Attacks on health care initiative

Background

In 2012, World Health Assembly Resolution 65.20 was adopted. In this resolution, Member States requested WHO to provide leadership at the global level in collecting and disseminating information on attacks on health care in complex humanitarian emergencies. WHO subsequently created the Attacks on Health Care (AHC) initiative to systematically collect evidence on attacks on health care, to advocate for the end of such attacks, and to promote best practices for protecting health care from attacks.

Goal

• Health workers everywhere can provide health care in a safe and protected environment;
• Health workers are protected, resilient and equipped with knowledge and resources;
• Parties to conflict understand and uphold their responsibilities under International Humanitarian Law;
• Health care delivery is not disrupted by attacks; and
• All forms of violence against health care stop.

Objectives

• Develop a body of evidence on the nature and extent of attacks on health care;
• Increase commitment to action through strong advocacy to end attacks;
• Assess the impact of attacks on health care delivery, and document good practices to prevent and mitigate consequences of attacks.

The initiative was created in response to this resolution with the understanding that data collection needs to be supported by other areas of work, such as strong advocacy and guidance on how to prevent attacks and increase resilience of health systems, in order to adequately address the issue.

Examples of types of attacks on health can include:

• Violence with individual weapons
• Violence with heavy weapons
• Psychological violence/threat of violence/intimidation
• Obstruction to delivery of care
• Assault without weapons
• Sexual assault
• Denial of access to services
• Armed or violent search of health resource
• Removal of health care assets 
• Setting fire to health resources
• Militarization of health care facility 
• Removal of health care assets

All health resources can suffer from attacks. Health resources include all personnel, supplies, facilities, transport and warehouses that play a role in the delivery of health services, as well as patients themselves.  

During emergencies, attacks on health care come in many shapes and forms and stem from various reasons depending on the context in which they took place. To better understand these reasons, it is important to first consider and analyse each attack within their context. 

Although understanding the context of an attack alone will not answer the full question of why attacks on health care occur, it provides the necessary tools to investigate the roots of the problem. To illustrate, the reasons behind the destruction of a health facility in Libya may be drastically different from those that motivated the destruction of a health centre in DRC during an Ebola outbreak. 

In Libya, the shelling of a health facility occurs against the backdrop of years of violent conflict, in which attacks on health care have become one of its manifestations. On the other hand, the attacks that took place in DRC during the 2014 Ebola outbreak seem to have targeted health facilities as a reaction to imposed public health measures. 

At this stage, more research is needed to identify drivers of violence against health care, but looking at the local contexts in which they occur already provides useful clues.

Attacks not only endanger health care providers; they can also deprive people of urgently needed care. The full extent of the impact of attacks on health care is not yet known.

The short-term and more immediate effects are better understood in terms of the facilities or health workers lost, but a more in-depth investigation of the mid- to long-term impact is required. WHO aims to better understand these consequences as defined under the third objective of the initiative- investigating the impact of attacks on health care to the health of the affected populations and health service delivery, availability and accessibility.

Furthermore, WHO seeks to document good practices undertaken by various actors to prevent attacks and mitigate the consequences of attacks. These findings will help to generate evidence-based recommendations for health actors to implement at the country level.