{"id":2121,"date":"2017-01-12T09:30:13","date_gmt":"2017-01-12T09:30:13","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/01\/HCiD-toolkit-for-Doctors-2015.pdf"},"modified":"2017-01-12T09:30:13","modified_gmt":"2017-01-12T09:30:13","slug":"hcid-toolkit-for-doctors-2015-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/accueil\/hcid-toolkit-for-doctors-2015-2\/","title":{"rendered":"HCiD-toolkit-for-Doctors-2015"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

HCiD-toolkit-for-Doctors-2015<\/a><\/p>\n\n

Toolkit\tfor\tDoctors
\nWorking\tin
\nSituations\tof\tViolence\t<\/p>\n

A\tcontribution\tof\tthe
\nWorld\tMedical\tAssociation
\n\tto\tthe
\nHealth\tCare\tin\tDanger
\nInitiative\tof\tthe
\nInternational\tCommittee
\nof\tthe\tRed\tCross\t<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 2
\nTHE WORLD MEDICAL ASSOCIATION, INC.<\/p>\n

Original\tDoc:\tMEC\t201\/HCiD\ttoolkit\tfor\tDoctors\/Oct2015
\nPROPOSAL\tFOR\tA\tTOOLKIT\tFOR\tDOCTORS\tWORKING\tIN
\nSITUATIONS\tOF\tVIOLENCE
\nApproved\tfor\tpublication\tby\tthe
\n201st
\n\tWMA\tCouncil\tSession
\nMoscow,\tRussia,\t16th
\n\tOctober\t2015\t<\/p>\n

This\ttoolkit\tfor\tdoctors\tworking\tin\tsituations\tof\tconflicts
\nand\tother\temergencies\thas\tbeen\tdeveloped\tfor\tthe\tWMA
\nby\tthe\tBritish\tMedical\tAssociation\twithin\tthe\tframework
\nof\tthe\tproject\tHealth\tCare\tin\tDanger\t(ICRC).\t<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 3
\nIntroduction\t<\/p>\n

The\tWorld\tMedical\tAssociation\tbelieves\tthat\tmedical\tethics\tis\tidentical\tin\ttimes\tof\tarmed\tconflict
\nto\tthose\tin\ttimes\tof\tpeace.\t\tIn\tstating\tthis\tthe\tWMA\trecognizes\tthat\tthe\ttensions\twithin\tthe
\nethical\tdecision\tmaking\tthat\tdoctors,\tnurses\tand\tother\thealth\tworkers\texperience\twill\tdiffer\tas
\nthey\tare\tstrongly\taffected\tby\tthe\tclinical,\tsocial\tand\tenvironmental\tsituation,\tincluding\tthe
\npresence\tof\tarmed\tconflict.\t<\/p>\n

Some\texamples\tof\trelevant\tethical\tcodes\tare\tmade\tat\tthe\tend\tof\tthis\tdocument\tunder\tfurther
\nreading.\t\tThis\tincludes\ta\tset\tof\tEthical\tPrinciples\trecently\tagreed\tbetween\tthe\tWMA,\tICN,\tFIP\tand
\nICMM.\t<\/p>\n

All\thealth\tcare\tworkers\tshare\tresponsibility\tfor\tprotecting\tthe\tethical\trights\tof\tevery\tpatient,
\nincluding\twhere\tthey\tare\tworking\ton\tpublic\thealth\tissues,\tthe\trights\tof\tthe\tcommunity\tat\tlarge,
\nand\tas\thealth\tworkers\tthey\tmust\tbalance\ttheir\tduties\tto\ttheir\tpatients,\tthe\tpublic,\ttheir
\ncolleagues\tand\tto\tthemselves.\t\tIn\tdoing\tso\tthey\tare\tguided\tby\tethical\tstandards\tset\tout\tin\tcodes
\nand\tin\texplanatory\tdocuments\tby\tnational\tand\tinternational\tbodies,\tsuch\tas\tthe\tWorld\tMedical
\nAssociation\tand\tthe\tInternational\tCouncil\tof\tNurses\tas\twell\tas\tother\thealth\tcare\tprofessional
\ngroups\tsuch\tas\tmidwives\tand\tpharmacists.\t\tThese\tstandards\ttake\tnote\tof\tnational\tand
\ninternational\tlaws\tbut\tare\theld\tby\tmany\thealth\tcare\tprofessionals,\tincluding\tthe\tWorld\tMedical
\nAssociation\tto\thave\ta\thigher\tstatus\tespecially\tover\tdomestic\tlaws.\t\tWhile\tthe\tWMA\tand\tICN\thave
\nno\tdisciplinary\tpower,\ttheir\tguidance\tis\tregarded\tas\tbinding\ton\tdoctors\tand\tnurses\tby\tcourts\tand
\ntribunals\taround\tthe\tworld.\t<\/p>\n

Ethical\tstandards\tdo\tnot\ttell\tdoctors,\tnurses\tand\tothers\twhat\tto\tdo.\t\tRather,\tthey\tprovide\ta
\nframework\tfor\trecognizing\tthe\tethical\tconflict\tand\tfor\texamining\tit,\tin\ta\tmanner\tthat\trecognizes
\nthe\tduty\tthe\thealth\tcare\tworker\towes\tto\tthe\tpatient\tand\tto\tsociety.\t\tThis\tframework\tguides\tthe
\ndecision\tmaking\tprocess,\tand\tshould\thelp\tto\tprovide\tconsistency.\t<\/p>\n

Some\tcountries\thave\tcodes\tof\tmedical\tethics,\twhich\tmay\tbe\tlegally\tbinding\ton\thealth\tcare
\nworkers.\t\tBut\teven\tthese\tcannot\tbe\tspecific\tand\tcomplete\tfor\tevery\tclinical\tsituation.\t\tDoctors
\nand\tnurses\tare\texpected\tto\tbe\table\tto\tadapt\tthose\tcodes\tto\tthe\tspecific\tcircumstances\tin\twhich
\nthey\tand\ttheir\tpatients\tfind\tthemselves.\t\tThis\tbooklet\tcarries\tout\tthe\tsame\tfunction\tfor\tthose
\nworking\tin\tsituations\tof\tarmed\tconflict.\t<\/p>\n

It\tis\trecognized\tthat\tduring\tarmed\tconflict,\tcircumstances\twill\tarise\tthat\tindividuals\thave\tnot
\nexperienced\tbefore.\t\tThis\tguidance\tis\tdesigned\tto\thelp\thealth\tworkers\tbecome\tcomfortable\twith
\nexamining\tclinical\tsituations\tfor\tareas\tof\tethical\tchallenge,\tand\tto\tapplying\tframeworks\tof\tethics
\ndecision\tmaking\tto\tthose\tchallenges.\t\tIt\tis\thoped\tthat\tit\twill\tbe\tread\tbefore\tthose\tchallenges\tare
\nreal.\t\tThe\tguidance\thas\tbeen\twritten\taround\ta\tseries\tof\tclinical\tcases,\tto\tdemonstrate\twhere\tthe
\nconflicts\tand\tchallenges\tarise.\t\tNone\tof\tthese\tcases\tis\tbased\tupon\ta\tsingle\tspecific\tcase,\tall\tare
\nbased\tupon\treal\tcases\texperienced\tin\tmany\tdifferent\tcountries\tand\tsituations.\t<\/p>\n

Throughout\tthis\tdocument,\tthe\tterm\thealth\tcare\tworkers\tis\tused\tto\tdescribe\tthe\tpeople\tinvolved
\nin\tmaking\tdecisions,\twith\tthe\tpatient,\tabout\tthe\tcare\tof\tindividuals\tand\tcommunities.\t\tIn\tsome
\ncases\tthe\tteams\tof\thealth\tcare\tworkers\twill\tbe\tled\tby\ta\tdoctor,\tin\tothers\tby\ta\tnurse\tand\tin\tsome
\nby\tanother\tworker\tincluding\tan\tadministrator,\tor\tpublic\thealth\tspecialist.\t<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 4
\nThe\tICRC\thas\tpublished\ta\tresearch\tpaper\t(include\treference)\texplaining\tthe\tpressures\tthat
\nindividuals\tcaring\tfor\tpatients\tface.\tWhile\tthe\tmajor\trelationship\tis\tbetween\thealth\tworker\tand
\npatient\tthere\tare\talso\tlinks\tto\tthe\temployer\tand\tto\tthe\tsystem\t\u2013\tincluding\tnational\tand\tlocal
\ngovernment.\t\t<\/p>\n

