Health Care in Danger

Building a community of concern- a responsibility of health professionals

Professor Sir Andy Haines

 Improving

documentation of attacks on health workers and the contexts in which these occur Estimating impacts on health and health care Strengthening the voice of professional associations, academic institutions etc. Engaging the UN system Communicating with non-state actors Raising the public profile of the issue

The need for systematic data capture and analysis

The ICRC estimates- 600 attacks on doctors, nurses, ambulances and hospitals from mid-2008 to the end of 2010 in 16 nations.

But

these statistics represent only the tip of the iceberg: they do not capture the compounded cost of violence health-care staff leaving their posts, hospitals running out of supplies and vaccination campaigns

 Documenting

the problems systematic collection and synthesis of data (a role for

WHO?)

Assessment

of high risk situations Analysis of overall impact on health care delivery and public health- millions at risk

 Indiscriminate

attacks on hospitals/health facilities e.g. shelling of Puthukkudiyiruppu hospital Sri Lanka 2009 Ethnic targeting of facilities e.g. burning of Uzbek-run clinic in Kyrgyzstan 2010 Attempts to free wounded e.g. 3 militants disguised as police killed visitors, staff in Lahore, Pakistan 2010

 Threats/attacks

against staff for treating enemy wounded e.g. Afghanistan, Colombia,

El Salvador, Kosovo, Chechnya, East Timor, Philippines. In some cases authorised under

local anti-terrorism laws Attacks on doctors as community leaders e.g.

Bosnia, Iraq
Attacks

on ambulances

e.g. Iraq, Nepal, Mexico,

Colombia, Libya, Yemen, Occupied Palestinian territory

Use of Ambulances in Attacks The use of an ambulance by Taliban suicide attackers in a raid on a police training centre in the southern province of Kandahar on 7 April has been acknowledged as a violation of war laws and the insurgents have promised investigations. Use of ambulance by Taliban attackers was "perfidy" ICRC KABUL, 12 April 2011

This will not happen again, Zabihullah Mujahid, a Taliban spokesman, told IRIN.

http ://www.afghanistannews.net/story

 WMA

Statement on the Protection and Integrity of Medical Personnel in Armed conflicts and other situations of violence (Oct 2011) Calls for systematic data collection and dissemination WHPA Proposed UN Rapporteur on Independence and Integrity of Health Professionals (1997) BMA letter to Syrian Government

 Particularly

when fighting occurs in densely populated urban areas e.g. Libya, Yemen, Rwanda, Serbia, occupied Palestinian Territory

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Doctors and Nurses detained in Bahrain

The President of the Bahrain Nursing Society, Mrs Al Saffar, speaking via video said that health professionals in Bahrain were 'delighted' by the support from the UKUNISON, BMA

Troops guard an entrance to Salmaniya Hospital

 Flight

of health professionals under threat of violence e.g. 18,000 of 34,000 Iraqi doctors fled between 2003-6 Violence and crime are major causes of migration of health professionals in nonconflict situations e.g. nearly 40 % in S.Africa and 20% in Zimbabwe of those intending to migrate.( WHO AFRO 2004 report)

 E.g.

Nepali doctors undertook vigorous programme of activities e.g. Documented human rights violations Organised protests against intimidation, Resisted Govt. pressure not to treat wounded rebels Organised international support

 Developing

targeted (on-line) materials and courses on violence against health professionals and how to address the abuses, including in armed forces colleges. Working with national associations and interest groups (e.g. Medsin , IFMSA), NGOs Incorporating the topic in (undergraduate), postgraduate training and CPD.

 Systematic

review of health human rights literature 1999-2008 identified 928 articles

( Mpinda et al Health and Human Rights: an International Journal 2011)

Only

7 % concerning violence and 0.6% torture health workers not mentioned Very few empirical studies Need for more empirical research and more interdisciplinary collaboration e.g. between health and legal researchers

neglected topic with wide ranging implications for health. Important roles for health professionals in urging involvement of the UN/WHO, diaspora and professional associations. Need to raise awareness in academic institutions. Share information and educational materials. Coherent approach to documenting abuses, consequent health burdens and strategies to address them.