Keeping health workers and facilities safe in war

Abstract

Robin Coupland knows what it's like to get caught up in conflicts. In Somalia, in the early 1990s, the former war surgeon was in the operating theatre when a colleague standing next to him was shot. There were no sandbags so we had to pile boxes of intravenous fluids against the windows he recalls. the past two decades Coupland, a medical adviser with the International Committee of the Red Cross (ICRC), has been working to reduce the likelihood of such incidents occurring through a mixture of advocacy and research, and. most recently by co-authoring an ICRC study titled Health Care in Danger, a first attempt to describe how and why health workers get caught in the cross fire, and what the consequences are when they do. study was released in August last year at the start of a four-year ICRC campaign to raise awareness around the problem and make a difference to health workers on the ground. harm done when health workers are attacked is not limited to the assault itself, but has a knock on effect that can deprive patients of treatment. This is one of the core messages of the study, which cites the example of the six ICRC health workers killed in the Chechen village of Novye Atagi (in the Russian Federation) on 17 December 1996, prompting the organization to suspend its operations in Chechnya. According to the study, this single incident deprived thousands of war-wounded of surgical care. But is health care, or are health workers, in more danger now than, say, 63 years ago when the Geneva Conventions were first drawn up? Susannah Sirkin, deputy director of Physicians for Human Rights, believes this is so. independent research and advocacy group has been gathering information about attacks on health workers and health institutions for years. The intensity of attacks, especially in terms of doctors being threatened, has increased, Sirkin says. But in the absence of reliable data on this phenomenon, Physicians for Human Rights, like the ICRC, can only make intelligent guesses about what is really going on. [ILLUSTRATION OMITTED] Coupland's guesses are based on two interesting observations. first is the way in which war itself is changing. The wounded and the hospitals are becoming integrated into the conflict'; he says, as wars are increasingly fought within rather than between countries with clearly defined fronts, where combatants are not always aware of these international conventions governing the way civilians should be treated. Because of the blurred nature of contemporary war, health facilities find themselves providing services to both sides of a conflict and exposing themselves in doing so. As Coupland points out, it is more common today for soldiers to enter a hospital to settle scores, for example, or indeed for government forces to come looking for insurgents and--as seen during last year's protests and uprisings in the Middle East--prevent doctors from treating opponents. Coupland's second observation is the ubiquity of cameras and journalists. What happens at a hospital is a focal point for the media, he says. In his opinion this makes health care not just an integral part of a conflict but also essential to the way the conflict is viewed by the outside world. Once again, media attention tends to bring people into the hospital who do not belong there. That's why people with experience in the field go to great lengths to avert such interference and when they open the hospital doors. Andrew Cunningham, Operations Adviser with nongovernmental organization (NGO) M6decins Sans Frontieres (MSF), for example, says that negotiating what he calls the parameters of intervention before starting operations is essential. For Afghanistan we spent about nine months communicating and negotiating with all the relevant military and paramilitary actors to create the neutral space in which we could work before starting the programme there, he says. …