The end of cold war put a relief to the global conflicts in the mid-20th century. However, the rise of internal and civil conflicts has faced an upward trend at an alarming rate. These conflicts are significant in the Asian, Africa, and South American countries, which lead to attacks on innocent civilians (Gawande, 2004). For example, the Boko Haram insurgence in Nigeria, and the Isis in Libya and Syria are just a few examples of the rising tide of internal conflicts among nations where thousands of non-militants have lost their lives (AM O’Hare and David, 2007). As a result, there have been frequent attacks on health workers and humanitarian officers who are rendering services to the affected communities. Towards the end of 20th century and the entire 21st century, the attack on humanitarian and health workers has increased with at least 167 incidents reported in 2012 alone (“Under Attack”, 2014). The insecurity is causing several adverse effects; for example, clinics closing up leaving the residents of the affected areas vulnerable to diseases and other related issues. Therefore, the safety of healthcare workers working in warring communities is a global health issue that should not be overlooked. This paper aims at identifying the attitude of medical practitioners who have endured this experience. In addition, it identifies the impacts or the consequences of working in insecure zone.
Background of the Study
On January 2014, police in Kiev, Ukraine, raided a Red Cross clinic shooting paramedics and medical volunteers (“Under Attack”, 2014). One year earlier, a similar incident happened in Nigeria where 9 polio vaccinators were shot dead at Kano. Another incidence was of an American aid worker, Peter Kassig, who was executed in Syria after working there for two years helping everyone despite their political affiliation. Similarly, the kidnapping rates of health workers have increased like the case of Central African Republic where 16 civilians were abducted by Seleka forces in 2014 (Mitchelle, 2015). The International Federation of the Red Cross (IFRC) recorded 2,300 incidents of violence on their workers since 2012. At least 80 polio vaccinators were killed by militant groups in Pakistan in 2012 (“Under Attack”, 2014).
The UNHCR Report indicates that the attacks on health workers have increased by 350% from 2006 to 2008 (Mitchelle, 2015). The world health organization (WHO) agrees that the attacks on medical practitioners are on the rise with several cases reported annually. As a result, medical practitioners are leaving their stations and are reluctant to work in countries prone to conflicts. For instance, the insecurity in Ciudad Juarez Mexico. Due to drug-related violence, doctors and nurses fled leading to the closure of 60 percent of the clinics. This left the health of 1.5 million people at stake for the past three years. Therefore, the safety of humanitarian and health workers is at stake and it risks the health of other civilians.
The problem of the study
The main aim of this study is to clearly understand the plight of health workers in warring communities and their willingness to work in such areas. This knowledge is important in triggering effective resolution to this scourge. Secondly, the research aims at identifying the health issues related to the insecurity of the health and humanitarian workers. Due to the shaky situation in their field of work, the study seeks to find the health challenges that arise.
Significance of the Study
This study is viable since it will aid in acquiring the figures and facts of medical practitioners in warring communities. This will help in invoking the responsible stakeholders, such as WHO to draft measures of protecting the affected individuals. Similarly, it will aid health workers who are set to offer services in this areA so that they can make prudent decisions.
- What is the health issues related to health workers insecurity in the warring communities?
- What are the health impacts to the health workers subjected to the violence in conflicting countries?
- Whether the health workers are willing to work in the conflicting communities
The proposition of this study is that health workers are reluctant to work in the war affected countries while those who are already there are intended to leave. The research also suggests there are health challenges attributed to these conflicts, such as mental health problems and post trauma stress disorder.
CHAPTER 2: LITERATURE REVIEW
Rubenstein (2012) asserts that human rights organizations always draft report on attacks on health care and they continuously identify extreme violations of international law. The violation of international law refers to the constant attacks, threats, abductions, and/or obstruction of healthcare services. The Human Rights Watch 2013 states that the international humanitarian law requires all parties in a conflict to respect and protect patients as well as health workers together with the facilities and equipment. It is a common incident to see humanitarian aid workers failing to report to work with varied reasons (Rubenstein, 2012). Therefore, the literature review section evaluates other literal works that talk about the causes and effects of insecurity among health workers in conflicting zones.
