A new, interactive database built by the World Health Organization will soon shine a spotlight on the extent of violence against health care workers and the risks they are facing in some of the world’s toughest places to deliver aid.
The online database, set to launch within the next few months, will track possible, probable and confirmed attacks in real-time, which any public user can search and sort by country or type of attack. It’s a “starting point,” which could lead to a reduction in future violence altogether, said Erin Maura Kenney, the acting chief of staff for the WHO’s emergency director, who is overseeing the database’s construction.
“When we can start to get the information out there, it can be used to understand the extent and nature of the problem, related trends, then we can advocate for change and target our humanitarian interventions to reduce the likelihoods of attacks,” Kenney told Devex in a recent phone interview.
“It is an awareness building exercise as well, and we think people will be more likely to report attacks if they see the type of attacks that are being reported through the system, they may say, ‘Wow we did not think that was an attack on health care,’” she added.
The Safeguarding Health in Conflict Coalition released its latest findings on attacks on health care workers and facilities from 2016, showing a continued "widespread and extremely serious problem."
There are various estimates for the number of aid workers — and, more specifically, health care workers — who are attacked, kidnapped or die on the job annually. This varies from the Aid Worker Security Database, which estimates more than 300 local and international aid workers killed, kidnapped or wounded in 2015, to the Safeguarding Health in Conflict Coalition, which did not issue an approximate total of the “staggering number” attacks on health care workers, patients and facilities in its recent report this spring.
“Data on a global level is weak and it is slightly dependant on the country, [but] even in the largest countries where ICRC is working, like Syria or Yemen or South Sudan or Democratic Republic of Congo there is the phenomenon of underreporting, and there is no single standardized methodology to document attacks,” said Giovanni Trambaiolo, the operations adviser of the Health Care in Danger project at the International Committee of the Red Cross.
ICRC research shows that at least 90 percent of health care workers who experienced violence 2012 to 2014 are local staff, not international workers, according to Trambaiolo. The organization documented a total of 2,398 incidents in 11 countries during this time frame.
The WHO database, built in coordination with the ICRC and Médecins Sans Frontières, among other partners, will collect and post reports of attacks from multiple sources as they roll in. Once there is enough evidence to show that an attack actually occurred, or verifiable information from a morgue, for example, to confirm a death, the attacks could be altered from “possible,” to “probable,” to “confirmed.”
A “possible” attack would require the confirmation of a secondary source, or maybe a photo or a phone call from an eyewitness as some form of corroborating evidence. “Probable” posted attacks would require additional layers of information, potentially written documents, or a video, and a “confirmed” attack would need further additional detail and sources.
“It’s a pyramid of evidence,” Kenney explained.
“For us, attacks is a very broad definition of what hinders the delivery of health care. It includes looting, abduction, assault, all sorts of [events], not just what you hear about in the news, very sadly, with the bombings, etc.”— Erin Maura Kenney, World Health Organization
At first, WHO will collect data from just 10 countries that are considered in conflict or dangerous for health workers. That number will be scaled to 14 more within a year.
“It became clear to us it was an issue we had to address as global community and from WHO, we made the decision we need to put dedicated resources toward this,” Kenney said. “The issue goes way back longer, but it was around 2011, 2012 when the issue finally became really a globally noted issue and that coincides with the beginning of the war in Syria, where attacks were happening with terrible frequency.”
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Several years later, that has led to the construction of a first-of-its-kind database, and some difficult questions over terminology: What is an attack? What is a health center? What is a health worker? Differences in such definitions can lead to a wide variation in both the number of attacks logged each year, and the legal protections put in place by national governments. Work is still underway to compile a compendium of “good practice” in certain countries that have been effective at reducing attacks, to see what ideas could be scaled, and to move from data to action.
“For us, attacks is a very broad definition of what hinders the delivery of health care. It includes looting, abduction, assault, all sorts of [events], not just what you hear about in the news, very sadly, with the bombings, etc. But it is a wide array of actions that can be taken and they are very contextualized for the type of attack, to the situation on the ground, etc. where global efforts can work or local, or community, or regional efforts might be more effective,” Kenney said.
WHO has not established an exact date for going live with the database, but it is “very close,” Kenney said, and expects it to be out and ready for use within this work quarter.
Attacks on aid workers as a whole have become increasingly common in the post-9/11 era, as they no longer have the protection in conflict zones that used to be a guarantee, said Ken Isaacs, the vice president for programs and government relations at the United States-based Christian international relief organization Samaritan’s Purse.
“There was a certain revered, or respected kind of space for us,” he said of the late 1970s, when he launched his career in humanitarian work. “Starting around 1998 or ‘99, you started seeing some initial targeted attacks against aid workers, and you get up to 2001, 2002, 2003, and aid workers were becoming political targets, whether that was in Afghanistan, or the destruction of a United Nations compound in Baghdad.”
The overall issue now, he says, is just “chaos on the ground.”
“There’s no security in the humanitarian space. Access has shrunk to something very, very small and it is very dangerous,” he said.
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