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Health Care Providers in War and Armed Conflict: Operational and Educational Challenges in International Humanitarian Law and the Geneva Conventions, Part II. Educational and Training Initiatives

Published online by Cambridge University Press:  05 July 2018

Frederick M. Burkle Jr*
Affiliation:
Harvard Humanitarian Initiative, Harvard Universityand Harvard T.C. Chan School of Public Health, Cambridge, Massachusetts Woodrow Wilson International Center for Scholars, Washington, District of Columbia
Adam L. Kushner
Affiliation:
Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Christos Giannou
Affiliation:
International Committee of the Red Cross, Geneva, Switzerland Blizard Institute, University of London, United Kingdom
Mary A. Paterson
Affiliation:
School of Nursing, The Catholic University of America, Washington, District of Columbia
Sherry M. Wren
Affiliation:
Center for Innovation in Global Health, Stanford University School of Medicine, Stanford, California Palo Alto Veterans Health Care System, Palo Alto, California
Gilbert Burnham
Affiliation:
Department of International Health, Center for Global Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
*
Correspondence and reprint requests to Frederick M. Burkle, Jr, Harvard Humanitarian Initiative, c/o 452 Iana Street, Kailua, HI 96734 (e-mail: [email protected]).

Abstract

No discipline has been impacted more by war and armed conflict than health care has. Health systems and health care providers are often the first victims, suffering increasingly heinous acts that cripple the essential health delivery and public health infrastructure necessary for the protection of civilian and military victims of the state at war. This commentary argues that current instructional opportunities to prepare health care providers fall short in both content and preparation, especially in those operational skill sets necessary to manage multiple challenges, threats, and violations under international humanitarian law and to perform triage management in a resource-poor medical setting. Utilizing a historical framework, the commentary addresses the transformation of the education and training of humanitarian health professionals from the Cold War to today followed by recommendations for the future. (Disaster Med Public Health Preparedness. 2019;13:383-396)

Type
Commentary
Copyright
Copyright © 2018 Society for Disaster Medicine and Public Health, Inc. 