Surrounding\tthis\tcomplex\tare\tall\tthe\texternal\tpressures,\tincluding\tlocal,\tnational\tand
\ninternational\tlaw\tand\tregulation,\twhich\twill\timpact\tand\taffect\tall\tthe\tfactors\tinside\tthe\tellipse.\t<\/p>\n

Further\treading\ton\tethical\tcodes\tor\tgeneral\tethical\tframeworks\tis\tavailable\tfrom\ta\tnumber\tof
\nsources,\tincluding\tthe\tWMA.\tA\tlist\tof\tsuch\tsources\tappears\tat\tthe\tend\tof\tthis\tguidance.\t<\/p>\n

Cases
\n1. An\t18-year\told\twoman\tis\tadmitted\twith\tabdominal\tpain\tand\tvaginal\tbleeding.\t\tYou\tare
\nworking\tin\ta\tplace\twhere\tthe\tculture\tputs\ta\tvery\thigh\tvalue\ton\tvirginity\tand\ther\tlife
\nmay\tbe\tat\trisk\tif\tshe\tis\tknown\tto\thave\tbeen\tsexually\tactive,\teven\twhere\tthis\thas\tbeen
\ndue\tto\trape.\t\tYou\tare\talso\taware\tthat\tduring\tthe\tcurrent\tconflict,\tsexual\tviolence
\nincluding\trape\thas\tbeen\tused\tas\ta\t\u201cweapon\u201d\tor\ttactic\tof\twar.\t<\/p>\n

The\toverwhelming\tduty\tof\tall\thealth\tcare\tworkers\tis\tto\tseek\tto\thelp\tthe\tpatient.\t\tIn\tthis\tcase\tthe
\nclinical\tcare\tneeds\tto\tbe\toffered\tin\tsuch\ta\tway\tthat\tit\tdoes\tnot\tundermine\tthe\tduty\tof
\nconfidentiality.\t\tWhile\tconfidentiality\tof\tpatient\tdata\tis\tnot\tabsolute,\tit\tis\tvery\timportant.\t\tIn\tmost
\ncountries\tthe\tduty\tto\tkeep\tinformation\tconfidential\tapplies\tto\tthe\tindividual;\tthat\tis\teach\tperson
\nas\tan\tindividual\thas\tthe\tright\tto\texpect\tthat\tinformation\tabout\tthem\twill\tnot\tbe\tshared\twith
\nothers.\t\tIn\tsome\tcountries\tcultural\tnorms\tallow\tthe\tsharing\tof\tinformation\twith\tfamily\tmembers
\nor\tlocal\tleaders,\tsuch\tas\tvillage\telders.\t\tFailure\tto\tshare\twith\tthem\twould\tbe\ta\tvery\tserious\tbreach
\nof\tethical\tand\tcultural\tnorms,\tbut\thealth\tworkers\thave\ta\tduty\tto\tconsider\twhether\tsuch\tsharing
\ncould\thave\tan\timpact\ton\tthe\thealth\texpectancy\tof\tthe\tpatient,\tand\tif\tit\twould,\tshould\tnot\tshare
\nEmployer
\nHCW
\nGovernment
\nPatient
\nHCiD\ttoolkit\tfor\tDoctors
\n\t 5
\nregardless\tof\tthe\tcultural\tnorms.\tWhere\tthere\tare\trisks\tto\tthe\tfuture\thealth\tof\tindividuals\tsuch
\nsharing\tshould\tnot\ttake\tplace.\t\tHealth\tcare\tworkers\thave\ta\tduty\tto\tunderstand\tthe\tlocal\tcultural
\nnorms,\tespecially\twhere\tthese\twill\timpinge\ton\tmedical\tdecision-making.\t<\/p>\n

In\tthis\tcase\tthe\thealth\tcare\tworker\tshould\talso\tbe\tprepared\tto\thelp\tthe\tpatient\tunderstand\twhat
\nhas\thappened,\tand\tto\tcollect\tevidence\tfor\ta\tpotential\tprosecution\tif\tthe\tpatient\twishes\tto
\nproceed\tdown\tthis\troute,\tbut\tdo\tso\tin\ta\tway\twhich\tcontinues\tto\tprotect\tthe\tconfidentiality\tof\tthe
\nindividual.\t\tIt\tis\toften\tfrustrating\tfor\thealth\tcare\tworkers\twhen\tpatients\twho\thave\tbeen\tvictims\tof
\nviolence,\tincluding\tinterpersonal\tviolence\tand\tsexual\tviolence,\tdo\tnot\twish\tto\treport\tthe\tmatter
\nto\tthe\tpolice\tor\tother\tauthorities.\t\tHealth\tcare\tworkers\tmight\talso\tfeel\tthat\treporting\tof\tthis\tcase
\nmight\tprevent\tfuture\tcases.\tThe\trole\tof\tthe\thealth\tcare\tprofessional\tis\tto\thelp\tthe\tpatient\tas\ta
\nperson,\tto\trecognize\ther\tfears\tand\tto\tprotect\ther\tfrom\tfurther\tharm.\t\tGathering\tevidence\tfor\tuse
\nat\ta\tlater\tdate\tmay\tbe\tthe\tbest\tpossible\tassistance.\t\t\t<\/p>\n

In\tconsidering\tthis\tcase,\tthe\thealth\tworker\tmust\tcommunicate\twith\tthe\tpatient\tand\tensure\tshe\tis
\naware\tthat\tinformation\twill\tremain\tconfidential.\t\tIn\tsome\tcircumstances\tpatients\tmight\tnot\tcome
\nforward\tfor\tcare,\tfearing\tthat\tattending\ta\tclinic\twill\tbe\tvisible\twithin\tthe\tcommunity\tand
\nprecipitate\tquestions\tfrom\tfamily\tmembers\tand\tothers.\t\tThose\torganising\thealth\tfacilities\tshould
\nconsider\tthe\tneed\tfor\tattendance\tto\tbe\tconfidential\tin\tthe\tsame\tway\tthat\tthe\tcontent\tof\tthe
\nconsultation\tis,\tand\tmake\tsuitable\tarrangements.\t\tIn\tthese\tcircumstances,\tarrangements\tthat
\nmake\treaching\tthe\thealth\tcentre\teasy\tfor\tthose\twithout\tindependent\taccess\tto\ttransport\tcan\talso
\nbe\tessential.\t<\/p>\n

Frequently\tthe\tpatient\tpresenting\tin\tthis\tway\tis\tunder\tthe\tage\tof\tconsent,\tand\tfamily\tmembers
\nmay\tbe\tvery\tinsistent\ton\tknowing\twhat\thas\thappened.\t\tThe\tsame\tguidance\tapplies\t\u2013\tit\tis\tfor\tthe
\npatient\tto\tdecide\twho\tknows\twhat.\t\tEven\tpatients\twho\tare\tnot\tcompetent\tto\tconsent\tto
\ntreatment\thave\ta\tright\tto\tmedical\tconfidentiality.\t<\/p>\n

Where\tclusters\tof\tsuch\tpatients\tare\tappearing\tthere\tis\ta\tclear\tduty\tto\tinform\tthe\tauthorities\tso
\nthat\tthey\tcan\tact,\tand\tto\tdo\tso\tin\ta\tway\tthat\tdoes\tnot\tidentify\tindividual\tpatients.\t\tAt\tthe\tsame
\ntime,\tand\tto\tencourage\tpatients\tto\tpresent\tfor\thelp,\tclinic\tarrangements\tshould\tbe\tmade\tin\tsuch
\na\tway\tthat\tit\twill\tnot\tbe\tobvious\tto\tothers\twho\tis\tpresenting\tand\tfor\twhat\ttype\tof\tcare.\t<\/p>\n

