pandemic, in which strong health systems and protected health personnel are more essential than ever in every country in the world.

FULL REPORT AVAILABLE HERE.

2019 was characterized by the aerial bombardment of hospitals in Libya, Syria, and Yemen; medics shot at while attending to injured protestors in Iraq, the occupied Palestinian territory, and Sudan; and health workers kidnapped in Burkina Faso, the Democratic Republic of the Congo (DRC), and elsewhere.

In Afghanistan and Syria, attacks on health care have continued at very high levels for many years. 2019 was no exception, with more than 100 reported incidents of violence each.

The violent incidents severely undermined efforts to respond to major public health threats in 2019. There were more than 400 attacks on health care in the DRC, most of them in connection with the response to the Ebola outbreak. In Pakistan, where polio remains endemic, violence inflicted on vaccination teams led to the suspension of immunization campaigns that left 1.8 million children unvaccinated.

As conflicts escalated in Burkina Faso and Libya, so did the number of attacks on health care, with 73 incidents in Libya alone.

While the Safeguarding Health in Conflict Coalition annual report covers calendar year 2019, violence against health care has also marred the COVID-19 pandemic response in countries in conflict as well as in countries at peace.

Insecurity Insight, a coalition member, reports 265 incidents of attacks and threats against health care from January through May 2020 across 61 countries in response to COVID-19 health measures. These included violent responses to testing, quarantine measures, and attacks against health workers arising out of fear that they could spread the infection.

In some countries, law enforcement entities have used violence to implement quarantine measures and to punish people expressing concerns about the pandemic response.

“Our disturbing findings reveal again that commitments to stopping violence against health care remain thin, more rhetoric than action,” said Leonard Rubenstein, founder and chair of the Safeguarding Health in Conflict Coalition and professor at the Johns Hopkins Bloomberg School of Public Health and Center for Humanitarian Health. “It has been four years since the United Nations Security Council committed the international community to take concrete steps toward prevention and accountability, but the health workers and patients they serve are still waiting.”

The report findings were announced today at an online briefing event hosted by coalition member Physicians for Human Rights (full recording of the briefing event will be posted here).

“Violence against health care continues during the COVID-19 pandemic, both related to ongoing conflicts as well as attacks specifically against COVID-19 response efforts,” said Christina Wille, director of Insecurity Insight. “According to our analysis, community members or members of the security forces who act out of personal interest perpetrated most of the COVID-19-related violence. Violence against health care will make it even harder to address the COVID-19 pandemic.”

In recognition of the 2020 International Year of the Nurse and the Midwife, the Safeguarding Health in Conflict Coalition dedicates the annual report to the nurses and midwives who work every day on the front lines in conflict settings to promote health and save lives.

“Nurses comprise the majority of the health workforce worldwide, and they are often the first and only point of care in many communities around the world,” said Erica Burton, senior advisor, nursing and health policy at the International Council of Nurses, who wrote an essay focused on nurses for the report. “Every time a nurse is taken from the health workforce due to violence against health care, communities suffer.”

“Impunity prevailed for attacks on health in 2019,” said Susannah Sirkin, director of policy for Physicians for Human Rights. “Despite a few limited and narrow investigations, governments, militaries, and the United Nations Security Council have utterly failed to live up to their duty to hold perpetrators of the gravest attacks on health facilities and personnel to account. The global community must do better for the nurses, midwives, EMTs, doctors, and other health workers under siege from Libya to Ukraine to Myanmar.”

The report makes detailed recommendations to prevent and respond to attacks on health, including specific appeals to United Nations (UN) member states, ministries of defense, ministries of health, the UN Security Council, the UN Secretary-General, the World Health Organization, civil society, and donors. Among other recommendations, the Safeguarding Health in Conflict Coalition calls on countries to:

Prioritize improvements to and investments in data collection, surveillance, and reporting mechanisms for attacks on health.
Develop a national policy framework that builds upon best practices and establishes clear institutional roles for protecting civilians and civilian objects in the conduct of hostilities. Fulfill UN Security Council resolution 2286, which seeks to end attacks against health facilities and personnel in conflict situations.
Reform laws and police and prosecutorial practices so as not to impede humanitarian and medical services or punish those who provide care to people who are wounded or sick, regardless of their affiliation.
Strengthen national mechanisms for thorough and independent investigations into alleged violations.
Ensure that perpetrators are held accountable for violations.
Take forceful diplomatic actions, such as public statements and démarches, against
perpetrators of incidents of violence.
Ensure respect for international humanitarian law, as set forth in the very first article of each Geneva Convention. Governments should initiate investigations of instances where partner military forces or their own may have targeted hospitals or other health facilities.
Improve, support, and invest in the World Health Organization’s Surveillance System of Attacks on Healthcare (SSA).

