Aïda Ndiaye
Advocacy Analyst on the protection of humanitarian and health workers
The protection of humanitarian and health workers is far from being a new topic for the humanitarian community. Widespread violence against civilians characterises contemporary conflict and humanitarian needs have nearly doubled in four years to reach a record of 339 million people in need in 2023.
Protecting humanitarian and health workers means to ensure that vulnerable communities, caught in man-made conflict and multifaceted humanitarian crises, can access impartial and life-saving aid and healthcare. These last few years States and non-governmental organisations (NGO) undertook various initiatives and commitments to address this topic ranging from enacting policy protective frameworks such as the United Nations Security Council (UNSC) resolution 2175 (2014) and UNSC 2286 (2016), to issuing recommendations such as those in the outcome paper of the 2021 Discussion Series on Ensuring the protection, safety and security of humanitarian and medical personnel in armed conflict ; as well as active NGO advocacy campaigns to promote better protection.
Despite these efforts, aid and health workers insecurity remains alarmingly high. In 2022, the Aid Worker Security Database recorded at least 444 attacks on aid workers, killing 116 of them. 2022 also ranked as the most violent year for attacks against healthcare in a decade with 1989 attacks and threats against health facilities and personnel, representing a 45% increase compared with 2021. Concerning the specific impact on health workers, the Safeguarding Health in Conflict Coalition (SHCC) reported 232 health workers killed, 298 kidnapped and 294 arrested. These figures confirm the need for continuous and joint efforts from the humanitarian community, states and donors to enhance the protection of humanitarian and health workers and maintain this issue at the highest-level political and diplomatic agenda.
In addition, national and local staff, including local health personnel, working outside the aid system account for 90% of the victims of attacks. Working closest to populations in the most perilous and remote areas, their specific challenges must be placed at the centre.
A recent report launched by Action contre la Faim, Federation Handicap International – Humanity and Inclusion and Médecins du Monde titled “The risks we face are beyond human comprehension: Advancing the protection of humanitarian and health workers” identifies as one of the NGOs priorities to better protect aid and medical personnel. Drawing from a consultation of 79 NGO representatives the report underscores common challenges to NGOs in ensuring their staff protection, and intends to provide avenues to advance security for local healthcare providers. It suggests operational-oriented recommendations falling under three key priorities that are widely shared by the NGO community to address this crucial issue.
As a top priority NGOs stress the need to scale up security risk management (SRM) and extend it to local and national actors, who remain the least protected while being the most exposed to risks. This requires adequate and effective funding for security related costs. Barriers remain for NGOs to get their security costs funded due to detrimental policies of donors such as those imposing a program-support costs ratio, or considering security costs as overheads. These eventually force them to cut-off security costs to preserve other costs necessary to the running of operations. On the other hand, NGOs also tend to self-censor in including security costs in their proposals. Donors and NGOs need to get a better understanding of what security costs may entail (security training, material, infrastructures, human resources, security risk assessments etc.) to ensure NGOs are able to meet their duty of care obligations toward their staff. Moreover, donors must provide dedicated budget lines to ensure NGOs security costs are fully covered. Concerning local and national NGOs (L/NNGOs), they report systematic difficulties or refusal from donors and international partners (e.g., INGOs and UN agencies) to fund their security costs. The risk transfer to already over-exposed L/NNGOs and local health workers need to be acknowledged and partners must understand its scope to better mitigate it. A way forward is to adopt a risk sharing approach; to include security in partnership agreements and to pass resources onto national and local partners to support them in implementing their own SRM strategies. The study also underscores the continued need to invest and strengthen Duty of Care (DoC) policies that include relocation, psychological, material and legal post-incident services to aid and health workers as well as their families; where appropriate. These policies should be fully funded and applicable on the ground, equally available for international and national staff. For local health workers outside the aid system, SRM and DoC remain a blind spot. Whereas NGOs are specifically used and trained to operate in exposed settings, a regular nurse, physician, or surgeon for instance, are not trained to do any kind of security risk management. Therefore, the humanitarian community should leverage its knowledge to extend it to health teams. This would require supporting and funding platforms for exchanges between humanitarian workers and healthcare providers, to share good practices, develop a context-based culture of SRM within the health sector, and SRM models adapted to specific risks faced by health workers.
