Attachments
Executive Summary
Background
The use of explosive weapons in populated areas (EWIPA) is the leading cause of civilian casualties in armed conflict. Nevertheless, their use has only escalated in recent years. The health needs of the civilian population drastically increase when EWIPA are used. The injuries inflicted by explosive weapons are often significant and life-changing, and require immediate and long-term complex treatment and care, including rehabilitation. Beyond the physical wounds, EWIPA exposes civilians to extreme emotional and psychosocial trauma beyond the “expected” stressors of exposure to conflict and violence, and can lead to intergenerational mental health issues.
Although explosive weapons do not discriminate between civilians, they affect diverse population groups differently, exacerbating existing vulnerabilities and inequalities. Women, children, persons with disabilities and older persons are some of the groups most severely impacted by the use of explosive weapons, with children seven times more likely to die from blast injuries than adults.
The use of EWIPA also severely degrades people’s health by seriously damaging or destroying health systems and interdependent networks and infrastructure, such as water and sanitation, power, communications and roads; especially where, as is often the case, attacks are ongoing and recurrent. 2023 saw at least 763 incidents in which explosive weapons damaged or destroyed health facilities, a staggering 12% increase from 2022. Attacks have not spared health workers, with a record high number of 209 health workers killed. The figures for 2024 are expected to be even worse. This is despite a strong and long-established normative framework that protects civilians and access to healthcare in conflict.
Recognising the humanitarian impact of EWIPA, in November 2022, 83 states – a number that now stands at 88 - endorsed the Political Declaration on strengthening the protection of civilians from the humanitarian consequences arising from the use of explosive weapons in populated areas. On endorsement, countries commit to taking concrete actions to address the harm caused by EWIPA, not least by restricting or refraining from using explosive weapons in areas where civilians live and work.
The Political Declaration explicitly acknowledges the devastating impact of EWIPA use on affected populations’ health and the provision of health services. It specifically requires endorsing states to protect “civilian objects”, including hospitals, during and after armed conflict, and to “provide, facilitate, or support assistance to victims” in a way that is “holistic, integrated, gender-sensitive, and non-discriminatory”. The Political Declaration thus provides an opportunity to both increase the visibility and understanding of the specific impacts of the use of EWIPA on healthcare access, and to foster collective, coordinated and practical action to prevent and reduce harm to healthcare and populations’ health.
Against this background, this report explores the main challenges and gaps in accessing healthcare in EWIPA contexts, and considers practical and innovative strategies and tools to implement the Political Declaration’s commitments on victim assistance, and improve humanitarian access to affected populations. The report is part of a process undertaken by Humanity & Inclusion - Handicap International (HI) to support the implementation of the Political Declaration’s humanitarian commitments. Its content draws on data and findings from desk-based research with a primary focus on specific country contexts (Gaza, Northwest Syria [NWS] and Ukraine), key informant interviews (KIIs), and discussions from a multi-stakeholder in-person workshop that took place in Brussels on 12-13 November 2024.
The report considers the most pressing challenges and gaps in accessing healthcare in EWIPA settings identified by the research and the workshop’s participants, before exploring and spotlighting practical mitigation and adaptation measures, tools, guidance and policy and advocacy approaches that provide critical solutions and strategies to move the agenda forward.