A UNAMID ambulance is visibly damaged after an ambush in Khor Abeche, South Darfur in 2013. Photo by: Albert González Farran / UNAMID / CC BY-NC-ND

There was a “staggering” — yet ultimately unknown — number of violent attacks on health care workers, patients and facilities in 2016, stretching across at least 23 countries in conflict or states of political unrest, a new report has found.

Syria alone experienced 108 attacks on hospitals and other health facilities, and 91 deaths of health professionals in 2016, according to Physicians for Human Rights — mostly carried out by the Syrian government and Russian forces. In Afghanistan, the number of attacks rose from 63 in 2015 to 119 in 2016, according to the United Nations Assistance Mission in Afghanistan.

Yet without a global data collection system on healthcare attacks, it remains difficult to capture an accurate assessment of the dangerous, sometimes deadly, landscape for many health care workers and their patients. The findings in “Impunity Must End: Attacks on Health in 23 Countries in Conflict in 2016,” released on Wednesday by the Safeguarding Health in Conflict Coalition, likely underestimate the scope of the problem, said Laura Hoemeke, communications and advocacy director of IntraHealth International.

“We know the numbers in the report are dramatically under-reported,” she said. “At the very least, the report shows the problem is not going away.”

But the evidence of an epidemic of attacks is still clear, says Leonard Rubenstein, director of the program on human rights, health and conflict, and chair of the coalition, which includes Physicians for Human Rights, Management Sciences for Health, IntraHealth International and the International Rescue Committee, among other groups.

“It shows that the problem is widespread and extremely serious,” he said in a phone interview.

“Information on attacks on healthcare is so episodic, in many countries, and there is no global picture of the problem. We thought it was really important for the international community to understand how extensive they are, and where they take place, and the incredible variety of types of attacks there are,” Rubenstein added.

In Yemen, there were 93 attacks on hospitals from March 2015 through December 2016, as the U.N. Children’s Fund verified, according to the report. Kidnapping of health workers was reported in nine countries last year: Afghanistan, Armenia, Iraq, Libya, Mali, Nigeria, Somalia, Sudan and Yemen.

Intimidation, assault or arrest of health workers occurred in almost all of the 23 countries, while attacks on humanitarian assistance were also somewhat common. There were 74 reported instances of intimidation, assault or arrest of health workers in Afghanistan alone last year, according to the U.N.’s mission there. This led to hospital directors shutting down the facilities.

The effects of this violence are varied. One impact is that patients face a decrease in health care access — in Ukraine for example, checks and roadblocks along conflict lines have complicated care for one-third of households in the eastern part of the country. It also means international healthcare groups and NGOs must limit their work in certain countries or regions. In Yemen — whose conflict has been fairly indiscriminate with its attacks — Médecins Sans Frontières withdrew obstetricians, pediatricians, surgeons and emergency doctors from six facilities after a hospital was bombed.

The report, the fourth in its series documenting attacks on healthcare, comes on the first anniversary of the U.N. Security Council’s landmark adoption of Resolution 2286. The Security Council, for the first time, condemned attacks on medical workers and personnel with this resolution, noting that the Geneva Conventions call for the respect and protection of all medical and humanitarian personnel.

At the time, the ICRC President Peter Maurer said that 2,400 targeted attacks had occurred against patients and health-care workers, transportation and centers in 11 countries over the last three years.

In September, the U.N. also reported that attacks on U.N. staff were on the rise.

There has been minimal follow-up — including by way of national investigations and other safety measures — on the implementation of Resolution 2286, as the Syrian American Medical Society documented in a report this January. The paper showed the rate of attacks on health care in Syria increased following the resolution’s adoption.

“The Security Council has not acted in the past year to fulfill the promise of the resolution,” Rubenstein said.

But there is one positive development. The World Health Organization is now completing its system for documenting attacks on health services, five years after it was requested to do so at the World Health Assembly in 2012, Rubenstein said.

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About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.