The right to health is understood as
the right to have access to medical services. While this legal aspect
is applicable at all times, including during armed conflicts, many of
today's armed conflict have been characterised by a breach of the
International Hummanitarian Law.
The wounds inflicted by armed conflicts
on heathcare facilities, healthcare providers and those receiving the
care are the affronts to every impulse that inspired the development
of International Humanitarian Law.
The development of International
Humanitarian law, in particular through the Geneva Conventions, was
based on moral and humanitarian concerns that seek to limit the
barbarity of war.
The law protects life and health. It
alleviates human suffering in situations of armed conflict. Those
protected are those who do not participate in the fighting:-
civilians, medics, and aid workers, and those who nolonger fight:
wounded, sick or shipwrecked troops or prisoners of war.
Several articles in the Geneva
Conventions and their additional protocols protect medical
structures, medical personnel and those requiring medical care. In
addition, the principle of medical neutrality ensures protection of
medical personnel, patients, facilities, and transport from attack or
interference, unhidered access to medical care and treatment; the
humane treatment of all civilians, and indiscrimatory treatment of
the injured and the sick.
Contemporary armed conflicts often turn
civilians, health facilities and health workers into delibarate
targets. The conflicts impede the delivery of healthcare services
that are essential for a healthy living.
Through displacement and trauma, armed
conflictsincrease the need for health services. At the same time, the
services are distrupted by the conflict. Destroying health
facilities, for instance, undermines the very foundation of human
life.
People die in large numbers not
necessarily because they are direct victims of a roadside bomb or a
shooting, but because an ambulance fails to get there in time,
healthcare workers are prevented from doing their work, hospitals
destroyed or simply because the environment is too dangerous and
hostile for effective healthcare to be delivered.
In most cases, health workers carryout
their life saving work in extremely difficult situations.
A major impact of armed conflicts is
the loss of health workers. These medical care providers flee to
neighbouring countries as refugees or become displaced in their own
countries. In countries like Syria and the Democratic Republic of
Congo (DRC), authorities have griviously violated the law of armed
conflict by targeting and killing medical personnel.
Volunteers and first-aid
providers have in the last two years been killed in Syria despite
wearing uniforms clearly marked with the neutral sign of a red
crystal. These deaths confirm the painful truth that healthcare is
often the first victim during armed conflicts.
Violence, both
real and threatened, against healthcare personnel is the most serious
and least recognised humanitarian issue facing the world today.
However, protections do exist for the provision of medical care in
times of conflict. The Geneva Conventions and their additional
protocols set out the right of the wounded and sick, combatants and
civilians alike, to be protected during armed conflicts and to
receive timely medical treatment. This means that deliberate assaults
on healthcare personnel violate the International Humanitarian Law.
Anytime a
physician is kidnapped, attacked or killed, the provision of
healthcare is adversely affected. Children become vulnerable to
mulnutrition and infections such as pneumonia, malaria, tetanus and
meningitis. This is occassioned by the absence of working medical
personnel. This therefore exposes them to great danger, including
death.
In addition,
influx of weapons that are used to terrorise, injure and kill
civilians creates even more danger for healthcare providers who
cannot protect themselves. They are not only unprotected from
conflict but also specifically and explicitly targeted. An example of
this illegal situation is in Mogadishu, Somalia.
In the recent
years, healthcare workers in Mogadishu have been subjected to
harassment, arrest, imprisonment and even death for complying with
their ethical duty of providing heathcare- irrespective of the
political, religious or other affiliation and allegence of the
patients. Worse still, Syrian prisons contain tens of doctors, nurses
and intensive care specialists who have been detained while
performing their respective duties.
This is a clear
violation of the 1997 Additional Protocil I, which requires that all
the wounded, sick and shipwrecked, to whichever party they belong,
should be respected and protected. In all circumstances, they must be
treated humanely and receive the medical care and attention of their
condition.
For the right to
health to be protected, health services must function normally and
populations allowed to access them. However, in violation of the
International humanitarian Law, most of today's armed conflicts
attack health facilities (hospitals, dispensaries and clinics).
Moreover, the
different violations of physical and mental integrity of persons:
torture, ill-treatment, sexual violence, mutilations and attacks on
the social integrity of populations (ethnic purges, forced
resettlement and breaking up of families) all have dramatic
consequences on health. Girls and women are particularly at risk
since they are less likely to be capacitated to protect themselves
from violence; being that combatants use rape as a tool of violence.
Apart from the psychological effects that accompany rape, the victims
are exposed to serious infectious diseases such as HIV/AIDS and heavy
blood loss which in the absence of blood transfusion or basic
surgery, can be life threatening. There is also a high prevalance of
septic abortion following self or non-professional attempts to end
the pregnancies.
