Healthcare under attack! International Council of Nurses condemns violence against healthcare workers

Geneva, Switzerland; 15 May 2019 – A new report released today shows that healthcare continues to be attacked, impeding the delivery of essential health services and injuring and killing patients and healthcare workers. The report, Impunity Remains: Attacks on Health Care in 23 Countries in Conflict in 2018 is the sixth annual report from the Safeguarding Health in Conflict Coalition and documents nearly 1,000 violations of the international humanitarian laws and United Nations resolutions designed to protect health workers in conflict zones in 2018. Such violations led to the deaths of 167 health workers and more than 700 injuries to staff who were only there to help the sick, injured and dying.

ICN condemns unreservedly all attacks on nurses and midwives who are working in conflict zones, whose sole aim is to provide care, treatment and comfort to the sick, injured and dying. ICN calls on all governments and other combatants to uphold the international laws that protect health workers.

Responding to the report ICN Chief Executive Officer Howard Catton said:

‘This report is shocking and everyone who reads it will be horrified by its tragic findings.’

‘Nurses are a force for good, providing impartial care based on their code of ethics. Their protection is an emblem of our humanity that should protect and respect nurses wherever they are delivering care and attention to the needy.’

‘Nurses provide help to all sides in war zones, and to the innocents who have been targeted or caught in the crossfire.’

‘Yet nurses and midwives were among the at least 167 health workers who were killed and the 710 who were injured in 2018.’

‘This report details how nurses and other health workers have been brutally attacked with knives, clubs, firearms, shells, bombs and fire. They have been intimidated, kidnapped, sexually assaulted and raped. They have been murdered. And sadly, their patients have suffered the same fates.’

‘Such attacks cause immediate suffering and death. But they also deprive populations of access to healthcare because facilities are closed, infrastructure is damaged, and NGOs and other providers have to withdraw their staff after attacks.’

‘They make it harder to tackle outbreaks of diseases, including the Ebola virus, they interfere with urgent life-saving interventions and they impede vaccination programmes.’

‘Ceasing these unwarranted attacks will make the world a better, safer place for us all.’

‘International leaders must now not just condemn these atrocities but take action to prevent them in the future and ensure Health for All.’

Selected case studies involving nurses and midwives

Afghanistan

In an incident on July 3, Islamic State-Khorasan Province claimed responsibility for a failed attempt to fire rockets at a hospital in Jalalabad that the President was there to open, missing the target. In an incident involving firearms in July, unidentified gunmen attacked a midwife training centre after letting off several explosions nearby. A resulting gun battle with security forces ensued that resulted in two people—a guard and a driver—being killed.

Cameroon

14 attacks were reported in Cameroon with weapons being used in five cases. In four attacks, perpetrators used firearms, and in one attack, clubs, machetes, and nail pullers were used. In one of the four attacks involving firearms, Cameroonian forces opened fire at an ambulance transporting patients, leaving a female nurse seriously injured. Both the armed group Boko Haram and Cameroonian forces reportedly perpetrated attacks against health care in Cameroon in 2018. Cameroonian forces reportedly carried out seven attacks. The Cameroonian forces were reportedly responsible for attacking a hospital in Labialem that killed a nurse.

In southern Cameroon, Cameroonian military forces allegedly attacked the Catholic Health Centre of Tadu, setting fire to the facility. The attack led to the deaths of 13 patients, including a woman who had just given birth. A nurse present during the attack reported that Cameroonian military forces ‘forced me to leave the hospital and began to destroy the maternity pavilion. Then they set fire to the whole hospital.’ The nurse stated that the Cameroonian military believed the hospital was harbouring English-speaking independence forces.

Central African Republic

In the Central African Republic, there were 47 attacks that affected health workers, facilities, and transports. Two health workers were killed (one midwife and one unknown health worker), two vaccination workers were kidnapped and tortured, two health workers were physically assaulted, one nurse was sexually assaulted, and at least ten health workers were threatened or intimidated.