“Health workers receive much-deserved applause and tributes for their lifesaving work in response to COVID-19 and other emergencies, but it should outrage all of us that many continue to face bombs, political violence, kidnapping, and threats,” said Carol Bales, advocacy and policy communications manager at IntraHealth International, which oversaw the report’s production. “Health workers must be safe to save lives. And ensuring safety for health workers includes states taking action to protect them from violence during conflict and holding perpetrators accountable.”

The report implemented an event-based approach to documenting attacks on health care and used multiple, cross-checked sources. The information was consolidated into a single dataset of recorded incidents that were coded using standard definitions, which is available on the Humanitarian Data Exchange. The data was compiled and analyzed by Insecurity Insight. Coalition member organizations contributed additional material from their respective areas of focus and research.

FULL REPORT AVAILABLE HERE.

The Safeguarding Health in Conflict Coalition, of which IntraHealth International is the secretariat and a member, consists of 40 organizations working to protect health workers and services threatened by war or civil unrest. The coalition presses governments and United Nations agencies for greater global action to protect the security of health care.

This article was originally published by the Safeguarding Health in Conflict Coalition.

Global health security Safety and Conflict Health in Conflict Health Workers Safeguarding Health in Conflict Coalition

Safeguarding Health in Conflict Coalition 2018 Report

cbishopp — Tue, 09 Jul 2019 19:54:25 +0000

Safeguarding Health in Conflict Coalition 2018 Report 2019 cbishopp July 09, 2019 Download

https://www.safeguardinghealth.org/sites/shcc/files/SHCC2019final.pdf

Projects Safeguarding Health in Conflict Coalition

Topics Global health security Safety and Conflict Health in Conflict

Publisher Safeguarding Health in Conflict Coalition

2018 a Year of Dangerous Attacks on Health Workers, Facilities

intrahealth — Tue, 14 May 2019 18:19:17 +0000

2018 a Year of Dangerous Attacks on Health Workers, Facilities intrahealth May 14, 2019 May 14, 2019 Washington

There were at least 973 attacks on health workers, health facilities, health transports, and patients in 23 countries in conflict in 2018, the Safeguarding Health in Conflict Coalition reported today. At least 167 health workers died and at least 710 were injured. This marks an increase in the number of documented attacks compared to 2017, when the coalition reported 701 such instances.

The coalition’s sixth annual report documents attacks on vaccination workers, paramedics, nurses, doctors, midwives, community volunteers, drivers, and guards, in violation of international norms and interrupting global efforts to stop dangerous disease outbreaks such as Ebola and to eradicate polio.

Evidence of attacks in the report, Impunity Remains: 2018 Attacks on Health Care in 23 Countries in Conflict, was gathered from humanitarian organizations, the World Health Organization and other United Nations (UN) agencies and coalition members, as well as from open source data.

“The UN and governments claim to be committed to stopping attacks and ensuring accountability,” says Leonard Rubenstein, chair of the coalition and senior scientist at Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Center for Humanitarian Health. “But we are seeing again widespread impunity by state militaries and armed groups, the targeting of health workers and the health of millions of people at risk.”

The report offers accounts of specific attacks, including:

In Afghanistan in January, a suicide bomber drove an ambulance packed with explosives through a busy checkpoint then detonated a bomb that killed at least 95 bystanders.
In February, 13 Médecins Sans Frontières International-supported hospitals and clinics in East Ghouta, Syria, were hit by bombs or shells.
In March in the northern Nigerian state of Borno, Boko Haram insurgents armed with automatic weapons, rocket-propelled grenades and gun trucks attacked an internally displaced persons camp, killed two Nigerians working for the International Organization for Migration and a doctor working for UNICEF, and kidnapped two midwives and a nurse. The two midwives were executed in September and October.
In one mass demonstration in the occupied Palestinian territory in April, at least 33 health workers were injured. Four paramedics were struck by direct fire and 29 health workers suffered from tear gas inhalation.
In May and June, armed men entered Bambari Hospital in the Central African Republic, firing shots, pillaging the hospital and threatening Muslim patients, who were forced to flee.
In November in the Democratic Republic of the Congo (DRC), the Allied Democratic Forces group attacked near the Ebola Emergency Operations Center and hotels where many Ebola responders were staying, killing seven UN peacekeepers and 12 members of the DRC military. Ebola treatment centers in the area were closed for two days as a result.

