Leonard Rubenstein, a lawyer who directs a program on human rights, health and conflict at the Bloomberg School of Public Health at Johns Hopkins. says there were a staggering number of assaults on health care facilities in 2016.
“The international community says it wants to stop this and then does nothing to implement its own recommendations,” he says. “These attacks go on.”
Rubenstein is the editor of a new report called “Impunity Must End” about aggression against health facilities and health workers globally last year.
Rubenstein found that health care facilities were under assault last year in many other parts of the world. The report was not able to compile data on the total number of attacks in each country.
“It’s quite remarkable how varied the forms of attack are,” Rubenstein says. “For example we found in 10 countries hospitals were bombed or shelled, in 11 countries health workers were killed, in about 20 countries there were various forms of intimidation — abductions, kidnapping of health workers.”
The whole world is buzzing this week about the latest “gate”scandal. This time it is “Cablegate,” sparked by a series of US diplomatic cables released by Wikileaks, which apparently shocked the world by demonstrating that things are not always as they seem on the surface with international politics. Aside from my confusion about why exactly this was news (isn’t it generally accepted in the diplomatic community that everyone is collecting information to send back their HQs?) and my dismay that work to combat human rights violations could be compromised, I was encouraged by the fact that release demonstrated that the State Department is very interested in the the UN and invested in stability and conflict prevention. For example, diplomats were asked to gather intelligence on Ban Ki-Moon’s plans for Iran, as well as information on Sudan and the Darfur conflict, Afghanistan, Pakistan, Somalia, Iran, and North Korea. (The jury is still out on whether this constitutes actual spying, which is illegal at the UN according to international treaties.) The State Department’s own Quadrennial Diplomacy and Development Review affirms this. The review is expected to be released in mid-December. Meanwhile, a draft summary revealed greater emphasis on improving civilian response to conflict. While response has (of course) been mixed, many organizations, including Oxfam America, have praised its emphasis on conflict prevention and response.
This has enormous public health implications as well. In war, obviously, people die. They also get injured, sick, raped, tortured, and traumatized. As APHA’s policy statement on armed conflict and public health points out, the damage that is done to population health and health systems as a result of armed conflict is colossal, devastating, and expensive. In addition to high mortality and injury rates, there are numerous, and often unseen, morbidity complications, including psychological trauma and severe or disabling injuries. Women are left more vulnerable as men are killed, and are targeted for rape, forced impregnation, and sexual slavery by armed groups. Children suffer from malnutrition and are often targeted for ethnic cleansing. Health systems are impaired (if not completely disabled) as equipment is destroyed, supply systems break down, and health workers flee, and they often face a higher burden due to the increased health care needs of the population ravaged by the violence. It is also really expensive: Medact estimated in 2002 that the financial burden of the Iraq war could exceed $150 billion, which would address the health care needs of the world’s poorest over four years.
The policy paper calls for a change in the mindset of public health professionals that war is “an inevitable force in the world” and argues that the profession should embrace the role of conflict prevention as a form of public health prevention. The State Department has indicated that it wants to take that step – shouldn’t we as well?