2. The\tmotorcade\tof\tthe\tlocal\tpolitical\tleader\tcomes\tunder\tattack\tas\the\tis\tarriving\tto\tvisit
\ncolleagues\tbeing\ttreated\tat\tyour\thospital,\tand\tthe\tleader\tis\tadmitted\twith\tgunshot
\ninjuries.\t\tYou\thave\twitnessed\tthe\tattack.\t\tThe\tmedia\tare\tpresent\tin\tthe\temergency
\nclinic.\t\tYou\talso\tadmit\tbystanders\tinjured\tin\tthe\tsame\tattack\tincluding\twomen\tand
\nchildren\tand\tinjured\tsoldiers.\t<\/p>\n

Decisions\tabout\twho\tto\ttreat\tfirst\tare\tbased\tupon\tan\tassessment\tof\tthe\tneed\tof\tthe\tindividual
\npatients,\tnot\ton\ttheir\trelative\tpositions\tin\tsociety.\t\tIn\tmass\tcasualty\tevents\ta\tsystem\tof\ttriage\tis
\nused,\tto\tidentify\tthose\tneeding\timmediate\tcare\tand\tthose\twho\tcan\twait,\tor\twho\tneed\tsimple\tfirst
\naid.\t\t\t<\/p>\n

The\tprinciple\tbehind\ttriage\tis\tof\tequity\tor\tjustice,\tthat\tis\tthat\ttreatment\tdecisions\tincluding
\npriorities\twill\tbe\tbased\tupon\tneed\tand\tno\tother\tnon-medical\tfactors.\t\tWhile\tin\tsome\tsituations
\nHCiD\ttoolkit\tfor\tDoctors
\n\t 6
\ntriage\tmay\tinclude\ta\tdecision\tnot\tto\ttreat\tsomeone\twho\twill\tnot\tsurvive\twhatever\ttreatment\tis
\noffered,\tand\tinstead\tto\tprioritise\tthose\tlikely\tto\tsurvive,\tthis\tis\trarely\tdone.\t\tIt\tis\tlegitimate\tto
\nrefrain\tfrom\toffering\theroic\tmedical\tinterventions\tto\tthose\twho,\twhen\tassessed,\tare\tunlikely\tto
\nsurvive\twhatever\tis\tdone\tbut\tthey\tmust\tbe\toffered\ttreatments\tto\tdeal\twith\tpain\tand\tsuffering.
\nAttempts\tto\tperform\tcurative\ttreatments\twould\tbe\tclassified\tby\tsome\tas\tfutile\tin\tsuch\tcases;
\nwhile\tothers\twould\targue\twith\tthe\tword\t\u00ab\u00a0futile\u00a0\u00bb\tthe\tkey\tfactor\tis\tthat\tthe\tpatient\twould\tbe
\nexposed\tto\tinterventions\tthat\twere\tintrusive\tand\tpossibly\tpainful\tfor\tno\thope\tor\texpectation\tof
\nbenefit.\tNo\tpatient\tshould\tbe\tabandoned\tand\tthe\temphasis\tshould\tbe\ton\treceiving\tsuffering,
\nusually\tpain.\t<\/p>\n

All\thealth\tcare\tworkers\tface,\tfrom\ttime\tto\ttime,\tpressures\tto\ttreat\tone\tperson\tbefore\tanother,
\nwith\tsuch\tpressures\toften\tcoming\tfrom\tfamily\tmembers\tor\tothers\tintimately\tinvolved\twith\tthe
\ninjured\tor\tsick\tperson.\t\tSuch\tpressures\tmust\tbe\tresisted,\tnot\tonly\tbecause\tit\tleads\tto\tinequity\tin
\ntreatment\tdecisions\tbut\tbecause\tthe\tbasis\tof\tgeneral\tacceptance\tof\tpriority\tsetting\tby\thealth\tcare
\nworkers\tis\tthat\tthis\tis\talways\tdone\ton\tthe\tbasis\tof\tneed\tand\tno\tother\tmeasure\tof\tmerit.\t\tAlthough
\nindividuals\tmay\tprotest\tand\texpress\tdistress\twhen\ttheir\tloved\tone\tis\tnot\trated\tfirst,\tthere\tis\ta
\ngeneralised\tacceptance,\tprovided\tthey\tsee\tthat\tno\tone\tjumps\tahead\tof\tthe\tqueue\ton\tanything
\nother\tthan\tmedical\tnecessity.\t<\/p>\n

In\tthis\tcase\tthe\tfact\tthat\tone\tof\tthe\tinjured\tis\ta\tlocal\tleader\tdoes\tnot\tgive\thim\tmore\tpriority\tthan
\nshould\tbe\tgiven\tto\tthe\tothers\tinjured\tincluding\tthe\twomen\tand\tchildren.\t\t\t<\/p>\n

Events\tthat\tlead\tto\tmass\tcasualties\toften\tbring\twith\tthe\tmedia\tinterest.\t\tIf\tsomeone\tprominent\tis
\nhurt\tthat\tinterest\tmay\tbe\teven\tmore\tintense.\t\tThe\tmedia\twill\tseek\tto\tobtain\tinformation\tabout
\nthe\tinjured\tincluding\tdetails\tof\ttheir\tinjuries.\t\t\t<\/p>\n

Every\tpatient\thas\ta\tright\tto\tconfidentiality,\tregardless\tof\tthe\tpublic\tinterest\tin\tthem.\t\tPatients
\nshould\tnever\tbe\texposed\tto\tthe\tmedia\tunless\tthey\thave\tgiven\tconsent\tto\tbeing\tinterviewed,
\nfilmed\tor\totherwise\tidentified.\t\tWhile\tfamilies\tare\toften\tpleased\tto\tsee\tmedia\tinterest\tas\tit\tgives
\nthem\tan\topportunity\tto\texpress\ttheir\toutrage\tto\tabide\taudience,\tthis\tshould\tnot\toccur\twithin\tthe
\nhealth\tcare\tsetting\tif\tit\texposes\tpatients\tto\ta\tloss\tof\ttheir\tright\tto\tprivacy.\t<\/p>\n

Occasionally\tafter\tmass\tcasualty\tincidents\tprominent\tpersons\twill\tvisit\tthe\tinstitution\t–\tincluding
\npoliticians\t–\toften\tbringing\tmedia\twith\tthem.\t\tAgain,\tthe\trights\tof\tpatients\tmust\tnot\tbe\tignored,
\nand\tthey\tshould\tbe\table\tto\trefuse\tsuch\ta\tvisit\tor\tto\trefuse\tbeing\tfilmed\tor\trecorded\tduring\tsuch\ta
\nvisit.\t\tFamilies\tand\tothers\tclose\tto\tpatients\tshould\talso\tbe\tmade\taware\tof\tthe\tright\tof\tthe\tpatient
\nto\tprivacy.\t<\/p>\n

In\tmost\tcountries,\tthe\tlaw\tsupports\tmedical\tconfidentiality\tand\trecognises\tthat\tthe\tpatient\tmust
\ndecide\twho\tis\ttold\tabout\ttheir\tmedical\tcondition.\t\tThis\tright\tmeans\tthat\tfamilies\twill\tonly\tbe\ttold
\nthe\tessentials\twhen\ta\tpatient\tcannot\tconsent\t(or\trefuse)\tto\tsharing\tinformation.\t\tSimilarly\tthe
\nfamily\twill\tonly\tbe\ttold\tfull\tinformation\tabout\ta\tcompetent\tpatient\twith\this\/her\tagreement.
\nFamilies\tmay\tfind\tthis\tdifficult\tto\taccept\tand\texpect\tto\tbe\tkept\tcompletely\taware.\t\tIt\tis\tessential
\nthat\thealth\tcare\tworkers\texplain\tthe\tconcept\tof\tconfidentiality\tand\tencourage\tpatients\tto\tshare
\ninformation\twith\ttheir\tclose\tfamily.\t<\/p>\n

