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Trends and Characteristics of Security Incidents Involving Aid Workers in Health Care Settings: A 20-Year Review

Published online by Cambridge University Press:  17 June 2019

Nanami Morokuma  and
Cindy H. Chiu Open the ORCID record for Cindy H. Chiu [Opens in a new window]
Nanami Morokuma
Affiliation:
Department of Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
Cindy H. Chiu*
Affiliation:
Department of Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
*
Correspondence: Cindy H. Chiu, PhD, MPH Department of Health Sciences Tohoku University Graduate School of Medicine 2-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan E-mail: cindychiu@med.tohoku.ac.jp
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Abstract

Introduction:

In recent years, several high-profile attacks on hospitals providing medical aid in conflict settings have raised international concern. The International Humanitarian Law prohibits the deliberate targeting of health care settings. Violation of this law is considered a war crime and impacts both those delivering and receiving medical aid.

Problem:

While it has been demonstrated that both aid workers and health care settings are increasingly being targeted, little is known about the trends and characteristics of security incidents involving aid workers in health care compared to non-health care settings.

Methods:

Data from the publicly available Aid Worker Security Database (AWSD) containing security incidents involving humanitarian aid workers world-wide were used in this study. The security incidents occurring from January 1, 1997 through December 31, 2016 were classified by two independent reviewers as having occurred in health care and non-health care settings, and those in health care settings were further classified into five categories (hospital, health clinic, mobile clinic, ambulance, and vaccination visit) for the analysis. A stratified descriptive analysis, χ2 Goodness of Fit test, and Cochran-Armitage test for trend were used to examine and compare security incidents occurring in health care and non-health care settings.

Results:

Among the 2,139 security incidents involving 4,112 aid workers listed in the AWSD during the study period, 74 and 2,065 incidents were in health care settings and non-health care settings, respectively. There was a nine-fold increase from five to 45 incidents in health care settings (χ2 = 56.27; P < .001), and a five-fold increase from 159 to 852 incidents in non-health care settings (χ2 = 591.55; P < .001), from Period 1 (1997-2001) to Period 4 (2012-2016). Of the 74 incidents in health care settings, 23 (31.1%) occurred in ambulances, 15 (20.3%) in hospitals, 13 (17.6%) in health clinics, 13 (17.6%) during vaccination visits, and six (8.1%) in mobile clinics. Bombings were the most common means of attack in hospitals (N = 9; 60.0%), followed by gun attacks (N = 3; 20.0%). In health care settings, 184 (95.3%) were national staff and nine (4.7%) were international staff.

Conclusion:

Security threats are a growing occupational health hazard for aid workers, especially those working in health care settings. There is a need for high-quality data from the field to better monitor the rapidly changing security situation and improve counter-strategies so aid workers can serve those in need without having to sacrifice their lives.

Keywords

delivery of health carehospitalshumanitarian aid workersviolencewar crimes
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 3 , June 2019 , pp. 265 - 273
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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References

