GA 2018-PlS Presentation Sirkin-Oct2018

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Dodd Center
Physicians for
Human Rights
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Preventing the Erosion
of a Longstanding Norm:
Protecting Health in
Conflict
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Healthcare Under Attack
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Leaders of Chilean Medical Association
Arrested:1986
Healthcare Under Attack
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Human Rights
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Violations of Medical Neutrality are not
new: Somalia and El Salvador 1980s
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Kosovo – more
than 100 health
facilities
destroyed
Chechnya – at
least 24 medical
facilities damaged
by federal forces;
>20 doctors
arrested
Iraq – kidnapping, murder of health workers,
destruction of facilities; 50-75% leave
Healthcare Under Attack
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Human Rights
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Geneva Conventions
“The wounded and sick, as well as the infirm, and
expectant mothers, shall be the object of
particular protection and respect.”
Extended to all medical functions in midst of war,
e.g., ambulances, hospitals, health workers, hospital
administrators, including civilians civilian facilities
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2017 Safeguarding Health in Conflict
Coalition Report
• Bombing, shelling, looting
• Killing of health workers
• Intimidation, assault, arrest
• Obstruction of access to care
• Takeover of facilities by military
• Attacks and blockage of aid workers
Healthcare Under Attack
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Human Rights
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Yemen
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Syria
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Syria
PHR online map of attacks in Syria
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• 537 attacks on 348 medical
facilities
• 321 by Syrian government
forces
• 161 by Syrian or Russian
forces
• 32 by non-state armed
groups
• 3 by international coalition
forces
• 18 by unknown forces
Toll in Syria
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Human Rights
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• 886 deaths of medical
personnel
• At least 168 (20%) of these
health professionals were
detained and extra-judicially
executed.
• The remaining cases are
attributed to bombing or
shelling (58%) and gunfire
(22%).
• Syrian government forces are
identified as perpetrators in
90% of these cases.
Toll in Syria
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Dar Al-Shifa hospital in Aleppo bombed
by government aircraft in Nov 2012
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Health Consequences
• Direct effect on civilian populations, medical personnel
and health facilities.
• Compounding effect on access and mortality and
morbidity among civilians
• Targeting of medical infrastructure and its destruction
disproportionally affects the vulnerable, including
children, mothers, elderly
• Reductions in health care capacity due to the flight of
medical personnel and destruction of services
undermine short and long-term capacity to deliver
health care.
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Indirect Consequences of Attacks
Psychological scarring
Eroded mental health treatment
Spread of infectious diseases
Pharmaceutical costs
Maternal health care
Treatment of chronic diseases
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What Motivates Attackers?
• Health care services to an enemy or alleged terrorist
considered an act against the state
• Predominance of strategic or tactical military
considerations over respect for health
• Lack of knowledge of/interest in the requirements of
the Geneva Conventions
• Perpetrators get away with attacks — Impunity for
violations
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Innovative cross-sectoral curriculum to improve collection, documentation and preservation of
sexual violence evidence in conflict and post-conflict zones
Physicians for
Human Rights
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The Criminalization of Health Care
June 2018
• Punitive measures against health care workers as a result of
their health care provision
• Complex situations where Geneva Conventions at
insufficient
• Laws criminalizing support to terrorists “inappropriately
applied to provision of medical care”
• General laws used to punish health providers
• Administrative sanctions: suspension, harassment, or
intimidation for fulfilling duty to provide care
• WMA Medical Regulations in Times of Armed Conflict
2012: duty to provide impartial care without discrimination,
“including whether they are the enemy.”
• 10 country survey; good examples: New Zealand, Colombia
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Dr. Sarder Kuni: Imprisoned in Turkey
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Turkey: 2013
• Government did not
provide care, so
volunteers stepped in
• Hospitals tear-gassed
• Attacks on medical
personnel
• Laws passed to make
unauthorized emergency
care a criminal act
• Medical colleagues
arrested for providing
care
• PHR observes trials,
advocates
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Bahrain: 2009-2011
• Ambulances
shot at by
security forces
• Doctors and
nurses,
arrested,
tortured and
jailed for crimes
against the state
• Arrests and
interrogation in
main hospital
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Human Rights
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What can WMA & Associations
do?
• Document and report incidents; collect data
• Stay informed and stay connected
• Speak out individually and collectively;
• Raise concerns diplomatically at every opportunity
• Send delegations to the field; visit threatened colleagues
• Raise publicly at conferences
• Honor doctors who do the right thing
• Invite threatened colleagues to study in your country; award
fellowships, scholarships
• Work to change laws that violate ethics
• Supports distance learning and provide equipment
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2018 PHR honors US doctors Hanna-
Attisha, Norma Price and nurse Alex
Wubbels
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Yesterday at Panzi Hospital, Bukavu,
DRC – Nobel Prize to Dr. Denis Mukwege