Violence against health workers during armed conflict
1
Correspondence 1276 www.thelancet.com Vol 381 April 13, 2013 University, Washington DC 20037, USA (HA); Monitoring & Evaluation, Policy and Performance, GAVI Alliance, Geneva, Switzerland (GWP); and Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden (GWP) 1 Adil M, Johnstone P, Furber A, Siddiqi K, Khan D. Violence against public health workers during armed conflicts. Lancet 2013; 381: 293. 2 WHO, Global Health Workforce Alliance. Global experience of community health workers for delivery of health-related Millennium Development Goals: a systematic review, country case studies, and recommendations for Integration into national health systems. Geneva: WHO, 2011. 3 WHO, Global Health Workforce Alliance, International Federation of Red Cross and Red Crescent Societies, UNICEF, United Nations High Commissioner for Refugees. Joint statement: scaling-up the community-based health workforce for emergencies. Geneva: WHO, GHWA, IFRC, UNICEF, UNHCR, 2011. 4 Rubenstein LS, Bittle MD. Responsibility for protection of medical workers and facilities in armed conflict. Lancet 2013; 375: 329–40. 5 World Medical Association. WMA urges Sri Lankan President to intervene on behalf of government doctors. June 1, 2009. http:// www.wma.net/en/40news/20archives/2009/ 2009_06/index.html (accessed Jan 31, 2013). CHWs are at the frontline interface between the professionals in the formal health-service delivery system and the community, and can help identify feasible options for protecting the health workforce from being attacked in a particular locality. During the years of insurgency in northern Uganda, CHWs in Kitgum district had a key role in protecting health assets, often tipping health workers on the movements and threats posed by the rebels of the Lord’s Resistance Army (authors’ personal experience). CHWs who are locally recommended, recruited, trained, and employed are better equipped with local knowledge, confidence, and linguistic skills. 2 They often sense emerging risks of assaults and attack through formal and informal local social networks, and can advise on the need for evacuation and, when scaled up as an integral part of the national health system, call for emergency supplies. The joint statement Scaling-up the Community-based Health Workforce for Emergencies 3 should be widely dis- seminated and used to highlight the crucial role of the community-based health workforce in emergencies. Adil and colleagues and Rubenstein and colleagues 4 insist that WHO is best positioned to lead the documentation of attacks against health workers and to champion their protection in armed conflicts. However, the complex and multifaceted nature of the problem requires collaborative action by all. Thus, the joint statement should be backed up by action to reinforce the efforts and appeals made by health workers’ representative bodies such as the World Medical Association. 5 We declare that we have no conflicts of interest. *Hirotsugu Aiga, George William Pariyo [email protected] Japan International Cooperation Agency (JICA) Vietnam Country Office, Ba Dinh district, Hanoi, Vietnam (HA); School of Public Health & Health Services, Medical Center, George Washington immediate actions that can be taken to enhance political commitment; coordinate key stakeholders; improve the legal framework; allocate roles and responsibilities; mobilise human, technical, and financial resources; and, most crucially, engender public trust. We cannot wait any longer. The recent focus on aid effectiveness and outcomes will simply be more rhetoric without functional CRVS systems. AL is Chair of the Health Metrics Network Executive Board. JT was an adviser to the Board. Alan Lopez, *Jane Thomason [email protected] Health Metrics Network, WHO, Geneva, Switzerland (AL); and Abt JTA, Milton, QLD 4069, Australia (JT) 1 AbouZahr C, Cleland J, Coullare F, et al. The way forward. Lancet 2007; 370: 1791–99. 2 Paris21. Statistics for transparency, accountability, and results: a Busan action plan for statistics. http://www.paris21.org/sites/ default/files/Busanactionplan_nov2011.pdf (accessed March 20, 2013). 3 UN Human Rights Council. Birth registration and the right of everyone to recognition everywhere as a person before the law. http:// www.unhcr.org/refworld/topic,4565c2252c,4 654592f2,503cdba52,0,,,.html (accessed March 20, 2013). 4 UNICEF Innocenti Research Centre. Birth registration: right from the start. http://www. unicef-irc.org/publications/330 (accessed March 20, 2013). 5 Commission on Information and Accountability for Women’s and Children’s Health. Keeping promises, measuring results. http://www.everywomaneverychild.org/ images/content/files/accountability_ commission/final_report/Final_EN_Web.pdf (accessed March 20, 2013). Violence against health workers during armed conflict Mahmood Adil and colleagues (Jan 26, p 293) 1 present six global responses to address violence against health workers during armed conflicts. Although we recognise the import- ance and validity of the measures they outline, we would like to propose that community health workers (CHWs) be considered as an indispensable resource in seeking field-based solutions. Department of Error Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–60—In this Article (Dec 15), an error in the estimates of attributable burden for alcohol use led to a larger fraction of ischaemic heart disease mortality and morbidity being incorrectly attributed to alcohol use. Also, results for Afghanistan were erroneously included twice in the estimates of attributable burden for household air pollution. These errors have been corrected, leading to changes to the estimates in the Findings section of the Summary, the Results and Discussion sections in the main text, tables 2, 3, and 4, all the figures, and the appendix. These corrections have been made to the online version as of April 12, 2013. Liou JM, Chen CC, Chen MJ, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2013; 381: 205–13—In figure 1 of this Article (Jan 19), the first box detailing patients entering second-line treatment in each of the three groups should have read, from left to right, “…S-14…”, “…S-10…”, and “…T-14…”. This correction has been made to the online version as of April 12, 2013. Eco Images/Getty Images
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Transcript of Violence against health workers during armed conflict
Correspondence
1276 www.thelancet.com Vol 381 April 13, 2013
University, Washington DC 20037, USA (HA); Monitoring & Evaluation, Policy and Performance, GAVI Alliance, Geneva, Switzerland (GWP); and Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden (GWP)
1 Adil M, Johnstone P, Furber A, Siddiqi K, Khan D. Violence against public health workers during armed confl icts. Lancet 2013; 381: 293.