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References

1. International Committee of the Red Cross website. https://www.icrc.org/en/who-we-are/history. Accessed October 1, 2017.Google Scholar
2. H.E.L.P. - A training course for managing relief operations in humanitarian crises. International Committee of the Red Cross. https://www.icrc.org/en/document/helpcourse. Published September 21, 2017. Accessed September 2, 2017.Google Scholar
3. Glick, RD. Lip service to the laws of war: humanitarian and United Nations armed forces. J Int’LL. 17 March 1995;(53). http://repository.law.umich.edu/mjil/vol17/iss1/2. Published March 17, 1995. Accessed September 1, 2017.Google Scholar
4. The Geneva Conventions of 1949 and their Additional Protocols 29-10-2010 Overview. International Committee of the Red Cross. https://www.icrc.org/eng/war-and-law/treaties-customary-law/geneva-conventions/overview-geneva-conventions.htm. Accessed September 1, 2017.Google Scholar
5. International Committee of the Red Cross: Treaties, States Parties and Commentaries. Protocol Additional to the Geneva Convention of 12 August 1949, and Relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II). https://ihl-databases.icrc.org/ihl/INTRO/475?OpenDocument. Published June 8, 1977. Accessed September 1, 2017.Google Scholar
6. The Geneva Conventions of 1949 and Their Additional protocols. https://www.icrc.org/eng/war-and-law/treaties-customary-law/geneva-conventions/overview-geneva-conventions.htm. Accessed September 1, 2017.Google Scholar
7. Terry, F. Violence against health care: insights from Afghanistan, Somalia, and the Democratic Republic of the Congo. Int Rev Red Cross. Spring 2013;95(889, Violence against health care Part I: The problem and the law):23-40.Google Scholar
8. Kelly, J. Is Medical Ethics in Armed Conflict Identical to Medical Ethics in Times of Peace? Newcastle on Tyne. United Kingdom: Cambridge Scholars Publishing; 2013.Google Scholar
9. What is International Humanitarian Law? International Committee of the Red Cross Advisory Service on International Humanitarian Law. https://www.icrc.org/eng/assets/files/other/what_is_ihl.pdf. Accessed September 1, 2017.Google Scholar
10. World Medical Association International Code of Medical Ethics. https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/. Accessed September 1, 2017.Google Scholar
11. Burkle, FM. Conversations in disaster medicine and public health: the profession. Disaster Med Public Health Prep. 2014 Feb; 8(1):5-11.Google Scholar
12. Rule 25 Medical Personnel. Customary Law, International Committee of the Red Cross. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule25. Accessed September 2, 2017.Google Scholar
13. International Committee of the Red Cross Advisory Service on International Humanitarian Law: Respecting and Protecting Health Care in Armed Conflicts and Situations Not Covered by International Humanitarian Law. https://www.icrc.org/en/document/icrc-advisory-services-international-humanitarian-law. Published January 1, 2015. Accessed September 2, 2017.Google Scholar
14. International Committee of the Red Cross, Focus. Health Care in Danger Making the Case. https://www.icrc.org/eng/assets/files/publications/icrc-002-4072.pdf. Published August 2011. Accessed September 2, 2017.Google Scholar
15. Footer, KH, Rubenstein, L. A human rights approach to health care in conflict. Int Rev Red Cross. 2013;95(889):167-187.Google Scholar
16. Schabas, W. Enforcing international humanitarian law: catching the accomplices. Int Rev Red Cross. 2001;83(842):439-459.Google Scholar
17. United Nations. International Covenant on Economic, Cultural and Social Rights. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx. Published 1966. Accessed September 2, 2017.Google Scholar
18. Henckaerts, JM. Study on customary international humanitarian law: a contribution to the understanding and respect for the rule of law in armed conflict. Publication 0860.2007. Int Rev Red Cross. https://www.icrc.org/eng/assets/files/other/customary-international-humanitarian-law-i-icrc-eng.pdf. Accessed September 1, 2017.Google Scholar
19. Perrin, R. War and public health, a handbook. International Committee of the Red Cross website. https://www.icrc.org/en/publication/0641-war-and-public-health-handbook-war-and-public-health. Accessed September 29, 2017.Google Scholar
20. MSF charter and principles. Médecins Sans Frontières website. http://www.msf.org/en/msf-charter-and-principles. Accessed September 3, 2017.Google Scholar
21. Brauman, R. Medecins Sans Frontieres and the ICRC: matters of principle [opinion note]. Int Rev Red Cross. Winter 2012;94(888):1523-1535.Google Scholar
23. Hopgood, SW. Keepers of the Flame: Understanding Amnesty International. Ithaca, NY: Cornell Press; 2006.Google Scholar
24. Comminos, A. Convergence, Confusion, Conflation: An Analysis of the Intersection of Human Rights and Humanitarian Discourses [thesis]. New York: Columbia University; 2016.Google Scholar
25. Armed Conflict, Latest MSF Updates. http://www.doctorswithoutborders.org/our-work/humanitarian-issues/armed-conflict. Accessed October 2, 2017.Google Scholar
26. Bouchet-Saulnier, F. The Practical Guide to Humanitarian Law. March 2007. http://guide-humanitarian-law.org/content/index/. Published March 2007. Accessed September 12, 2017.Google Scholar
