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.
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.
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 http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/411/18/PDF/N1141118.pdf?OpenElement] 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
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.