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A way forward in protecting health services in conflict: moving beyond the humanitarian paradigm

Published online by Cambridge University Press:  22 January 2014

Leonard S. Rubenstein
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Extract

Attacks on health workers, clinics, hospitals, ambulances and patients during periods of armed conflict or civil disturbance pose enormous challenges to humanitarian response and constitute affronts to the imperatives of human rights and civilian protection. Violence inflicted on humanitarian aid workers is gaining the global attention it warrants. While the number of attacks on aid workers has decreased in recent years, in a handful of places, notably Sudan, Afghanistan, and Somalia, they have become more spectacular and frightening, with aid agencies targeted for kidnapping and subjected to use of explosives because of their perceived affiliation with Western governments. The assaults have galvanised the humanitarian aid community to track attacks and to engage in intensive and sophisticated discussion of means to increase operational security. After worldwide consultation, in 2011 the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA) issued a report that summarised the fruits of experience and stimulated consideration of security strategies for aid providers. By contrast, however, until very recently the far larger number of incidents of violence inflicted on and interference with indigenous health services and on international and local development agencies by state and armed groups has received comparatively little attention.

Keywords

health carehealth servicesneutralityimpartialityhuman rightsconflicthumanitarian law
Type
Opinion Note
Information
International Review of the Red Cross , Volume 95 , Issue 890: Violence against health care Part II: The way forward , June 2013 , pp. 331 - 340
Copyright
Copyright © icrc 2014 

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References

1 Abby Stoddard, Adele Harmer, and Victoria DiDomenico, Providing Aid in Insecure Environments: 2009 Update, Humanitarian Policy Group, 2009, available at: www.humanitarianoutcomes.org/resources/ProvidingAidinInsecureEnvironments20091.pdf. All internet references were last visited in August 2012, unless otherwise stated.

2 Humanitarian Outcomes, Aid Worker Security Database, 2012, available at: https://://aidworkersecurity.org/.

3 Jan Egeland, Adele Harmer, and Abby Stoddard, To Stay and Deliver: Good Practice for Humanitarians in Complex Security Environments, UN Office for the Coordination of Humanitarian Affairs, 2011, available at: http://ochanet.unocha.org/p/Documents/Stay_and_Deliver.pdf; see also Abby Stoddard and Adele Harmer, Supporting Security for Humanitarian Action: A Review of Critical Issues for the Humanitarian Community, Humanitarian Outcome, March 2010, available at: http://reliefweb.int/sites/reliefweb.int/files/resources/9B8094812827584485257719005804D4-HO-SupportingSecurityforHumanitarianActionMarch2010.pdf.

4 Leonard S. Rubenstein, Protection of Health in Armed and Civil Conflict: Opportunities for Breakthroughs, Center for Strategic and International Studies, 2011, available at: http://csis.org/files/publication/120125_Rubenstein_ProtectionOfHealth_Web.pdf.

5 ICRC, Health Care in Danger: A Sixteen-Country Study, 2011, available at: www.icrc.org/eng/assets/files/reports/4073-002-16-country-study.pdf.

6 31st International Conference of the Red Cross and Red Crescent Movement, Resolution 5, ‘Health Care in Danger: Respecting and Protecting Health Care’, 2011, available at: www.icrc.org/eng/resources/documents/resolution/31-international-conference-resolution-5-2011.htm.

7 WHA Res. 65.20, 26 May 2012.

8 UNSC Res. 1998, 12 July 2011.

9 Report of the Secretary-General on the Protection of Civilians in Armed Conflict, UN Doc. S/2012/376, 22 May 2012, paras. 13, 14, 33, 34, 74.

10 Report of the Independent National Commission of Inquiry on the Syrian Arab Republic, UN Doc. A/HRC/22/59, 5 February 2013, para. 138.

11 J. Egeland, A. Harmer, and A. Stoddard, above note 3.

12 Ibid. Also see A. Stoddard and A. Harmer, above note 3.

13 J. Egeland, A. Harmer, and A. Stoddard, above note 3.

14 Abby Stoddard, Adele Harmer, and Katherine Haver, Safety and Security of National Humanitarian Workers, 2011, Annex to J. Egeland, A. Harmer, and A. Stoddard, above note 3, pp. 14–15, available at: http://ochanet.unocha.org/p/Documents/Safety%20and%20Security%20for%20National%20Humanitarian%20Workers,%20PDSB,%202011,%20English.pdf.

15 OCHA, Humanitarian Principles, 2010, available at: http://ochanet.unocha.org/p/Documents/OOM_HumPrinciple_English.pdf.

16 World Medical Association, Declaration of Geneva, as amended, 2006, available at: www.wma.net/en/30publications/10policies/g1/. See also World Medical Association, Regulations in Times of Armed Conflict, as amended, 2006, paras. 4, 11, available at: www.wma.net/en/30publications/10policies/a20/.

17 OCHA, Humanitarian Principles, above note 15. Other humanitarian principles, including humanity and operational independence, also apply to local health programmes.

18 Donini, Antonio, ‘Between a rock and a hard place: integration or independence of humanitarian action’, in International Review of the Red Cross, Vol. 93, No. 881, 2011, pp. 141–157CrossRefGoogle Scholar; Feinstein International Center, Briefing Paper, Navigating Without a Compass: The Erosion of Humanitarianism in Darfur, 2011, available at: http://dl.tufts.edu/ProxyServlet/?url=http://://repository01.lib.tufts.edu:8080/fedora/get/tufts:UA197.005.005.00009/bdef:TuftsPDF/getPDF&filename=tufts:UA197.005.005.00009.pdf.

19 Kalshoven, Frits, ‘International humanitarian law and violation of medical neutrality’, in Reflections on the Law of War: Collected Essays, Brill Academic Publishers, Leiden, Netherlands and Boston, MA, 2007, p. 1002CrossRefGoogle Scholar.

20 Ibid.

21 Rubenstein, Leonard S. and Bittle, Melanie D., ‘Responsibility for protection of medical workers and facilities in armed conflict’, in The Lancet, Vol. 375, 2010, pp. 329–340CrossRefGoogle ScholarPubMed.

22 Orbinski, James, Beyrer, Chris, and Singh, Sonal, ‘Violations of human rights: health practitioners as witnesses’, in The Lancet, Vol. 370, pp. 698–704CrossRefGoogle Scholar.

23 Report of the Secretary-General, above note 9, paras. 74(e), 80(e), 82.

24 There is one mechanism with a specific mandate to address attacks on health-care services, the Special Representative of the Secretary-General for Children in Armed Conflict. Other global mechanisms include the Human Rights Council, treaty-based committees on torture and children, and regional mechanisms such as the Inter-American Commission on Human Rights, the European Court of Human Rights, and the African Commission on Human Rights.

25 2005 World Summit Outcome, UN Doc. A/60/L.1, 2005, paras. 139–140, available at: http://responsibilitytoprotect.org/world%20summit%20outcome%20doc%202005(1).pdf.

26 Paul R. Williams, J. Trevor Ulbrick, and Jonathan Warboys, ‘Preventing mass atrocities: the responsibility to protect and the Syrian crisis’, American University, Washington College of Law Research Paper No. 2012-45, 1 November 2012, available at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2174768 (last visited 27 February 2013).

27 On this topic, see the article by Katherine H. A. Footer and Leonard S. Rubenstein, ‘A human rights approach to health care in conflict’, in this issue and the Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, UN Doc A/68/297, 9 August 2013.

28 UNSC Res. 1998, above note 8.

29 31st International Conference of the Red Cross and Red Crescent Movement, Resolution 5, above note 6.