by Maryalice Yakutchik
via The Johns Hopkins Bloomberg School of Public Health


People who live in fragile and conflict-affected states have been largely left behind, even by the field of global health, says Leonard Rubenstein, JD, LLM, senior scientist at the Bloomberg School’s Center for Public Health and Human Rights, and faculty member at the Berman Institute of Bioethics.


That’s a lot of people left behind.


In fact, almost one and a half billion people live in these countries, a number expected to grow to 1.9 billion by 2030. They are one-fifth of the world’s population, representing more than 43 percdent of people living on less than $1.25 a day.


Exacerbating their misery resulting from poverty and weak health systems are persistent, brutal attacks that destroy facilities, kill doctors, nurses and patients, force health workers to flee, and deter access to care.


Ignored though they are by most, vocal pockets are championing their cause.


“Our School has been at the forefront of raising the visibility of the problem, providing research studies to show its dynamics and impacts, engaging key international institutions to address it, collaborating with key partners in the field and advocating to stop the attacks,” said Rubenstein, having just concluded a panel discussion at the Council on Foreign Relations in New York City.


The panel’s focus: those who are losing lives to save lives; healthcare workers targeted by not only ramshackle regimes and terrorist groups, but also major states (most notably Syria), for the “crime” of providing healthcare.


Joining Rubenstein on stage were Jason Cone, executive director of Medecins Sans Frontieres USA, and Yves Daccord, Director-General of the International Committee of the Red Cross. Representatives of various humanitarian aid organizations attended, and CFR Fellow Laurie Garrett presided.


Garrett’s questions were hard-hitting and provocative, especially those involving Kunduz—the site of an aerial attack by U.S. forces on October 3, 2015 of an MSF hospital. Patients burned in their beds and medical staff were decapitated. In fact, 14 MSF staff and 28 patients and caretakers were killed in the attack, which the U.S. military acknowledged on April 29 resulted from multiple human and procedural errors.


Those numbers hardly reflect the real human toll, the panelists agreed. For months and years after, many more will suffer the loss of services provided by the Kunduz Trauma Centre—the only facility of its kind providing quality, free surgical care in northeastern Afghanistan. More than 22,000 people received healthcare there in 2015, and more than 3,000 limb-saving, life-saving surgeries were performed between January and August 2015.


Indeed, quantifying the nature and extent of attacks is important; data is vital to illuminate patterns and trends, create political will and ultimately devise interventions, stressed Rubenstein. He is founder and chair of the Safeguarding Health in Conflict Coalition which recently issued its third annual report, No Protection, No Respect, a 58-page document about attacks on healthcare that took place in 19 countries in 2015 and the first quarter of 2016. The report relied on secondary sources for lack of systematic data collection on these attacks.


When Garrett asked how the current situation of attacks on health care workers and facilities compares to 5 years ago, Rubenstein explained, “We don’t know. No one’s tracking the data.


“We need real-time and longitudinal reporting to figure out how to address this on a pragmatic level, through preventive and accountability measures.”


Nevertheless, available evidence reveals that the targeting of humanitarian workers is pervasive around the world, Rubenstein said, explaining that it comes in many varieties and for a range of reasons and motives.


Bloomberg School students are deeply involved in the important work of reviewing the nature of the problem and gaining skills to address it by taking human rights courses, engaging in research, developing policy options, supporting tools for data collection and participating in advocacy.


“The School is unique in enabling and supporting faculty and students to identify this long-neglected but critical realm of global health and develop a full range of strategies to address it, from research to advocacy,” Rubenstein said.


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