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ICRC highlights dangers facing aid workers

Libyan hospitals faced staff shortages when health works fled the uprising Reuters

In the first in-depth report of its kind, the International Committee of the Red Cross (ICRC) has looked at the dangers facing medical staff in conflict zones.

The report’s lead author, Robin Coupland, has spent seven years working as a war surgeon, and tells that basic respect for the neutrality of the Swiss-run ICRC and the Geneva Conventions is eroding.

“Healthcare in danger: making the case”, published this month, cites bombing attacks on medical centres and the prospect of jail as just some of the problems facing humanitarian workers.

“In Sri Lanka and in Somalia hospitals are bombed. In Libya and Lebanon shots are fired at ambulances. In Bahrain, medical staff are brought before the courts, after treating demonstrators. And in Afghanistan the injured languish for hours in vehicles held up at border check points,” says the report.

Elsewhere, from Colombia to Gaza, the neutral status of medical operations, the staff and vehicles is ignored, as they come under attack or are taken for military gains, he says. Why was this report released?

Robin Coupland: The subject is not new. It’s even at the heart of why our organisation was founded 150 years ago. But we haven’t carried out an in-depth investigation of the problem until now. Also, recent and current conflicts have often happened in urban areas and involved existing hospital structures, while in the past our work was on the battle field with two opposing armies and where each side had their own hospitals in the field.

When clashes happen in cities, the injured are taken to existing hospitals, often accompanied by their families who pressure and even threaten medical staff. These families can also become victims when hospitals, ambulances or medical staff come under attack.

In short, civilian hospitals and their staff are today very often drawn into conflicts between regular forces and rebel groups, known as asymmetrical war.

The aim of our report is to stress that security is an absolutely essential condition for delivering care. Our study also shows that every attack which affects the healthcare system – kidnapping, attacks on ambulances, hospital bombings – seriously deprives many civilians of care or interrupts their continued treatment. Hundreds of thousands of people can therefore be end up being affected. Your report talks of an urgency in addressing issues. Are healthcare services increasingly coming under attack?

R.C.: We do not have a way of comparing. But these acts are reported more and more frequently in the media.      

If we look at our activities on the ground, we had 13 countries affected by this problem in 2008, while 34 countries were affected in 2010. Our study was carried out in 16 countries and recorded 655 acts of violence against healthcare services.  And we have also integrated  new cases following the events in North Africa and the Middle East. Are attacks on healthcare services also being used as a weapon of war?

R.C.: What we are sure about is that healthcare services are today a part of conflicts on both sides. If one of the sides wants to send out shockwaves, it deliberately attacks a hospital, as has happened in Iraq, Somalia and Afghanistan. 

In addition, in this context healthcare staff become credible, working witnesses, and therefore a target for armed or security forces. Respect for the injured and the people treating them is nonetheless a founding principle of the ICRC and the Geneva Conventions. Is this principle now crumbling?

R.C.: This basic principle is not always respected. And changes in the nature of conflicts makes this problem more acute than ever. In traditional conflicts, the injured are armies who are treated by army doctors, each side has its own hospitals in the field. Today, civilian hospitals are finding themselves in the middle of warring sides.

That is a big problem. But we can’t look to the healthcare services for the answer. It is the military, the political leaders, the armed groups who should be involved. That is the reason why we have begun a four year project during which we are going to be taking legal, diplomatic and educational action directed at these groups and will hold humanitarian talks on the ground with all those involved, including armed groups.

Libya case study

“Libya, where a large proportion of the medical workforce was made up of migrant workers, has experienced an exodus of professional health workers since the uprising at the start of 2011.

In February, when foreign governments ordered their citizens to leave the country, many vital medical structures, notably hospitals  in Benghazi and Misrata, suddenly found themselves in a critical situation with insufficient staff.

Today this shortage has repercussions not only for people injured in combat but also for Libyans suffering from chronic illness and needing regular care.”

(Case study completed before events of August 21).

Iraq case study

“In 2003 in Baghdad the pillaging of hospitals and the destruction of infrastructure and storage units for medical supplies took place on such a large scale that the health system in the city literally collapsed. Hospitals were forced to shut, abandoning the injured and the dying.”   

(Extract of “Healthcare in danger: making the case”)

(Translated from French by Jessica Dacey)

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