Violence against health-care workers: an urgent problem worldwide

On the occasion of World Humanitarian Day (19 August), this joint Op-Ed from ICRC and ECHO looks at the drastic and long-term effects that attacks on health-care staff and facilities have on the untold numbers that are deprived of the care they need. This article was written by Peter Maurer, president of the ICRC, and Kristalina Georgieva, European Commissioner for international cooperation, humanitarian aid and crisis response.

World Humanitarian Day is dedicated to those who have lost their lives in humanitarian service and those who continue to work for humanitarian causes. It is also an occasion to draw attention to the fact that health-care personnel are often among the first to be attacked in war and other situations of violence. As a result, untold numbers of people are deprived of the care they need. This is currently one of the most serious and pressing issues of humanitarian concern.

Many of us in Europe may only be aware of violent incidents against people providing or receiving health care on the rare occasions when they make international news headlines. The deadly attack on a hospital in the Pakistani city of Quetta, in June, where survivors of an earlier attack on a bus were being treated, is just one recent example.

The vast majority of incidents that in one way or another deny the right of wounded or sick people to health care go unreported. While ambulances or hospitals are in some cases directly targeted, health-care workers are far more frequently harassed or threatened by fighters seeking to stop them from treating enemies, or demanding supplies from them. It is not unusual for ambulances to be deliberately prevented from reaching wounded people, or to be held up for hours at checkpoints. The unacceptable reality is that the neutral status of health-care facilities, transports and personnel is routinely flouted. Not only is the scale of the problem alarming, but the patterns of violence themselves reveal worrying trends.

A recent study by the International Committee of the Red Cross shows that in most cases by far of violence against health-care personnel and facilities, it is local workers who suffer (in 2012, this was the case in over 90 per cent of the more than 900 recorded incidents in 22 countries). And of the people caught up in those incidents, around 25 per cent were killed or wounded. In some cases, later explosions even targeted those trying to assist the victims of an initial explosion – a particularly repugnant practice causing further injury and death and preventing care reaching those who urgently need it.

A single violent incident against health-care facilities or workers can have immeasurable longer-term repercussions on entire communities. When a bomb exploded at a medical graduation ceremony in the Somali capital Mogadishu in 2009, or, more recently, when polio vaccination workers were killed in Nigeria and other countries, the impact went beyond the immediate loss of life. As a result of these attacks and others like them, many thousands of people every year will not be seen by doctors, or receive life-saving vaccinations, in countries where health care is already under pressure.

Beyond the effects of specific incidents, the general lack of security arising from armed conflict and other violence, while hard to measure, clearly has a major impact on health care. Consider, for example, the large-scale flight of health-care workers in the face of attacks, threats or security concerns. From Afghanistan to remote conflict-affected areas of Colombia, from the Central African Republic to northern Mali, the main problem facing health care today is less the direct attacks against those providing it than the inability of the wounded and the sick to obtain it – which can ultimately be just as deadly.

Violence against health-care facilities and personnel – in all its forms – is not only morally reprehensible, it is illegal under international law. Primary responsibility for ensuring that the law is obeyed lies with States and with combatants. In addition, national legislators and courts must fulfil their responsibility for ensuring that domestic legislation recognizes the criminal responsibility of anyone who violates international humanitarian law, and of actually enforcing such legislation. Offenders must be held accountable.

Humanitarian organizations and health-care personnel themselves also have a critical role to play. Securing acceptance for their activities from all communities and political and military groups – an essential prerequisite to being able to work in sensitive and volatile contexts – has to be based on an unequivocal demonstration of impartiality. Health care has to be provided on the basis of strictly clinical needs and not on any other grounds.

Raising awareness of the human cost of violence against health-care workers, and fostering a culture of responsibility among all concerned, requires a concerted international effort using diplomatic, legal and other means.

To this end, a campaign led by the International Committee of the Red Cross, mobilizing the entire International Red Cross and Red Crescent Movement and other humanitarian organizations, with the support of the European Commission, will be presented in seven European capitals as of October 2013. The objective is to make more people aware of the urgency of the issue, and of the harm that is being caused, so that more suffering may be prevented and lives saved.

For more information (including photos, videos, and first-person accounts of delivering frontline medicine), click here. Also, check out Francoise Duroch of MSF talking about the targetting of medical workers here.