The greatest number of attacks occurred in Afghanistan, the Central African Republic, Libya, the occupied Palestinian territory, Syria and Yemen. Airstrikes were conducted against hospitals in Syria and Yemen. Vaccinators were attacked in Afghanistan, the CAR, the DRC, Pakistan, Somalia, and Sudan. Eighty-eight health workers were killed in Syria. More than 500 health workers were injured in the occupied Palestinian territory. Armed men entered a health facility in the DRC, looted and beat patients, and attacked and raped a nurse.

“Attacks on health facilities and health workers not only cause immediate damage and loss of life but also impede access to essential health services for vulnerable people around the world, jeopardizing universal health coverage and global health security,” says Carol Bales, advocacy and policy communications manager at IntraHealth International, who oversaw the report’s production. “We need to do more to ensure health workers are safe and able to improve and save lives.”

International humanitarian law—codified in the Geneva Conventions and its Additional Protocols, as well as international human rights law—prohibits attacks on health facilities and health workers. The United Nations Security Council has repeatedly condemned attacks on health facilities and health workers and demanded governments take concrete actions to protect health facilities and medical workers during armed conflict.

“Attacks on health care workers and facilities are egregious violations of international humanitarian law and they are war crimes, sometimes rising to the level of crimes against humanity,” says Susannah Sirkin, director of policy at Physicians for Human Rights. “In the three years since the UN passed Resolution 2286 to protect health in conflict, attacks on health facilities and health personnel have continued with utter impunity. It’s high time for the international community to demand accountability for these heinous crimes.”

To better document the number and impact of these attacks and stimulate compliance, the WHO launched its Surveillance System for Attacks on Health Care in January 2018. And the NGO Geneva Call issued a Deed of Commitment to encourage nonstate armed groups to protect and respect health care in conflict and to agree to performance monitoring.

“More than 900 documented attacks on health care is particularly alarming because it does not cover the full extent of the problem,” says Christina Wille, director of Insecurity Insight, which led data collection for the report. “Underreporting means that the number of attacks in 2018 is likely much higher than the report reflects. Each attack has consequences for the delivery of health care and the number of attacks does not quantify the impact of death and destruction on the broader health outcomes for affected communities.”

The new Safeguarding Health in Conflict report calls on states in conflict, through their ministries of defense, interior and health, to do more to protect health workers, end impunity and ensure that access to health care is available to all. Its recommendations include:

States should strengthen military doctrine and training, reform laws that permit parties to deny health care to those they deem enemies and arrest caregivers, and improve investigations and accountability mechanisms for those who initiate attacks.
The UN Security Council and the UN Secretary-General must ensure that international investigations and accountability procedures take place for states that permit impunity.

Download the report data and find interactive data visualizations at https://data.humdata.org/dataset/shcchealthcare-dataset.

Talking points and a social media guide are available from the Safeguarding Health in Conflict Coalition.

The Safeguarding Health in Conflict Coalition, of which IntraHealth International is the secretariat and a member, consists of 40 organizations working to protect health workers and services threatened by war or civil unrest. The coalition presses governments and United Nations agencies for greater global action to protect the security of health care.

Policy & Advocacy Safety and ConflictIllustration by Denise Todloski for IntraHealth International and the Safeguarding Health in Conflict CoalitionSafeguarding Health in Conflict Coalition

How Do Attacks on Health Care Affect Women?

mnathe — Tue, 17 Jul 2018 20:10:58 +0000

How Do Attacks on Health Care Affect Women? mnathe July 17, 2018

July 17, 2018

When hospitals or clinics are attacked, women often become targets. But what do we know about the real impact on their health and well-being?

In April 2017, 60 militia members attacked a hospital in Cinq, a city in the Kasai district of the Democratic Republic of Congo. The rebels set fire to a surgical suite, trapping 35 patients inside, and then torched most of the hospital. They sexually assaulted women and girls with sticks and firearms, including a woman who had just given birth hours before.

The details of this attack are horrifying. More than 100 people died, including 90 patients and two health workers.

But it isn’t uncommon.

In 2017 there were at least 701 attacks on health facilities, health workers, patients, or ambulances in 23 countries in conflict around the world, according to a 2018 report by the Safeguarding Health in Conflict Coalition.

As an intern for IntraHealth International, I helped disseminate the report. And as a master’s in public health student focusing on maternal and child health, I was concerned to see how many attacks documented in the report include violence against women—including women health workers—and how often they become a direct target.

Women are more likely to be targets

Attacks like the one in Cinq affect entire communities—often leaving them without access to safe, high-quality health care in times of intense vulnerability. According to UNICEF, 224 health centers in Kasai have been looted, burnt, or destroyed by the violence, eliminating health services for hundreds of thousands of households.

