Losing Lives to Save Lives

Destroyed medical facility in Aleppo, Syria
Image credit
Syrian American Medical Society


Prior to this declarative utterance, Council on Foreign Relations Fellow Laurie Garrett had presided Tuesday over a meeting at CFR in New York by launching hard questions at panelists from Médecins Sans Frontières (MSF), the International Committee of the Red Cross (ICRC) and the Program on Human Rights, Health and Conflict at the Johns Hopkins Bloomberg School of Public Health. Her line of inquiry focused on those who are losing lives to save lives: healthcare workers targeted by not only ramshackle regimes and terrorist groups, but also major states (most notably Syria), for the “crime” of providing healthcare.

Garrett’s mention of Kunduz—the site of an aerial attack by US forces on an MSF hospital last October—needed no elaboration for the panel or audience members, many representing various humanitarian aid organizations. Kunduz evokes patients burned in their beds and medical staff who were decapitated. More specifically, Kunduz means 14 MSF staff and 28 patients and caretakers killed in the attack, which the US military acknowledged on April 29 resulted from multiple human and procedural errors.

Those numbers hardly reflect the real human toll, noted panelist Jason Cone, executive director, MSF USA. They don’t tell the story beyond lives lost in the attack and immediate aftermath, he said, alluding to the loss of services provided by the Kunduz Trauma Centre—the only facility of its kind providing quality, free surgical care in northeastern Afghanistan—where more than 22,000 people received healthcare in 2015, and more than 3,000 limb-saving, life-saving surgeries were performed between January and August 2015.

Indeed, quantifying the nature and extent of attacks is important; data is vital to illuminate patterns and trends, create political will and ultimately devise interventions, stressed Leonard Rubenstein who directs the Bloomberg School’s Program on Human Rights, Health, and Conflict. He’s founder and chair of the Safeguarding Health in Conflict Coalition which just last month issued its 3rd annual report, No Protection, No Respect, documenting attacks on healthcare that took place in 19 countries in 2015 and the first quarter of 2016. The report relied on secondary sources for lack of systematic data collection on these attacks.

When Garrett asked how the current situation compares to 5 years ago, Rubenstein admitted, “We don’t know. No one’s tracking the data. 

“We need real-time and longitudinal reporting to figure out how to address this on a pragmatic level, through preventive and accountability measures.” 

Nevertheless, available evidence reveals that the targeting of humanitarian workers is pervasive around the world, Rubenstein said, explaining that it comes in many varieties and for a range of reasons and motives. For instance, there’s the systematic and strategic bombing of hospitals, and killing and torture of doctors by Syria—which is the focus of a harrowing feature story (The Shadow Doctors) in The New Yorker.

Interference with the passage of medical aid, including blockage of ambulances at check points, also deprives vast numbers of people of health care, he said, adding that in the Ukraine, it’s incredibly difficult for people living in the rebel-controlled areas to get medication for diseases, including HIV. And in the West Bank, the Palestinian Red Crescent has reported more than 300 attacks on ambulances since October 2015.

The Safeguarding Health in Conflict Coalition obtained passage of a resolution requiring WHO to develop means for systemically collecting and disseminating data on attacks on health services in emergencies. Although the system is not in place, in May WHO issued its first report, based on secondary data. Although methods differed from those used by the Coalition, its findings were similar.

Garrett noted that hashtag-not-a-target (#notatarget) was trending on Twitter: “It reminds me that when I started out as a reporter covering wars, and saw the Red Cross . . . that was no guns, no bullets, this is a safe place. And if people made it to that Red Cross or Red Crescent, they would be confident they reached safety.”

Now that same red cross logo, or the blue and white MSF logo, makes people targets for kidnapping or for bombing, she added:  “How did we lose control of the notion of something sacred about the red cross?”

ICRC Director-General Yves Daccord said that what strikes him the most over the last few years isn’t so much a lack of respect for the Red Cross, or MSF, but for the basic elements of humanity. 

“It seems this basic is not with us anymore,” he observed. “And I think here, we have to reveal a taboo about that—a positive taboo.

“We, as an organization, have to take more risks . . . we have to engage. We cannot just complain. There are solutions.”

With the support from all 3 groups on the panel, the UN Security Council in May took a potentially key step toward protection of health care in conflict by adopting a resolution condemning attacks and calling for measures to prevent attacks as well as increased accountability—which all 3 panelists emphasized is important.

Cone advocated for independent investigations of attacks like the one in Kunduz. “We can’t begin to develop preventive and corrective measures until we understand the circumstances of the attack.  The US government has done, I think, a thorough investigation, but it doesn’t rise to the level of being independent, and outside the chain of command.”

Rubenstein agreed and added: “We need to hold people criminally accountable for deliberate attacks (on humanitarian workers in conflict zones). And even if it’s not deliberate, there need to be consequences.

“I would never compare the Kunduz attack to (what’s being perpetrated by) Syria,” he clarified, adding that Kunduz was one attack resulting from gross negligence as opposed to Syria’s 300-plus overtly strategic attacks.   

“But you have to hold people accountable.”


See also Brian W. Simpson's related story, Attacks on Health Workers, featuring World Health Assembly attention to the issue this past May.

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