The\tmedia\tfrequently\tignore\tconcepts\tof\tconfidentiality\tand\tassume\tthat\tthe\tbroader\tpublic\thas
\na\tright\tto\tknow\teverything\tthat\thas\toccurred;\tTV\tfilming\tin\thospital\temergency\trooms\tis
\nHCiD\ttoolkit\tfor\tDoctors
\n\t 7
\ncommonplace.\t\tEvery\tinstitution\tshould\thave\tsomeone\tnominated\tand\ttrained\tto\tdeal\twith\tthe
\nmedia,\tkeeping\tthem\tout\tof\tpatient\ttreatment\tareas\tunless\tprivacy\tcan\tbe\tmaintained.\t\tWhile
\nthose\tworking\tat\tthe\tinstitution\tmay\twish\tto\tbring\tlocal\tconditions\tto\tinternational\tattention,\tas\ta
\nmeans\tof\tseeking\tsome\thelp\tor\ta\tresolution,\tthey\tcannot\tdo\tso\twithout\tfull\tregard\tto\tthe\tright\tof
\nevery\tindividual\tto\tconfidentiality.\t\t\t<\/p>\n

3. The\tlocal\tmilitia\tmakes\tan\tarmed\tentry\tinto\tthe\tclinic\tto\tsearch\tfor\trebel\tsoldiers\tand
\ntheir\tsupporters.\tThey\tstate\tthey\tare\tprepared\tto\tuse\tforce\tagainst\tyou\tand\tthe\tclinic
\nstaff\tif\tyou\tdo\tnot\tlet\tthem\tsearch\tfor,\tand\tremove,\tany\tenemy\tcombatants.\t<\/p>\n

Hospitals,\tdispensaries\tand\tclinics\tshould\tbe\texempt\tfrom\tintrusion\tby\tlocal\tor\tnational\tmilitia,
\npolice\tor\tother\tagents\tof\tthe\tstate\tand\tof\tnon-state\tactors.\tSuch\tincursions\tat\tthe\tvery\tleast
\nmight\tdisrupt\tthe\tfunctioning\tof\tthe\tinstitution\tand\tthe\tdelivery\tcare\tto\tthose\tin\tmedical\tneed\tof
\nsuch\tcare.\tSadly\tit\tis\tbecoming\tincreasingly\tcommon\tfor\tsuch\tincursions\tto\tput\tthe\tlife\tand\tsafety
\nof\tstaff\tand\tpatients\talike\tat\trisk.\t\tThis\tis\ta\tmajor\ttheme\tof\tthe\tICRC\tproject\tHealth\tCare\tin
\nDanger.\t<\/p>\n

There\tare\tcircumstances\tin\twhich\tit\tis\tlegitimate\tfor\tarmed\tentries\tto\toccur.\t\tThe\tkey\tpoints\there
\nare\tthat\tthese\tcircumstances\tare\tlimited\tand\tshould\ttake\tplace\tin\ta\tmanner\tthat\tlimits\tthe
\nadverse\timpact\ton\tthe\tdelivery\tof\tcare\tto\tpatients.\t\t<\/p>\n

There\tare\ttimes\twhen\tsuch\tincursions\tare\ta\tsign\tof\tsignificantly\thigher\tthan\tusual\ttensions;
\nprevention,\tor\tclarity\tabout\tthe\tcircumstances\tin\twhich\tthey\tare\tacceptable\tare\tbetter\tachieved
\nin\tnegotiation\tbeforehand.\t<\/p>\n

It\tis\tessential\tthat\tthose\tresponsible\tfor\tmanaging\tthe\thealth\tcare\tfacility\tattempt\tto\tlink\twith
\npeople\twho\tare\tlikely\tto\thave\tthe\ttype\tof\tpower\tand\tresponsibility\tthat\tmake\tthem\tkey\tdecision
\nmakers\tin\tterms\tof\tsuch\tincursions.\t\tThe\tnature\tof\tthe\tdiscussions\tshould\tbe\tabout\thow\tto\thandle
\nsecurity\tconcerns\tabout\tactivities\twithin\tthe\thealth\tcare\tinstitution\tand,\twhere\tpossible,\thow\tto
\nreduce\tthe\tlikelihood\tof\tincursions.\t<\/p>\n

Those\tworking\tin\tHealth\tCare\tInstitutions\tshould\tunderstand\tthat\trecognition\tof\tthe\tinstitutions
\nneutrality\tand\timmunity\tfrom\tbecoming\tpart\tof\tany\tarmed\tconflict\tactions,\tunder\tIHL,\trequire
\nthat\tthe\tInstitution\titself,\tand\tits\tstaff,\tmaintain\tproper\tneutrality.\t\tWhile\tneutrality\tis\tlegally
\ndifferent\tfrom\tcoping\twith\tsecurity\tissues,\tthose\tworking\tin\tthe\tinstitution\tshould\tunderstand
\nthat\tit\tmight\tappear\tto\tshow\tthe\tinstitution\tas\tbeing\tpart\tof\tthe\tsecurity\tproblem,\tand\tmake
\ndiscussions\taimed\tat\tavoiding\tsecurity\tcrises\tmore\tdifficult.\t\t\t<\/p>\n

While\tit\tmight\tappear\tattractive\tto\tenhance\tthe\tsecurity\tof\tpatients\tand\tstaff\tby\tproviding
\nsecurity\tservices\twithin\tthe\tinstitution,\tincluding\tarmed\tguards\tor\tsystems\tto\tlimit\taccess,\tthese
\nseriously\tmay\tdistort\tattitudes\tto\tand\tconfidence\tin\tthe\tinstitution\tand\tmay\talso\tsignificantly
\nobstruct\taccess\tby\tthose\tin\tneed\tof\thealth\tcare.\t<\/p>\n

Doctors,\tnurses\tand\tother\thealth\tstaff\tare\tas\tlikely\tas\tany\tother\tmember\tof\tsociety\tto\thold
\npolitical\tviews.\t\tIt\tis\tessential\tthat\tthese\tare\tnot\texpressed\tto\tthe\tbroad\tpublic\tfrom\tthe\tplatform
\nof\tthe\tinstitution\tas\tthis\tthreatens\tits\tneutrality.
\nHCiD\ttoolkit\tfor\tDoctors
\n\t 8\t<\/p>\n

Advance\tdiscussions\twith\tlocal\tpolitical\tand\tmilitary\tleaders\tshould\tbe\tbased\taround
\nunderstandings\tof\tneutrality\tcoupled\twith\tthe\trequirement\tof\thealth\tcare\tprofessionals,\tand\tthus
\nthe\tinstitutions\tin\twhich\tthey\twork,\tto\ttreat\tall\tthose\tin\tneed\tof\tcare\tregardless\tof\ttheir\tpolitical
\nviews,\trace,\treligion,\tgender\tor\tother\tpotential\tareas\tof\tdiscrimination.\t<\/p>\n

Where\tthose\tin\tpositions\tof\tpower\tseek\tto\tstop\tmedical\tor\tother\thealth\tcare\thelp\tfrom\tbeing
\ndelivered\tto\tthose\tfrom\topposition\tgroups,\tthey\tmust\tbe\tmade\taware\tthat\tthis\tdamages\tthe
\nneutrality\tof\tthe\tinstitution\tand\tcould\teventually\taffect\tthe\tability\tto\toffer\tcare\tin\tdifficult
\nsituations\tto\ttheir\tsupporters.\t\t\t<\/p>\n

There\tis\tglobal\tconcern\tabout\tthe\tlack\tof\tunderstanding\tof\tthis\taspect\tof\tmedical\tneutrality\tand
\nmore\texamples\tof\tthreats\tto\tits\trecognition\tare\twelcome\tas\tpart\tof\tthe\ton-going\tcampaign\tto
\nincrease\tunderstanding\tand\tcompliance\tat\tnational\tand\tlocal\tlevels.\t<\/p>\n

Patients\thave\ta\tright\tto\texpect\tthat\tthe\tplace\tin\twhich\tthey\tare\toffered\ttreatment\twill\tbe\tas\tsafe
\nas\tpossible.\t\tThis\tdoes\tnot\tmean\tthat\tthe\tinstitution\tmust\tarm\tor\tfortify\titself,\tbut\tthat\tit\twill\tseek
\nin\tthe\tfirst\tinstance\tto\tensure\tthat\tits\tneutral\tposition\twill\tbe\tunderstood\tand\trecognised\tby\tkey
\npower\tbrokers\tin\tthe\tlocality.\t\tArming\tand\tfortification\tshould\tnot\tbe\tthe\tfirst\tpreference\tin\tterms
\nof\tprotection,\talthough\tthey\tmay\tbe\tthe\tlast\tresort.\t<\/p>\n