But the impact of these attacks seems magnified for women. Women make up 70% of the global health workforce, so are more likely to be present during an attack on a hospital or other facility. And the attacks leave them without resources to ensure health care for themselves and their families.

As in Cinq, conflict and sexual violence commonly happen together. In 2016 alone, the UN found 179 reported cases of sexual violence in the Central African Republic, the continued enslavement of 1,882 women and girls in Iraq, and rates of sexual violence among women fleeing Myanmar as high as 50%. These estimates are likely low due to underreporting, as data collection can be challenging and potentially traumatizing for victims.

These attacks can lead to physical injuries, unwanted and potentially dangerous pregnancies, and serious mental health challenges. The effects can be life-threatening without a strong health system and access to health care.

Obstructing care is an attack on health and on women

The definition of attacks on health care in the coalition’s report includes obstruction of health care and the supplies needed to provide it.

Human Rights Watch, for example, discovered evidence of obstruction in the Nuba Mountains in Sudan—the government stopped all deliveries of contraceptives and medical supplies to the region when violence erupted over five years ago. Without access to reliable contraceptives, women are vulnerable to unplanned pregnancies and sexually transmitted infections and do not have access to prenatal services or emergency obstetric care, meaning the risks of hemorrhage, eclampsia, and infection go up.

Most maternal deaths could be prevented through access to prenatal care.

All of this is incredibly dangerous for women. Local officials told Human Rights Watch that about 350 women died in this part of Sudan in 2016, and they suspect that most of them were pregnant and died due to pregnancy-related causes. The UNFPA estimated 61% of all global maternal deaths in 2015 occurred in just 35 conflict-stricken countries.

According to the World Health Organization, approximately 830 women die every day due to complications related to pregnancy and childbirth. And most of those maternal deaths could be prevented through access to prenatal care and a skilled health worker at birth. But where health is under attack, these services may not be available.

In Syria in January 2018, Russian and Syrian government forces bombed the Al-Salam Hospital in Ma’arat al-Nu’man. The attack killed five people and caused so much damage that the hospital was forced to suspend operations. It’s the only maternity hospital in the city, serving 500,000 people, and had over 650 deliveries in December 2017 alone.

The impact of all this on mental health cannot be overstated. Researchers have found that women in conflict areas have greater risk than men of depression, anxiety, and post-traumatic stress disorder. Some reasons for this include the correlation between child and mother distress, gender-based violence, and unplanned pregnancies.

Women commonly become the emotional foundation for the family in conflict, and without access to mental health services, this burden can be overwhelming.

We need a gender lens

The Safeguarding Health in Conflict Coalition uses evidence from its annual report to advocate at the global level to end attacks on health and hold perpetrators like the militia in Cinq and the offending governments accountable.

But in this report, victims of attacks are not disaggregated by gender because this information is often not available. So how do we know what the real effects of attacks on health are for women?

Attacks on health care need to be looked at through a gender lens.

This topic is complicated and multifaceted, but what is clear is that the issue of attacks on health care needs to be looked at through a gender lens.

We need to improve data on attacks on health, including collecting gender disaggregated data. We need more research on the physical and mental impact of attacks on health for women. And we need to look deeper into the impact on female health workers.

War has lasting effects on everyone it touches, but without women-focused interventions, we won’t be able to do everything possible to protect the lives of women and their families in conflict.

By Elynn Kann

Former advocacy intern, IntraHealth International

Safeguarding Health in Conflict Coalition Maternal and Newborn Health Policy & Advocacy Gender Equality Health in Conflict

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Twelve Countries Pledge to Protect Health Workers and Facilities in Conflict Areas

cbales — Tue, 05 Dec 2017 18:17:04 +0000

Twelve Countries Pledge to Protect Health Workers and Facilities in Conflict Areas cbales December 05, 2017 December 05, 2017

IntraHealth International, as co-secretariat of the Safeguarding Health in Conflict Coalition, applauds a new declaration by France and 11 other UN member states to take concrete actions to protect health workers in conflict areas around the world.

A report by the coalition documents attacks on health workers or facilities in 23 countries in conflict or political unrest last year. Health workers were arrested, assaulted, kidnapped, punished, and even killed just for doing their jobs. The report also finds that accountability for committing these attacks remains inadequate or non-existent.

In 2016, there were attacks on health workers or facilities in 23 countries in conflict around the world.

At a meeting hosted by the France UN Mission on October 31, the coalition joined member states and others to discuss measures needed to implement UN Security Council Resolution 2286. Adopted in May 2016, the resolution set out a roadmap for the protection of health workers and facilities globally, which have come under increasing attack in recent years. So far the UN Security Council has failed to enforce the resolution.