Bruderlein and Gassman (2006), states that the United Nations takes the forefront in response to disasters and armed conflicts . However, the increased attacks on health workers are attributed to vulnerability and exposure to insecurity in their places of work (Bruderlein and Gassman, 2006). Over 500 humanitarians lost their lives between 2000 and 2010, whereby 138 died within the last two years (Bruderlein and Gassman, 2006). According to Rubenstein (2012), the medical and nursing organizations urged the Human Rights Commission to develop a well-designed rapporteur on attacks on health workers over a decade ago. This suggestion was not taken seriously and the number of suffering humanitarian aid workers is increasing each dawn.
Rujumba and Kwiringira (2010) state that over 33 million people in the Sub-Saharan African countries had HIV in 2007, attracting humanitarian actions in the countries. Uganda was not spared with an estimated 6.4% HIV prevalence where a number of Non-Government Organizations came to salvage the situation (Rujumba and Kwiringira, 2010). However, the LRA rebel group presented dissident that scared the existent of the workers leaving the residents prone to war and health crisis. Those who persevered either endured violence or contracted mental illnesses. Lim, Stock and Jutte (2013) acknowledge that in conflict and disaster settings, medical practitioners may suffer from psychological stressors that threaten their well-being and productivity.
Post-Traumatic Stress Disorder (PSTD) is a common illness found in lay medics who offer primary health care in warring regions (Lim, Stock and Jutte, 2013). Lim, Stock and Jutte conducted a research on 72 medics who worked in Karen estate in Myanmar conflicting zones. The method included filling questionnaires, oral interviews, and tests for local idioms of distress. The results showed predominant existence of stressors, which were caused by transportation barriers, lack of resources, isolation from families, threats from military and rebel groups, injuries due to violence, and trauma caused by replacement and experiencing conflict first-hand. Lim, Stock and Jutte found out that work-related challenges were more profound among the 72 medics that could cause PSTD and serious mental illnesses that could lead to death at later age (Lim, Stock and Jutte, 2013). The consistent noise from gunshots, ugly scenes of injured civilians does not augur well with the medics (Miller, 2010). In some instances, they experience people they had a connection or close relationship with die, which may dent their emotions deeply.
In multiple conflicts and violence occurrences, the medical experts may fail to endure: hence, they opt to leave or seek safety. This would mean that their services are hindered and they cannot treat people anymore. Skidmore (2003) found out that the community that was enjoying the services is left bare and they experience numerous challenges. Medical assistants have been forced to seek refuge in contemporary conflicts (Miller, 2010). The resultant impact is that the affected civilians succumb to injuries and illnesses that lead to their deaths. In Burma, over 10 000 people have died each year for the last 40 years due to lack of medical attention where the large number died having labor (Skidmore, 2003). The insecurity in Ciudad Juarez Mexico due to drug-related violence has made doctors and nurses to flee, leading to closure of 60 percent of the clinics. This left the health of 1.5 million people at stake for the next three years (AM O’Hare and David, 2007). This is a clear indication that the insecurity of health workers impact even the civilians because these deaths could have been curbed or reduced if there were medical care. Similarly, Rujumba and Kwiringira (2010) linked the spread of HIV in Uganda to the insecurity posed by the LRA group to the health workers. First, the NGOs could not have a chance to counsel the residents about the disease and give them medication. In fact, the spread of HIV was due to lack of knowledge and the medical workers were the only ones who could help. Secondly, instances of rape are very much profound in wars; hence, there was increased spread of HIV (Yassi, 2001).
Bruderlein and Gassman (2006) outline a number of factors that lead to the insecurity exposure in the conflicting zones. There are many field operations in failed states where residents are uprising against each other. Most of the conflicts are politically motivated where people are hungry for power (Bruderlein and Gassman, 2006). These led to higher deployments where the number of U.N. staff marked 40, 000 in 2003 (Bruderlein and GassmaN, 2006). Secondly, during the operations, it is hard to differentiate between civilians and combatants because the target places incorporate all types of people. Thirdly, there is globalization of terror movements increasing the number of people who require medical attention.
