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Health care in danger

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05-08-2011 Publication Ref. 4072

This publication draws attention to one of the most crucial yet overlooked humanitarian issues of today: violence against health care. Attacking health-care structures and personnel, and ambulances – as well as deliberately obstructing the efforts of the wounded to find help – are common features of conflicts throughout the world.

In Sri Lanka and Somalia, hospitals have been shelled; in Libya and Lebanon, ambulances have been shot at; in Bahrain, medical personnel who treated protesters are on trial; and in Afghanistan, the wounded languish for hours in vehicles held up in checkpoint queues. From Colombia to Gaza, and from the Democratic Republic of the Congo to Nepal, there is a lack of respect for the neutrality of health-care facilities and personnel, and medical vehicles, among both those attacking them and those who misuse them for military gain.

The ICRC has been documenting violence against health-care facilities and personnel, and against patients, since 2008 in 16 countries where it is working. The number of incidents that have been recorded is striking. But statistics represent only the tip of the iceberg: they do not capture the compounded cost of violence – health-care staff leaving their posts, hospitals running out of supplies and vaccination campaigns coming to a halt. These knock-on effects dramatically limit access to health care for entire communities, many of whose members may be suffering from chronic or war-related health problems.

Deliberate attacks on health-care facilities and personnel, and on patients and medical vehicles virtually always violate international law. The Geneva Conventions and their Additional Protocols assert the right of the wounded and the sick – combatants and civilians alike – to be spared further suffering during armed conflict and to receive assistance. To ensure this in practice, health-care facilities and personnel, and medical vehicles, are given protected status as long as they maintain their neutrality and treat all patients – irrespective of their political, religious or ethnic affiliation – equally. Medical installations, vehicles and personnel are clearly identified by protective symbols such as the red cross, red crescent and red crystal. Furthermore, all parties to a conflict are obliged by law to search for and collect the wounded after battle, and to facilitate their access to health-care facilities. These laws, binding on all, are not always respected.

The ICRC and its partners in the International Red Cross and Red Crescent Movement strive to find ways of reaching and assisting those wounded during armed conflict and internal strife, and to protect health-care facilities. Some initiatives are purely legal, such as spreading knowledge of international humanitarian law among State and non-State actors and raising the subject of violations with them when these occur. Some take more material form, such as protecting hospitals with sandbags and bomb-blast film for the windows and marking their roofs and sides with a red cross or red crescent, or teaching safer access techniques to ambulance crews. And some are innovative measures to meet local needs, like the taxi referral service in southern Afghanistan, which transports the wounded from the front lines to hospital. But more has to be done to halt violence against health care before it occurs. Primary responsibility for protecting health care lies with combatants and States, who have an obligation to respect the law, not with humanitarian organizations, who invariably deal with the consequences of violations.

The ICRC is launching a major campaign to raise awareness of this pressing issue, and mobilizing a community of concern. This global initiative will last four years and aims at making a crucial difference for people affected on the ground.