Eleven states—Spain, Italy, Japan, Kazakhstan, the Netherlands, Peru, Senegal, Switzerland, Uruguay, Canada, and Ukraine—endorsed France’s non-binding declaration, promising to “take practical measures to enhance the protection of, and prevent acts of violence against, medical and humanitarian personnel, and to better ensure accountability for violations in accordance with our obligations under international humanitarian law.”

In particular, these states will:

Review national legislation, policies, and procedures relevant to the protection of health care in armed conflict and formulate recommendations needed to ensure strict compliance with international law and medical ethics.
Ensure protection to all wounded and sick, health and humanitarian workers engaged in medical duties and their transport and equipment, and hospitals and health facilities in situations of armed conflict.
Ensure legislation, policies, and procedures allow for the impartial and unimpeded provision of medical care in line with medical ethics to all wounded and sick in armed conflict.
Systematically call upon the Security Council to adopt measures to respond to repeated acts of violence and other acts impeding the provision of health care in armed conflict, including sanctions against responsible parties.
Review military doctrine, procedures, and practices to ensure they specifically take the protection of the wounded and sick, health and humanitarian workers and their transport and equipment, and hospitals and other medical facilities in armed conflict into account in the planning and conduct of military operations.

The Safeguarding Health in Conflict Coalition welcomed France's strong call to action. “These steps are essential to realize the promise of Resolution 2286,” said Susannah Sirkin of Physicians for Human Rights, a coalition member, “Especially after 18 months of inaction at the Security Council.”

The Safeguarding Health and Conflict Coalition disseminated eight concrete steps states can take to implement Resolution 2286. These include an annual review by all member states of the resolution's failure and successes; the absolute prohibition of the criminalization of medical care; and a clear, accurate, and credible list in the Secretary General’s annual report on children and armed conflict of perpetrators for grave violations of children’s rights, including attacks on hospitals and health workers.

The United States and the United Kingdom, both at the meeting and both permanent members of the Security Council, declined to sign on. The Safeguarding Health in Conflict Coalition urges them to endorse the declaration.

The Safeguarding Health in Conflict Coalition consists of more than 30 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.

Safety and ConflictAftermath of an attack on a health facility in Aleppo, Syria. Photo courtesy of the Syrian American Medical Society (SAMS), a member of the Safeguarding Health in Conflict Coalition. Safeguarding Health in Conflict Coalition

Everyday Violence against Health Workers Takes a Toll—on Us All

mnathe — Mon, 20 Nov 2017 13:04:20 +0000

Everyday Violence against Health Workers Takes a Toll—on Us All mnathe November 20, 2017

November 20, 2017

Attacks on health care range from catastrophic to casual. At what cost?

During September in Syria, there were 10 attacks on health care in 10 days. Air-to-surface missiles sought out and destroyed ambulances and hospitals and killed the people inside them.

I follow the news. I’d read the devastating report by the Safeguarding Health in Conflict Coalition. So I knew that catastrophic attacks like this have escalated and that, in fact, 2016 was the worst year on record for such violence. War is a dangerous time for health workers and their clients, despite the Geneva Convention’s ban on such crimes.

In some US states, nursing is more dangerous than being a police officer.

But I didn’t realize until last week at the Fourth Global Forum on Human Resources for Health the extent of everyday violence health workers face around the world. Slapping. Kicking. Pushing. Verbal abuse.

In some US states, nursing is more dangerous than being a police officer or a prison guard. In Spain, the problem was so widespread that the government created a national observatory for violence against health workers to collect data about the attacks. Media advocacy campaigns led to changes in the penal codes, so that attacks against health workers are now punished as severely as those against public servants.

In fact, said Juan Manuel Garrote, secretary general of the Spanish Medical Association, Friday at the forum, Spain even created a national day against attacks on health care professionals (March 16, #stopagresiones).

In Pakistan, health workers have a surprisingly high tolerance for everyday abuse, said Lubna Baig, pro-vice chancellor of Jinnah Sindh Medical University, on Friday. She was the principal investigator in a 2015 study in Karachi, Pakistan, to pinpoint evidence-based strategies that prevent violence.

Pakistan has a big problem in this area, Baig said. Every day, health workers are being shot or kidnapped, vaccinators killed, ambulance drivers attacked. “That’s just the tip of the iceberg,” she said.

When the researchers talked to health workers in Karachi, they found that 66% of those interviewed had experienced or witnessed violence. Many are just used to it.

