COVID-19 has shifted the important work carried out by health professionals to the forefront of all of our minds. Yet, despite the applause these workers often receive, they remain exposed to many risks. For this instalment of the GISF Blog, we interviewed Christina Wille, Director of Insecurity Insight. In the piece, she exposes some of the threats health workers are facing around the world and the added challenges brought about by COVID-19.
Can you tell us what safety and security risks health workers face?
Health workers are at a high risk of catching the viral infection [COVID-19] and they need appropriate personal protective equipment. In addition, and varying between countries, they also face threats and are exposed to violence. For example, people suspected of carrying the virus may violently object to screening or quarantining. In some countries, health workers experience assaults on their way to work as security forces attempt to enforce lockdowns. There are reports of health workers having lost their rental contracts or being denied access to shops or transport, or being physically assaulted because people fear they may spread the virus.
What are currently the most dangerous countries for health professionals?
The most dangerous countries for health professionals are the fragile areas of countries experiencing conflict where fighting continues despite the calls for a ceasefire during the pandemic. The bombing of hospitals continues in Libya, quarantine centres have been hit in Yemen, conflict violence has killed an ambulance driver transporting COVID-19 test results in Myanmar, to mention just a few.
The pandemic has brought some long-standing concerns about violence against health workers to the forefront. In some countries, like India and Mexico, patients, their families and other community members are known to have been violent towards health workers. Now, during the pandemic, we are seeing a sharp rise in reported incidents.
Health facilities are sometimes directly attacked by both non-governmental forces and governmental forces (Syria, Afghanistan…), despite international law forbidding such acts and requiring medical attention to be delivered in a neutral and impartial way. Why do health centres remain primary targets in conflicts?
The simple answer is that we do not know. Perpetrators who attack healthcare usually do not communicate their reasons. In the case of airstrikes, both parties often deny responsibility or claim that the damage was collateral. However, when the same hospitals are hit again and again, we may assume that either the conflict parties have extremely poor capabilities to target accurately, or that they strategically select hospitals. If [the attack] is intended, this could be because wounded fighters are treated in health facilities. It could be a strategy to weaken the resilience of populations in opposition areas. Targeting hospitals is against International Humanitarian Law [so] every conflict actor would deny such allegations in the strongest terms.
In many horrific attacks, gunmen enter health facilities and kill patients and health workers. Such attacks are closely linked to violence against civilians. They often harm a particular ethnic, religious or otherwise defined group. While we do not know why the [MSF] maternity hospital in Kabul was recently attacked, and young mothers and their newborn babies, along with midwives and nurses, were shot on the wards, we may speculate that such attacks aim at hurting particular communities and may be perpetrated with the intention to limit population growth of specific groups.
The brutal attack against MSF’s maternal clinic reminds us that activities associated with women’s health face hostile reactions in many environments. Are programmes related to women’s sexual and reproductive health generally more at risk of being targeted?
In some contexts, reproductive health can be a selected target. Ethnic politics or ideological reasons that object to birth control might drive this. Underlying all of this is a fundamental disrespect for women. People who plan and execute such attacks probably reduce women to a reproductive function. Under such logic, reproductive health service may appear a legitimate target in the battle over which population group grows and dominates, and which communities shrink.
Are other health programmes particularly high risk?
Other health programmes that often come under attack are vaccination campaigns or communicable disease responses. Polio vaccinators have been shot in Pakistan and other countries. The Ebola response in the Democratic Republic of the Congo was affected by over 400 violent incidents or threats of violence in 2019 alone. We are also seeing a sharp rise in COVID-19 related attacks on healthcare. Such violence may be driven by underlying conflicts between [the] individual and the state, or local identity versus dominating outside powers. Public health programmes are attacked [because they are seen] as a symbol of this external power that wants to dominate the body of individuals through the injection of ‘poison’ [(vaccines)].
But not everything is ideologically driven. There can also be very practical reasons why health care is attacked. Non-state actors may hijack ambulances, steal drugs or even hospital beds because they lack medical equipment to treat their own fighters.
Insecurity Insight is part of the coalition ‘Safeguarding Health in Conflict’. Could you tell us a bit more about this initiative and NGOs’ coordinated efforts to spotlight attacks against health workers?
The Safeguarding Health in Conflict Coalition (SHCC) brings together 40 organisations to promote the security of health workers and services threatened by war or civil unrest. SHCC monitors attacks on and threats to civilian health and advocates to strengthen universal norms of respect for the right to health. The coalition also demands accountability for perpetrators and seeks to empower providers and civil society groups to be champions for their right to health.
They released the latest report last week.
The United States recently blocked a vote on a United Nations resolution to declare a global ceasefire, reflecting the barriers of the international community to effectively protect the delivery of aid in conflict. Is there any chance for a global ceasefire to take place, or for security risks to decrease for health workers in conflict during the pandemic?
I am not very optimistic for changes of a global ceasefire. However, there are pockets of hope. Attacks on health facilities have stopped in Syria over the past weeks. However, in Libya and Yemen airstrikes have continued. In other countries, non-state actors may use the preoccupation of states to deal with the pandemic to advance their objectives in less controlled parts of the country.
Insecurity Insight has launched a reporting initiative on COVID-19 related incidents. Can you tell us about the current state of incidents and how do you think it is likely to evolve in the future?
Insecurity Insight is monitoring violent events that have been triggered by the COVID-19 response – such as lockdowns and health measures, and those that affect the COVID-19 response, as well as aid delivery in general. There are over 100 events identified every week and I don’t think I can predict where this will go. I think you have to follow our bulletins to find out how this evolves.
You can find more information on Insecurity Insight and subscribe to their newsletter on their website.
You can also find Insecurity Insight’s Aid in Danger monthly news briefs on the GISF website.
About the author
Christina Wille is Director of Insecurity Insight, an organisation dedicated to improving and supporting data collection on violence and its consequences for the humanitarian and development agenda. The Aid in Danger project covers areas such as aid security, attacks on healthcare, attacks on education and sexual violence. The project team uses innovative measures to monitor open-source information and works with a wide range of network partners to collate relevant information. The organisation supports global coalitions, such as the Safeguarding Health in Conflict Coalition (SHCC) and the Global Coalition to Protect Education from Attack (GCPEA). Insecurity Insight uses the Humanitarian Data Exchange (HDX) to share information.
The Safeguarding Health in Conflict Coalition announces the publication of 'Impunity Must End', its fourth annual report on attacks on health around the world.