Attacks on health carers in danger zones 

Hospitals, ambulances and healthcare workers are coming under increasing attack as they tend to the sick and wounded in areas of armed conflict and violence. Dr Robin Coupland, advisor on armed violence for the International Committee of the Red Cross in Geneva, looks at work to tackle this growing issue.


_{An ambulance hit by a mortar shell: Medical services and personnel are coming under increased attack
Photo: ICRC/J Mohr}

The recent popular uprisings in North Africa and the Middle East show how conflict is changing, and this affects the delivery of healthcare to the wounded and sick. Such events tend to happen in major cities and the civilian healthcare infrastructure is therefore the destination for those who need medical assistance.

However, such facilities and their staff often become an integral part of the conflict. People needing medical attention, such as wounded insurgents, may be sought by security services for arrest, interrogation - or worse. This can make local hospitals too dangerous and so they are avoided. Healthcare staff may be prevented from treating certain people. Furthermore, what happens at hospitals or to ambulances or healthcare staff is a powerful element of today's ubiquitous and immediate media coverage, influencing how the conflict is viewed and reacted to by the outside world.

From a professional point of view, treating people who have been wounded or fallen ill in areas of conflict can be both challenging and rewarding. Conditions can change rapidly, for example, when fighting erupts nearby and staff cannot get to work, or when they are threatened by armed men. At a practical level, already-fragile electricity and water supplies may run out completely. It may even be impossible for the wounded and sick to reach healthcare owing to obstruction at check points.

All of these issues render the delivery of healthcare difficult, or even impossible.

Events in 2011 have provided numerous examples of how healthcare can be rendered non-functional owing to insecurity and the need for healthcare peaks precisely when conflict and insecurity make its delivery or accessibility most difficult. And it is impossible to deliver effective and impartial healthcare if personnel and their premises are insecure, so many communities could see even the most basic healthcare simply evaporate when conflict erupts.

The International Committee of the Red Cross (ICRC) has collected and analysed reports pertaining to 655 violent events affecting healthcare in 16 unnamed countries where it works. The study details the types of perpetrators of violence, the means they use, who is affected and in what way.

And on April 23, 2012, in partnership with the British Red Cross (BRC), the British Medical Association (BMA), and the World Medical Association (WMA), the ICRC is hosting a symposium in London called 'Health Care in Danger'.

The London symposium is just one of a number of events planned for the next two years, the ultimate goal of which is to assure the security and delivery of effective and impartial healthcare in contexts of conflict or violence. The ICRC will be presenting the outcome of all such events to an inter-governmental conference in 2014.

The aim is raise awareness of the issue of insecurity of healthcare in armed conflict and other situations of violence and to permit an important section of the health community and other relevant stakeholders to generate recommendations for national and international policymakers.

Three panel discussions will focus on the following questions:

• What are the responsibilities of health professionals, their institutions and the health community to work constructively for greater security of health care in armed conflict and other situations of violence? And what form does this work take?
• What action can the health community recommend to governments and inter-governmental organisations with respect to improving security of healthcare in armed conflict and other situations of violence? and
• How do medical ethics apply in armed conflict and other situations of violence? How do health professionals working in these contexts manage the dilemmas arising from being a witness to possible violations of international law?

It is likely that the symposium will, in attempting to find answers, raise more questions. However inconvenient, these questions - and others - must be raised as the first step in assuring that the wounded and sick in conflict receive the healthcare to which they have a right.

For more details see www.icrc.org/eng/resources/documents/event/hcid-expert-panel-2011-12-09.htm

This article appears in Crisis Response Journal, Volume 6:4

Resources

Coupland R, Wille C, Taback N, Regard S: Health care in danger: a 16-country study. ICRC, 2011; and V Nathanson: Delivering healthcare in situations of conflict or violence. BMJ, 2011