States must do more to stem "new & frightening trend" of attacks against health care

ICRC President, Peter Maurer (left) speaks with UN Under Secretary General, Valerie Amos (right) at the UNGA panel. Copyright: ICRC A Nelso

ICRC President, Peter Maurer (left) speaks with UN Under Secretary General, Valerie Amos (right) at the UNGA panel. Copyright: ICRC A Nelso

Health workers are under attack as never before and it's high time that States take concrete action to ensure that patients and health care personnel, facilities, and vehicles are respected and protected. That was the conclusion of a high-level panel, which took place on the sidelines of the United Nations General Assembly in New York on Thursday.

Watch the webcast of the event

The President of the International Committee of the Red Cross (ICRC), Peter Maurer, co-chaired the event with the Director General of the World Health Organization (WHO), Margaret Chan. The panel was moderated by the UN's Under Secretary General for Humanitarian Affairs and Emergency Relief (OCHA), Valerie Amos. Opening remarks were delivered by the UN's Deputy Secretary General, Jan Eliasson, and speeches were also delivered by the Foreign Minister of Norway, Børge Brende, the Foreign Minister of Sweden, Carl Bildt, and Côte d'Ivoire's former Minister of Health, Thérèse N'dri Yoman.

"New & frightening trend"

"We're meeting at a time of great crisis in the world. When violence restricts humanitarians from helping those in need, millions suffer. This is a new and frightening trend," Mr. Eliasson said, adding that he would like to see urgent preventative measures and diplomatic steps taken to put a stop to the problem.

The aim of the debate was to reinforce the role and commitment of States in ensuring the protection of health care, particularly in situations of armed conflict and emergencies, while garnering support for an eventual UN resolution on the topic.

Citing an alarming increase in the frequency of violence and threats against health care personnel and infrastructure, the WHO's Margaret Chan bluntly stated: "This can't be the 'new normal'."  She added that there was an urgent need for more "awareness, advocacy, attitude change, action, and accountability" if governments and the international community hope to effectively tackle the problem. 

Around 100 people attended Thursday's event, including Britain's Ambassador for Development and Human Rights, Martin Shearman, the Director General for Globalization, Development and Partnerships at the French Foreign Ministry, Anne-Marie Descôtes, the Director of Operations for ECHO, Jean-Louis de Brouwer, and the Commissioner General of UNRWA, Pierre Krähenbühl.

US Assistant Secretary of State for Population, Refugees, and Migration, Anne Richard, also addressed the panel.

"World should be outraged"

"The United States agrees with the goals of the [Health Care in Danger] campaign and appreciates the role of the ICRC and the broader International Red Cross and Red Crescent Movement in bringing attention to this important issue," Assistant Secretary Richard said. "In recent weeks, the world has been appalled by the beheadings of journalists and humanitarians – and it's absolutely right to be disgusted by these acts – but the world should be equally outraged over what's happening to health care workers in Syria and across the globe," she added.

Since 2011, 45 Red Crescent volunteers have been killed while trying to help others in Syria. Worldwide, ICRC research turned up more than 2,300 incidents involving serious acts or threats of violence in 23 countries between January 2012 and July 2104.

"No one should die while striving to save another's life," Minister Brende of Norway told the group. "We can't take this principle for granted. It's become a principle we must fight for. And we will fight."

He also voiced his nation's strong support for a UN resolution on the matter and invited States to "commit to preventative measures that would increase protection for health personnel."

Concrete action needed

ICRC President Maurer also spoke of the need for concrete action, explaining that the Red Cross Red Crescent had consulted a wide range of stakeholders – from armed forces to lawmakers and from health authorities to medical professionals, resulting in a set of recommendations aimed at mitigating risks. For example, at checkpoints, during medical evacuations, or when troops are deployed near hospitals.

He called on the government representatives in the room to adopt measures to ensure that their national legislation protects health care infrastructure and transport. "Such legislation must also adequately reflect the rights and the obligations of health care personnel. In other words, it should reflect health care ethics, as well as the rights of patients to access and receive treatment in a timely manner."

