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Risks of Armed Conflicts for International Health and Rescue Workers

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23% saw destroyed medical facility. 21% saw medical facilities used by Serb forces ... I saw more than 150 paramilitary wearing different uniforms. ... – PowerPoint PPT presentation

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Title: Risks of Armed Conflicts for International Health and Rescue Workers


1
Risks of Armed Conflicts for International
Health and Rescue Workers
  • Jirair Ratevosian, MPH
  • Physicians for Human Rights
  • Boston, Massachusetts

2
Acknowledgments
  • Leonard Rubenstein, US Institute for Peace
  • Colleen Longacre, Physicians for Human Rights

3
Medical Neutrality Law and Practice
  • Origins
  • Core elements
  • Circumstances of violations
  • Kosovo
  • Chechnya
  • West Bank/Gaza Strip
  • Darfur
  • Long term consequences of grave breaches
  • Future considerations

4
Origins of Medical Neutrality
  • Geneva Conventions
  • 4th Geneva Convention -- 1949
  • Protection of civilians in time of war
  • Protection of medical personnel, hospitals
  • Protocol I and II 1977

5
Core elements of Medical Neutrality
  • Non-interference with medical facilities,
    transports and units
  • Allow access to and treatment of wounded and sick
  • Allows Red Cross to move freely
  • Protected status for medical personnel
  • Upholds non-discrimination in treatment
  • Protects confidentiality
  • Uphold independent judgments and medical ethics

6
Circumstances of Violations
  • Attacks on medical facilities, personnel and
    patients as one element of more general attack on
    civilians
  • Violations of medical neutrality as a conscious
    strategy
  • Lack of awareness or acceptance of independence
    of medical function

7
Kosovo, 1998-1999
8
Key Findings from PHR report
  • 50 of 1,180 refugees interviewed during war
    witnessed instance of violation of medical
    neutrality
  • 23 saw destroyed medical facility
  • 21 saw medical facilities used by Serb forces
  • 20 witnessed Serb forces removing medical
    personnel from medical facilities
  • 100 medical facilities destroyed
  • 58 medical facilities used for military purposes

9
Attacks on physicians, patients and medical
facilities
10
Testimonial
  • I dont know how many, but there were lots of
    tanks and armored vehicles. I saw more than 150
    paramilitary wearing different uniforms. I went
    at 6am to alert the doctor that we all had to
    leave the house because we were surroundedthe
    doctor said, I am a doctor. Im a health
    worker. they told him, you are exactly the
    person we are looking for and shot him. We
    buried the body, it has a lot of bullet wounds.
  • Dr. S.F., 1999

11
Testimonials
  • Every time we go into the field to see a
    patient, we run a big risk from the police, who
    classify you as a terrorist if you work with
    terrorists. We give help to everyone, we are
    humanitarians.
  • Dr. B.I, 1998

12
Chechnya, 1999-2000
13
Key Findings from Survey
  • 32 witnessed destruction of or damage to medical
    facilities
  • 4 witnessed use of medical facilities for
    military purposes
  • 5 witnessed expulsion of patients or health
    workers from health facilities

14
Bombing of hospitals
15
West Bank/Gaza Strip, 1988-2008
16
Key findings from PHR report, 1988
  • Assaults on physicians, nurses, and other
    hospital staff, seizures of patients from
    hospital beds, beatings of doctors and other
    health workers, tear-gas attacks on hospitals and
    clinics
  • Refusal of entry to ambulances and physicians
  • Enforced curfews limit patient access to medical
    care
  • Hijacking of ambulances for military use
  • Demeaning of physicians

17
Key Findings from 2008 Reports
  • Patients unable to obtain exit visas/security
    clearance to get life-saving procedures in
    hospitals in Israel and Egypt
  • Proportion of patients denied exit visas rose
    from 10 in early 2007 to 35 in early 2008.
  • 14 medical workers killed and 24 medical staff
    injured trying to reach wounded patients in the
    last 3 months.
  • Collapsed coordination mechanism

18
Darfur, 2003-??
19
Key Violations to Date
  • Restricted access/harassment of humanitarian aid
    workers
  • Recent expulsion of aid workers has led to clinic
    closures and increased disease burden
  • Indictment of President Bashir in March 2009 by
    ICC has led to an increase in kidnappings of aid
    workers

20
Conclusions
  • In wars on civilians, medical neutrality is an
    element of general assault on population
  • States, militaries and insurgents have not
    completely accepted the principle of medical
    independence
  • Long term consequences of medical neutrality
    violations
  • Destruction of health infrastructure
  • Demoralization of profession

21
Future Considerations
  • Only if wars do not target civilians
  • Education and acceptance by military
  • International monitoring
  • Public accountability for crimes and violations
  • Role of health professionals in US Torture
  • Advocacy Health professional expressions of
    outrage at violations
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