Preventing access to health: a tool of war?

NEW RELEASES – The Office of the United Nations High Commissioner for Human Rights (OHCHR) stated: “As human beings, our health and the health of those we care about is a matter of daily concern. Regardless of our age, gender, socio-economic or ethnic background, we consider our health to be our most basic and essential asset.”1 The right to health represents a vital, fundamental human right that stands at the very basis of our existence. As such, “Healthcare is fundamental at all times, but especially during times of war. It is necessary […] for treating war-time injuries, and for helping the elderly, pregnant, and youth.”2 This article will explore the issues surrounding access to health care and the exercise of the right to health in conflict zones.

English

A human right to health

In international human rights law, the right to health was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines health as  “a  state  of  complete  physical,  mental  and  social  well-being  and  not merely the absence of disease or infirmity.”3 The preamble further states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”4

In light of the definition provided by the WHO, the right to health needs to be understood in a broad sense. It includes, in fact, the possibility of accessing health care just as much as a wide range of factors that can help us lead a healthy life. Some of these elements are: safe drinking water and adequate sanitation, safe food, healthy working and environmental conditions, health-related education, gender equality.5

Thus, many rights are interconnected with the right to health and they need to be understood and interpreted accordingly. For instance, there is a strong, clear link between the right to health and the right to water. As the OHCHR reported, “Most diarrhoeal disease in the world is attributable to unsafe water, sanitation and hygiene. In 2002, diarrhoea attributable to these three factors caused approximately 2.7 per cent of deaths (1.5 million) worldwide.”6


Access to health

Being able to access health care is absolutely vital in promoting the full exercise of the right to health. As the International Committee of the Red Cross stated, “Access to health care for the wounded and sick must be equitable. This obligation is immediate and non-derogable.”7

The question now is: who needs to provide equitable access to health care? Who is under the obligation to do so?

The OHCHR specifically stated that the State is under such obligation towards its citizens. Public health facilities must be functioning and available in sufficient quantity within a State. Moreover, “They must be accessible physically as well as financially and on the basis of non-discrimination.”8 Notably, the OHCHR specifies that “A country’s difficult financial situation does NOT absolve it from having to take action to realize the right to health.”9 It’s evident that the resources available to each state at a given moment of time need to be considered. Nonetheless, the lack of advanced resources is not a justification for not guaranteeing the right to health to the maximum of the available resources, even when these are tight, even in times of war.


Health and war

“All forms of violence are detrimental to the health and development of human beings.”10 In times of war, particularly, human beings need health care more than ever. However, because of violent upheavals, access to health care aid is often obstructed. Firstly, medical facilities close down. For instance, in Afghanistan, 23 health clinics were closed in early 2016 as a result of violence and insecurity.11 In Mali, all access to medical health care in the North of the country was shut down, resulting in very hard outcomes especially for children and pregnant women.12 Moreover, the passage of health and other humanitarian aid is frequently restricted, as happening in Sudan where NGOs cannot access areas of great need for health care aid in Darfur. Finally, “factors such as lack of food and clean water as a result of armed conflict are often highly significant.”13 In Yemen, lack of access to health care and lack of immunizations have resulted in the deaths of nearly 10,000 children under the age of five.14

What happens, then, when hospitals become the target of aerial bombing? Whilst hospitals in conflict zones try to uphold a policy of no-weapons in their facilities15 and efforts are made to situate medical facilities away from military objective16, aerial bombings keep on targeting them. Blatantly violating international humanitarian law and the Geneva Conventions, armed groups blindly attack medical facilities, without recognising the difference between a civilian and a military target. “In five countries—Afghanistan, Iraq, Libya, Syria, and Yemen—hospitals were subjected to aerial bombing, as well as to explosives launched from the ground.”17 In 2015 only, 122 attacks on hospitals were reported in Syria, with some facilities hit multiple times.

In light of these serious issues, Mr. François Delattre, Permanent Representative of France at the UN, has suggested that the attacks committed against medical facilities amount to war crimes: “If those are not war crimes, then I honestly do not know what war crimes could possibly be.”18 Further, he argued that “Preventing access to health care is increasingly used by the parties to the conflict as a tool of war.”19 The lack of medical supplies kills people just like bombs and weapons, essentially.  Remarking that access to humanitarian assistance must be “the norm and not the exception”20, Mr. Delattre importantly highlighted the fact that those responsible for these crimes must be brought to justice since the protection of medical personnel cannot be effective without fighting impunity. He called on the UN Security Council to act as a matter of urgency. Finally, Emma Lipschultz of the Harvard College emphasised the role of education in this process of granting access to health care in war zones. “Citizens and local leaders must be educated on dealing with common illnesses”21 and NGOs should play a key role in this process.

