Attacks on health care Q&A
27 November 2019 | Q&A
Background
Health care is under attack. The sanctity of health care, the right to health, and International Humanitarian Law are threatened. Such attacks deprive people of urgently needed care, endanger health care providers, and undermine health systems.
In 2012, World Health Assembly Resolution 65.20 was adopted, which requested WHO to provide leadership at the global level in collecting and reporting information on attacks on health care. WHO subsequently created the Attacks on Health Care (AHC) initiative to systematically collect evidence on attacks on health care, to advocate for the end of such attacks, and to promote best practices for protecting health care from attacks
Goal
The vision of the initiative is that essential life-saving health services must be provided to emergency-affected populations unhindered by any form of violence or obstruction.
Ultimately, WHO seeks to ensure that:
- health workers everywhere can provide health care in a safe and protected environment;
- health workers are protected, resilient and equipped with knowledge and resources;
- parties to conflict understand and uphold their responsibilities under International Humanitarian Law;
- health care delivery is not disrupted by attacks; and
- all forms of violence against health care stop.
Objectives
To achieve this mission, three main objectives and work streams of the initiative have been established:
- Develop a body of evidence on the nature and extent of attacks on health care;
- Increase commitment to action through strong advocacy to end attacks;
- Assess the impact of attacks on health care delivery, and document best practices to prevent and mitigate consequences of attacks.
WHA Resolution 65.20 (2012) called on WHO’s Director-General to provide global leadership in the development of methods for systematic collection and dissemination of data on attacks on health facilities, health workers, health transport and patients in complex humanitarian emergencies, in coordination with other relevant United Nations bodies and partners.
The initiative was created in response to this resolution with the understanding that data collection needs to be supported by other areas of work, such as strong advocacy and guidance on how to prevent attacks and increase resilience of health systems, in order to adequately address the issue.
WHO defines an attack on health care as any act of verbal or physical violence or obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies.
Examples of types of attacks on health can include
- Violence with heavy weapons
- Violence with individual weapons
- Obstruction to delivery of care
- Psychological violence/threat of violence/intimidation
- Militarization of health care asset
- Assault without weapons
- Chemical agent
- Removal of health care assets
- Arson
- Sexual assault
- Armed or violent search
- Abduction/arrest/detention of health workers or patients
Attacks not only endanger health care providers; they can also deprive people of urgently needed care. The full extent of the impact of attacks on health care is not yet known. The short-term and more immediate effects are better understood in terms of the facilities or health workers lost, but a more in-depth investigation of the mid- to long-term impact is required. WHO aims to better understand these consequences as defined under the third objective of the initiative- investigating the impact of attacks on health care to the health of the affected populations and health service delivery, availability and accessibility. Furthermore, WHO seeks to document best practices undertaken by health actors to prevent attacks and mitigate the consequences of attacks. These findings will help to generate evidence-based recommendations for health actors to implement at the country level.
Attacks on Health Care dashboard- Secondary data collection
At WHO HQ, monitoring of secondary sources on the internet is undertaken daily to capture any potential attacks made against health care. Since not all countries are reporting to the SSA currently, and since the SSA can also fail to capture all attacks, the secondary source data allows for a better understanding of other countries where the SSA is not being used, and to triangulate the SSA data. The secondary data is compiled and analyzed quarterly, with statistics published on the Attacks on Health Care dashboard to the Attacks on Health Care website. Secondary data is not verified by WHO.
Surveillance System for Attacks on Health Care (SSA)
The SSA is a global, standardized monitoring system to collect primary data of attacks on health care. WHO works closely with partners on the ground to gather relevant information which is then reviewed by the WHO country office and published in near-real time to a publically available web site. The SSA is currently being rolled out to emergency affected countries and fragile settings that are priority areas of the WHO Health Emergencies Programme.
The SSA publishes a limited number of data points that are collected by WHO to protect the confidentiality of sources and to prevent any further harm to survivors of an attack and affected population. Information such as the date of an attack, type of attack that occurred and affected health resources are publicly available. Furthermore, the SSA website aggregates the global data and allows users to filter the data for tailored analysis.
WHO is working closely with the Global Health Cluster and Health Clusters in each country where the initiative is rolled out. WHO country offices also engage with non-health partners at the country level who have experience on this issue, such as the Office for United Nations High Commissioner for Human Rights.
Additionally, WHO works with ICRC’s Health Care in Danger initiative, Safeguarding Health in Conflict Coalition and Médicins Sans Frontières Attacks on medical care program.
WHO participates in the Friends of Security Council Resolution 2286 working group in Geneva and regularly briefs Member States on the progress of the initiative.
WHO is developing an advocacy strategy which includes a work plan linking action undertaken at the country, regional and global levels.
WHO participates in all relevant global-level fora and coordinates regularly with other agencies who are advocating on this issue to highlighting the problem and action to be taken.
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