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Protected status of health workers under siege

A new global campaign led by the International Committee of the Red Cross is seeking to improve the safety of health workers abroad. Linda Belardi reports.

It was dusk on an unassuming evening when Ruth Jebb, a Brisbane nurse on deployment to Darfur realised she was being followed.

For 25 minutes, Jebb and her driver were trailed by three men armed with AK47s as they travelled from the refugee camp where she managed and coordinated a local feeding centre to her nearby residence.

Being several months into her African mission, the Australian Red Cross medic had just entered the gruelling peak malnutrition season in Darfur, with 2500 children under her watch.

As soon as Jebb had arrived at her residence, the men swooped on the driver and demanded the keys to the marked ICRC vehicle.

Immediately following the breach, all healthcare operations including delegate movements were temporarily suspended for three days, as the motive for the attack was established. As a consequence, thousands of malnourished children, many of them severe, were unable to receive the nutritional supplies they needed to survive.

Increasingly, the ability for healthcare workers to carry out their medical mission – to provide basic healthcare for victims of war and conflict – is being compromised. In growing numbers, health workers are themselves the victims of violence, in addition to attacks on healthcare facilities, medical vehicles and other patients.

Since 2008, the International Committee of the Red Cross (ICRC) has been documenting the number of incidents of violence in the 16 countries in which it operates, in an attempt to identify the scope of this security and humanitarian crisis.

Jebb’s personal experience, recounted at the Sydney launch of the final report, is just one of the 655 security and legal breaches recorded by the study.

The report, Health Care in Danger, identified this growing phenomenon as both serious and widespread, affecting health workers of all nationalities and from various local and international health and aid organisations.

Between 2008 and 2011, nearly 2000 people either giving or receiving medical assistance were either killed or injured in violent incidents, including 159 healthcare personnel.

In 50 per cent of those cases it led to some form of wider disruption to a medical service for others.
International NGOs providing healthcare were most affected, followed by disruptions to local services. Red Cross or Red Crescent organisations were involved in 110 of the 655 incidents.

Jeremy England, head of the Australian office of the ICRC, said the surface statistics, although stark, did not reveal the compounded costs of these incidents on communities. This included the knock-on effects from staff abandoning their posts, hospitals running out of supplies and vaccination campaigns being disrupted.

“From Columbia to Gaza, Somalia to Afghanistan there is a blatant disrespect for the neutral status of health facilities, health transport and health personnel,” England told the launch.

“And this is true not only in situations of war. We are also very concerned about areas such as in Mexico, where criminal gangs are regularly entering clinics and hospitals and regularly carrying out targeted killings and abducting medical personnel.”

The increased targeting of health workers and operations in conflict zones is one of the most overlooked but urgent humanitarian challenges of our time, he said. Deliberate assaults on healthcare personnel and infrastructure violate international law under the Geneva Convention and perpetrators should be held accountable for their actions.

“As my Director-General, Yves Daccord points out, the most shocking finding is that people die in large numbers not because they are direct victims of a roadside bomb or a shooting. They die because the ambulance doesn’t get there in time; because healthcare personnel are prevented from doing their work; because hospitals themselves have become targets of attacks, or simply because the environment is too dangerous for an effective healthcare program to be delivered.”

To tackle the issue, the ICRC in partnership with the Red Cross Red Crescent and the Australia Red Cross has launched a four-year global campaign to halt the trend.

“The core principle of international humanitarian law – that those who do not take part in hostilities be protected – is eroding fast. At its very origin, humanitarian law was about ensuring medical care for the sick and wounded and protecting those who provide it. Without this assurance, the basic evidence of humanity during times of conflict surely comes into question,” said England.

England, who has also worked in international aid for 18 years, shared his own experiences from the field.

While posted to Bosnia-Herzegovina in 1996, he described losing a field nurse due to stress after learning that six colleagues were executed in their beds in a hospital under the emblem of the Red Cross. The loss of these medics was a tragedy in itself but it had unquantifiable effects on further health delivery to the region.

Jebb, who worked in the African republic of Sudan for 10 months, described how this one carjacking had a ripple effect to the whole population under her care.

It was 2008, the height of the peak season for malnutrition and a critical stage in the delivery of services to 2500 Sudanese children. Within the preceding six weeks, demand for the crucial service had skyrocketed – jumping from 90 to multiple thousand enrolments.

“For some children this was the only food that they were receiving and children that were already on the brink of life and death were further compromised, and as a result some died.”

Once security clearance was obtained, all ICRC health activities had to be conducted using locally available transport, including donkey and horse cart.

This meant Jebb’s team could no longer operate a timely emergency response service or transport supplies and patients to the local hospital. The time wasted waiting for local transport also drained staff of valuable time in an already restricted working day. A dusk curfew meant medical work could not be performed after dark, as armed groups ramped up their violent activities at night.

Unable to operate a 24-hour feeding program, children in the refugee camp, including the most severely malnourished were sent home or flown to the nearest town to continue their treatment, despite many children requiring continuous, intensive care.

Unfortunately, many children often unaccompanied by their mother, died en route or upon arrival in the next town.

“There are obvious limitations in sending children away from the camps. Dealing with the death and the burial of a child away from their family and community has huge consequences,” Jebb said.

The alarming trend in attacks on workers was a significant humanitarian tragedy which confronted all nations, including Australia, said Robert Tickner, CEO of the Australian Red Cross.

“Australians are affected very deeply – not just in the Red Cross but other humanitarian workers. Australians do witness these violations, these preventable attacks and they do see firsthand the injury and loss of life that occurs.”

Last year, the Australian Red Cross sent more than 65 aid workers on health-related missions to countries like Afghanistan, Sudan and Haiti.

“It beggars belief that in this day and age that these attacks are increasing and not decreasing.
“These medics are there because their whole raison d’être is their commitment to fellow human beings and their humanitarian work. We need to look after these precious people.”

While acknowledging there would be no quick fixes to this significant humanitarian challenge, Tickner said Australia had a significant opportunity and responsibility to lead the campaign.
He said Australia had a long tradition of leading the world in the struggles of international humanitarian law.

“So often Australia can be a real beacon for the world. Australia provides a great model for countries where people don’t have the same level of mutual trust and ability to organise freely on the basis that we do. We are the kind of case study, so often in this field of international humanitarian law, of being active in the public space and educating the wider community about these issues.”

To advance the campaign, a series of intergovernmental expert roundtables and international conferences will be begin from next year.

The issue will also be raised at the International Conference of the Red Cross and the Red Crescent societies in November.

In attendance at the Sydney project launch were eminent figures in the field of international humanitarian law and social justice, including John Dowd, president of the International Commission of Jurists and distinguished humanitarian lawyer, Dr Keith Suter.

Ultimately, Jebb told NR the campaign provided an important opportunity to promote debate not just within Red Cross agencies but also within the international community about how we can raise the level of respect for all aid and healthcare workers, local and international.

“The evidence is there that acts of violence are increasing and as a healthcare worker that is concerning,” she said.

“It is the reality of the work that we are placing ourselves in risky situations while abroad in conflict zones but this campaign recognises that risk is no longer acceptable. Sometimes as healthcare workers we kind of just take it as being with the territory that we face these kind of situations and risks. But it is time to actually say ‘no, this isn’t acceptable.’ We are there to do a job. We are there to help people and we should be allowed to do that. These people have every right to access the healthcare that we are there to provide.”

The report can be downloaded from the campaign’s website. Go to: http://www.icrc.org/eng/what-we-do/safeguarding-health-care/index.jsp

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