Vector Volume 11 Issue 1 - 2017

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death” [4]. According to data from Physicians for Human Rights, 796 health workers were killed between March 2011 and December 2016. Of these deaths, shelling and bombing accounted for just over half (55%), followed by shooting (23%), torture (13%), and execution (8%).[5] In addition to health worker fatalities, military forces have also targeted health facilities. This escalated in late September 2015, when Russia intervened militarily to provide support for the Syrian government, with 2016 data showing an 89% increase in verified attacks on healthcare facilities. The Syrian Network for Human Rights documented “289 attacks on medical facilities, ambulances and Syrian Arab Red Crescent bases, 96% of which were by Syrian or Russian forces”.[6] In contrast to the attacks in Afghanistan, such as that of the MSF Hospital in Kunduz, these documented attacks became so blatant that the United Nations (UN) Security Council condemned them in Resolution 2286 on May 2016.[7] In 2009, Syria had 29,927 doctors,[8] a figure that has fallen by 15,000 due to persecution and war, as reported by Physicians for Human Rights in 2015.[9] In 2009, Syria had 29,927 doctors,[8] a figure that has fallen by 15,000 due to persecution and war, as reported by Physicians for Human Rights in 2015.[9] This vacuum of physicians has led to the development of gaps and deficits in the skills and numbers of healthcare personnel available to serve the civilian population, which is already under duress from open conflict and aerial bombings. However, a deeper look at this gap reveals a disparity between government controlled areas and nongovernment controlled areas. In 2015, the non-government controlled region of Eastern Aleppo had a doctor-to-patient ratio of 1:7000; just 5 years prior, the ratio was 1:800. Research from The Syrian Centre for Policy Research has demonstrated a gross disparity in healthcare cover, with 31% of Syrians living in areas with insufficient health workers and 27% living in areas with a complete absence of health workers.[4] Many medical students in Syria have abandoned their studies, either because there are no longer doctors to teach them, or because there is such an urgent need to replace missing health workers that students are required to provide care. This has amplified the potential for suboptimal outcomes, with inexperienced doctors and medical students forced to practice outside of their scope of proficiency, increasing the risk of complications for patients. Indeed, surgical complications and infections have become more common, potentially reflecting shortcomings in medical training.[4] Responses to healthcare weaponisation In the face of these atrocities, what is there to do? In keeping with observations regarding healthcare in conflict zones, particularly in the context of healthcare weaponisation, health policy released by The Lancet and American University of Beirut (AUB) Commission has explored priorities for maintaining and promoting healthcare despite the challenges of conflict. Strengthening accountability with respect to the protection of health workers has been noted as the key priority in combating the surge in violence towards health workers and facilities. Multiple nations and key advocates, such as the UN Secretary General and the UN Strengthening accountability with respect to the protection of health workers has been noted as the key priority in combating the surge in violence towards health workers and facilities. High Commissioner of Human Rights, have supported and referred numerous war crimes from the Syrian conflict to the International Criminal Court. These attempts have been obstructed by Russia and China, two of the five permanent members of the UN Security Council. Indeed, the UN Security Council has issued multiple resolutions demanding humanitarian access and condemning chemical warfare, the latter of which is particularly pertinent given recent chemical attacks in Syria. However, these resolutions have resounded emptily due to political and diplomatic obstruction. Fouad et al., publishing under the Lancet/AUB Commission, suggest that responsibility falls to the civic society and medical community 19