Such medical
complications can only be treated in medical strucures such as
hospitals, and apart from the fact that hospitals may have been
incapacitated, there is also the great risk of travelling to access
them for treatment. The absence of functional health structures
therefore results to numerous maternal deaths and cause permanent
disabilities from untreated complications.
Whilst primary
healthcare can do much to prevent such eyesores through treatment,
inevitably there will be a percentage who, when ill, will require
hospitalisation. This is particularly the case for most armed
conflicts, where patients are hopitalised due to their complex and
extreme medical conditions.
Damage on
hospitals, clinics and dispensaries therefore perpetuates human
suffering which contravenes the four Geneva Conventions of 1949
supplemented by their additional protocols. In particular, the law
provides for the protection of hospitals, medical apparatus and
instruments used exclusively in caring for the sick.
Human beings and
especially the female population depend on these medical elements for
their well-being. Health education, care, counselling and treatment
are particularly crucial for those of them who have been raped or
forced into prostitution.
Another typical
violation, more often committed with impunity, is the unlawful
killing of patients receiving medical care. Patients in the
Democratic Republic of Congo (DRC) have previously been dragged from
their hospital beds and killed.
Such actions are
generalised violence directed towards the patients to achieve a
political goal: ethnic cleansing, government destabilisation, control
or forced movement of populations, or demoralisation of a population
sympathetic to an enemy.
The warring
factions attack the wounded and sick individuals, threaten,
intimidate and unlawfully use them for exacerbating conflicts. In
effect,this phenomenon on health patients results in the use of
patients as human shields.
The
International Humanitarian Law prohibits causing great suffering or
serious injuries to the wounded and the sick. As a matter of fact,
parties of the conflict must protect these people from pillage and
ill-treatment. This means that patients posses a significant risk as
compared to other people in armed conlicts. Warring factions are
therefore required by law to demostrate humanity in the fullest sense
of the term. They are obliged to keep the humanist vision of a world
which dignity of an enemy deserves as much respect as that of a
friend or indeed as one's own dignity.
The rule
applying to ambulances or other ground vehicles are also captured in
the International Humanitarian Law. Like patients and medical
personnel, they “may in no circumstances be attacked,” but must
be, “respected and protected,” in line with articles 35 and 19 of
the first Geneva Convention. However, today's armed conlicts belong
to a family where the Geneva Conventions are honoured more in breach
than in observance. Even when medical transports are clearlly marked
with a red cross and are obviously and purely carrying casualties and
medical personnel, they are often shot at and burned down. Attack on
such vehicles present far-reaching secondary and knock-on effects
that deny the civilian population the much needed medical care.
Besides poor
infrastructure and other logistical obstacles that have obstructed
the delivery of humanitarian aid, restriction on nationwide movement
has even complicated trasportation of medical supplies. In blatant
disregard to the law of war, conflicting parties in the Democratic
Republic of Congo for example, have literally turned away ambulances
marked by internationally recognised symbols at their check points.
Heavy fighting
and lack of security has also cast a dark shadow on the delivery of
drugs and pharumacetical equipment to hospitals. In Ivory Coast,
medical structures have closed down as a result of lack of medical
supplies occassioned by restriction of movements and transport.
The obstruction
of medical supplies also compromises the quality of heathservices.
Health personnel lose experience through non-practice of skills
occassioned by lack of equipment, medicine and phaumacetical
supplies. In this case, an armed conflict becomes a humanitarian
catastrophe, where needs outstrip the aid that is being provided.
Article 55(1) of
the 1949 Geneva Convention (IV) prescribes that the party occupying a
territory has a duty of ensuring supply of relief and medical
supplies. It incurs a definite obligation to maintain at a reasonable
level the material conditions under which the population of the
occupied territory lives. Furthermore, the belligerent party, at good
will, could distribute medical supplies without undue difficulty.
Yet, it persues a deliberate policy of denying supplies to those
inneed. This is categorised as a war crime persuant to article 8(b)
(xxv) of 1998 Rome Statute of the International Crimminal Court
(ICC). This, among others, are just but a tip of the ice-berg on the
challenges facing the delivery of healthcare during armed conflicts.
The expectation
that countries or non-state factions involved in a conflict will
adhere to the existing medical ethics, in line with the International
Hummanitarian Law (IHL), has proved to be inoperable. The Geneva
conventions of 1949 and their additional protocols of 1977 contain
statements designed to protect healthcare. However, these conventions
have been violated with impunity in most armed conflicts. Recognising
the challenges involved in providing robust information, regular and
systematic documentation of attacks on healthcare is lacking.
International
Crimminal justice institutions have potential power, but do not
operate in the time frame necessary to protect healthcare during
armed conflict. Peace-keeping forces have been themselves involved in
grand-scale violation and abuse of healthcare. As a matter of fact,
they have been inadequately mandated with regard to how far they can
act in protecting civilian healthcare.
Unless the world
wakes up to this reality, many innocent lives will forever be lost.
