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EXECUTIVE SUMMARY

INTRODUCTION

The Safeguarding Health in Conflict Coalition identified more than 1,203 reported incidents of violence against or obstruction of health care in 20 countries and territories experiencing conflict in 2019, compared to the 973 we reported in 23 countries and territories for 2018. The higher number may be due to improved reporting rather than an increase in incidents. It is likely, however, that a large number of incidents still go unreported and that the number is even greater than reported here.

At least 151 health workers died in 2019 as a result of incidents in 18 countries and territories, and 502 health workers were injured in 17 countries. Health facilities were damaged or destroyed in at least 19 countries, and health transports were damaged or destroyed in at least 14 countries.

Violence against health care in conflict around the world continues to deprive millions of people of their right to health and protections under international human rights and humanitarian law. It also hampers states’ efforts in attaining universal health coverage.

In addition to the human suffering and loss of life, the incidents in 2019 impeded public health initiatives, from the Ebola response in the Democratic Republic of the Congo (DRC) to polio vaccination campaigns in Afghanistan and Pakistan. Violence also exacerbated shortages of health workers and resources. Many of these countries already faced acute shortages of health workers, as measured by the World Health Organization (WHO)’s standards.

METHODS AND LIMITATIONS

We used the Uppsala Conflict Data Program (UCDP) to determine if countries are in conflict, and included those that had experienced at least one incident of violence against or obstruction of health care in 2019.

The report is based on the collation of incident-based information from multiple sources, which are cross-checked and presented in a standardized format in a single dataset. Key sources are: Coalition member Insecurity Insight’s Attacks on Health Care Monthly News Briefs and the WHO Surveillance System of Attacks on Healthcare (SSA). The latter covers ten countries and territories: Afghanistan, Burkina Faso, the Central African Republic (CAR), the DRC, the occupied Palestinian territory (oPt), Libya, Mali, Nigeria, Sudan, and Yemen. Coalition members Physicians for Human Rights provided information on incidents in Syria, and Medical Aid for Palestinians provided information on incidents in the oPt. The report also includes information from the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA), the UN Office of the High Commissioner for Human Rights (OHCHR), the UN High Commissioner for Refugees (UNHCR), and media reports deemed reliable. Our dataset of incidents is available for open source access on the Humanitarian Data Exchange (HDX) at https://data.humdata.org/dataset/ shcchealthcare-dataset.

The report does not aim to include or analyze incidents related to interpersonal or gang-related violence, even when these occurred in conflict-affected countries. In some circumstances, however, the distinction between these forms of criminal violence and political violence is difficult to make (for example, community member violence against the Ebola response in the DRC). In cases of doubt, we included the events. We also included violence against health workers in the context of demonstrations or public unrest if these occurred in countries that were also experiencing conflict as defined by the UCDP.

Where possible, the report aims to identify perpetrators of violence against health care. Unfortunately, many reports, including incidents identified in the WHO’s SSA, do not contain information on perpetrators or context that would contribute to identifying them.

The report codes the context of attacks to determine perpetrators and the intentionality of the violence based on information available. Many events cannot be coded as there is insufficient information. Further information on methodology and definitions is available at http:// insecurityinsight.org/projects/healthcare/shcc.