 

1 Office of the United Nations High Commissioner for Human Rights and World Health Organization, “The Right to Health – Fact Sheet No.31”, United Nations, Geneva. Available at:  http://www.ohchr.org/Documents/Publications/Factsheet31.pdf
2 LIPSHULTZ Emma (2013) “Securing Health Care in War Zones”, Harvard College, Global Health Review. Available at: https://www.hcs.harvard.edu/hghr/online/securing-health-care-in-war-zones/
3 Constitution of the World Health Organisation 1946. Available at: http://www.who.int/governance/eb/who_constitution_en.pdf
4Ibidem
5 OHCHR, Op.Cit.
6Ibidem
7 International Committee of the Red Cross (2012) “Respecting and Protecting Health Care in Armed Conflicts and in Situations Not Covered by International Humanitarian Law”, Advisory Service on International Humanitarian Law. Available at: https://www.icrc.org/eng/assets/files/2012/health-care-law-factsheet-icr...
8 OHCHR, Op.Cit.
9Ibidem
10 Safeguarding Health in Conflict (2015/2016) “No Protection, No Respect – Health Workers and Health Facilities under Attack.” Available at: https://www.safeguardinghealth.org/sites/shcc/files/SHCC2016final.pdf
11Ibidem
12 International Committee of the Red Cross (2013) “Mali: Access to health care remains challenging in the north”, Operational Update No 10/2013. Available at: https://www.icrc.org/eng/resources/documents/update/2013/11-28-mali-heal...
13 Safeguarding Health in Conflict (2015/2016), Op.Cit.
14Ibidem
15 Médecins Sans Frontières/Doctors Without Borders (2016) “Conflict and war.” Available at: http://www.msf.org.uk/conflict-and-war
16 ICRC (2012), Op.Cit.
17 Safeguarding Health in Conflict (2015/2016), Op.Cit.
18 Permanent Mission of France to the United Nations in New York (2016) “Protection of healthcare in armed conflicts”, Statement by Mr. François Delattre, Permanent Representative of France to the United Nations - Security Council. Available at: http://www.franceonu.org/Preventing-access-to-health-care-is-increasingl...
19Ibidem
20Ibidem
21 LIPSHULTZ (2013), Op.Cit.

 

MR – Research Assistant at CIPADH 

 

Webography

Constitution of the World Health Organisation 1946. Available at: http://www.who.int/governance/eb/who_constitution_en.pdf

Geneva Conventions 1949. Available at: https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/vwTreaties1949.xsp

International Committee of the Red Cross (2013) “Mali: Access to health care remains challenging in the north”, Operational Update No 10/2013. Available at: https://www.icrc.org/eng/resources/documents/update/2013/11-28-mali-heal...

International Committee of the Red Cross (2012) “Respecting and Protecting Health Care in Armed Conflicts and in Situations Not Covered by International Humanitarian Law”, Advisory Service on International Humanitarian Law. Available at: https://www.icrc.org/eng/assets/files/2012/health-care-law-factsheet-icr...

International Covenant on Economic, Social and Cultural Rights 1966. Available at: http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx

LIPSHULTZ Emma (2013) “Securing Health Care in War Zones”, Harvard College, Global Health Review. Available at: https://www.hcs.harvard.edu/hghr/online/securing-health-care-in-war-zones/

Médecins Sans Frontières/Doctors Without Borders (2016) “Conflict and war.” Available at: http://www.msf.org.uk/conflict-and-war

Office of the United Nations High Commissioner for Human Rights, “Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”, United Nations. Available at: http://www.ohchr.org/EN/Issues/Health/Pages/SRRightHealthIndex.aspx

Office of the United Nations High Commissioner for Human Rights and World Health Organization, “The Right to Health – Fact Sheet No.31”, United Nations, Geneva. Available at:  http://www.ohchr.org/Documents/Publications/Factsheet31.pdf

Office of the United Nations High Commissioner for Human Rights (2000) “CESCR General Comment No. 14:  The Right to the Highest Attainable Standard of Health (Art. 12)”, 22nd Session of the Committee on Economic, Social and

Cultural Rights. Available at: http://www.ohchr.org/Documents/Issues/Women/WRGS/Health/GC14.pdf

Permanent Mission of France to the United Nations in New York (2016) “Protection of healthcare in armed conflicts”, Statement by Mr. François Delattre, Permanent Representative of France to the United Nations - Security Council. Available at: http://www.franceonu.org/Preventing-access-to-health-care-is-increasingl...

Safeguarding Health in Conflict (2015/2016) “No Protection, No Respect – Health Workers and Health Facilities under Attack.” Available at: https://www.safeguardinghealth.org/sites/shcc/files/SHCC2016final.pdf

Universal Declaration of Human Rights 1948. Available at: http://www.un.org/en/universal-declaration-human-rights/

World Health Organization (2012) “WHO: Health and human rights - interview with Professor Paul Hunt.” In: YouTube. Available at: https://www.youtube.com/watch?v=P-oWpXNWOfk

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