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Wednesday, August 10, 2011


Foreign wars, occupiers continue pushing people down
ICRC reports wars’ relentless hampering of health and threat to health-care personnel in 16 countries — Violent events cause healthcare to be suspended, withdrawn, or rendered impossible
Excerpting, editing by Carolyn Bennett

Countries suffering sustained periods of conflict have the lowest numbers of health-care personnel, the International Committee of the Red Cross reports; and where health-care personnel are available, they often come under attack, are hampered in their work and threatened with violence. 

Per 10,000 inhabitants, the five permanent members of the UN Security Council [France, United Kingdom, United States, Peoples Republic of China, Russian Federation] have on average 28.4 doctors and 56 nurses. 
By comparison —
Afghanistan has 2 doctors and 5 nurses
Democratic Republic of the Congo has 1 doctor and 5 nurses.
Somalia has 0.5 doctors and 1 nurse.
Iraq has 5 doctors and 10 nurses.

“The danger to health-care workers and facilities in armed conflict and other situations of violence is widespread and serious. It is heterogeneous in terms of the nature and impact of the violence, the people committing violence and the agencies affected.


Principal forms of violence affecting health-care personnel:

  • Use of explosive weapons by State armed forces during active hostilities, causing deaths and injuries;
  • Kidnapping of health-care personnel from their place of work by armed groups;
  • Killing of expatriate health-care personnel by armed groups;
  • Arrests;
  • Threats by a variety of parties

Violence affecting health care — in relation to hospitals, and other health-care facilities:

  • Use of explosive weapons by State armed forces during active hostilities, that – intentionally or unintentionally – strike health-care facilities, at the same time killing and injuring people; 
  • Armed entry into health-care facilities by State entities (State armed forces and police) with the main purpose of arresting or interrogating the wounded and the sick; 
  • Armed entry into or takeover of health-care facilities by armed groups to harass personnel, steal materials, occupy the premises or commandeer vehicles for their own medical or tactical purposes.

Principal forms of violence affecting medical vehicles:

  • Violence by State armed forces and armed groups against vehicles and personnel en route; 
  • Damage to ambulances caused by State armed forces, and to a lesser extent by armed groups using improvised explosive devices; 
  • Harassment and delaying of ambulances or other vehicles transporting the wounded or the sick at checkpoints by State armed forces and police.

Insecurity with regard to health care (real dangers to which the wounded and sick, health-care workers, professional or not, are exposed) includes:

  • Death, injury, rape, kidnapping, arrest, harassment of and threats to health-care personnel, the wounded and the sick, and other people in health care;

  • Material damage, such as the physical destruction of, theft of or damage to health-care facilities or medical vehicles, or cutting off electricity and water; 
  • Preventing access of the wounded and the sick to health care; 
  • Removing wounded or sick people, against their best interests, from health care

Health care that is suspended, withdrawn or rendered impossible 
as a result of violent events has “knock-on effects [far-reaching consequences] for thousands of wounded and sick people.”

In AFGHANISTAN PAKISTAN, for example, “Polio eradication is hampered by insecurity and so hundreds of thousands of children cannot be vaccinated against polio.”

In this latest report, “Health care in danger: a sixteen-country study,” the International Committee of the Red Cross finds, “Thousands of wounded and sick people can be denied effective health care when hospitals are forcibly entered by fighters, damaged by explosive weapons, or when ambulances are hijacked, and when health-care personnel are threatened, kidnapped, injured or killed.”

The study based on an analysis of reports collected over two years and six months describes 655 violent incidents affecting health care in 16 countries where the ICRC operates. In its study, the organization obtained reports from humanitarian agencies, including the ICRC, and from open sources such as the media and websites.

ICRC researchers found that “in 33 percent (216/655) of the events, the violence was committed by State armed forces, and 36.9 percent (242/655) by armed groups. Events involving explosive weapons had a much greater impact both on people and on health-care facilities.

“A variety of institutions involved in the delivery of health care were affected: international NGOs in 34.5 percent (226/655) of events, local health-care services (e.g. ministries of health) in 25.6 percent (168/655), and Red Cross or Red Crescent organizations in 16.8 percent (110/655).

“In all, 1,834 people giving or receiving care and others were killed or injured, of whom 20.1 percent (368/1834) were already wounded or sick and 8.7 percent (159/1874) were health-care personnel.

“Hospitals and other health-care premises were damaged in 17.7 percent (116/655) of events, and ambulances were damaged in 4.9 percent (32/655) of events.

Follow on
In re-reporting today, Reuters and Deutsche Welle highlight Afghanistan, Iraq, Sri Lanka and Somalia as having “suffered some of the worst attacks against medical centers and staff.

“During Israel’s 2008-2009 invasion of Gaza, four starving Palestinian children were found sitting near the bodies of their dead mothers, four days after shelling. Israeli forces prevented ambulances from reaching the victims.”

Somalia lost its “second batch of medical graduates in 20 years when a suicide bomber blew himself up at a university ceremony in Mogadishu in December 2009.” Twenty-two people died.

Taliban insurgents last April in Kandahar, Afghanistan, “used an ambulance packed with explosives to kill 12 people at a police training base.”

In recent weeks, healthcare personnel have been threatened in Bahrain, Syria and Yemen. Protesters in these countries, Reuters reports, “have been too afraid to use medical facilities for fear their wounds will identify them and provoke harsh reprisals.”

Sources and notes

“Health care in danger: a sixteen-country study10-08-2011 Report,” http://www.icrc.org/eng/assets/files/reports/report-hcid-16-country-study-2011-08-10.pdf
“Health care in danger: a sixteen-country study” http://www.icrc.org/eng/resources/documents/report/hcid-report-2011-08-10.htm

“A SIXTEEN-COUNTRY STUDY: Healthcare in Danger,” July 2011, http://www.icrc.org/eng/assets/files/reports/report-hcid-16-country-study-2011-08-10.pdf

The ICRC’s Assistance Division commissioned the study. Robin Coupland (ICRC) was responsible for the study and was the principal writer; he was also involved in data interpretation. Christina Wille (Insecurity Insight) designed the study and the database, read the reports, entered the details into the database, analyzed and interpreted the data and co-wrote the report. Nathan Taback (University of Toronto and Insecurity Insight) helped with the design of the study and with analysis and interpretation of the data. Simon Regard (ICRC) undertook background research in relation to the impact of insecurity on health care.

“Hospitals, medical staff targeted in wars: ICRC” Reuters (Editing by Gareth Jones), August 10, 2011, http://news.yahoo.com/hospitals-medical-staff-targeted-wars-icrc-164540659.html


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