"Health Care in Danger"

1. "Health Care in Danger" Protecting health care personnel and infrastructure in armed conflict and other situations of violence Robin Coupland International Committee of the Red Cross

2. The reality • Imbalance of needs and capacity • Standards / ethics • Constraints • SECURITY • Health care is not respected!

3. Rules of international humanitarian law • Care for wounded and sick • Permit access to health care • Protect health personnel and infrastructure • Respect emblems of Geneva Conventions • Discrimination (-) • Unethical practices (-)

4. Objectives of "Health Care in Danger" • Respect for international humanitarian law • "Other situations of violence" • Monitoring events • Real picture of health care in danger • Identify threats and vulnerabilities • Improved security policies • Improve security?

5. Monitoring health care in danger • Taback Coupland Model • Converts (any) reports of events into data • Definitions • Pilot – 10 countries, 119 events • 65 health care, 59 humanitarian aid • Sri Lanka, ILOT, Afghanistan, Somalia - 80% • Killed 66, Wounded 73, Kidnapped 52 • Patterns of violence in: • Health care in buildings • Health care not in buildings • Aid (not health care) • Who, what, to whom, how, when and where?

6. What?

7. How? +

8. Threats and vulnerabilities: health care (buildings) • Active hostilities • Military actors • Explosive weapons (buildings) • Not targeted • Not deliberate • Low lethality • Few expats

9. Threats and vulnerabilities: aid workers • Outside active hostilities • Unknown / non-state actors • Firearms • Targeted • Lethal or kidnap • Many expats • Where….? • ROAD!!!!

10. Threats and vulnerabilities: health care (not buildings) • A mixture? • On the road • Ambulances • Few kidnappings?

11. Preventive measures Health care (buildings) • Threats - IHL • Vulnerabilities – explosive force Aid workers • Threats - perception • Vulnerabilities – road

12. Thank you

13. What is Health Care? • Hospitals / clinics / first aid posts / ambulances • Personnel & health professionals • Movement staff / volunteers in health care • Military health infrastructure and personnel

14. Violence affecting health care Events which result in: • Death, injury, kidnap, arrest, rape, threat, harrassment • Material damage inc. cut off electricity and water • Prevention of access • Attacking / removing sick or wounded from health care • Use of health care for attack / defence • PLUS aid workers

15. The "Model" • Perpetrator • Victim • P – physical means (weapons) • P – motivation (intent) • V – vulnerability • V – effects • Context – Time and place • Any use of any weapons (or threat) with any effects

16. Perpetrator Victim Weapon Vulnerability Number of weapons EFFECTS of armed violence Use (motivation)

17. How does the TCM work? • Info from real events • Written reports • Details of reports – XL spreadsheet • Fields for perpetrator and victim data • Analysis • Accuracy?

18. HEADLINE:Patient shot in bed Reuters (date) Two masked men entered hospital X last night and shot dead a sleeping patient. This is the fifth such attack since… In terms of TCM: Two [number of people armed] masked men [who] entered hospital X [where] last night [when] and shot [weapon (firearms)] dead a [outcome] sleeping [vulnerability] patient. "shot dead" [intent]