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At Least 1,335 Attacks and Threats to Health Care Perpetrated in Conflicts in 2021, Marring Health Systems: Report

Health facilities and health workers were subjected to devastating and widespread violence and obstruction of care in 49 conflict-affected countries in 2021.

A new report published today by the Safeguarding Health in Conflict Coalition, based on data collated by coalition member Insecurity Insight, identifies 1,335 incidents of violence or obstruction against health care perpetrated in 2021.

The report finds that in 2021, 161 health workers were killed and 320 were injured in attacks on health care. 170 health workers were kidnapped while 713 were arrested. Health facilities were destroyed or damaged in 188 incidents, and on 82 occasions, militaries occupied health facilities. 111 health transports were destroyed or damaged, while 64 health transports were stolen or hijacked.

The figures – drawn from credible media reports as well as reporting by intergovernmental organizations, states, non-governmental organizations, and aid agencies – is likely a severe undercount, due to underreporting in many places around the world.

“The world’s attention has understandably focused on Russia’s invasion and its apparent strategy of targeting hospitals and ambulances, with more than 200 attacks on health care in Ukraine confirmed by the World Health Organization through the end of April,” said Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition and professor at the Johns Hopkins Bloomberg School of Public Health. “Such violence against nurses, doctors, and other health workers, however, takes place throughout the world and amounts to a global crisis.”

Attacks on health in 2021 were perpetrated in new or escalating conflicts such as in Ethiopia, the occupied Palestinian territories, and Myanmar, as well as in long-standing wars around the world, including in Syria, Yemen, and across the Sahel region.

“Global leaders – the UN Security Council, political leaders, militaries, and ministries of health – must move from rhetoric to action and take concrete steps to stop attacks on health care and hold perpetrators to account,” said Joe Amon, Director of Global Health, Dornsife School of Public Health at Drexel University.

The report highlights how attacks on health have damaged health system across the world, interrupting both acute care and programs addressing COVID-19, HIV/AIDS, tuberculosis, malaria, and other infectious and chronic diseases.

Three-quarters of the health facilities in Ethiopia’s Tigray region were destroyed in the conflict that began in November 2020. In Gaza, in the spring of 2021, 30 health facilities were damaged. In Myanmar, the public health system has all but collapsed since the coup in February 2021 and more than 300 health workers have been arrested. Attacks on health care also continued in protracted conflicts such as in Afghanistan, the Central African Republic, and the Democratic Republic of the Congo.

The number and type of incidents included in the report represent only those incidents where information was available from reputable sources. The reported numbers of incidents by country or by year should not be compared to those of other countries or years without considering the factors that affect the flows of information, such as the internet shutdown by authorities in Ethiopia and Myanmar and inconsistent reporting of attacks on health care.

“Only a fraction of attacks on health care are reported and the numbers of incidents in our report is surely an underestimate,” said Christina Wille, director at Insecurity Insight and led the data collection and analysis. “Violence against health care resulted in widespread impacts on public health programs, vaccination campaigns, and population health, contributing to avoidable deaths and long-term consequences for individuals, communities, countries, and global health writ large.”

The report sets out several recommendations to the UN Security Council, the World Health Organization, Ministries of Health and Defense, legislators, and medical, nursing, and public health organizations. Specifically, the Coalition called on:

  • The UN Security Council to refer to the International Criminal Court (ICC) credible reports of war crimes involving the targeting of health facilities, health workers, health transports, or the wounded and sick;
  • Governments to use their powers under principles of universal jurisdiction to prosecute war crimes committed against health care;
  • The World Health Organization to reform its Surveillance System for Attacks on Health Care to cover all conflicts and provide meaningful information about the circumstances, location, and perpetrators of attacks;
  • Military chiefs of staff to review and reform military doctrine, practice, and training to prevent attacks on health care;
  • Governments to reform their laws to end criminalization of the provision of health care in accordance with professional ethics; and
  • Ministers of health to expand efforts to protect health care in conflict and to engage with their military and security forces, peacekeepers, armed groups, and front-line health workers to protect health care from violence.

“Those in a position of authority and power, including political, military, and health leaders and UN institutions, must accompany their statements and declarations with meaningful actions. Six years after passing Security Council Resolution 2286, countries have made no significant progress in enacting its requirements. The unrelenting horrors in Ethiopia, Myanmar, Haiti, Yemen, Ukraine, and beyond should be the overdue wakeup call for world leaders to defend besieged doctors and nurses around the globe,” said Houssam al-Nahhas, Middle East and North Africa Researcher at Physicians for Human Rights.

Information on the Safeguarding Health in Conflict Coalition:

The Safeguarding Health in Conflict Coalition is a group of more than 40 organizations working to protect health workers and services threatened by war or civil unrest. SHCC has raised awareness of global attacks on health and pressed United Nations agencies for greater global action to protect the security of health care. The coalition monitors attacks, strengthens universal norms of respect for the right to health, and demands accountability for perpetrators.

The Steering Committee includes: Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, IntraHealth International, Human Rights Watch, Insecurity Insight, International Council of Nurses, International Federation of Medical Students’ Associations, Johns Hopkins Center for Humanitarian Health, Management Sciences for Health, Medact, Office of Global Health, Drexel Dornsife School of Public Health, Physicians for Human Rights, Syrian American Medical Society, Watchlist on Children and Armed Conflict, and Human Rights Center, University of California, Berkeley School of Law.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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