Health Care in Danger: the ICRC Project

Wilson_edited-1 (05.11.12) In an earlier blog I reported on the Conference on Violence in the Health Sector held last month in Vancouver, Canada. Presentations at the conference highlighted the reality and extent of violence in the workplace against health care workers around the world; a problem that is increasing in magnitude.

An additional aspect of this problem, reported at the conference, is violence against health care workers and patients in areas of armed conflict. Robin Coupland, FRCP, Medical Advisor, Assistance Division, International Committee of the Red Cross (ICRC), gave a report on the ICRC's "Health Care in Danger" campaign.

Over the next four years this initiative will seek to address the widespread and severe impact of illegal and sometimes violent acts that obstruct the delivery of health care, damage or destroy facilities and vehicles, and injure or kill health-care workers and patients in armed conflicts and other emergencies.

Foundational to that effort is a study conducted by Dr. Coupland and published in 2011.  The study provided an analysis of reports collected over a two and-a-half year period describing violent incidents affecting health care (patients and health care workers) in countries where the ICRC is operational. These reports were obtained from humanitarian agencies, including the ICRC, and from open sources such as the media and websites. The grim statistics include:

  • All sources, 32 months
  • 16 countries
  • 655 events
  • 727 people killed
  • 1101 people wounded
  • 166 people kidnapped
  • 128 denied access to care or care removed
  • 188 threatened
  • 462 health care facilities damaged
  • 92 arrested
  • 35 robbed

State armed forces and armed groups were equally responsible. Explosive devises and firearms were the predominant weapons used.

As was pointed out in the study, "the means to address this problem do not lie within the healthcare community; they lie first and foremost in the domain of law and politics, in humanitarian dialogue and in the adoption of appropriate procedures by State armed forces."

Tangible solutions to this problem will be devised during expert workshops organized in partnership with National Societies, States, members of health-care organizations and non-governmental organizations (NCOs). Through a series of regional conferences, the ICRC and the Red Cross/Red Crescent Societies will review the conclusions and recommendations of the workshops and encourage States to endorse and implement them.

As Dr. Coupland appropriately pointed out, the concern about the safety of health care workers should not in any way minimize the importance of the safety of patients. However, the reality is that the most important prerequisite for health care professionals to be able to provide care in these challenging circumstances (armed conflict) is personal security. Absent that, it is difficult to provide the best quality care and patients suffer.

In addition a single act of violence that damages a hospital or kills health-care workers has an ongoing effect, depriving many patients of treatment they would otherwise have received from the facility or workers in question. For example, the killing of six ICRC and Red cross nurses in Novye Atagi, Chechnya, on 17 December 1999, deprived an estimated 2,000 war-wounded per year of needed surgical care. The effect on the wounded and sick of just one violent incident directed against medical personnel or facilities may be felt by hundreds or even thousands of people.

There is an adage that "what gets measured gets done". To their great credit Dr Coupland and the ICRC have provided a groundbreaking study that measures the impact of one of today's major humanitarian issues - violence against health-care workers and beneficiaries in areas of armed conflict. In addition, they have provided a road map to move toward solutions. I look forward to those solutions.

WMA President Cecil. B. Wilson, MD travels around the world talking about the WMA's work representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavors to achieve the highest possible standards of medical care, ethics, education and health related human rights for all people. This blog will chronicle these travels and important issues.