27. Magone, C, Neuman, M, Weissman, F. Eds. Humanitarian Negotiations Revealed: The MSF Experience. New York: Oxford University Press; 2011.Google Scholar
28. Allie, MP. Introduction: Acting at Any Price? Humanitarian Negotiations Revealed: the MSF Experience. https://www.msf-crash.org/en/publications/agir-tout-prix-negociations-humanitaires-lexperience-de-msf/introduction-acting-any. Published February 17, 2012. Accessed September 5, 2017.Google Scholar
29. International Activity Reports: MSF 2003-2017. http://www.msf.org/en/international-activity- reports. Accessed September 5, 2013.Google Scholar
30. Arie, S. MSF: how a humanitarian charity found itself leading the world’s response to Ebola. BMJ. 2014 Dec 23;349:g7737.Google Scholar
31. Hayden, E. MSF takes bigger global-health role. Nature. 2015 Jun 4;522(7554):18-19.Google Scholar
32. Lartey, M, Puplampu, P, Seneadza, NA, Oliver-Commey, J, Amoah, S, Ohene, S-A. Preparing for Ebola, the experiences of a national training team (Ghana). Pan Afr Med J. 2015 Oct 10;22(Suppl 1):12.Google Scholar
33. The nurse, the Geneva Conventions and human rights. Int Nurs Rev. 1992 Mar-Apr39(2):61-63.Google Scholar
34. Health care in danger: community of concern. International Committee of the Red Cross 2 December 2014. https://www.icrc.org/en/document/health-care-danger-community-conern. Accessed September 18, 2017.Google Scholar
35. Kusano, Y. Nursing ethics in times of conflict. Nurs Ethics. 2014 Dec 21(8):859-860.Google Scholar
36. The Society of Apothecaries of London Guide to the Diploma in the medical Care of Catastrophes. Jan 2016. http://www.apothecaries.org/getattachment/Examination/Diploma-in-the-Medical-Care-of-Catastrophes/Guide-DMCC-Jun-15-v-9.pdf. Published January 2016. Accessed September 22, 2017.Google Scholar
37. Burkle, FM, Walls, AE, Heck, JP, Sorensen, BS. Academic affiliated training centers in humanitarian health, Part I. Program characteristics and professionalization preferences of centers in North America. Prehosp Disaster Med. 2013 Apr28(2):155-162.Google Scholar
38. Ingrassia, PL, Foletti, M, Djalali, A, Scarone, P. Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs. Prehosp Disaster Med. 2014 Apr29(2):115-126.Google Scholar
39. University of Manchester Humanitarian and Conflict Response Institute. http://www.hcri.manchester.ac.uk/. Accessed September 22, 2017.Google Scholar
41. Humanitarian medic. CRIMEDIM, Università del Piemonte Orientale, Italy. 2017. http://www.crimedim.uniupo.it/humanitarian-medic/. Accessed September 14, 2017.Google Scholar
42. Our teaching. Karolinska Institute, Department of Public Health Sciences. http://ki.se/en/phs/our-teaching. Accessed September 11, 2017.Google Scholar
43. AUB Launches Conflict Medicine Program as Part of its Strategic Health Initiatives. https://www.aub.edu.lb/news/2016/Pages/conflict-medicine.aspx#. Published May 16, 2016. Accessed July 12, 2017.Google Scholar
44. Humanitarian Response Intensive Course. http://www.humanitarianacademy.harvard.edu/education#intro. Accessed October 12, 2017.Google Scholar
45. Humanitarian Studies, Ethics and Human Rights. http://www.humanitarianacademy.harvard.edu/education/husehr#requirements. Accessed October 12, 2017.Google Scholar
46. Remote Sensing for Humanitarian Programs Workshop. http://www.humanitarianacademy.harvard.edu/education/workshops. Accessed October 12, 2017.Google Scholar
47. Building a Better Response. [email protected]. Accessed October 12, 2017.Google Scholar
48. Humanitarian Response to Conflict and Disaster/edX. mhttps://www.edx.org/course/humanitarian-response-conflict-disaster-harvardx-ph558x-0. Accessed October 12, 2017.Google Scholar
49. Hazardous environment awareness training. Danish Refugee Council. https://drc.ngo/what-we-do/safety-training/training-courses/hazardous-environment-awareness-training. Accessed September 5, 2017.Google Scholar
50. Where Is Everyone? Responding to Emergencies in the Most Difficult Places. http://www.msf.org/sites/msf.org/files/msf-whereiseveryone-def-lr-july.pdf. Accessed September 24, 2017.Google Scholar
51. Maurer, P. Medical care in the line of fire [op-ed]. International Committee of the Red Cross website. https://www.icrc.org/eng/resources/documents/article/05-21-maurer-msf-health-care-in-danger.htm. Published May 21, 2013. Accessed October 5, 2017.Google Scholar
52. Safeguarding Health in Conflict. https://www.safeguardinghealth.org/sites/shcc/files/SHCC2017final.pdf. Accessed September 23, 2017.Google Scholar
53. MSF Analysis: Reflections on Humanitarian Action. http://msf-analysis.org/introducing-msf-analysis/. Accessed September 12, 2017.Google Scholar
54. Amat Camacho, N, Hughes, A, Burkle, FM Jr, et al. Education and Training of Emergency Medical Teams: Recommendations for a Global Operational Learning Framework. PLoS Curr. 2016 Oct 21;8.Google Scholar
55. World Health Organization. Welcome to the WHO Emergency Medical Teams Initiative. https://extranet.who.int/emt/page/welcome-who-emergency-medical-teams-initiative. Accessed October 12, 2017.Google Scholar
56. Burkle, FM Jr. Operationalizing public health skills to resource poor settings: is this the Achilles heel in the Ebola epidemic campaign? Disaster Med Public Health Prep. 2015 Feb; 9(1):44-46.Google Scholar
