Guest post by Leonard Rubenstein and Katherine Footer.
The consternation of the international community in response to attacks on health workers, patients and facilities during conflict has for years been combined with passivity in response to these acts of violence. This week, though, the World Health Assembly, meeting in Geneva, signaled that that the World Health Organization is prepared to take concrete steps toward securing greater respect for international norms on the sanctity of health even in times of war and civil unrest.
Despite firm standards rooted in the Geneva Conventions and human rights law to protect health facilities, health workers, and the patients they serve during conflict or in times of civil strife, assaults on and interference with health functions are common. In Bahrain recently, security forces attacked ambulances, obstructed hospital access and arrested doctors. These assaults grossly violate the human rights of health workers – indeed they are crimes – that deny people health care in the most urgent circumstances, and unlawfully intimidate political opponents.
The attacks also fundamentally undermine the ability of doctors and nurses to adhere to their ethical duty to treat people irrespective of the political views or affiliation of the person in need of care – a duty protected under international law. The longer-term impacts of conflict are equally severe. They include the loss of health infrastructure, flight or departure of health workers and the hampering of public health control measures such as disease control and vaccination programs.
That the international community has taken few steps to promote compliance with laws demanding respect for health functions or even to assess and report on violations in a uniform and comprehensive manner remains an anomaly at a time when protection of human rights has become of such universal concern. Sound methodologies for data collection of assaults have consequently not been developed. The lack of systematic reporting and documentation in turn contributes to continued disregard for an established and internationally recognized legal framework for protection. Thus, a critical first step is to devise methods for the collection of this evidence.
That is why WHO leadership is so important, as it has a mandate to assure the collection of standardized, quality data on global health and shape a research agenda in health. On May 12, 2011 sixteen medical, human rights, development, and humanitarian NGOs urged WHO to exercise this responsibility by convening an expert group to address means to develop the evidence of attacks that can provide a platform for others to develop protection strategies and accountability mechanisms. The Obama Administration endorsed this approach. The need for action was reinforced by a planned briefing at the Assembly by the Johns Hopkins Bloomberg School of Public Health along with the US Government, the World Medical Association, and the NGO IntraHealth International, to highlight the need and capacity for WHO to place expertise at the forefront of tackling the problem of attacks on health workers and facilities. The International Committee of the Red Cross, which has stood virtually alone in seeking to prevent attacks, made clear that participation by WHO remained essential.
With this push from NGOs, academic centers, the ICRC and the Obama Administration, the Director General acted. In her opening address to the Sixty-Fourth World Health Assembly WHO Director General Margaret Chan said, “We are extremely distressed by reports of assaults on health personnel and facilities in some of these conflict situations. We urge all parties to ensure the protection of health workers and health facilities in conflict situations, to enable them to provide care for the sick and injured.” It was more than rhetoric, as WHO’s Health Action in Crisis unit, in cooperation with academic partners, NGOs, and member states, began to explore a way forward.
There are encouraging signs that other entities and institutions will to engage in the work of prevention and accountability. The International Committee of the Red Cross plans to launch a campaign this summer and place the protection of health workers, patients and facilities on the agenda on November’s Quadrennial International Conference of the Red Cross and Red Crescent societies and States Parties to the Geneva Conventions. The UN Security Council is likely to consider a resolution in July, 2011 to expand the trigger for UN monitoring and reporting mechanisms on children and armed conflict to include attacks on schools and hospitals. The U.S. State Department is also considering including reporting on attacks on health functions in its annual human rights reports.
The 64th World Health Assembly May is just a start to what will be an arduous process, but it marks an important milestone in the struggle to begin the journey towards protection of critical health functions in times of social stress and violence. The days when brutality against health functions provokes no more than a listless response may finally come to an end.
Leonard Rubenstein is Senior Scholar and Katherine Footer is a Visiting Scholar at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. The authors declare no competing interests.