More than 700 healthcare workers and patients have died, and more than 2000 have been injured in attacks on health facilities across 17 emergency-affected countries and fragile settings since December 2017, according to a new WHO report released on Tuesday. 

Countries at risk included Ethiopia, Yemen, Syria, Mozambique, Nigeria, occupied Palestinian territory, Myanmar and the Central African Republic. 

“We are deeply concerned that hundreds of health facilities have been destroyed or closed, health workers killed and injured, and millions of people denied the healthcare they deserve,” said Altaf Musani, WHO Director of the Health Emergencies Interventions, in a Tuesday briefing on the report. 

This three-year analysis is based on data from the WHO’s Surveillance System for Attacks on Healthcare (SSA), which monitors attacks on healthcare workers, patients, facilities, and healthcare transport, the resources that they affected and their immediate impact on health workers and patients. 

One out of six incidents leading to loss of life for health worker or patient in 2020 

The surveillance reported a record-high 1029 attacks on health care in 2019, with the number of reported attacks during the first quarter of 2020. 

But despite fewer reports of incidents in 2020, these incidents were associated with a higher proportion of deaths than in previous years, with the proportion of attacks on health care resulting in at least one loss of life reaching 17% (one in six incidents resulting in deaths).

This year, there have been 603 attacks on healthcare workers in 14 countries with emergencies, resulting in 115 deaths and 281 injuries of healthcare workers and patients. 

‘Ripple effect’ on health workers and health system

The changes in fragile, conflict-affected, and vulnerable (FCV) settings were related to different contexts.For example, attacks in the Deomocratic Republic of the Congo’s (DRC) were related to the country’s second largest Ebola outbreaks in 2018 and 2020. Meanwhile, the 2018-2019 demonstrations in the occupied Palestinian territories’ (oPt) Gaza Strip accounted for two thirds of all reported attacks in 2019. 

Following these crises, reports on attacks on health care became markedly less prevalent. 

The impact of these attacks “reverberates on health workers’ mental health and willingness to report to work, on the communities’ willingness to seek healthcare and also drastically reduces resources for responding to health crises, among others,” noted Musani. 

The “ripple effect of a single incident is huge”, he said, and has “long-term consequences for the health system as whole.”

While the tireless work of health care workers has been championed during the pandemic, these workers have been, for the most part, largely absent from the mental health discourse.

The analysis has shown that healthcare workers are the most affected resource, with over two-thirds of attacks in 2018 and 2019 and over half in 2020 affecting health personnel, rather than facilities or supplies.  

This “worrying data”, says Musani, “goes well beyond claiming lives.”  

COVID-19 shifted pattern of health facility attacks 

The COVID-19 pandemic has further compounded the challenges faced in these FCV settings, causing a shift in patterns of violence. 

Attacks affecting health facilities, transport, and patients have become more frequent after the onset of the COVID-19 crisis.

This has brought unprecedented attention to the acts of violence health response is exposed to, with the report emphasizing that “changes in patterns of attacks on health care are to be expected whenever a major event or crisis of any kind occurs.” 

WHO calls on relevant parties in conflicts to “ensure the establishment of safe working space for the delivery of healthcare services, and equitable, safe access to healthcare, free from violence, threat or fear.”

“During the COVID-19 pandemic, more than ever, health care workers must be protected and respected, and hospitals and health facilities and transportation, including ambulances, should not be used for military purposes – essential conditions for the continued delivery of critical health services,” said Musani. 

Image Credits: www.laprensalatina.com, WHO.