There is laxity in the responsible units that are charged with taking care of the humanitarian aid workers. According to Bruderlein and Gassman (2006), the United Nations has not structured measures that ensure safety among the health workers in conflicting areas. Similarly, insecurity among health workers is directly detrimental to them because they have been reported to contract Post Traumatic Stress Disorders. Lim, Stock and Jutte (2013), clearly define the health challenges that health workers face during and after delivering services in the conflicting zones. Lastly, Skidmore talks of the aftermath of the clearances of medics due to insecurity. The community is left in ripples causing more deaths (Skidmore, 2003).
CHAPTER 3: RESEARCH METHODS
The purpose of this study is to identify the health challenges associated with insecurity in the militant operational area or conflict zones. The research incorporates both qualitative and quantitative methods in order to answer the research questions. However, it is a descriptive research that describes the attitude of medics towards warring places. Qualitative research aims at gathering in depth understanding of the impact of insecurity among health workers. It involves researching from on line platforms and other publications that have information regarding health workers who have worked in places that are involved in a conflict. Quantitative research takes statistical figures of what medics feel about the areas prone to war and violence.
The sampling method applied will be random sampling to obtain the scientific result that can be applied in representing the entire population. A list of health care facilities that host medical practitioners who have worked in warring communities will be identified. Participants will be picked from these facilities on a random basis. However, they must come from diverse stations of work that experience violence. They should be spread from the entire globe. A letter of consent will be sent to them prior to the study to create an awareness of the ongoing study and seek their permission and that of the employers. The letter will also seek to review their medical information when they were relieved from their duties in the conflicting zones.
Data will be collected in questionnaires and audio recordings of the participant’stestimonies. The questionnaire will contain both closed and open-ended questions in order to drive information from the respondents. Questions will include how many years they have worked in warring zones, their experiences, and their general attitude about the experience; that is, whether they would wish to get back to work in such stations. Audio recordings will be important to record any testimony that the respondent would wish to share for analysis and future references. Similarly, the researcher will collect their medical documents that contain their medical history when they came from their station. The information collected will aid in identifying whether the suffered from any illnesses when they came back.
Insecurity is on the rise based on the statistics available. Therefore, deployment of medical staff will continue to rise in order to render services to the affected communities. Consequently, their safety is at stake in spite of their great importance in those areas. Knowing the attitude or the general feeling of medics who have experienced this first-hand will be important in improving the security of the others. The findings and recommendations of this research will be of great importance to an array of individuals. When their security improves, many lives will be saved curbing this health challenge.
AM O’Hare, Bernadette, and David P. Southall. (2007). “First do no harm: the impact of recent armed conflict on maternal and child health in Sub-Saharan Africa.”Journal of the Royal Society of Medicine 100(12), 564-570.
Bruderlein, Claude and Gassman, Pierre. (2006). Managing Security Risks in Hazardous Missions: The ChallnegsOf Securing United Nations Access Vulnerable Groups. Harvard human rights journal (19), 63- 93
Gawande, Atul. (2004). “Casualties of war—military care for the wounded from Iraq and Afghanistan.” New England Journal of Medicine 351(24), 2471-2475.
Lim, George, Stock, Lawrence and Jutte Douglas. (2013). Trauma and Mental Health of Medics in Eastern Myanmar’s Conflict Zones: A Cross-Sectional and Mixed Methods Investigation. Conflict and health. 7(15), 7-15
Miller, Kenneth E., and Andrew Rasmussen. (2010). “War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks.” Social Science & Medicine 70(1), 7-16.
Mitchell, David. (2015) Blurred Lines? Provincial Reconstruction Teams and NGO Insecurity in Afghanistan, 2010–2011. Stability: International Journal of Security & Development, 4(1): 9, pp. 1-18
Rubenstein, Leonard (2012). Protection of health care in armed and civil conflict.A report for center for strategic and international studies. Retrieved from: http://csis.org/files/publication/120125_Rubenstein_ProtectionOfHealth_Web.pdf
Rujumba, Joseph and Kwiringira (2010). Interface of culture, insecurity and HIV and AIDS: Lessons from displaced communities in Pader District, Northern Uganda. Conflict and health. 4:18
Skidmore, Monique. (2003). Medical assistance and refugee safety in contemporary conflicts.Health and human rights. 362 (9377), 75
“Under Attack”. (May 2014). Human Rights Watch.
Yassi, A., et al. (2001). “A randomized controlled trial to prevent patient lift and transfer injuries of health care workers.” Spine 26(16), 1739-1746.