Healthcare in war zones: risks and prejudices

Is it possible for doctors to provide care without being perceived as taking sides during conflicts? This question is posed more and more as attacks on health workers in war zones increase.

In January 2012, Khalil Rashid Dale, a doctor travelling in a clearly marked International Committee of the Red Cross (ICRC) vehicle to Quetta, the capital of Baluchistan province in Pakistan, was abducted by unknown armed men. Some four months later the doctor’s beheaded body was found in an orchard. Also in January two Médicins Sans Frontières (MSF) health workers were killed in Mogadishu, Somalia. The consequences of such attacks are disproportionate in their impact. A consequence of the Somalia killings led to the MSF closing two 120-bed medical facilities in Mogadishu, which served a population of some 200,000 and which over the previous year, had treated close to 12,000 malnourished children and provided measles’ vaccinations and treatment to another 68,000 patients.

In 2011 Robin Coupland, a former trauma surgeon, now a medical adviser with the ICRC, co-authored Health Care in Danger, a study, which describes how and why health workers get caught in the cross fire and what the consequences are when they do. The study was used to launch an ICRC campaign to raise awareness of the problem and make a difference to health workers on the ground.

For some people however, it is impossible for doctors to provide care without being perceived as taking sides during conflicts. Some argue that as the quantum of humanitarian aid has increased over the past decade, so humanitarian aid agencies have been compelled to rely on sub-contracting in actual conflict areas. This, it is suggested, provides a breeding ground for aid corruption to finance nefarious elites and to further destabilize conflict areas, implying that healthcare activities of humanitarian organisations in war-torn regions have become increasingly politicised. Even agencies that make considerable efforts to disassociate themselves from political actors and project an image of neutrality have not been immune from attack.

Do warring factions perceive health workers as supporting the enemy and therefore see them as legitimate targets? Or are health workers targeted because they represent an opportunity to amplify messages to a global audience? It is likely both are true, but the impact on society as a result of removing vital healthcare in war zones, due to these attacks, can have devastating consequences.