Geneva (ICRC) – On World Health Day, 7 April, the International Committee of the Red Cross (ICRC) is issuing a report on "Violent incidents affecting health care," showing new trends on attacks on people seeking or providing health care in conflict areas around the world.
From January 2012 to December 2013, the ICRC recorded 1,809 violent incidents against patients, health-care personnel, ambulances or medical structures in 23 countries. It is the first time the analysis has been based on such a large number of incidents, and highlights some new trends in obstruction of medical transport and attacks on patients and health care personnel.
Katarina Oberg-Fichtel, an ICRC nurse working in Central African Republic often struggles to get patients to hospital: "A difficulty we have is access to the wounded, to have authorisation from fighting parties, from armed groups to bring health care to the wounded. She believes weapon bearers are particularly at risk of not being able to access health care because: " The fighting parties don't always respect the right for a wounded soldier to have his injuries looked after."
Access to health care is also in danger as patients delay seeking treatment for fear of attack in conflicts around the world. Luisa Mancini, an ICRC surgeon who has been working in South Sudan says: “They are afraid to find soldiers or rebels or armed people. That's why they stay in the bush hidden."
Compared to the last report published in 2012, the situation is not improving: 40% of incidents involve the targeting of health care premises, and patients are being targeted and even killed. Apollo Kinyokie Barasa, ICRC Nurse recalls the violence he witnessed in a hospital in Malakal, South Sudan: "Some of the patients were shot. I remember one patient was shot by a stray bullet when he was in the compound of the hospital."
Apollo explains how this violence affected him and other health care personnel in Malakal: "We could not stay because everything from our residences had been taken away. We did not even have drinking water."
Doctors, nurses and carers working in conflict areas and situations of violence are afraid to come to work, according to Alice Nielsen, a ward nurse working at a hospital in Juba in South Sudan: "It is always an issue for ICRC staff to have a secure place to work. And when we started working here the team did not feel quite secure because there were armed people all around, inside the emergency room and inside the operating theatre. So we worked with the hospital management and they have been very supportive. We have put up a fence around the emergency room and they have a guard so it's only the patients and their relatives that can enter not a big crowd of armed people. So this situation has improved our working environment a lot."
In some of the incidents, medical personnel were forced to breach medical ethics, for example by being required to withhold treatment for political reasons. Incidents in which health-care facilities were bombed, shot at or looted often resulted in extensive property damage.
"We were threatened by armed men who insisted on getting in the car and making us take them where they wanted to go," said Liana Kakesa, the ICRC's assistant medical coordinator in Bangui, in the Central African Republic. "When we tried to explain our work to them they became angry and threatened us with machetes and rifles."
Violence or threats directed against health-care personnel, medical facilities and transport on duty breach international humanitarian law. The wounded and sick – combatants and civilians alike – have the right to receive timely and impartial medical treatment.
The entire “Violent incidents affecting health-care” study can be found on the new website www.healthcareindanger.org.
A workshop entitled: “Ensuring safety of health facilities” will take place in Pretoria 8-10 April. Renowned experts will discuss how to secure hospitals, health-centres and other premises in areas affected by armed conflict or other emergencies.
Facts and Figures
From January 2012 to December 2013 ICRC recorded 1809 violent incidents affecting health care in 23 countries
Shotlist
Location: Various including Central African Republic and South Sudan
Length: 8’42’’
Format: Mpg4 SD and HD
Production: Christopher Nicholas
Camera: Jón Björgvinsson and Christopher Nicholas
Sound: English and French
ICRC ref: AV168N
Date: 4 April 2014
Copyright: ICRC access all
00:00 Shots of destroyed hospital damaged by shells and gun fire. Reflection of a face through a cracked mirror.
00:11 Looted and destroyed hospital. Broken operating table. Wall peppered with bullets.
00:22 ICRC nurse Katarina Oberg-Fitchel to Bangui getting in to ICRC Land Cruiser with wounded patient with an abdominal wound.
00:37 ICRC nurse Katarina Oberg-Fitche wetting lips wounded patient with an abdominal wound, with water bottle and tissue.
00:46 Two ICRC Land Cruisers leaving Mbaiki Hospital, Central African Republic.
01:08 In back of the Land Cruiser on the road from Mbaiki to Bangui in Central African Republic, ICRC nurse Katarina Oberg-Fitche reassuring wounded patient with an abdominal wound (In French): "Is the pain getting a little better since the injection? A little bit? Not at all? OK we will wait a bit and then we'll see if I give you a bit more…but we'll take it gently…we'll wait a bit more to see if it works. "
01:33 C/U Face of patient Aubin Befio, wounded patient with an abdominal wound
01:47 M/S Aubin Befio, wounded patient with an abdominal wound in pain
01:57 In back of Land Cruiser on the road between Mbaiki and Bangui, Central African Republic. Soundbite from ICRC nurse Katarina Oberg-Fitche:
"A difficulty that we have has is access to the wounded, to have the authorisation from the fighting parties, from the armed groups to accede to bring health care to the wounded and also for the evacuations to do the transports of both sides of this conflict".
