“In Syria, having a medical kit visible on your car seat can be more dangerous than having a Kalashnikov”, says Bruce Eshaya-Chauvin, medical adviser to the International Committee of the Red Cross (ICRC). “Health-care workers in conflict zones are literally being hunted down.”
Eshaya-Chauvin was talking at an ICRC conference about violence against health-care workers in London, UK, on Dec 3. The ICRC, along with key players in global health such as the World Medical Association (WMA), the British Medical Association (BMA), and Médecins Sans Frontières (MSF), is spearheading a project called Healthcare in Danger to raise awareness of the way that medical workers in war zones are targeted.
The Geneva Conventions and human rights laws to protect sick people during conflict state that all wounded and sick must have access to medical assistance, but this international framework is frequently flouted. For many in the humanitarian community, this situation is reaching a crisis point that requires urgent action both internationally and on the ground.
A 2011 report by the ICRC recorded violent acts in 16 countries and gives some insight into the perpetrators and the victims, and shows how indiscriminate this violence is. The state was responsible for a third of the events, and armed groups for another third. A point worth highlighting, says Eshaya-Chauvin, is that attacks are not just aimed at international humanitarian workers—in many situations, local medical staff bear the brunt of the attacks. Indeed, international non-governmental organisations (NGOs) were affected in 34·5% of attacks, and local health-care workers in 25·6%.
The violence is often brutal. Health-care workers might be beaten severely, kidnapped and tortured, or shot at by snipers. Those seeking health care might be killed on their way to hospitals, and those hospitals themselves might be the target of gunfire and bombing. Armed forces on either side of the conflict regularly block ambulances or destroy medical supplies.
Providing health care in conflict zones is obviously inherently dangerous, but sometimes the level of violence aimed at health-care workers—irrespective of how neutral they are—means that providing humanitarian aid can become untenable.
This August, for instance, MSF was forced to pull out of Somalia after 22 years because the extreme security situation meant that the NGO could no longer ensure the safety of their staff. By the time MSF left the country, 16 of its workers had been killed since 1991, and several staff had been attacked.
Whether or not violence against health-care workers is on the rise is debatable. For one thing, data are fairly scarce. A seeming rise in violent attacks could also be due to increased levels of reporting. What is certain is that violence against humanitarian workers in war zones isn't new, says David Nott, a consultant general surgeon at Chelsea and Westminster hospital in London who has provided emergency care in conflict zones for the past 20 years. The first time he was shot at, in an ambulance in Bosnia in 1993, he “was very shocked. I never knew things like that could happen. It was an eye-opener.”
Then in Darfur, the ambulance he was in was stopped by children wielding AK-47s. “They were very young—about 9 years old—and it would have been impossible to explain to them who we were. They've never seen people like us—they think you're from Mars.” Negotiation being impossible, the doctors got through by stepping on the accelerator and driving as fast as they could.
These anecdotal reports have been crucial in raising awareness, but a key focus now is on gathering comprehensive data. “I know doctors always say they want more data, but in this case it is vital”, says Vivienne Nathanson from the BMA.