Collateral Damage—Attacks on Health Care

SEATTLE — Across the world, attacks on health care create barriers for health care treatment, emergency response and overall global health advancement. For many developing countries, attacks on hospitals, ambulances, physicians and even patients are not an uncommon occurrence. While these attacks have the potential to halt the growth of developing health systems, action is being taken to combat and prevent future violence against health care.


Between January 2014 and December 2015, the World Health Organization reported 594 attacks on health care in 19 countries in the middle of health emergencies such as natural disasters, war or other health hazards. As a result of these attacks, 959 people died and 1,561 were seriously injured. More than half of these attacks were directed at health care facilities such as hospitals and clinics, which means a higher death and injury rate. Another 25 percent of these attacks were against health care workers themselves.

One country in particular has had significant trouble with health care attacks. Between 2011 and 2017, Syria experienced 492 attacks on physicians, hospitals and other health care facilities, killing 847 health care personnel. During the first half of 2018, there were an additional 126 attacks.

The Devasting Impact of Conflict

Why are Syria and other developing countries facing such violent attacks on health care? According to recent data, the answer lies in the amount of conflict happening in an area. Conflict often has a negative impact on access to health care and causes unsafe conditions for health care workers, patients, and the facilities themselves.

Since conflict has such an extreme effect on health care, it is no surprise that the majority of developing nations experiencing these attacks are embroiled in tense or outright violent situations.

For example, Occupied Palestinian Territory, currently experiencing extended conflict with Israel, had the most obstruction to health care in 2017, with a total of 57 reported cases.

The conflict in Ukraine has had violent repercussions for health care as well. Soldiers and protestors have bombed hospitals and clinics, blocked the paths of ambulances, and even prevented patients from receiving necessary care.

In Nigeria, 70 were killed (including six Red Cross workers) and many more were wounded in a 2017 bombing of a vaccination site for displaced persons. The fact that the Nigerian government claimed the bombing was a mistake only proves that attacks on health care are almost always a consequence of conflict, even accidentally.

In 2017, a total of 56 health programs closed their doors in 15 countries experiencing conflict, either as a direct result of violence or in anticipation of an attack. Though access to impartial health care has long been regarded as a human right, these attacks have continuously breached this understanding with little consequence.


While it is difficult to establish safe health care in areas with extreme conflict, several organizations have accepted the challenge.

The Safeguarding Health in Conflict (SHC) coalition aims to encourage respect for humanitarian and human rights laws for the safe access of health care facilities in areas where violence against health care is widely reported, such as Syria, Yemen, Afghanistan, Nigeria and the Occupied Palestinian Territory. The coalition also works to encourage the documentation of attacks on health care in an effort to hold the attackers accountable and prevent further violence.

In December 2017, the World Health Organization launched the Surveillance System for Attacks on Health care (SSA), a global program used to document violence against health care services. The system records the area of the attack and the impact on the health of the surrounding population in an effort to track and anticipate patterns of violence.

While attacks on health care in areas of conflict are far from over, the response from international health organizations has been united and innovative. The World Health Organization’s SSA program monitors patterns of violence and addresses them when possible, and the SHC coalition is working to hold violators of health care rights accountable. With more organizations willing to work together to address and prevent health care attacks in conflict zones, health care systems will actually have the chance to fully develop.

– Holli Flanagan
Photo: Flickr


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