Human Rights Watch. Hospitals, Health Workers Under Attack - UN Security Council Should Strengthen Call for Justice. https://www.hrw.org/news/2017/05/24/hospitals-health-workers-under-attack. Published 2017. Accessed June 3, 2018.Google Scholar
International Committee of the Red Cross. Geneva Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/INTRO/365?OpenDocument. Published 1949. Accessed June 3, 2018.Google Scholar
United Nations Security Council. Resolution 2286 - Adopted by the Security Council at its 7685th meeting, on 3 May 2016. http://www.refworld.org/pdfid/57319b0f4.pdf. Published 2016. Accessed June 3, 2018.Google Scholar
Bhuyan, SS, Ebuenyi, I, Bhatt, J. Persisting trend in the breach of medical neutrality: a wake-up call to the international community. BMJ Glob Health. 2016;1(3):e000109.CrossRefGoogle ScholarPubMed
Heisler, M, Baker, E, McKay, D. Attacks on health care in Syria - normalizing violations of medical neutrality? N Engl J Med. 2015;373(26):2489–2491.10.1056/NEJMp1513512CrossRefGoogle ScholarPubMed
International Committee of the Red Cross. Health Care in Danger: Violent Incidents Affecting the Delivery of Health Care, January 2012 to December 2014. https://www.icrc.org/en/publication/4237-health-care-danger-violent-incidents-affecting-delivery-health-care-january-2012. Published 2015. Accessed June 3, 2018.Google Scholar
Lohman, D. Retreat from human rights and adverse consequences for health. JAMA. 2018;319(9):861–862.10.1001/jama.2018.0271CrossRefGoogle Scholar
Humanitarian Outcomes. Aid Worker Security Database. https://aidworkersecurity.org/. Accessed March 4, 2017.Google Scholar
Humanitarian Outcomes. Aid Worker Security Report 2017 - Behind the Attacks: A look at the perpetrators of violence against aid workers. https://www.humanitarianoutcomes.org/publications/aid-worker-security-report-2017-behind-attacks-look-perpetrators-violence-against-aid. Published 2017. Accessed June 3, 2018.Google Scholar
World Health Organization. Attack on health care: Report on attacks on health care in emergencies. http://www.who.int/hac/techguidance/attacksreport.pdf. Published 2016. Accessed June 3, 2018.Google Scholar
International Committee of the Red Cross. Health care in danger - Violent incidents affecting health care, January to December 2012. https://www.icrc.org/eng/resources/documents/report/2013-05-15-health-care-in-danger-incident-report.htm?__hstc=163349155.4dd982d665f306afcdd82a837c9e52a0.1503443909518.1512376925283.1512389640606.7&__hssc=163349155.3.1512389640606&__hsfp=2433286270. Published 2013. Accessed June 3, 2018.Google Scholar
Physicians for Human Rights. A Map of Attacks on Health Care in Syria. http://physiciansforhumanrights.org/library/multimedia/a-map-of-attacks-on-health-care-in-syria.html. Accessed June 3, 2018.Google Scholar
Hoelscher, K, Miklian, J, Nygård, H. Understanding Attacks on Humanitarian Aid Workers. https://reliefweb.int/report/world/attacks-humanitarian-aid-workers-five-new-findings. Published 2015. Accessed June 3, 2018.10.2139/ssrn.2700772CrossRefGoogle Scholar
Wille, C, Fast, L. Operating in Insecurity - Shifting patterns of violence against humanitarian providers and their staff (1996-2010). http://www.insecurityinsight.org/publications.html. Published 2013. Accessed June 2018.Google Scholar
Carmichael, JL, Karamouzian, M. Deadly professions: violent attacks against aid-workers and the health implications for local populations. Int J Health Policy Manag. 2014;2(2):65–67.10.15171/ijhpm.2014.16CrossRefGoogle ScholarPubMed
Rubenstein, L, Bittle, M. Responsibility for protection of medical workers and facilities in armed conflict. Lancet Global Health. 2010;375(9711):329–340.Google ScholarPubMed
Bhutta, ZA. Infectious disease: Polio eradication hinges on child health in Pakistan. Nature. 2014;511(7509):285–287.10.1038/511285aCrossRefGoogle ScholarPubMed
Hotez, PJ. “Vaccine diplomacy:” historical perspectives and future directions. PLoS Negl Trop Dis. 2014;8(6):e2808.10.1371/journal.pntd.0002808CrossRefGoogle ScholarPubMed
Kennedy, J. How drone strikes and a fake vaccination program have inhibited polio eradication in Pakistan: an analysis of national level data. Int J Health Serv. 2017;47(4):807–825.10.1177/0020731417722888CrossRefGoogle Scholar
Fouad, M, Sparrow, A, Tarakji, A, et al. Health workers and the weaponization of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria. Lancet. 2017;390:2516–2526.CrossRefGoogle Scholar
Humanitarian Outcomes. Aid Worker Security Report 2011 - Spotlight on security for national aid workers: Issues and perspectives. https://www.humanitarianoutcomes.org/publications/aid-worker-security-report-2011. Published 2011. Accessed June 3, 2018.Google Scholar
Feinstein International Center. Breaking the Hourglass: Partnerships in Remote Management Settings–The Cases of Syria and Iraqi Kurdistan. http://fic.tufts.edu/publication-item/breaking-the-hourglass-partnerships-in-remote-management-settings-the-cases-of-syria-and-iraqi-kurdistan/. Published 2015. Accessed June 3, 2018.Google Scholar
Humanitarian Outcomes. Aid Worker Security Report 2014 - Unsafe Passage: Road attacks and their impact on humanitarian operations. https://www.humanitarianoutcomes.org/publications/aid-worker-security-report-2014. Published 2014. Accessed June 3, 2018.Google Scholar
International Committee of the Red Cross. Ambulance and pre-hospital services in risk situations. http://healthcareindanger.org/wp-content/uploads/2015/09/icrc-002-4173-ambulance-pre-hospital-services.pdf. Published 2013. Accessed June 3, 2018.Google Scholar
Hemat, H, Shah, S, Isaakidis, P, et al. Before the bombing: high burden of traumatic injuries in Kunduz Trauma Center, Kunduz, Afghanistan. PloS One. 2017;12(3):e0165270.10.1371/journal.pone.0165270CrossRefGoogle ScholarPubMed
The Center for Public Health and Human Rights. Syrian Medical Voices from the Ground - The Ordeal of Syria’s Healthcare Professionals. https://www.sams-usa.net/wp-content/uploads/2016/09/Syrian-Medical-Voices-from-the-Ground_F.pdf. Published 2015. Accessed June 3, 2018.Google Scholar
Global Humanitarian Assistance. Global humanitarian assistance report. http://devinit.org/wp-content/uploads/2017/06/GHA-Report-2017-Full-report.pdf. Published 2017. Accessed June 3, 2018.Google Scholar
Human Rights Watch. Attacks on health - global report. https://www.hrw.org/sites/default/files/related_material/HHR%20Attacks%20on%20Hospitals%20brochure%200515%20LOWRES.pdf. Published 2015. Accessed June 3, 2018.Google Scholar
Stoddard, A, Jillani, S, Caccavale, J, Cooke, P, Guillemois, G, Klimentov, V. Out of reach: how insecurity prevents humanitarian aid from accessing the neediest. Stability. 2017;6(1):1–25.10.5334/sta.506CrossRefGoogle Scholar
Médecins Sans Frontières. South Sudan Conflict: Violence Against Health Care. https://www.doctorswithoutborders.org/news-stories/special-report/south-sudan-conflict-violence-against-health-care. Published 2014. Accessed June 3, 2018.Google Scholar
Harvard Humanitarian Initiative. Protecting Humanitarian Action: Key Challenges and Lessons from the Field. https://www.hhi.harvard.edu/publications/protecting-humanitarian-action-key-challenges-and-lessons-field. Published 2016. Accessed June 3, 2018.Google Scholar
International Committee of the Red Cross. Ensuring the Preparedness and Security of Health-Care Facilities in Armed Conflict and Other Emergencies. https://shop.icrc.org/des-structures-medicales-plus-sures-et-mieux-preparees-aux-conflits-armes-et-autres-situations-d-urgence-2338.html. Published 2015. Accessed June 3, 2018.Google Scholar
World Health Organization. Tracking attacks on health workers– Don’t let them go unnoticed. http://www.who.int/features/2015/healthworkers-in-emergencies/en/. Published 2015. Accessed December 6, 2017.Google Scholar
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