“They might say, ‘Abusive language and a little bit of pushing are no big deal,” Baig said, “‘but if I get a broken tooth, that’s not okay.’”

Of course, none of it is okay.

What’s the cost of this everyday violence against health workers? And how can we measure and manage it?

Collecting credible, unbiased data on violence against health in times of war is incredibly difficult (though a method in Syria highlighted in The Lancet this year is showing promising results). Everyday violence is even tougher to quantify. Baig estimates that over half of incidents go unreported.

Mental well-being for health workers is often overlooked.

But there are some methods that are proving effective in preventing it. In Pakistan, officials are seeing great results after developing training for physicians on how to deescalate violence, including how to sense when it’s coming. The training, Baig said, has improved health workers’ confidence and made them better able to deal with violence when it does happen.

“Why not consider after-action reviews when there are incidents of violence, to determine what happened leading up to it and what could have been done to deescalate it?” Barbara Stilwell, senior director of health workforce solutions at IntraHealth International, suggested on Friday at the forum. “The military does this, but we don’t tend to do it in the health sector. And what about mental health support for health workers who’ve been attacked?”

The uptick in complex global emergencies has resulted in prolonged stressful conditions for health workers around the world, and yet, Stilwell says, mental well-being for health workers is often overlooked.

We know that, particularly in low-income countries where health worker shortages are most severe, the loss of even one health worker can leave thousands of people without health care. We lose too many health workers not only to catastrophic violence, but also to stress. Imagine being shoved by a stranger, spit on by a client, yelled at by the people you’re responsible for helping—day after day. It would be upsetting for anyone. And the quality of care they could provide would likely decline.

“This is a global problem,” Rudi Coninx of the World Health Organization said on Friday. “It’s here to stay. So we all have to work together solve it.”

Check out #HRHforum2017 and Global Health Writes for more on what happened at the forum last week.

The session “Health Care in Danger: How to Better Prepare and Protect Health Care Personnel?” was chaired by Giovanni Trambaiolo of the International Committee of the Red Cross and included presentations by Rudi Coninx of the World Health Organization, Juan Manuel Garrote of the Spanish Medical Association, and Lubna Baig of Jinnah Sindh Medical University.

IntraHealth International serves as the secretariat for the Safeguarding Health in Conflict Coalition, which collaborates with International Committee of the Red Cross’s Health in Danger campaign. Find out more about IntraHealth’s involvement at the Fourth Global Forum on Human Resources for Health.

This post was originally published by Global Health Writes.

By Margarite Nathe

Strategic communications advisor, IntraHealth International

Safeguarding Health in Conflict Coalition Global Forum on Human Resources for Health Safety and Conflict

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What's Not a Target

cbales — Fri, 18 Aug 2017 02:18:02 +0000

What's Not a Target cbales August 17, 2017

August 17, 2017

Health workers are supposed to save lives and health facilities are supposed to be safe places for health and healing. They’re protected by the rules of war, but are still being attacked.

Health workers.

It was really hard for me to get my head around at first—that someone would deliberately harm a health worker. A nurse, a doctor, a midwife. A community health worker delivering polio vaccines. Someone who spent years studying, practicing, sacrificing to save lives.

I mean when I meet a health worker, I’m often tongue-tied. They practically have celebrity status. They’re doing something meaningful with their lives, every day.

Or the facilities they work in.

But from my cubicle and laptop, on social media and across the Internet, I read reports of health workers being harmed, or their facilities or clients attacked, every week. Sometimes more often.

Here are just a few incidents in the past month that I’ve spotted, often because the posts about them include #NotATarget (a hashtag campaign started by the International Committee of the Red Cross, or ICRC, two years ago):

Six Red Cross volunteers died after being attacked during a crisis meeting at a health facility in the Central African Republic.
In the West Bank, Israeli forces stormed a Palestinian hospital, terrifying staff and clients, and prevented doctors from providing emergency medical care to critically injured patients.
In Afghanistan, 35 civilians died as a result of an attack during which the Taliban set a hospital on fire in central Ghor Province.

Many more attacks are not reported. And often no perpetrators are named.

Attacks on health in 23 countries last year

Through my work on the Safeguarding Health in Conflict Coalition, I track attacks on health care to help raise awareness of them.

I coedited the coalition’s last two annual reports, which detail attacks on health workers and facilities around the world, and provide recommendations to stop them. Our latest report, Impunity Must End, shows attacks happened in 23 countries in conflict in 2016. These included:

In Iraq, ISIS executed four doctors in Nineveh in July, allegedly for refusing to provide medical treatment to ISIS members.
In Libya, unidentified aircraft dropped two bombs on the Al-Wahda Hospital compound. The bombs hit the internal medicine and kidney wards, as well as the staff dormitory, causing extensive damage and killing a pharmacy staff member and her 10-year-old son, both of whom had been asleep in the staff residence.
In Syria, the worst country for attacks, there were 108 attacks on health facilities and 91 health workers killed.