02:19 In back of Land Cruiser on the road between Mbaiki and Bangui, Central African Republic. Soundbite from ICRC nurse Katarina Oberg-Fitche:
"As we are infact treating wounded from both sides of the conflict it could always be perceived that we are helping the enemy and the fighting parties don't always respect the right of a wounded soldier to have his injuries looked after."
02:39 In back of Land Cruiser on the road between Mbaiki and Bangui, Central African Republic.ICRC nurse Katarina Oberg-Fitche checking wound of patient with an abdominal wound
02:55 ICRC Land Cruiser transporting wounded patient with an abdominal wound, driving through check point gates.
03:07 ICRC Land Cruiser arrives at Bangui hospital, Central African Republic passing Misca soldiers on a vehicle.
03:15 No weapon sign in front of Bangui hospital as ICRC land Cruisers drive up to main entrance of Bangui Hospital.
03:19 Carrying patient in to Operating Theatre of Bangui hospital, Central African Republic
03:33 Operating theatre of Bangui hospital, surgeon operating wounded patient with an abdominal wound
03:58 Dawn Anderson, ICRC Nurse giving wounded patient with abdominal wound water recovering in bed at Bangui Hospital, Central African Republic.
04:14 Soundbite Dawn Anderson ICRC Nurse: “It’s been a very busy couple of days. We had 11 people arrive at 2am yesterday and five of them died on arrival and the rest of them have had multiple surgeries from laparoscopies and wounds to the head. It’s been like this very busy for the past couple of days so we don’t know when it is going to slow down again.
04:44 C/U of head and drip to nose of wounded patient with an abdominal wound
04:54 Patients walking out of a hospital building of a hospital in Juba in South Sudan.
05:14 South Sudan Red Cross Volunteers carrying patient out of operating theatre of a hospital in Juba in South Sudan.
05:28 Ward of a hospital in Juba South Sudan. Ward Nurse Alice Nielsen treating wound of patient who has lost his leg.
06:00 Ward of a hospital in Juba South Sudan. C/U Ward Nurse Alice Nielsen’s head as she treats wound of patient who has lost his leg.
06:04 Ward of a hospital in Juba South Sudan. C/U of the wound and Alice Nielsen applying cotton gauze
06:12 Ward of a hospital in Juba South Sudan. Soundbite Ward Nurse Alice Nielsen:
"That is always an issue for ICRC staff to have a secure place to work. And when we started working here the team did not feel quite secure because there was armed people all around, inside the emergency room, inside the operating theatre. So we have had a cooperation with the hospital management and they have been very supportive so we have put up a fence around the emergency room and they have a guard so it's only the patient and their relatives that can enter not a big crowd of armed people. So this situation has improved our working environment a lot."
06:45 Pan from ICRC patient tents to gates that have been constructed outside operating theatre entrance in order to restrict the movement of people in and out of the operating theatre.
06:56 C/U of the gates that have been constructed outside the operating theatre and fortified with barbed wire.
07:04 : M/S gates that have been constructed outside the operating theatre and fortified with barbed wire.
07:11 At ICRC delegation in Juba. Soundbite from Apollo Kinyokie Barasa, ICRC Teaching Nurse:
"It was very tense. It was complex. Some of the patients were shot. I remember one patient was shot by a stray bullet when he was in the compound of the hospital. And we had to attend to this patient. It was on the head"
07:28 At ICRC delegation in Juba. Soundbite from Apollo Kinyokie Barasa, ICRC Teaching Nurse who had been working in Malakal, South Sudan:
"The security became much more fluid and we could not stay anymore. The following day, because when we went back home, everything from our residences had been taken away. And you know there was no basic item even to live on. We could not even have the drinking water. So the conditions became very tough and we had to evacuate."
07:53 At ICRC delegation in Juba. Soundbite from Luisa Mancini, an ICRC surgeon who has been working in South Sudan
"There are no facilities, there is nothing, there are no road, there are no car, and also they are afraid to find soldier or rebel and armed people. That's why they stay in the bush hidden."
08:15 In back of Land Cruiser on the road between Mbaiki and Bangui, Central African Republic. Soundbite from ICRC assistant medical coordinator Liana Kakesa (in French):
"During the time when things were taking place in Central African Republic, on the road to Bosambele we were threatened by armed men who insisted on getting in the car and making us take them where they wanted to go. When we tried to explain our work to them they became angry and threatened us with machetes and rifles".
08:42 ENDS