Documentation Vital to Ending Attacks on Health Care Workers

2014 was a distressing year for health care workers in conflict areas around the world, as attacks on medical professionals and facilities were carried out in numerous countries. As these attacks continue, they must be appropriately documented in order to increase available information, raise awareness, and find appropriate solutions that facilitate accountability and ultimately prevent future violence.

In the past year, polio vaccination teams in Afghanistan, Nigeria, and Pakistan have all been under threat. In Pakistan, these teams lost at least 42 people, including polio workers, UN staff, NGO personnel, and police escorts, between January and November 2014. An additional 18 people were injured and 19 kidnapped. Health care workers were also under attack in eastern Ukraine, Gaza, and regions of Iraq held by the self-declared Islamic State – all areas where hospitals have been bombed. In South Sudan and Central African Republic, medical facilities were looted and destroyed, and patients and civilians executed.

In a positive step – which reminded the international community just how appalling and widespread attacks against health care have been – the UN General Assembly passed a resolution in December calling for the protection of medical workers and facilities from violence. Among other recommendations, this call to member states and other concerned parties stresses cooperation and coordination between relevant institutions in efforts to collect “data on obstruction, threats and physical attacks on health workers.” While disturbing statistics on violations against medical workers surfaced in 2014, the numbers are likely underreported due to challenges in documentation and research. This resolution, therefore, comes at a crucial time and illustrates how multiple actors, ranging from local and national structures to international institutions, must work together in order to better document attacks.

The targeting of health care in Syria has reached egregious proportions as well. Physicians for Human Rights (PHR) has documented 86 attacks on 69 medical facilities and the deaths of 178 health care workers in 2014 alone. At PHR, a significant portion of our investigative work entails researching open source information on attacks on health care. Social media provides a lot of initial data on Syria, which informs our more in-depth research and corroboration of attacks. However, in Sub-Saharan Africa, reports on social media have been scarce, due to sparse access to technology.

An important question around documentation of attacks on health care is who is responsible for detailing these atrocities. A November 2013 conference convened by the John Hopkins’ Center for Public Health and Human Rights concluded that as many parties as possible – ranging from international institutions and human rights organizations to health ministries and NGOs – should actively participate in the process of documenting attacks against health care. Interestingly, the first witnesses of these attacks are often the medical service providers themselves. Therefore, they also have a critical role to play in taking an early account of the nature of such attacks against facilities, patients, or personnel before secondary witnesses arrive on the scene.

This nonetheless introduces some significant concerns. Would health care workers lose their neutrality if they assume this specific duty? Would they come under added danger? Would they have the necessary expertise, resources, and time to document, while also completing their primary medical duties on the frontlines?

As to the possible loss of neutrality, merely documenting experiences and events would not subject a doctor to a charge of bias. If an armed group carries out an attack against a medical facility, pointing out this fact is not an act of partiality. And while recording attacks alone will likely not put medical workers in danger, the dissemination of that documentation must be completed with extreme caution, and personnel’s safety must be prioritized.

On the frontlines, health care workers who are often eyewitnesses to extreme violence need support in documenting such attacks. Health ministries, particularly in peace time, must train medical workers in the techniques of documentation. Mechanisms for reporting violations must be established and strengthened so they can function during conflicts. International assistance from UN bodies and the International Committee of the Red Cross (ICRC) –monitored by civil society and right groups – is crucial, especially when national governments are sometimes the perpetrators. The World Health Organization and the ICRC must maintain and improve access points with local health care providers so documentation and information can be transmitted through these conduits should health care be in danger.

During present-day armed conflicts, medical professionals are – deliberately or indiscriminately – made victims of recurrent attacks. It is imperative to train health care professionals on how to document assaults against them and their facilities in order for them to continue providing lifesaving care on the frontlines. With training, the establishment of structures through which proper documentation can be completed and transmitted, and national and international instruments of support, local medical facilities have a greater chance of reporting attacks on health care. Civil society, media, governments, and international institutions play equally important roles in ensuring that such violations are brought to light and that such violence is eventually prevented altogether.

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