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Center for Public Health and Human Rights

Center for Public Health and Human Rights

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Protection of Health in Armed Conflict

Led by Leonard Rubenstein, Katherine Footer, and Sonal Singh


Despite firm standards rooted in the Geneva Conventions to protect health facilities, health workers, and the patients they serve during armed conflict, and to enable health professionals to act consistently with their ethical obligations, assaults on and interference with health functions are all too common in war.   Aside from the human toll they take, these attacks often compromise the ability to deliver care to populations in great need, impede efforts to reconstruct health systems after war, and lead to the flight of health workers whose presence in a time of great social stress is essential.

A recent study by the International Committee of the Red Cross conducted in 16 countries found more than 650 separate attacks on health facilities, transports, and personnel, as well as on patients, leading to more than 1800 deaths or injuries.

Despite the seriousness of the problem, the international community has taken few steps to provide guidance to promote compliance with the law, nor even to assess and report on violations in a uniform and comprehensive manner.  Sound methodologies for data collection about these assaults have not been developed.  The lack of systematic reporting and documentation of these violations contributes to continued disregard for an established and internationally recognized legal framework of protection. Mechanisms to encourage compliance with these international norms are needed as a first step in preserving critical health services in conflict settings.

Our Work:

The Center’s strategy is three-pronged:  improved documentation of assaults as a means of better understanding the reasons for attacks and mobilizing political will to stop them; prevention; and accountability.  The Center is collaborating with partners including theInternational Committee of the Red Cross and its Health Care in Danger Campaign Intrahealth, the World Medical Association and many others.

Improved Documentation

The Center is developing both the technical means to enable systematic collection of data and the international mechanisms to assure that the data is collected.  We have already achieved significant results:

As a result of the Center’s initiative, for the first time the managers of the Country Reports on Human Rights practices issued by the US State Department, will solicit information on attacks on health and humanitarian access.

At the 2011 World Health Assembly, at the urging of a group of partner NGO’s, (more) Director General Dr. Margaret Chan’s opening address noted reports of assaults on health personnel and facilities in some armed conflict and the Center co-sponsored a discussion of the role of the World Health Organization in collecting data on assaults on health during conflicts with the World Medical Association, the Director of Global Health Affairs of the US Department of Health and Human Services, and IntraHealth International. 

With the support of the Center, WHO’s Department of Emergency Risk Management and Humanitarian Response will convene an expert consultation on means and methods of data collection.

The Center is collaborating with the Karen Human Rights Group, Back Pack Health Worker Team, the Burma Medical Association and the Karen Department of Health and Welfare to develop an instrument that can be used to develop systematic data on assaults on health.

The Center has urged the UN Special Representative of the Secretary General for Protection of Children in Armed Conflict and its partner UNICEF to ensure that it collects information on the full range of attacks that violate international humanitarian, and has prepared a legal analysis to support its recommendations.


The Center is collaborating with the International Committee of the Red Cross to review the practices of military forces and non state actors that could be changed to prevent attacks on health in the first place.   Senior Scholar Leonard Rubenstein spoke at the 31st Quadrennial Conference of the ICRC, Red Cross and Red Crescent Societies and States Parties to the Geneva Conventions at a workshop on Using New Technology to Addressing the Problem of Insecurity of Access to and Provision of Health Care in Conflict and Other Situations of Violence and will speak at a symposium to sponsored by ICRC, the British Medical Association, the British Red Cross and the World Medical Association in London on responsibilities of the health community to increase greater security of health care in armed conflict and strategies can it recommend to achieve it.

The United States Department of Defense has agreed to host a workshop on military practice, to be held late in 2012.


Perpetrators of attacks must be held accountable through all the diplomatic, human rights, and legal mechanisms available.

The Center provided evidence to the UN Security Council to support a resolution to extend the “name and shame” accountability mechanism available under the program to protect children in armed conflict to attacks on hospitals and medical personnel [link to document B] and schools, an initiative supported by non-governmental organizations as well [link to document C and ].  In July, 2011, the UN Security Council adopted resolution 1998 to achieve that goal. [LINK to]  The Center will provide support to the Special Representative of the Secretary General on Children in Armed Conflict regarding implementation of the resolution.

In December, 2011, states parties to the Geneva Convention adopted a resolution calling for greater accountability, including strengthening and enforcing criminal law.


Rubenstein, L and Bittle, M, Responsibility for Protection of Medical Workers and Facilities in Armed Conflict, Lancet 2010;375:329-340

Blog posts

Leonard Rubenstein and Katherine Footer, WHO steps up and addresses the issue of attacks on health workers and facilities, PLOS Blog 

Leonard Rubenstein, Health in Conflict-Affected States: Valuable Lessons and Unanswered Questions

Leonard Rubenstein, Turning a Corner on Protection of Health Workers and Facilities?  Global Health Council Blog 4 Global Health. 

In the News...