Patients\tmust\talso\tbe\table\tto\texpect\tthat\thealth\tcare\tstaff\twill\tnot\tput\tthem\tat\trisk,\teither\tby
\nwillfully\tbreaching\tneutrality\tor\tby\treadily\tcomplying\twith\tdemands\tfrom\toutside\tagencies\tfor
\naccess\tto\tpatients,\tor\teven\tjust\tto\tpatient\tnames.\t<\/p>\n

If\tthere\tis\tan\tarmed\tincursion\tinto\tthe\tinstitution,\tstaff\thave\trights,\tas\tdo\tpatients,\tthat\ttheir
\nsafety\twill\tbe\tconsidered\tby\tthose\trunning\tthe\tinstitution.\t\tAgain\tthis\trequires\tthe\tinstitutions
\nleaders\tto\tmake\tlocal\tconnections\tin\tadvance\tof\ta\tcrisis\tto\treduce\tthe\tlikelihood\tof\tsuch\trisks
\narising.\t\tIf\tthe\tinstitution\tis\tunable\tto\tobtain\treasonable\tsecurity\tundertakings\tthey\tshould
\nconsider\twithdrawing\tfrom\tthe\tarea,\tto\tprotect\ttheir\tstaff\tthat\thave\ta\tlegitimate\texpectation\tof
\nworking\tin\ta\tplace\tthat\tis\treasonably\tsafe.\t<\/p>\n

It\tis\tunderstood\tthat\tduring\tperiods\tof\tarmed\tconflict,\tpolitical\tand\tmilitary\tunrest\tand\tother
\nemergencies,\tthe\tsafety\tof\tdifferent\tplaces\tmay\tchange\tquite\tquickly.\t\tInstitutions\tshould\tensure
\nthat\tthey\tare\table\tto\trespond,\tand\tagain\tearly\tdiscussions\twith\temerging\tleaders\tare\tessential.\t<\/p>\n

4. A\tcivilian\tis\tbrought\tin\tfrom\ta\triot.\t\tHe\thas\tsustained\ta\thead\tinjury,\tprobably\tfrom
\nblunt\tforce\ttrauma\tsustained\tduring\tthe\triot.\t\tHe\tis\twearing\tthe\tcolours\tof\tthe
\nsupporters\tof\tthe\tuprising.\t\tYou\thave\tno\ttraining\tin\tneurosurgery,\tbut\tthe\tnearest
\nneurosurgeon\tcannot\treach\tyou\tbecause\tof\tthe\ton\tgoing\triots.\t\t\tDo\tthings\tchange\tif
\nthe\tpatient\tis\t13\tyears\told?\t<\/p>\n

It\tis\ta\tclear\tprinciple\tof\thealth\tcare\tethics\tthat\thealth\tcare\tworkers\tshould\tnot\texceed\ttheir\tlevels
\nof\tcompetence.\t\tIt\tfollows\tfrom\tthis\tthat\twhen\tmanaging\ta\tpatient\twith\ta\thead\tinjury\tonly\ta
\nclinician\ttrained\tin\tneurosurgery\tshould\toperate.\t\tMedical\tregulators\toften\texpress\tthis\tas\tnot
\noverstepping\tthe\tboundaries\tlinked\tto\tyour\ttraining\tand\texpertise;\tin\tall\tethical\tguidance
\nHCiD\ttoolkit\tfor\tDoctors
\n\t 9
\nphysicians\tare\trequired\tto\texplain\tto\tpatients,\twithin\tthe\tprocess\tof\tgaining\tconsent\tfor\tany
\nintervention,\ttheir\town\tlevel\tof\texpertise\tand\texperience\tlinked\tto\tthe\tlikely\toutcome\tfor\tthis
\npatient.\t\tIn\tnormal\tcivilian\tpractice\tthe\tlack\tof\texperience\tand\texpertise\tby\tone\tclinician\trarely
\ncauses\ta\tproblem\tas\twell\testablished\tsystems\texist\tfor\treferral\ton\tto\ta\trelevant\tspecialist.\t<\/p>\n

Non-intervention\tby\tthe\tnon-expert\tis\ta\tcounsel\tof\texcellence.\t\tIn\tsome\treal\tclinical
\ncircumstances\tthis\twould\tleave\tpatients\twith\tno\trecourse\tto\tnecessary\ttreatment.\t\tIn\tevery
\nclinical\tcircumstance\thealth\tcare\tworkers,\tand\tespecially\tdoctors\tare\tthose\twith\tthe\thighest\tlevel
\nof\ttraining\tand\tthe\tbroadest\tability\tto\tmake\tdiagnoses,\tand\tindeed\tassessing\tthe\timpact\tof
\nchoosing\tnot\tto\ttreat\tbecause\tof\tthe\tabsence\tof\ta\tsuitably\tqualified\texpert.\t\t\t<\/p>\n

The\tethical\trequirement\tis\tto\tassess\tthe\timpact\tof\teither\tnot\ttreating,\tor\tof\twaiting\tfor\taccess\tto
\nan\texpert\tfrom\telsewhere\t(which\tmight\tmean\ttransferring\tthe\tpatient).\t\tAgainst\tthis,\tthe\tdoctor
\nshould\tweigh\tthe\talternative\tof\ta\ttreatment\tattempt\tby\tthe\tnon-expert.\t\tThere\tmay\twell\tbe
\ncircumstances\twhere\tsuch\tan\tintervention\tis\tthe\tleast-\tworst\toption\tfor\tthe\tpatient.\t\tIt\tshould
\nalso\tbe\tclear\tthat\tthe\tintervention\tshould\tbe\tlimited\tto\twhat\tis\tessential,\tand\tplanned\tin\tsuch\ta
\nmanner\tas\tto\tlimit\tthe\tpotential\tfor\tiatrogenic\tdamage\tor\trisk.\t\t<\/p>\n

Consent\tto\ttreatment\tis\ta\trequirement\tfor\teach\tand\tevery\ttreatment\toffered\tto\tevery\tpatient.
\nThere\tare\tcircumstances\twhere\ta\tpatient\tis\tunable\tto\tconsent\tbecause\tof\ttheir\tmedical\tcondition;
\nthis\tis\tlikely\tto\tbe\tthe\tcase\tafter\ta\tserious\thead\tinjury\trequiring\temergency\tsurgical\tintervention.
\nWhile\tmost\tlegislations\tdo\tnot\trecognise\tconsent\tgiven\tby\tthose\tother\tthan\tthe\tpatient,\tit\tis\tgood
\npractice\tfor\thealth\tcare\tworkers\tto\tdiscuss\toptions\tand\ttheir\tintentions\twith\tthose\tclose\tto\tthe
\npatient,\twhere\tthat\tis\tpossible.\t\tIn\tsome\tlegislatures\tthere\tmay\tbe\talternative\tsystems\tfor\tgaining
\nagreement\tto\ta\tclinical\tprocedure\ton\tan\tincompetent\tpatient\t–\tthey\tshould\tbe\tfollowed.\t\tWhere
\nthere\tis\tno\tsuch\tprocedure\tor\twhere\tthe\tuse\tof\tit\tis\timpossible\t(and\tnot\tjust\tinconvenient)\tit\tis
\nethically\tappropriate\tfor\tlife-preserving\ttreatment\tto\tbe\toffered\tprovided\tthere\tis\tno\tcompetent
\nadvance\trefusal\tof\tsuch\ttreatment.\t<\/p>\n

Consent\tdescribes\tthe\tconcept\twithin\twhich\tindividuals\tmake\tdecisions\tabout\tthe\ttreatment\tthey
\nwill\treceive.\t\tThat\tdecision\tis\tbased\tupon\tthe\tinformation\tthey\tare\tprovided\tby\thealth\tcare
\nworkers\tincluding\tdoctors\tand\tnurses,\tand\twill\tbe\tinfluenced\tby\ttheir\town\tunderstanding\tof\tthat
\ninformation,\tincluding\ton\tthe\trisks\tand\tbenefits\tof\tdifferent\ttreatment\toptions.\t<\/p>\n

