Health workers in the firing line

By Peter Maurer and Unni Karunakara

Whether it’s health facilities being used to identify and apprehend enemies, or ambulances blocked from accessing the wounded, the International Committee of the Red Cross (ICRC) and Doctors Without Borders (MSF) strongly condemn any act that deliberately aims to distort medical action and to deny healthcare to the sick and wounded.

A patient cannot be an enemy. The sick and the injured are not combatants.

Medical ethics oblige all health workers to care for all patients and to keep the medical act free from interference. Medical staff must act impartially, prioritising the delivery of care solely on medical grounds. To do that, the places where they work — ambulances, mobile clinics, health posts and hospitals — must be safe, neutral spaces.

However in places like Syria, the Democratic Republic of Congo, Bahrain, Mali and Sudan, these spaces are not safe and health workers’ impartiality is not being respected. Meanwhile, civilians pay the price as thousands are deprived of medical attention.

Since last December, 29 people have been killed while carrying out polio vaccination campaigns in Nigeria and Pakistan, where polio remains endemic. As in many cases of violence against health facilities and workers, the victims’ deaths and their families’ pain are only the most direct consequences of these attacks. Thousands of children who would have been immunised have been left at risk of polio and paralysis. Health organisations have been forced to review their activities and add security issues to the challenges of healthcare provision.

The overall scale of such problems is alarming. Most incidents that in one way or another deny the right of wounded and sick people to healthcare go unreported. While the number of such incidents remains unknown, certainly large numbers of people continue to suffer illness or injury without recourse to medical care.

MSF and the ICRC are seeking to expose the scale and consequences of these threats to healthcare. The objective is to bring about real change on the ground so that people can access the medical care they need without fear, whoever and wherever they are.

The performance and behaviour of health workers themselves — staff involved in management, administration and transportation as well as diagnosis, prevention and treatment — is critical. Securing acceptance for their work from all community, political and military groups is an essential prerequisite to being able to operate in sensitive and volatile contexts. This requires an unequivocal demonstration of respect for medical ethics and impartiality.

In some countries in which we work, for example in Afghanistan, there are instances in which medical facilities have remained safe spaces and healthcare has been assured despite a context of brutal violence. If we are to make sure these cases do not remain remarkable exceptions to the rule and if we are to foster responsibility for the protection of healthcare among all actors, we need a concerted, global effort.

Symbols clearly indicating medical services, such as the Red Cross and Red Crescent, or the MSF insignia, must oblige respect and the protection of medical practice. When they are exploited, or ignored, no amounts of sandbags will offer protection to patients and health workers.

The real challenge is to find ways to prevent such acts in the first place. The primary responsibility to prevent the targeting, obstruction or abuse of medical services lies with states and parties engaged in conflict. Health workers must be supported in carrying out their medical duties. States must ensure that all possible measures are taken to protect medical action through national legislation and that these measures are implemented.

The protection of the sick and the injured lies at the heart of the Geneva Conventions, yet violence — in all its forms — against health facilities and personnel represents one of the most serious yet neglected humanitarian issues of today. The medical act benefits everyone, whether combatant or non-combatant, and anyone in need should be able to access it, unconditionally.

Peter Maurer is the president of the International Committee of the Red Cross and Unni Karunakara the international president of Doctors Without Borders.