The second priority calls to sustain and scale data collection, sharing and analysis on security incidents at local and global levels. The humanitarian community has made great progress in setting effective data collection and sharing systems. However, there is more to be done in terms of data sharing between the different entities doing data collection (e.g., operational and non-operational NGOs, NGO forums and security platforms, UN-led working groups or initiatives). As data sharing relies on trust relationships, it is crucial that data collection bodies share data, in order to have a complete picture of what is happening on the ground. Efforts are also needed to raise awareness on existing data collection mechanisms and provide all actors, including local actors with the necessary means and tools to meet reporting requirements. The inclusion of national and local workers in data platforms should be strengthened and greater support for localised approach to data collection and sharing is needed. Moreover, for an efficient use of the available data on violence against aid and health workers it should be ensured that data can be used for operational safety purposes, but also for advocacy and policy change or to shed light on a situation to potentially trigger a judicial investigation. In addition, strengthening data to protect healthcare from attacks in conflict zones, requires collecting and sharing enough precise data (including dates, locations, and perpetrators) and available for public use, while addressing security risks (i.e retaliation from perpetrators) that may arise from data sharing. In line with UNSC resolution 2286 (2016) it is crucial that the ministries of health at national level refrain from politicising data collection and guarantee meaningful reporting, including when attacks are carried out by their own forces.
The NGO community identified a third priority which calls to address the broader picture of aid and health workers insecurity which is the shrinking of humanitarian space. If SRM and data collection and sharing are necessary tools to prevent, mitigate and respond to attacks against aid and health workers, they do not address the root causes. Aid and health workers insecurity is rooted in widespread disregard for international humanitarian law (IHL), humanitarian principles and medical ethics, and the ever-growing politicisation of aid. These are key structural challenges to tackle and involve joint action from States, donors the UN and NGOs. For instance, States and donors’ political allocation of humanitarian funding based on economic or security objectives instead of needs, the blurred lines between the military and the humanitarian mandates and the growing disinformation around humanitarian mandates, impede humanitarian and health workers to act in accordance with humanitarian principles and medical ethics. These phenomena result in putting workers at further risks of violence. The impact of sanction regimes and counterterrorism measures (SCTMs) is also identified as a problem. It poses increasing risks of criminalisation of workers for delivering impartial aid and healthcare, especially at national level, when measures prohibit dialogue with non-state armed groups or to provide assistance in areas under their control; in contradiction with IHL.
Consequently, it is urgently needed that States include humanitarian exemptions in all sanction regimes and counterterrorism related frameworks, including at national level in criminal codes, in line with the spirit of UNSC resolution 2664 which provide humanitarian carve-out across all UN sanctions regimes.
Finally, lack of knowledge and understanding as well as deliberate violations of international humanitarian law, humanitarian principles, and medical ethics, are considered by NGOs as fundamental issues that need to be addressed. These protection frameworks are the cornerstone of humanitarian action and medical assistance, but their effective implementation is lacking. Consequently, there is a need to ensure sufficient resources for awareness-raising, training, and mainstreaming of the rights and obligations arising from these frameworks, by promoting a common understanding of how they translate into concrete action by all key actors (authorities, non-state armed groups, beneficiary communities and humanitarian and health workers themselves). Ultimately, the persistent impunity for attacks on humanitarian and health workers, due to a lack of political will and the ineffectiveness of existing accountability mechanisms and national legal systems in conflict contexts, remain problematic. NGOs as well as health workers engaged outside the aid system, should be provided with knowledge, legal support, adapted tools and capacity strengthening to speak out when attacks occur and support the fight against impunity among voluntary organisations and those concerned.
Hence, protecting humanitarian and health workers is a collective responsibility and must be reinforced at all levels of the international and humanitarian communities. It will imply comprehensive and sustained follow-up to operationalise effectively the existing commitments and protective frameworks, to make a substantive change for these men and women who have chosen to dedicate their lives to help others.