It\tis\ta\tfundamental\tethical\tprinciple\tthat\tindividuals\tare\tautonomous,\tthat\tis\tthey\tdetermine\tfor
\nthemselves\twhat\tshould\thappen\tto\tthem,\tand\tthat\tnothing\tcan\tbe\tdone\tto\tthem\twithout\ttheir
\nunderstanding\tand\tagreement.\t\tIt\tfollows\tfrom\tthis\tthat\tindividuals\thave\tthe\tright,\tand\tmust\tbe
\ngiven\tthe\topportunity\tto\tmake\tsuch\tdecisions,\tand\tthat\tthese\tdecisions\twill\tbe\trespected\teven
\nwhere\tthe\tdecision\tmade\tis\tnot\tone\tthat\twould\tbe\tmade\tby\tothers\tin\tthe\tsame\tclinical
\ncircumstances.\t\tThis\tis\tsometimes\texplained\tas\trecognising\tand\trespecting\tthe\tright\tof\tindividuals
\nto\tmake\tdecisions,\tincluding\tbad\tdecisions,\tabout\ttheir\tfuture\thealth\tcare.\t<\/p>\n

It\talso\tfollows\tthat\tfor\tindividuals\tto\tmake\tsuch\tdecisions\tthere\tis\ta\tstrong\trequirement\ton\thealth
\ncare\tworkers\tto\tcommunicate\teffectively\twith\tthe\tpatient.\t\tUnless\tthere\tis\tgood\tquality
\ncommunication\tit\tis\tunlikely\tthat\tthe\tpatient\twill\thave\tthe\tbest\tinformation,\twhich\tis\tneeded\tto
\nmake\tan\tinformed\t(and\ttherefore\tlegally\tvalid)\tdecision.\t\t\t<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 10
\nThere\tare\tmany\tblocks\tto\tgood\tcommunication\tbetween\tpatient\tand\thealth\tcare\tworker.\t\tIn
\nsituations\tof\tarmed\tconflict,\tthis\twill\tinclude\ttime,\tand\toften\tlanguage.\t\tGive\tthe\timportance\tof
\nconsent\tto\tall\tand\tany\ttreatment,\tsystems\tto\tdeal\twith\tcommunication\tbetween\thealth\tworker
\nand\tpatient\tshould\tbe\testablished\tincluding\tmanaging\tlanguage\tdifferences,\tby\temploying
\ntranslators\tand\tproducing\tbasic\tinformation\tin\tlocal\tlanguages.\tThis\tshould\tinclude\tall\tforms
\nwhich\tpatients\tmight\tbe\texpected\tto\tsign.\t\tIdeally\tsimply\twritten\tleaflets\tin\tlocal\tlanguages\tthat
\nenable\tpatients\tto\tread\tabout\tthe\tdecisions\tthey\tare\tbeing\tasked\tto\tmake\tshould\tbe\tavailable,
\nespecially\tin\trelation\tto\tthe\tmost\tcommonly\tperformed\tprocedures.\t<\/p>\n

In\tmost\tlegislations\tthe\tability\tto\tmake\tdecisions\ton\tmedical\ttreatment\tis\tlinked\tto\tthe\tage\tof
\nmajority\tor\tlegal\tcompetence\tas\twell\tas\tto\tother\telements\tof\tcompetence\tto\tmake\tdecisions.
\nOne\talternative\tis\tdescribed\tin\tlaw\tin\tEngland\tto\tallow\tyoung\tpeople\tbelow\tthe\tage\tof\tlegal
\nmajority\tto\tmake\tdecisions\tprovided\tthey\tunderstand\tthe\tconcepts\tthey\tneed\tto\tunderstand\tto
\nmake\tthat\tdecision.\tThe\thealth\tcare\tprofessional\tassesses\tthe\tcompetence\tof\tthe\tyoung\tperson,
\ninformally\t\u00ab\u00a0testing\u00a0\u00bb\ttheir\tunderstanding\tof\trelevant\tissues\tsuch\tas\trisk\tbefore\tconsidering\ttheir
\nbelief\ton\twhat\ttreatment\tshould\tbe\toffered.\t\t\tThe\tage\tof\tthe\tpatient\tthen\tbecomes\trelevant\tonly
\nin\tthat\tadults\tare,\tin\tmost\tlegislations,\tregarded\tas\ta\tdefault\tposition\tto\tbe\tcompetent\tto\tmake
\ndecisions\tfor\tthemselves,\tbut\tthat\tyoung\tpeople\tnot\tyet\tlegally\tadults,\thave\tto\tbe\ttested\tfor
\ncompetence.\t\t\t<\/p>\n

In\tthe\tcase\tdescribed\tabove,\tsuch\ta\tdiscussion\twould\tgive\tthe\topportunity\tto\texpress\tconcerns
\nover\tthe\tlack\tof\taccess\tto\ta\tfully\ttrained\tand\texpert\tneurosurgeon,\tand\tto\tobtain\tthe\tviews\tof\tthe
\npatient\tor\tothers\tmaking\tdecisions\ton\tbehalf\tof\tthe\tpatient.\tAt\tthe\tvery\tleast\tit\toffers\tan
\nopportunity\tto\texplore\tthe\trelative\trisks\tof\tnon-treatment\tand\tof\ttreatment\tby\ta\tnon-expert.\t<\/p>\n

It\tis\tlikely\tthat\tin\tsome\tcases\tdecisions\twill\thave\tto\tbe\tmade\twithout\tany\tdiscussion\twith\tthose
\nconsidering\tmatters\tfrom\tthe\tpoint\tof\tview\tof\tthe\tpatient.\t\tIt\tis\tstrongly\tadvised\tthat\tthe\tclinician
\nshould\tif\tpossible\tdiscuss\this\/her\tintent\tto\ttreat\twith\tother\tclinician\tcolleagues\tto\tensure\tthat
\nhis\/her\tdecision\tis\tone\tthat\twould\tbe\tsupported\tby\tothers.\t\tThis\twill\talso\tgive\tan\topportunity\tto
\nshare\tconcerns\twith\tother\tclinicians,\tand\tto\ttake\tinto\taccount\ttheir\tviews\tabout\twhat\ttreatment
\nshould\tbe\toffered,\tand\twhere\tthe\ttreatment\tlimits\tshould\tlie.\t<\/p>\n

5. A\tman\tarrives\tat\tyour\tICRC\tclinic\tfor\twar\twounded.\tHe\thas\tbeen\tin\ta\tmotor\tbike
\naccident\tjust\tdown\tthe\tstreet\tand\tis\ta\tlocal\tpolice\tofficer.\t<\/p>\n

Many\thealth\tcare\tinstitutions\twill\ttreat\tall\tor\tany\tpatient\tpresenting\tto\tthem.\t\tThere\tare,
\nhowever,\tsome\tthat\tare\tset\tup\twith\ta\tspecific\tremit.\t\tWhen\tinstitutions\tare\testablished\tby
\ncharities\tor\tother\tnon-\tstate\tand\toften\tnon-\tnational\tgroups,\tthey\tmay\thave\tto\tregister\ta\tvery
\nspecific\tremit\tand\tgroup\tof\tpatients,\twho\tare\tall\tthey\tare\tentitled\tor\tallowed\tto\ttreat.\t\tBreaching
\nthat\tduty\twould\tpotentially\topen\tthem\tto\tcriminal\tcharges\tand\tthreaten\ttheir\tability\tto\tcontinue
\nto\tprovide\tcare\tto\ttheir\tspecific\tgroup\tof\tpatients.\t<\/p>\n

Against\tthis\tis\tthe\tethical\trequirement\ton\thealth\tcare\tprofessionals\tto\tthat\tall\tthose\tneeding
\ntreatment\twithout\tfavouritism.\t\tIn\tthis\tcase\tdoing\tso\tmight\trisk\tthe\tability\tof\tthe\tICRC\tto\tcontinue
\nto\ttreat\tother\tpatients.\t\t\t<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 11
\nIf\tthe\tpatient\twill\tsuffer\tuntreatable\tharm,\tor\twhere\tthere\tis\ta\trisk\tof\tdeath\tthan\tthe\tlimits\tthat
\nwould\totherwise\tapply\tcannot\tbe\tfollowed;\tagain\tthere\tis\ta\tkey\tissue\tof\tinstitution\tmanagers
\nensuring\tthat\tlocal\tleaders\tand\tother\tmajor\tstakeholders\tare\taware\tthat\tthese\tare\texceptional
\ncases\tand\tdo\tnot\treflect\ta\twidening\tof\tthe\tremit\tof\tthe\tinstitution.\t<\/p>\n

