Are health services important in an armed conflict? Of course. Yet across the world there are attacks on health workers, hospitals and ambulances. The result is widespread loss of life and a lot of avoidable suffering. This humanitarian scandal affects civilians and injured soldiers - who are protected under international law. So too are health workers. Explore what is going wrong, who's helping and how the law can be better enforced.
Help needed fast
Ask students to imagine a wounded soldier being removed from a conflict zone. How do they picture the scene? Discuss images students have seen and the era they come from. Do they imagine, for example, stretcher bearers taking the wounded from trenches in the First World War? Or perhaps they think of a helicopter evacuating someone to a field hospital.
Discuss the need for urgent medical help in a war zone - and the difficulties providing it. Then show students the photograph.
Explain that it was taken in late September this year in the Syrian city of Aleppo during intense fighting between government forces and opposition armed groups. The injured man was reportedly shot during clashes between the Free Syrian Army and Syrian Army forces.
Focus on the expression of the man in the centre. How would students describe it? Tense, anxious? Note that the men are not taking cover, so they must think they are not likely to come under direct attack. So what are they worried about? Is their main concern for the injured man?
The caption the photographer supplied said the men were shouting for help. Discuss the kind of help that they might be hoping for. Remember that this is a conflict area. Normal health services will have seen massive disruption as well as enormous demand. Any ambulances and medical personnel risk being hit by stray shells. They could even come under direct attack. This is illegal, but it happens.
Spend a few moments thinking about what might have happened in the period after this photograph. What chances of survival would the injured man have compared to someone who could just call an ambulance in peace time?
Explain to students that violence against health-care workers, hospitals and injured people in armed conflicts and other emergencies, although a violation of the law, happens a lot. It is a serious humanitarian challenge that is rarely discussed. Find out more by exploring some of the activities below.
By the end of the activity students will be able to describe the kinds of medical help needed during an armed conflict.
Think about students' own lives. You are with someone who needs emergency help fast. You call an ambulance. How long would it take for an ambulance to get to you for an immediately life-threatening condition? Have a guess, then look at these targets for the NHS in England.
- An emergency response will reach 75 per cent of calls within eight minutes.
- Where onward transport is requested, 95 per cent of life-threatening calls will receive an ambulance to transport the patient safely within 19 minutes.
Discuss students' own experience of ambulance response times. How do people feel in that period of waiting? What is the best way to comfort and reassure the patient?
Then imagine that you were calling for an ambulance during an armed conflict. How might the following affect the response time:
- Armed soldiers have set up a roadblock and are turning away all traffic.
- Several roads in the area have been destroyed by shelling.
- Many health workers have moved away with their families to a safer area.
- Ambulances risk being shot at.
Consider all this and make a list of options for someone in need of urgent care.
By the end of the activity students will recognise the target emergency response times for NHS ambulances in England and describe how an armed conflict could affect them.
Humanitarian groups are raising awareness of attacks on health workers. The International Committee of the Red Cross has created the following posters. Download them and show them to students.
The campaign is hardhitting and graphic. The four posters are titled ‘Mother and baby’, ‘Checkpoint’, ‘Cholera tent’ and ‘Emergency room’. Discuss each one, perhaps in groups first. Ask people to describe how understandable, memorable and effective they think each poster is, and why.
Can the group agree which one makes the most powerful statement about attacks on health-care workers?
Invite students to design a poster of their own to raise awareness of the need to improve life for injured civilians and combatants in a conflict zone. See below for other activities that might provide useful background and additional information.
French language students might also listen to a song: Question de Vie ou de Mort (Matter of Life or Death), by singers from Côte d'Ivoire.
By the end of the activity students will be able to give their assessment of the effectiveness of a humanitarian group's campaign posters and identify potential improvements.
Health care consequences
Here are the ingredients for an in-depth exploration of how and why conflict can be so damaging to health-care services. Prepare the exercise as a worksheet for individuals. Or do it together as a large group. Note that many of the actions described are illegal. Attacks on health care workers or facilities are prohibited by the laws of war.
The following half-sentences need linking with their missing half - from the assortment below. The exercise needs concentration, and is a great way to think deeply about some of the realities of armed conflict.
- Armed conflict scares people...
- Violence affects existing health-care programmes...
- Sometimes armed groups target health-care facilities as a way of attacking their enemy...
- Attacks on hospitals can be criminal...
- Sometimes hospitals are used as cover to store weapons or launch attacks...
- Road closures and checkpoints cause delays...
- Bypassing a checkpoint because of a medical emergency is a high risk...
- Sometimes combatants ignore their responsibilities in law to search for and assist the wounded...
a. ...as health services can collapse after drugs and medical equipment are stolen and sold.
b. ...for example, in Gaza checkpoint soldiers ignored the cries of children in a shelled house who were later found crouching beside their dead mothers.
c. ...so civilians, including health-care workers and their families, often move to a safer area.
d. ...and many times in Afghanistan and Iraq health vehicles were shot at as they drove past waiting traffic.
e. ...and such security measures can prevent wounded or ill people getting the rapid access to health care they need.
f. ...so in countries such as Afghanistan and the Democratic Republic of the Congo the fight to eradicate polio has been slowed.
g. ...so patients and hospital staff risk being caught in the crossfire.
h. ...so, for instance, an explosion at a hospital in Karachi targeted people who had survived an earlier attack.
1 c; 2 f; 3 h; 4 a; 5 g; 6 e; 7 d; 8 b
For a follow-up exercise ask students to identify the places mentioned in the sentences. Where are they? Locate them on a map and describe them. Say what you know, or can discover, about any armed conflict there recently.
By the end of the activity students will be able to list numerous ways in which armed conflict affects the delivery of health care to civilians and wounded combatants.
What would you do?
Humanitarian groups are doing what they can to save lives, reduce suffering and persuade people to stop attacks on health-care workers. Here are statements describing some of the work the International Committee of the Red Cross is doing around the world. Resources are limited and no one can do everything. Bearing that in mind, invite students to say what they would do. Use a prioritising activity to debate the options. There are no right answers. It all depends on local need and the realities of the situation.
To reduce suffering I would:
- Negotiate ceasefires so health teams can get to the injured.
- Reinforce hospitals with sandbags and bomb-blast film for windows.
- Mark health-care facilities with a red cross or red crescent emblem.
- Take GPS co-ordinates of health-care facilities and give them to all parties in a conflict.
- Provide first-aid training for groups exposed to violence.
- Discuss the importance of letting ambulances through with those operating checkpoints.
- Run information campaigns warning of the dangers and consequences of attacks on health workers.
- Go with sick and wounded people to hospital if they are afraid of being treated badly because they are on the "wrong" side.
- Provide mobile health-care services in hard-to-access areas.
- Ensure that parties to the conflict know that health services are protected under international law.
By the end of the activity students will be able to debate several options for reducing suffering in a conflict and prioritise the most effective.