Years of advocacy

For five years the coalition, made up of more than 30 universities and organizations around the world, has advocated at the global level and with the United Nations and the World Health Organization (WHO) to take action to protect health workers and end attacks against them, including collecting data. Since then, we and others have welcomed several positive steps, most importantly:

The United Nations Security Council passed Resolution 2286 in May 2016, its first-ever resolution condemning attacks on health and setting a course to prevent them and hold perpetrators accountable.
The WHO has started publishing its own reports of attacks on health, and in July announced it will launch a new online database to document and verify attacks.

And tomorrow #NotATarget is the focus of World Humanitarian Day 2017. The message is clear: Civilians are not a target. Children are not a target. Women and girls are not a target. Humanitarian aid workers are not a target. And health workers are not a target.

But it’s not enough.

The Geneva Conventions already officially protect civilians who are not taking part in hostilities, including health workers and humanitarian aid workers. Yet the WHO reports that 979 health workers were injured or killed in attacks in 2016.

And as the violence continues, so does its impact. Earlier this week, the WHO announced 500,000 suspected cholera cases in Yemen this year, and more than 2,000 related deaths. The WHO says 99% of people who can access treatment can survive. But only 50% of health facilities in Yemen are even functional due to the ongoing conflict and the near total collapse of the country's health system.

What more can we do?

The Security Council needs to implement its resolution (it’s done practically nothing to enforce it). The people behind attacks need to be held responsible. UN member states need to share what they’re doing to prevent more attacks from occurring. The Safeguarding Health in Conflict Coalitions and our allies will continue to push for these actions.

Of course, to most of us, health workers are “not a target.” We shouldn’t shoot them. We shouldn’t attack the buildings where they work, or the vehicles that rush them to the sick. Of course not. They’re supposed to save lives, not fear for their own.

Because how can health workers save lives if they’re not safe? If they’re hiding? Running? Gone?

We all need them. We also need hospitals to be safe places of healing.

You can help. Follow @SafeguardingHC and share the coalition’s messages. Sign the World Humanitarian Day petition and tell our world leaders they must do everything in their power to protect civilians in conflict, including health workers.

IntraHealth International believes everyone everywhere deserves access to the care they need to thrive, including people living in countries in conflict. It’s also working to keep health workers safe and in the places where they’re needed most. IntraHealth shares the secretariat of the Safeguarding Health in Conflict Coalition with the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health.

By Carol Bales

Strategic communications manager

Safeguarding Health in Conflict Coalition Health in Conflict Health Workers Global

A health worker in South Sudan, one of at least 23 countries around the world experiencing attacks on health care. Photo by Trevor Snapp for IntraHealth International.

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Through Bullets and Bombs to Reach Health Care

cbales — Fri, 02 Jun 2017 14:05:50 +0000

Through Bullets and Bombs to Reach Health Care cbales June 02, 2017

June 02, 2017

In conflict areas around the world, health workers like Patrick in South Sudan continue to risk their lives to do their jobs.

“There were guns, bullets, and bombs everywhere,” says Patrick Hakim, a clinical officer in South Sudan.

That was the scene around Juba last July after fighting broke out at the presidential compound between the Sudan People’s Liberation Army (SPLA) and the SPLA in Opposition (SPLA-IO) forces.

Amidst the country’s already horrific and brutal conflict, Patrick says those two weeks were characterized by widespread terror. Many borders, roads, and markets were closed. Patrick and his fellow health workers were afraid of leaving home, of being attacked or stopped at armed check points.

But he did. He went to work.

“I felt compelled to risk my life, get out of my house, and walk to Juba Teaching Hospital,” he says. “Because there were clients I had booked the previous week.”

Patrick is part of an IntraHealth International team supporting USAID’s LINKAGES project, which provides HIV testing, care, and treatment largely to foreign female sex workers—a key population in South Sudan’s fight against HIV. The team distributes condoms and antiretroviral drugs, which require regular follow-up and refilling of prescriptions.

So during the days of the July crisis, Patrick was still receiving calls for HIV services.

He and his colleagues continued offering some HIV services to their clients and other South Sudanese. The team provided condoms to the female sex workers in Juba town through their peer leaders. And condoms, test kits, and antiretrovirals were made available at the Juba Teaching Hospital and Al-Saba Children’s Hospital, the other main hospital in Juba town.