57. World Health Organization. Ebola Situation Report. http://apps.who.int/ebola/current-situation/ebola-situation-report-21-october-2015. Published October 21, 2015. Accessed October 20, 2017.Google Scholar
58. Vetter, P, Dayer, J-A, Schibler, M, Pittet, D. The 2014–2015 Ebola outbreak in West Africa: hands on. Antimicrob Resist Infect Control. 2016;5:17.Google Scholar
59. GOARN: collaborative learning for excellence in international outbreak response. Course Series: WHO. https://openwho.org/channels/goarn. Accessed November 14, 2017.Google Scholar
60. Burkle, FM. Triage and the lost art of decoding vital signs: restoring physiologically based triage skills in complex humanitarian emergencies. Disaster Med Public Health Prep. 2017 Apr 21:1-10.Google Scholar
61. Lin, Y, Dahm, JS, Kushner, AL, Kuwayama, DP. Are American surgical residents prepared for humanitarian deployment? A comparative analysis of resident and humanitarian case logs. World J Surg. 2017 Aug 4. doi: 10.1007/s00268-017-4137-x.Google Scholar
62. Wong, EG, Trelles, M, Dominguez, L, Gupta, S, Burnham, G, Kushner, AL. Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Médecins Sans Frontières facilities. Surgery. 2014 Sep156(3):642-649.Google Scholar
63. Trudeau, MO, Swaroop, M, Rothstein, DH. Humanitarian skill set acquisition trends among graduating US surgical residents, 2004-2014. J Surg Res. 2016 Jun 15;203(2):319-323.Google Scholar
64. Wong, EG, Razek, T, Elsharkawi, H, et al. Promoting quality of care in disaster response: a survey of core surgical competencies. Surgery. 2015;158(1):78-84.Google Scholar
65. Rosenfield, JV. Training the military surgeon: definitive surgical trauma course (DSTC) and the development of a military module. ADF Health. 2002;3:68-70.Google Scholar
66. Humanitarian Surgery in Austere Environments/UCLouvain. https://uclouvain.be/fr/etudier/iufc/program-humanitarian-surgery.html. Accessed October 1, 2017.Google Scholar
67. Rule 103: collective punishments. Customary International Humanitarian Law. International Committee of the Red Cross. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule103. Accessed September 30, 2017.Google Scholar
68. CERAH Geneva: Education, Training and Research in Humanitarian Action. https://www.cerahgeneve.ch/home/. Accessed October 1, 2017.Google Scholar
69. ATHA: Harvard Humanitarian Initiative. Harvard University. https://hhi.harvard.edu/education/atha#intro. Accessed October 1, 2017.Google Scholar
70. Advanced Regional Workshops on Frontline Humanitarian Negotiations. http://www.atha.se/negotiationworkshop. Accessed October 1, 2017.Google Scholar
71. Online Peacekeeping Training/Peace Operations Training Institute. http://www.peaceopstraining.org/. Accessed October 1, 2017.Google Scholar
72. 51. Online Training on the Law of Armed Conflict. https://www.icrc.org/en/document/law-armed-conflict-essentials. Accessed October 1, 2017.Google Scholar
73. Health in Humanitarian Crises, Online Course. https://www.futurelearn.com/courses/health-crises. Accessed October 1, 2017.Google Scholar
74. Perrin, P. Strategy for medical assistance in disaster situations. Int Rev Red Cross. 1991;284:494-504.Google Scholar
75. Krin, CS, Giannou, C, Seppelt, IM, et al. Appropriate response to humanitarian crises. BMJ. 2010 Feb 2;340:c562.Google Scholar
76. Giannou, C, Baldan, M. War Surgery: Working with Limited Resources in Armed Conflict and Other Situations of Violence. Vol 1. Geneva: International Committee of the Red Cross; 2010.Google Scholar
77. Giannou, C. A volunteer surgeon in war zones: experience of 35 years and a call to action. Curr Trauma Rep. 2017;3(1):75-77.Google Scholar
78. Management of limb injuries. International Committee of the Red Cross, AO Foundation. https://icrc.aoeducation.org/files/downloads/A_Field_Guide_Low_res.pdf.Done by WHO/ICRC/AO. Published 2016. Accessed October 12, 2017.Google Scholar
80. Rule 14: proportionality in attack. Customary International Humanitarian Law. International Committee of the Red Cross. Available at: https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_cha_chapter4_rule14. Accessed 1 Nov 2017.Google Scholar
81. Coordinating emergency medical teams provides predictable and timely response. Humanitarian Health Action. http://www.who.int/hac/events/2016/coordinating_EMTs/en/. Accessed October 12, 2017.Google Scholar
82. Bussmann, M, Schneider, G. A porous humanitarian shield: the laws of war, Red Cross, and the killing of civilians. Presented at: the Pan-European Meeting of the Standing Group on International Relations, Stockholm, 9-11 Sept 2010. http://eisa-net.org/be-bruga/eisa/files/events/stockholm/Bussmann_Schneider_16082010.pdf. Accessed November 20, 2017.Google Scholar
83. International Committee of the Red Cross. Digital technology and war. https://www.icrc.org/en/international-review/article/digital-technology-and-war. Pulished June 27, 2017. Accessed November 20, 2017.Google Scholar
84. Burkle, FM Jr. Global health security demands a strong international health regulations treaty and leadership from a highly resourced world health organization. Disaster Med Public Health Prep. 2015 Oct; 9(5):568-580.Google Scholar