2 WHO, Global Health Workforce Alliance. Global experience of community health workers for delivery of health-related Millennium Development Goals: a systematic review, country case studies, and recommendations for Integration into national health systems. Geneva: WHO, 2011.
3 WHO, Global Health Workforce Alliance, International Federation of Red Cross and Red Crescent Societies, UNICEF, United Nations High Commissioner for Refugees. Joint statement: scaling-up the community-based health workforce for emergencies. Geneva: WHO, GHWA, IFRC, UNICEF, UNHCR, 2011.
4 Rubenstein LS, Bittle MD. Responsibility for protection of medical workers and facilities in armed confl ict. Lancet 2013; 375: 329–40.
5 World Medical Association. WMA urges Sri Lankan President to intervene on behalf of government doctors. June 1, 2009. http://www.wma.net/en/40news/20archives/2009/ 2009_06/index.html (accessed Jan 31, 2013).
CHWs are at the frontline interface between the professionals in the formal health-service delivery system and the community, and can help identify feasible options for protecting the health workforce from being attacked in a particular locality. During the years of insurgency in northern Uganda, CHWs in Kitgum district had a key role in protecting health assets, often tipping health workers on the movements and threats posed by the rebels of the Lord’s Resistance Army (authors’ personal experience).
CHWs who are locally recommended, recruited, trained, and employed are better equipped with local knowledge, confi dence, and linguistic skills.2 They often sense emerging risks of assaults and attack through formal and informal local social networks, and can advise on the need for evacuation and, when scaled up as an integral part of the national health system, call for emergency supplies.
The joint statement Scaling-up the Community-based Health Workforce for Emergencies3 should be widely dis-seminated and used to highlight the crucial role of the community-based health workforce in emergencies. Adil and colleagues and Rubenstein and colleagues4 insist that WHO is best positioned to lead the document ation of attacks against health workers and to champion their protection in armed confl icts. However, the complex and multi faceted nature of the problem requires collaborative action by all. Thus, the joint statement should be backed up by action to reinforce the eff orts and appeals made by health workers’ representative bodies such as the World Medical Association.5
We declare that we have no confl icts of interest.
*Hirotsugu Aiga, George William [email protected]
Japan International Cooperation Agency (JICA) Vietnam Country Offi ce, Ba Dinh district, Hanoi, Vietnam (HA); School of Public Health & Health Services, Medical Center, George Washington
immediate actions that can be taken to enhance political commitment; coordinate key stake holders; improve the legal framework; allocate roles and responsibilities; mobilise human, technical, and fi nancial resources; and, most crucially, engender public trust. We cannot wait any longer. The recent focus on aid eff ectiveness and outcomes will simply be more rhetoric without functional CRVS systems.AL is Chair of the Health Metrics Network Executive Board. JT was an adviser to the Board.
Alan Lopez, *Jane [email protected]
Health Metrics Network, WHO, Geneva, Switzerland (AL); and Abt JTA, Milton, QLD 4069, Australia (JT)
1 AbouZahr C, Cleland J, Coullare F, et al. The way forward. Lancet 2007; 370: 1791–99.
2 Paris21. Statistics for transparency, accountability, and results: a Busan action plan for statistics. http://www.paris21.org/sites/default/fi les/Busanactionplan_nov2011.pdf (accessed March 20, 2013).
3 UN Human Rights Council. Birth registration and the right of everyone to recognition everywhere as a person before the law. http://www.unhcr.org/refworld/topic,4565c2252c,4654592f2,503cdba52,0,,,.html (accessed March 20, 2013).
4 UNICEF Innocenti Research Centre. Birth registration: right from the start. http://www.unicef-irc.org/publications/330 (accessed March 20, 2013).
5 Commission on Information and Accountability for Women’s and Children’s Health. Keeping promises, measuring results. http://www.everywomaneverychild.org/images/content/fi les/accountability_commission/fi nal_report/Final_EN_Web.pdf (accessed March 20, 2013).
Violence against health workers during armed confl ict
Mahmood Adil and colleagues (Jan 26, p 293)1 present six global responses to address violence against health workers during armed confl icts. Although we recognise the import-ance and validity of the measures they outline, we would like to propose that community health workers (CHWs) be considered as an indispensable resource in seeking fi eld-based solutions.
Department of ErrorLim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–60—In this Article (Dec 15), an error in the estimates of attributable burden for alcohol use led to a larger fraction of ischaemic heart disease mortality and morbidity being incorrectly attributed to alcohol use. Also, results for Afghanistan were erroneously included twice in the estimates of attributable burden for household air pollution. These errors have been corrected, leading to changes to the estimates in the Findings section of the Summary, the Results and Discussion sections in the main text, tables 2, 3, and 4, all the fi gures, and the appendix. These corrections have been made to the online version as of April 12, 2013.
Liou JM, Chen CC, Chen MJ, et al. Sequential versus triple therapy for the fi rst-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2013; 381: 205–13—In fi gure 1 of this Article (Jan 19), the fi rst box detailing patients entering second-line treatment in each of the three groups should have read, from left to right, “…S-14…”, “…S-10…”, and “…T-14…”. This correction has been made to the online version as of April 12, 2013.
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