Where\tit\tbecomes\tclear\tto\tthose\tmanaging\tthe\tinstitution\tthat\tthey\tare\tthe\tonly\tfacility\tcapable
\nof\toffering\tcare\tto\ta\tgroup\tof\tpatients,\tand\tthat\ttheir\tcurrent\tremit\tprohibits\tthem\tfrom\tmaking
\nthat\toffering\tthen\tthey\tmust\tenter\tinto\tdiscussion\tabout\thow\teither\tthey\tcan\textend\ttheir\trole\tor
\nthat\tthey\tcan\tencourage\tand\tsupport\tthe\tprovision\tof\tan\talternative\tfacility.\t<\/p>\n

6. You\tare\tadmitting\tmany\tpatients\twith\tsevere\tdiarrheal\tdisease,\tand\tsuspect\tan
\noutbreak\tof\tCholera.\t\tMost\tof\tthe\tpatients\thave\tjust\tcrossed\tthe\tborder\tto\twhere\tyour
\nclinic\tis,\tfrom\ta\tplace\tin\tthe\tmiddle\tof\ta\tconflict.\t\tMany\trefugees\tare\tgathering\ton\tthat
\nborder\tand\twant\tto\tcross\tinto\tthe\tsafer\tareas\tnear\tyour\tclinic,\tand\tthen\tto\tmove
\ndeeper\tinto\tthe\tcountry\tto\tstay\twith\trelatives\tand\tfriends,\tbut\tthe\tlocal\tgovernment\tis
\nasking\tfor\tyour\tadvice\tin\tterms\tof\tthe\toutbreak.\t\tThere\tare\tfew\tlocal\tfacilities,\tand\tyou
\nknow\tthat\tthe\trefugee\tcamps\thave\tno\tsecure\twater\tsupply\tor\tsewerage\tsystems.
\nDoes\tit\tmake\ta\tdifference\tif\tthose\twanting\tto\tmove\tare\tIDPs1
\n?\t\tDoes\tit\tmake\tany
\ndifference\tif\tthe\tepidemic\tis\ttransmissible?\t<\/p>\n

Many\tof\tthe\tfacilities\tprovided\tby\thumanitarian\torganisations\tand\tother\tnon-state\tagencies\tand
\nproviders\tin\tfailing\tStates\tor\tin\tstates\tundergoing\tarmed\tconflict\tare\tlikely\tto\thave\tgood\tor
\nexcellent\tabilities\tto\tcollect\tand\tanalyse\tdata.\t\tThis\tmay\twell\tmean\tthat\tthey\tare\tthe\tfirst\twith\tthe
\nability\tto\tspot\tan\temerging\ttrend\tsuch\tas\tan\temerging\tepidemic.\t\tThey\tmust\thave\ta\tprocess\tin
\nplace\tfor\thandling\tthe\tinformation,\tincluding\tliaison\twith\tlocal\tpublic\thealth\tauthorities\tand
\npossibly\talso\twith\tWHO\tor\tother\tglobal\tor\tintergovernmental\tagencies.\t<\/p>\n

In\tthe\tsituation\tset\tout\tin\tthe\tcase\tstudy\tthere\tare\ta\tnumber\tof\tcomplicating\tfactors\tincluding\tthe
\nplace\ton\ta\tnational\tborder\tand\tthe\tpossible\tinfectious\/contagious\tnature\tof\tthe\toutbreak.\t\tIt
\nshould\talso\tbe\tremembered\tthat\tsuch\toutbreaks\tcan\tcause\tmore\tloss\tof\tlife\tthan\tthe\tconflict
\nitself.\t\t<\/p>\n

Epidemics\tof\tall\tsorts\tneed\timmediate\tand\tcomprehensive\tplans\tfor\tmanagement,\tincluding
\nestablishing\twho\twill\tbe\tinformed.\t\tIt\tis\tclearly\tpart\tof\tthe\texpertise\tof\tthose\testablishing
\nmanagement\tplans\tto\tconsider\tthe\tnature\tof\tthe\tepidemic,\tand\tparticularly\tthe\telements\tthat
\nwill\tdecrease\ttransmission.\t\tAirborne,\twater\tborne\tand\tother\tforms\tof\ttransmissible\tdisease\tneed
\ndifferent\tmanagement\tprocesses.\t<\/p>\n

One\telement\tof\tmanaging\tthe\tepidemic\tis\tensuring\tthat\tthe\tinstitution\tdoes\tnot\titself\tbecome
\nthe\tmajor\tvector\tfor\tincreasing\tthe\tnumber\tof\tpeople\taffected;\tthat\tis\tthat\tthere\tis\tno\tavoidable
\ntransmission\twithin\tthe\tinstitution.\t\tIt\tis\tfully\tunderstood\tthat\tin\tmany\tepidemics\thealth\tcare\tstaff
\nmight\tbe\tinfected\twhen\tthey\ttreat\tpatients.\t\tWhile\tinstitutions\thave\ta\tresponsibility\tto\tstaff\tto
\nprovide\tas\tsafe\tas\tpossible\ta\tworking\tenvironment,\tit\tis\talways\tbeen\taccepted\tthat\tthere\tcan\tbe
\n1
\nInternally Displaced Persons
\nHCiD\ttoolkit\tfor\tDoctors
\n\t 12
\nsome\trisks\tin\ttreating\tpatients.\t\tInstitutions\tshould\tdo\tall\tthey\tcan,\tincluding\tproviding\tpersonal
\nprotective\tequipment,\tvaccinations\tand\timmunisations\tand\treasonable\topportunities\tfor
\ntreatment\tif\tany\tis\tavailable.\t<\/p>\n

In\tthe\tcase\tcited,\tit\tis\tessential\tthat\tthe\tinstitution\t(which\tmay\twell\tmean\tyou\tas\tthe\tphysician)
\nshould\tensure\tthat\tlocal\tcivil\tand\tpolitical\tleaders\tare\tinvolved\tin\tplanning\tas\tone\tlarge\telement
\nof\tstopping\tthe\tepidemic\tis\tproviding\tsafe\tpotable\twater,\tand\tgood\tsewerage\tfacilities\tas\tmatters
\nof\turgency.\t\tThere\tis\talso\ta\tclear\tneed\tfor\tleadership\tin\tproviding\ta\tclinical\tresponse\tto\thelp\tthose
\nalready\taffected\tas\twell\tas\ta\tpublic\thealth\tneed\tto\tensure\tplanning\tfor\tepidemic\tcontainment\tis
\nadequate\tand\tappropriate.\t<\/p>\n

The\tcivil\tor\tpolitical\tstatus\tof\tthose\taffected\tmakes\tno\tdifference\tto\tyou\tas\ta\tclinician,\tand\tone
\nelement\tof\tyour\trole\tmay\tbe\tto\tpersuade\tlocal\tauthorities\tthat\tpolitical\tinterference\twith\ttheir
\nmovement\tinto\ta\ttreatment\tfacility\twill\thave\tserious\tand\timmediate\tconsequences\tclinically\tand
\nto\tepidemic\tcontrol.\t\t\t<\/p>\n

The\tnature\tof\tthe\tepidemic\thas\ta\tsignificant\timpact\ton\tthe\tpublic\thealth\tplanning.\t\tManaging\tan
\noutbreak\tof,\tsay,\tinfluenza\thas\tdifferent\trequirements\tfrom\tmanaging,\tsay,\tEbola\tViral\tDisease.
\nPlanning\tmust\tbe\tbased\tupon\tan\tunderstanding\tof\tthe\tnature\tof\ttransmissibility\tas\twell\tas\tother
\nfactors.\t\tInterfering\twith\tthe\tliberty\tof\tindividuals,\tincluding\ttheir\tability\tto\tleave\tthe\tarea,\tor
\neven\tthe\thealth\tcare\tfacility,\tcan\tonly\tbe\tethical\tif\tit\tis\tproportionate\tand\tnecessary\twithin\tthe
\nepidemic\tresponse.\t\t\t\t<\/p>\n