Mr Maurer added that authorities could learn from each other at a local, national and international level when it comes to both practical and policy issues. "Many countries have worked on their internal normative frameworks," he said. "Colombia, for instance, has developed a series of regulations over the past decade, accompanied by practical tools and training materials, which have made a positive difference on the ground in recent years."

Ultimately, the ICRC's President said true success could only be achieved if governments and the international community "stand together" with the Red Cross Red Crescent, UN agencies, NGOs, medical bodies, and health care associations. He, too, encouraged States to "adopt a strong resolution that would reaffirm the need to protect the delivery of health care."

Reinforcing resiliency

Acknowledging that "health care in danger" is a problem on a global scale, Côte d'Ivoire's ex Health Minister, N'dri Yoman, stressed the need to reinforce the resiliency of local hospitals and clinics on the ground.

She cited the period of post-electoral violence that gripped Abidjan in 2010 as an example of a situation where health workers simply weren't prepared to handle the widespread looting and vandalism of health facilities that went on.

"Clinics and hospitals were already overburdened with an influx of injured… when the looting started, they understandably fled out of fear and that weakened the whole health care system," she told Intercross. "One of my primary messages is that in rebuilding the system, its foundations must be strengthened so that you don't fall into a vicious cycle of repairing something that's broken only to have it break again the next time violence occurs."  

France's Anne-Marie Descôtes also spoke of the need to "adopt comprehensive policies that build the resilience and sustainability of health care systems" at a local level.

Not just in war zones

With regard to the problem itself, many of the participants cited the risks faced by first responders, who are on the front line of providing live-saving help in armed conflicts. Several highlighted the fact that local health providers overwhelmingly bear the brunt of violence, with 90 per cent of reported incidents affecting them directly.

It was also underscored that the problem doesn't only exist in war torn nations.

"Health workers trying to stem the Ebola outbreak in Africa face a three-fold threat," Dr. R. Bruce Aylward, the Assistant Director General of the WHO in charge of polio and emergencies, told Intercross. "Not only are they falling prey to the virus themselves, but they're also coming under attack by communities that don't understand they're there to help. What's more, their livelihoods are being affected."

Reprehensible & unlawful

While there was clear consensus that attacking and targeting patients, doctors, nurses, and ambulance drivers is abhorrent, it was also pointed out several times that it's downright illegal.

"Attacks against health care workers and systems are a recurring and blatant violation of international humanitarian law," said Minister Bildt.

"Sweden has traditionally been a champion of the humanitarian principles of humanity, impartiality, independence, and neutrality. These principles are not principles for the sake of principles but the very foundation for being able to save lives and alleviate suffering in humanitarian crises. It is essential that the international community continues to safeguard these principles and continues to push for the provision of health care without discrimination," he added.

His comments were echoed by the Interim Director of US Policy at Physicians for Human Rights, Andrea Gittleman.

"Attacks against health workers are not just reprehensible, they're unlawful," she told the panel. "Such acts should not be seen as a mere side effect of conflicts. They should be seen as totally unacceptable."

Several speakers pointed out that those found responsible for attacking health workers or patients must be held to account and that States have a role to play in ensuring that alleged violations of the law are investigated and prosecuted."

"We cannot walk away"

But as the WHO's Bruce Aylward told Intercross, "people need to know what the rules are in order not to violate them" and it was clear from the discussion that in addition to attaining firmer commitments and concrete action from States, the need for more awareness is also acute.

"There's a certain horror that is expressed but people don't necessarily understand the full extent of the problem or what to do about it," said Mr Aylward. "Comprehension needs to grow at all levels – from villages and communities all the way up to governments. Additionally, States need to lead by example. It will take time to get to where we want to be and it will likely take years of debate, documenting, and dissemination to get there, but this problem is becoming systemic and we cannot afford to walk away from it. Now is the time to stay focused and secure commitments."

More resources:Health care and violence: the need for effective protection (statement and key recommendations for States) Joint WHO & ICRC news release (includes contacts for spokespeople)