Just Released: Safeguarding Health in Conflict Coalition’s 3rd annual report: No Protection, No Respect. The report details attacks on health care facilities, infrastructure, workers, and patients during 2015 and the first quarter of 2016.
Congratulations! Director Chris Beyrer to be installed as first Desmond M Tutu Professor of Public Health and  Human Rights.
News: African academinc challenge homophibic laws. Read here.
Listen! CPHHR Director Chris Beyrer discusses the AIDS Pandemic on Minnesota Public Radio.
New Publication: Sexual violence against female sex workers in the Gambia
Just Released! New JAIDS Special Issue: HIV Risks and Vulnerabilities Among Key Populations in West and Central Africa - Evidence to Inform HIV Prevention, Treatment, and Care
Join Us: March 31 4-5:30pm in Sheldon Hall for 'Health Transitions in Myanmar: 2015'
New Report: Syrian Medical Voices from the Ground: The Ordeal of Syria’s Healthcare Professionals.
Free: Editors of The Lancet have identified important articles from their respective journals to highlight World AIDS Day. They're freely available Dec. 1-31, including the Series on HIV and Sex Work.
Hot News! CPHHR Director Chris Beyrer has been appointed to the UNAIDS Scientific Experts Panel and is a newly elected member of the Institute of Medicine.
Just Released! The Lancet Series on HIV and Sex Work was recently released at AIDS 2014 in Melbourne. Congratulations to the team on an incredible Series!
New publication: MSM in Malawi: a qualitative assessment of health seeking and provision practices
New Publication: GBV in Conflict: Displaced Women in Colombia
Article: Sex Work Criminilization and HIV - Facing Reality
AIDS 2014: The 20th International AIDS Conference is fast approaching! The newly released destination guide is a great resource for LGBT attendees.
Just released! On the frontline of eastern Burma’s chronic conflict - Listening to the voices of local health workers in Social Science and Medicine. Full article.
New Report: The full report from the conference on the protection of health workers, patients and facilities in times of violence is now available.
Post-Doc Position: The CPHHR is looking for a post-doctoral research fellow to conduct analysis of quantitative data from studies with MSM in several settings. Details and application instructions.
Call to Action: Len Rubenstein recently convened a group of experts to address the issue of protection of health workers, patients and facilities in times of conflict. The Call to Action is available here.
Tribute: Please visit the IAS website for a tribute to Nelson Mandela, as well as links to his AIDS conference speeches.
New Reports: OSF profiles 11 access to justice projects in their new report Bringing Justice to Health. Read.
Just out: The Task Force on Preserving Medical Professionalism has found that since 9/11/2001, the DoD and CIA have involved U.S. military and intelligence agency health staff in activities that inflicted severe harm on detainees in U.S. custody. Read.
New Reports! Meeting the HIV-related needs of gay men, other MSM and Transgendered persons worldwide. Read.
Just Released: 'A Human Rights Approach to Heath and Conflict' by Center faculty Katherine Footer and Len Rubenstein. Read.
New Report: Center faculty have just published a new report 'Social and Structural Risks for HIV among migrant and immigrant MSM in Moscow." Read.
Just Released: Turning surveillance into support for MSM in Africa. Read.
HOT NEWS! The US Supreme Court ruled that Groups receiving federal money to combat AIDS abroad may not be required to adopt policies opposing prostitution. Read the full article here.
New Report: A new project lead by Dr. Stef Baral highlights HIV risk among MSM in Malawi and the discusses the need for data. Read.

New! Center faculty have published a new article"Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics" available here.

Read! Center faculty have published a new article 'Modeling the impact of HIV prevention and treatment for MSM on HIV trajectories in LMICs. Read.
Exclusive: The AMA has written to Secretary of Defense Hagel concerning allegations that detainees on hunger strike are being force-fed with assistance from physicians. Click here to view the letter.
Just out! Center faculty member Len Rubenstein published an article in Foreign Affairs describing issues of compromised medical care in conflict zones.
Hot News! The Huffington Post released an article on a recently published study on HIV among transgendered women, led by Center Faculty member Stefan Baral. Read.
New! The NYTimes published a letter comcerning a recent piece on attacks on Syrian doctors, written by Center faculty member Len Rubenstein. Read.
Update: HIV among MSM examined at CROI 2013. Read.
New! Click here for video of the CROI 2013 Plenary 'The Global HIV MSM Epidemic: Time to Act', by Center Director Chris Beyrer.
Hot Topic: The Center recently hosted the film "Beneath the Blindfold", which reveals the reality of life after torture. This informative documentary follows the lives of four torture survivors as they build new lives, careers and relationships. Please visit the website for more information.
Just Released! The eBriefing for the NYAS/CPHHR event 'New Paradigms of Risk and Protection: Understanding the HIV Epidemics among Gay and Bisexual Men' is now available on the NYAS website. Congratulations to everyone who worked together and made this event a tremendous success!
Congratulations! Gift Trapence attended the LGBT Human Rights Defenders event at the UN in NYC with Secretary General Ban Kyi-Moon, Yvonne Chaka Chaka and Ricky Martin as a leader in the fight against homophobia. Congratulations on this incredible honor!
Just Released: 'Free and Equal', a booklet published by the UN human rights office describes sexual orientation and gender identity in international human rights law. Read.
New Report: 'Impact of Maternal Depressive Symptoms on Growth of Preschool- and School-Aged Children', just published in Pediatrics, found that Maternal depressive symptoms during infancy may affect physical growth in early childhood. Congratulations to the Center's Pam Surkan and team on this interesting article. Read. Article.
Hot News! Burma's Daw Aung San Suu Kyi spoke via video to the International HIV/AIDS Conference in Washington D.C. on Thursday about ending the stigma experienced by many HIV/AIDS patients. Read. 
New Video! Burma's Aung San Suu Kyi accepts Nobel Peace Prize in Oslo, Norway. Watch Video.

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