to bring governments and warring factions to account, and to end war crimes against both health workers and civilians. Groups in the Netherlands, Belgium, Spain, France, and Sweden have already had some success in bringing the agenda of health workers in conflict zones to peace negotiations.[4] Other recommendations include supporting health workers in conflict zones with resources, and reinforcing their capacity to deliver a wide range of services beyond trauma management. The Syrian conflict has highlighted the shortand long-term complexities of healthcare in conflict zones, and it is not feasible to allow other domains of care, such as maternal and neonatal care, to suffer as a consequence of conflict, or to allow vaccine-preventable endemics to resurge, as has happened in Nigeria. Institutions, including military organisations, should actively encourage and promote the concept of medical neutrality, and work to minimise disruption to healthcare services. It must also be realised that promoting global solidarity with health workers will help to develop an environment within which protection in times of conflict is more readily achieved. Initiatives such as the Safeguarding Health in Conflict Coalition and the Red Cross’ Health Care in Danger Project should be developed further to prevent targeting of health workers, or at least to facilitate early mobilisation and response to violence against health workers and facilities. Finally, but perhaps most importantly, more research on health workers in conflict is required, with an emphasis on developing understanding across multiple nations and conflict zones, given the heterogeneity in warfare and its effects on healthcare. Such data will allow governments and organisations to draw precedence for future conflicts, and will lend weight to arguments advocating for the protection of health workers and the civilian populations they serve. Conclusion Finally, but perhaps most importantly, more research on health workers in conflict is required, with an emphasis on developing understanding across multiple nations and conflict zones, given the heterogeneity in warfare and its effects on healthcare. Fighting against this paradigm shift away from medical neutrality is an arduous and daunting task. Even with strong backing from top UN position holders and many governments, offending parties still roam free of retribution and accountability. Despite feeling like a David vs. Goliath battle, the fate of healthcare in conflict relies upon the empathic and moral consideration of medical neutrality, a responsibility which belongs to every health worker, medical student, and civilian. “The standard you walk past is the standard that you accept” – General David John Hurley (AC). References Acknowledgements None Conflict of Interest None declared Correspondance miwu5665@uni.sydney.edu.au 1. Shaw M. Geneva Conventions. In: Encyclopaedia Britannica [Internet]. Chicago: Encyclopaedia Britannica Inc; 2004. Available from: https://www.britannica.com/ event/Geneva-Conventions. (Accessed March 30th 2017) 2. Thomas K. What was lost in the Kunduz Hospital Attack [Internet]. Medecins Sans Frontieres; 2016. Available from: https://www.msf.org.au/article/storiespatients-staff/what-was-lost-kunduz-hospital-attack. (Accessed March 30th 2017) 3. Institute for Economics & Peace. Global Peace Index 2016 Report. IEP Report 39. 2016. Available from: http://visionofhumanity.org/app/uploads/2017/02/GPI- 2016-Report_2.pdf. (Accessed March 30th 2017) 4. Fouad F, Sparrow A, Tarakji A, Alameddine M, El-Jardali F, Coutts A, et al. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet –American University of Beirut Commission on Syria. Lancet. 2017. DOI: http://dx.doi. org/10.1016/ S0140-6736(17)30741-9 5. Anatomy of a Crisis: A Map of Attacks on Health Care in Syria [Internet]. Physicians for Human Rights. Available from: https://s3.amazonaws.com/PHR_syria_ 20
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Page 3 and 4: Contents Editor’s Note: The Sky
Page 5 and 6: Rise of Trump/Fall of Health [Comme
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Page 9 and 10: may perceive the risks from vaccina
Page 11 and 12: Climate Change and Vector-Borne Dis
Page 13 and 14: REFUGEE AND ASYLUM SEEKER UPDATE MA
Page 15 and 16: Just two weeks after Dukhan’s let
Page 17 and 18: Redefining Women’s Health: A Nonc
Page 19 and 20: posit in Women’s Health: A New Gl
Page 21: Healthcare in Conflict Zones [Featu
Page 25 and 26: Surgery: Luxury or Necessity? [Feat
Page 27 and 28: providing surgery are high, investi
Page 29 and 30: Beyond the horizon and back again I
Page 31 and 32: soft-drinks in day-to-day practice.
Page 33 and 34: prevention method.[15] At-risk indi
Page 35 and 36: Mental illness following disasters
Page 37 and 38: increase the incidence of disasters
Page 39 and 40: Factors that contribute to the redu
Page 41 and 42: does not allow for the provision of
Page 43 and 44: Medical electives in resource-poor
Page 45 and 46: the tensions which exist between se
Page 47 and 48: IFMSA - 5 letters with one big miss
Page 49 and 50: Health, was involved in presenting
Page 51 and 52: million more people into extreme po
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