Professor Sir Andy Haines, London School of Hygiene and Tropical Medicine on Health Care in Danger

8/2/2019 Professor Sir Andy Haines, London School of Hygiene and Tropical Medicine on Health Care in Danger

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Health Care in Danger

Professor Sir Andy Haines

Building a community of concern- aresponsibility of health professionals


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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


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The need for systematic datacapture 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 ofviolence health-care staff leaving

their posts, hospitals running out of

supplies and vaccination campaigns


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Documenting the problems systematic

collection and synthesis of data (a role forWHO?)

Assessment of high risk situationsAnalysis of overall impact on health care

delivery and public health- millions atrisk


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Indiscriminate attacks on hospitals/health

facilities e.g. shelling of Puthukkudiyiruppu

hospital Sri Lanka 2009

Ethnic targeting of facilities e.g. burning ofUzbek-run clinic in Kyrgyzstan 2010

Attempts to free wounded e.g. 3 militants

disguised as police killed visitors, staff in

Lahore, Pakistan 2010


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Threats/attacks against staff for treating

enemy wounded e.g. Afghanistan, Colombia,El Salvador, Kosovo, Chechnya, East Timor,

Philippines. In some cases authorised underlocal anti-terrorism laws

Attacks on doctors as community leaders e.g.Bosnia, Iraq

Attacks on ambulancese.g. Iraq, Nepal, Mexico,

Colombia, Libya, Yemen,

Occupied Palestinian territory


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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, ZabihullahMujahid, a Taliban spokesman, told IRIN.

http ://www.afghanistannews.net/story


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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 ofHealth Professionals (1997)

BMA letter to Syrian Government


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Particularly when fighting occurs in denselypopulated urban areas e.g. Libya, Yemen,

Rwanda, Serbia, occupied Palestinian

Territory


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47 Doctors and Nurses detained in BahrainThe 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 UK-

UNISON, BMA

Troops guard an entrance to Salmaniya Hospital


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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 ofmigration of health professionals in non-

conflict situations e.g. nearly 40 % in S.Africa

and 20% in Zimbabwe of those intending to

migrate.( WHO AFRO 2004 report)


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E.g. Nepali doctors undertook vigorousprogramme of activities e.g.-

Documented human rights violations

Organised protests against intimidation,

Resisted Govt. pressure not to treat wounded

rebels

Organised international support


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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.


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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. betweenhealth and legal researchers


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A neglected topic with wide rangingimplications 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.

Professor Sir Andy Haines, London School of Hygiene and Tropical Medicine on Health Care in Danger

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