This is a guest blog by Leonard Rubenstein, senior scholar at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health
The international media attention to repression in response “Arab Spring,” included reports of and expressions of outrage about attacks by Bahrain’s security forces on health workers, obstruction of hospital access and arrest and prosecution of doctors and nurses. The attention was atypical, as assaults on hospitals, medical personnel, ambulances and patients during armed and civil conflict usually pass without notice or protest.
An analysis by the International Committee of the Red Cross in 16 countries released on August 10 in conjunction with its new campaign, Health Care in Danger, revealed 655 violent events against health care, including kidnapping, killing, and wounding health care workers, over just two a half years. Few of these attacks elicited a response from the medical, human rights, or the global health community. Indeed, systematic reporting of incidents, sustained inquiry into the medium and long-term impacts of attacks on health care on health infrastructure and health worker migration, prevention and accountability strategies, are also absent. To be sure, assaults on humanitarian workers have stimulated attention to their vulnerability and the need for better security, but local health providers, emergency personnel and facilities, which are most frequently targeted, are all but ignored.
Yet the lassitude may be ending, with new initiatives by the International Committee of the Red Cross, the US State Department, the World Health Organization and the UN Security Council to advance documentation and reporting of violations, development of prevention strategies, accountability, and mobilization of political will.
Last month, the UN Security Council expanded its mechanisms to identify and stigmatize states and armed groups that commit grave human rights violations against children in war to attacks on schools and hospitals and the personnel who work in them. Given the broad interpretation given to the phrase hospitals, the mechanism has potential to bring needed attention to violations and accountability for perpetrators.
Almost simultaneously, in response to an initiative by the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, the State Department will begin collecting and publishing information on attacks on or obstruction of access to health care services and humanitarian access as part of its annual Human Rights Country Reports, covering 190 countries and available in 50 local languages. Although formerly subject to political bias, in recent years the reports have become credible and widely-read sources of information on human rights abuses. Inclusion of assaults on health can increase their visibility, validate the work of local activists, and ratchet up pressure on perpetrators to cease the violations.
An even more robust plan for reporting, by the World Health Organization, is on the horizon. At the behest of NGOs and academics, and with the support of the US and other governments, WHO plans to convene a group of experts, governments, NGOs and health providers to examine methods and strategies for WHO to systematically collect and report data on violence in civil or armed conflict against health facilities, patients and workers. The goal is for WHO to obtain quality information directly from the field and report the results on its website as a resource for health workers, officials, NGOs, and advocates in affected countries and throughout the global community who seek to increase protection of health.
Expanded attention to assaults must be accompanied by mobilization of political will. Toward this end, on August 10 the ICRC launched its Health Care in Danger campaign, designed to bring states, civil society, and health professionals together to galvanize international action to develop practical and effective strategies to prevent attacks. The four year campaign seeks to increase respect for norms and rules, support front line health-care workers, engage with security forces and armed groups, and put security of health care on the diplomatic agenda.
These nascent initiatives in combination offer a hopeful way forward. Realizing their potential depends on everyone in the global health community, including professional associations, civil society organizations, ministries of health and health providers, rallying behind the opportunity and committing to support colleagues and patients who are at risk of violence during armed and civil conflict. The means – demanding high quality information, collaborating on protection strategies, and assuring that perpetrators suffer consequences – are within our grasp.