But many of Patrick’s clients weren’t calling. They were scared, too. Many fled Juba and even South Sudan. Some hid in the bush. And some ran out of food and stopped taking their antiretroviral medications to avoid the side effects.

One client, a sex worker who travelled from Yei to Juba to refill her prescriptions every couple months, was determined to get her medication. She walked through bushes and villages to avoid the roads. The trip that usually took her four hours by bus took her almost four weeks. When she finally reached Juba Teaching Hospital, Patrick says, she had lost a lot of weight, was malnourished, and had a persistent cough. In fact, she could hardly breathe.

But she made it. Patrick can only guess how many others did not.

Disease Doesn't Wait for War to End

Since civil war broke out in South Sudan in December 2013, tens of thousands of people have been killed and three million people have been displaced. The country has plunged into a humanitarian crisis that has been exacerbated by famine in the northern-central region. The crisis worsened in 2016, and 7.5 million people are in need of humanitarian assistance.

Now millions of people are vulnerable to disease and injury and unable to reach the health care they need. More are dying from vaccine-preventable and treatable diseases, such as measles and cholera—deaths that are directly linked to the lack of basic health services. Women lack skilled birth assistance and access to contraception, and people with HIV/AIDS or tuberculosis have been cut off from life-saving medications.

Only 43% of South Sudan’s health facilities are now functional. More than 100 have closed, and at least 29 have been looted or destroyed since the beginning of the civil war.

In February 2016, a Médecins Sans Frontières medical center in Jonglei state was caught in crossfire. A six-year-old boy was shot and died. Thirty-five other patients were injured. The center was looted of medical equipment and medicines.

In the days of the July crisis, when Patrick’s client was avoiding roads and hiding in the bush, shelling hit the maternity wing of an International Medical Corps hospital within a UN Protection of Civilians site in Juba. Fifty thousand people were suddenly without medical services and humanitarian aid.

Patrick had reason to be scared. Health workers, patients, and facilities are deliberate targets.

Last May, for example, soldiers at a checkpoint in Yei shot a doctor in the stomach while she was driving an ambulance late at night, returning from rushing a pregnant woman for emergency care. She died four days later from her injuries. In September, armed men threatened health officials at gunpoint while ransacking a health center in Lasu. In December, also in Lasu, SPLA-IO forces abducted three health workers during road clashes (they were later released).

And that’s not all. What’s happening in South Sudan exemplifies a continuing trend among conflict-ridden countries.

Impunity Must End

A new report by the Safeguarding Health in Conflict Coalition, Impunity Must End, documents attacks on health care in 23 countries in conflict around the world.

In Syria, there were 108 attacks on health facilities and 91 health workers killed.
In Afghanistan, there were 119 attacks on health facilities and health workers.
In West Bank/Gaza, 162 medical technicians were injured by violence or interference with ambulances.

But documentation of such attacks remains spotty. The report’s numbers may greatly understate the actual extent and severity of these attacks.

And accountability remains almost non-existent. Despite the adoption of UN Security Council Resolution 2286 last year, which set out a roadmap to protect health in conflict, practically nothing has been done to enforce and implement it.

Impunity Must End makes concrete recommendations to end these atrocities, including regular reporting by countries to the UN on how they are preventing attacks, investigating those that occur, and holding perpetrators accountable. If member states fail to act, the UN Security Council—which met last week to discuss the resolution again—should initiate thorough investigations and establish accountability procedures. The UN Security Council must act.

It was Patrick’s childhood dream to become a health worker so that others wouldn’t suffer the hardships his family endured due to lack of access to health care. But he and his colleagues need to be safe to save lives. They should not have to be scared to go to work. And no one should have to be scared to seek out health care.

The impunity must end.

Read more about Patrick in this Picture It post.

LINKAGES is a USAID-funded project working to reduce HIV transmission among key populations and to improve their enrollment and retention in care. FHI 360 leads the project in partnership with IntraHealth International, PACT, and the University of North Carolina at Chapel Hill.

IntraHealth is a founding member of the Safeguarding Health in Conflict Coalition. IntraHealth leads communications for the coalition and co-authored and edited the new Impunity Must End report. This blog post sites data from the report.

By Cecilia Amaral

Global Health Corps Fellow, IntraHealth International

By Carol Bales

Strategic communications manager

Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES)Safeguarding Health in Conflict Coalition Policy & Advocacy Health in Conflict Health Workers South Sudan

Photos

A tank sits alongside the road between Juba and Yei, South Sudan. Photo by Trevor Snapp for IntraHealth International.

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