The\tNuffield\tCouncil\tof\tBioethics\tpublished\twhat\tthey\tcall\ta\tladder\tof\tintervention.\t\tThis\tsets\tout
\nthat\tthe\tmore\ta\tstep\twould\tlimit\tindividual\tfreedoms\tthe\tmore\tit\tmust\tbe\tdemonstrable\tthat\tit\tis
\nan\tessential\tstep\tto\tdealing\twith\ta\tpublic\thealth\tproblem,\tthat\tthere\tis\tevidence\tthat\tit\twill\twork
\nand\tthat\tit\tis\tproportionate\tto\tthe\tharm\tdone\tby\tnot\tintervening.\t\t<\/p>\n

There\tis\tan\tethical\tduty\ton\tlocal\tauthorities\tto\tensure\tthat\tthe\tpublic\tthey\tserve\tare\tprotected
\nfrom\tavoidable\tharm\t\u2013\tso\tthey\talso\thave\ta\trequirement\tto\tput\tsystems\tin\tplace\tthat\twill\treduce
\nthe\tlikelihood\tof\tepidemics.\t\tBut\ta\tculture\tof\tblame\tdoes\tnot\thelp\tresolve\tthe\tproblem\twhen\tan
\nepidemic\toccurs.\t\tIf\tas\ta\tphysician\tyou\tsee\tno\tepidemic\tbut\tconditions\tdeteriorating\tto\tthose\tthat
\nare\tlikely\tto\thasten\tan\tepidemic,\tthen\tyou\thave\ta\tduty\tto\tbring\tthe\tattention\tof\tauthorities\tto\tthe
\nproblem.\t\tUsing\tmedical\tevidence\tcan\thelp\tto\tpersuade\tauthorities;\tdealing\twith\tthe
\nconsequences\tof\tan\tepidemic\tusually\tcosts\tmore\tthan\tbasic\tsteps\tto\tprevent\tit\tfrom\toccurring,\t<\/p>\n

Refugees\tand\tIDPs\thave\tlittle\tpolitical\tpower\tand\twith\tsome\tother\tgroups\tin\tsociety\tmay\thave
\nlittle\ttraction\tin\tseeking\thelp\tor\tsupport\tform\tgovernments,\tnationally\tand\tlocally.\t\tThe\trole\tof
\ndoctors\tis\tto\tadvocate\tthat\tall\tpeople\thave\tthe\tsame\tbasic\trights,\tand\tthat\tpublic\thealth\trequires
\nprotection\tof\teveryone\tregardless\tof\twhether\tthey\thave\tpolitical\tpower\tor\tnot.\t\tThose\twho\tare
\nnot\tcitizens\tare\talso\tthe\tresponsibility\tof\tthe\tstate\twithin\twhose\tborders\tthey\tfind\tthemselves,\tat
\nthe\tvery\tleast\tfor\tsafe\tenvironmental\tconditions\tin\twhich\tto\tlive\twhile\tdecisions\tabout\ttheir\tright
\nto\tstay\tare\tbeing\tmade.\t\t<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 13
\nFinally\t<\/p>\n

Throughout\tthis\tguidance\tit\tshould\thave\tbeen\tclear\tthat\tmany\tof\tthe\tcases\tare\tmost\teasily\tdealt
\nwith\twhen\ta\trelationship\tof\ttrust\thas\tbeen\testablished\twith\tthe\tlocal\tcommunity\tincluding\tthe
\npolitical\tand\tsocial\tleaders.\t\tThis\tallows\ttensions\tto\tbe\tdefused\tand\tmay\treduce\tthe\trisk\tof\tissues
\nsuch\tas\thospital\tsearches\tfor\t\u201cthe\tenemy\u201d\tfar\tless\tlikely.\t\t\t<\/p>\n

It\tis\tthe\tduty\tof\thealth\tcare\tworkers\tto\tensure\tthat\tsuch\tdialogues\thave\tbeen\topened\tup,\tand\tto
\nbe\tpart\tof\tthe\tdialogue\tprocess\tif\tthey\tcan\tadd\tanything\tconstructive\tto\tit.\t\tIt\tis\talso\tclearly\tthe
\nduty\tof\tthe\temployers\tof\tthose\tHCWs\tis\tto\tensure\tthat\tthey\tare\tsuitably\tprotected,\tand\tsuch
\ndialogues\tare\ta\tpractical\tmeans\tof\tachieving\tthis.\t<\/p>\n

These\tdialogues\talso\tgive\tan\topportunity\tto\tconsider\tother\timportant\tissues,\tmany\tof\twhich\twill
\nhave\ta\tmajor\tethical\tcomponent.\t\tThese\twill\tinclude\tthe\tresponsibility\tthat\tthe\thealth\tcare
\ninstitution\thas\tto\tthe\tlocal\thealth\tcare\tinfrastructure\t\u2013\tnot\tto\tundermine\tit,\tto\tremove\tits\ttrained
\nstaff,\tor\tto\toverride\tlocal\tcultural\tnorms.\t\tAt\tthe\tsame\ttime\timported\thealth\tcare\tworkers\tshould
\nnot\tbe\texpected\tto\tignore\tmatters\twhere\tlocal\tcultural\tnorms\tconflict\tsignificantly\twith\tethical
\nnorms\t\u2013\tsuch\tas\tassisting\twith\tSharia\u2019a\tpunishments,\tor\twith\tpractices\tsuch\tas\tFemale\tGenital
\nCutting.\t\tIn\tthese\tcircumstances\tthe\tInstitution\tmust\tbe\tclear\tthat\tit\twill\tnot\ttake\tpart\tin\tthese
\npractices,\tand\tin\tthe\tlatter\tcase\tit\tmay\tchoose\tto\ttry\tto\tremove\tthe\tpotential\tfor\tharm\tby\tworking
\nwith\tlocal\tactivists\tseeking\tto\tend\tthis\tpractice.\t<\/p>\n

Further reading
\nWilliams J R Medical Ethics Manual WMA [Internet]. 2015; Available from:
\nhttps:\/\/www.wma.net\/en\/30publications\/30ethicsmanual\/pdf\/Ethics_manual_3rd_Nov2015_en.pdf
\nWorld Medical Association WMA Declaration of Geneva [internet]. 2006; Available from:
\nhttps:\/\/www.wma.net\/en\/30publications\/10policies\/g1\/
\nWorld Medical Association WMA International Code of Ethics [Internet]. 2006; Available from:
\nhttps:\/\/www.wma.net\/en\/30publications\/10policies\/c8\/
\nBMA Ethics department Everyday medical ethics and law. West Sussex: Wiley-Blackwell; 2013
\nBMA Ethics department Ethical decision-making for doctors in the armed forces: a tool kit
\n[Internet].2012; Available from: http:\/\/bma.org.uk\/support-at-work\/ethics\/armed-forces-
\nethical-decision-making-toolkit
\nCoupland R Health care in danger: the responsibilities of health-care personnel working in armed
\nconflicts and other emergencies. [Internet]. 2012; Available from:
\nhttps:\/\/www.icrc.org\/eng\/assets\/files\/publications\/icrc-002-4104.pdf<\/p>\n

HCiD\ttoolkit\tfor\tDoctors
\n\t 14\t<\/p>\n"},"caption":{"rendered":"

HCiD-toolkit-for-Doctors-2015 Toolkit for Doctors Working in Situations of Violence A contribution of the World Medical Association to the Health Care in Danger Initiative of the International Committee of the Red Cross HCiD toolkit for Doctors 2 THE WORLD MEDICAL ASSOCIATION, INC. Original Doc: MEC 201\/HCiD toolkit for Doctors\/Oct2015 PROPOSAL FOR A TOOLKIT FOR DOCTORS WORKING […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":454,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/01\/HCiD-toolkit-for-Doctors-2015.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/2121"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=2121"}]}}