Democratic Republic of the Congo

In the Democratic Republic of the Congo there were 24 attacks that affected health workers and facilities. Three health workers were killed, eight were kidnapped, two were assaulted, and two were victims of sexual violence; at least 13 patients were also affected, with 12 stabbed and one raped. In the incident in which a patient was raped, armed men in plain clothes entered a health facility, looted it, and attacked and raped one nurse and a patient, before attempting and failing to rape another nurse. After beating some of the patients, they stole some unspecified items and left the facility.

Nigeria

On March 1 in the Kala Balge local government area of Rann, Nigeria, Boko Haram insurgents armed with automatic weapons, rocket-propelled grenades, and gun trucks attacked an internally displaced persons camp housing 55,000 people.

The insurgents killed at least two Nigerians working for the International Organization for Migration and a doctor working for UNICEF. They also kidnapped two female midwives - Saifura Hussaini Ahmed Khorsa and Hauwa Liman - working at a health centre supported by the ICRC, and a female nurse - Alice Loksha - working at another health centre supported by UNICEF.

Following this incident, on March 2, MSF announced the suspension of its medical activities in the town and evacuated 22 national and international staff. MSF reported it was unclear how many people were killed and injured in the violent attack, but reported that its staff had treated nine injured patients. MSF said 40,000 people in Rann were relying almost entirely on its services to access health care, and 60 children enrolled in its nutrition program would be left without medical care.

On September 17, Boko Haram militants killed one of the kidnapped midwives, 25-year-old Saifura Hussaini Ahmed Khorsa, and released a video of the execution. The ICRC condemned the killing and urged the captors to release the remaining health workers.

Head of the ICRC delegation in Abuja Eloi Fillion said: ‘Saifura moved to Rann to selflessly help those in need. We urge those still holding our colleagues Hauwa and Alice: release these women. Like Saifura, they are not part of the fight. They are a midwife and a nurse.’

On October 16, the Islamic State West Africa Province, a militant group affiliated with the Islamic State and a faction of Boko Haram, killed the other abducted midwife, 24-year-old Hauwa Liman. The ICRC said Liman was a ‘dynamic and enthusiastic woman who was much loved by family and friends. She was truly dedicated to her work helping vulnerable women in her family’s home area.’

The ICRC also said, ‘Hauwa and Saifura’s deaths are not only a tragedy for their families, but they will also be felt by thousands of people in Rann and other conflict-affected areas of north-east Nigeria, where accessing health care remains a challenge.’ UN Secretary-General António Guterres condemned the kidnappings and killings: ‘All parties to the conflict must protect aid workers who provide life-saving humanitarian assistance to the millions of people in need in north-east Nigeria.’

Based on reports of Hauwa Liman’s execution, nurse Alice Loksha remains in captivity.

Ukraine

In 2018 there were 11 attacks on health workers and health facilities. The majority were in eastern Ukraine, with nearly half of the incidents occurring in Donetsk. In these 11 incidents, two health workers were reportedly killed, seven were reportedly injured, three were reportedly threatened and intimidated, and three guards or drivers were affected. Additionally, two health facilities were reportedly damaged, with four forced closures of health facilities.

In nine of the reported incidents, the perpetrator remains unknown. The SHCC received information on perpetrators for only two incidents, with one incident reportedly carried out by Russian-backed militants and the other by Russia’s hybrid military forces. In this attack, a Ukrainian military nurse was killed in a militant shelling while providing treatment to civilians in the Donbass conflict zone.

Note for Editors

The International Council of Nurses (ICN) is a federation of more than 130 national nurses’ associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.

ICN is a member of the Safeguarding Health in Conflict Coalition, a group of international nongovernmental organizations working to protect health workers, services, and infrastructure.

Safeguarding Health in Conflict Coalition (2019) Safeguarding Health in Conflict Coalition 2018 - Impunity Remains: Attacks on Health Care in 23 Countries in Conflict. SHCC, Washington DC.

For further information please contact

Gyorgy Madarasz, Press Officer, International Council of Nurses, Tel: +41 22 908 01 16

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