Health Care in Danger

Sjekkes mot fremføring

Introduction

• Thank you for the invitation to participate at this expert workshop in connection with the very timely Health Care in Danger initiative.

• Syria as case: In Syria we daily witness how hospitals and ambulances are directly targeted by all sides to the conflict.

• In January the Secretary-General of the Syrian Arab Red Crescent, Dr Abd-al-Razzaq Jbeiro, was killed. The vehicle he was in was clearly marked with the Red Crescent emblem. He was one of many Syrians risking their lives and health every day to help fellow citizens in need and to save lives.

• According to the Norwegian doctor Dag Horntvedt, who recently spent 7 weeks working for MSF, there is a dire need for medical services. Many are afraid of seeking medical assistance.

• In fact the Syrian Arab Red Crescent (SARC), assisted by the ICRC, has been one of the very few organisations able to provide assistance in the precarious humanitarian situation in Syria today.

• SARC is operating under extremely demanding conditions. Nevertheless, hundreds of volunteers have been mobilised to provide first aid, food and medical care across sectarian divides.

• The Syrian case illustrates why the initiative “Health Care in Danger” in relation to conflicts, crisis and war is so important.  

• But the challenge is much broader. We witness similar situations all over the world, like in the Democratic Republic of Congo.

Normative framework in place            

• At the same time, we know that the normative framework is in place. International humanitarian and human rights law for the protection of civilians in armed conflict and other situations of violence is comprehensive and relevant.
• The right to health is enshrined in human rights law. The protection of medical missions in armed conflict is highlighted in International humanitarian law. The problem is not law, but the lack of implementation. The lack of both understanding and respect of the law.

• We see on a daily basis that civilians are affected in a myriad of ways by armed conflict and violence, whether directly, suffering death, injury, rape and forcible displacement, or indirectly due to conflict-induced increases in disease, hunger and malnutrition.  

The reclaiming initiative

• There are three categories of why international humanitarian law is not respected:

• The first category, which is the case in many conflicts around the world, parties to a conflict do not know international humanitarian law. They lack the knowledge.  Training is key.

• In the second category, soldiers don’t seem to care about the international law despite their knowledge. Deliberate breaches. One logic seems to be that since the enemy is breaking the law, they break the law.

• A third category applies to the new battlegrounds. There might be a willingness to abide with international humanitarian law, but there is uncertainty about how the law applies when the battleground is taking place for instance in an urban area where civilian people live. Interpretation is the challenge.

• This is why the Norwegian Government has launched an initiative called “Reclaiming the protection of civilians under international humanitarian law”. We have reopened the discussion.

• The aim is not to negotiate new law, but to agree on practical measures that will effectively improve the situation for civilians in situations of armed conflict.

• The intention is to engage states and civil society across the world in discussions in a series of regional seminars that will culminate in a global conference in May 2013.

• We hope that we will be able to agree on strong, concrete recommendations on how international humanitarian law should be understood and implemented in order to provide the protection that civilians are entitled to.


ICRC study. Examples

• Access to health care is a case in point. Health care is in danger, and common efforts are needed. The evidence base is comprehensive and gives rise to great concern.

• An ICRC study of 16 countries over a two-year time-span has identified no less than 644 violent incidents that affected the opportunities for providing or receiving health care. The use of explosive weapons, the destruction of ambulances, kidnappings and killings of health-care personnel are just some of the examples mentioned.

• One example is from Somalia where a bomb killed more than 20 people, including two doctors and a number of medical students at a graduation ceremony in Mogadishu in December 2009.

• Another example is from the Democratic Republic of Congo where an estimated 40 000 deaths per month are due to easily treatable diseases. The main reason why these people are not receiving treatment is the lack of security due to the armed conflict.

• One of the important roles played by Red Cross and Red Crescent Societies is to mobilise volunteers. Renewed relevance in the context of our response to today’s humanitarian challenges.

• We have seen this in our own country. On 22 July 2011, Norway was hit by the worst attack since World War II. Government buildings were bombed and young people shot at a political youth camp on Utøya Island. A total of 77 lives were lost.

• Also saw that this was a case where the mobilisation of health personnel and volunteers trained in first aid from organisations such as the Norwegian Red Cross Society played an important role in preventing additional lives from being lost.

• This illustrates the value of having a network of volunteers that can be mobilised fast and can respond quickly. With this in view, it is crucial to support capacity-building at a local level. The Red Cross and Red Crescent Movement is a model in this regard.

Reflections on the role of the National Red Cross

• I would like to end with four reflections on the role of the National Red Cross and Red Crescent Societies:

• First: National Societies have a specific role to play in disaster preparedness. Through the networks of volunteers they promote international humanitarian law and human rights and provide relevant training for health-care personnel. Is it possible to strengthen this role even further? Is it possible to work better within and across regions? Would it be possible to establish partnerships for learning and exchange of best practices?

• Second: National Societies provide health care in all situations of armed violence, including in situations of violence that are not defined as full-scale armed conflict. In working in situations such as these, it is national legislation and human rights law that provides the legal framework. A real dilemma and challenge is: what should be done when confronting a state that does not appear to care about its own people? How do National Societies deal with these situations? Is it possible to take a more proactive approach towards the governments concerned and to try to make them adhere to their commitments under international law?

• Third: National Societies talk to everyone and are part of the societies in which they operate. Being able to talk to all parties to a conflict is critical when negotiating access to people in need of humanitarian assistance. This can also help. National Societies are also strategically placed to break down “enemy images”, reduce polarisation, and create arenas for dialogue and concerted humanitarian action. These arenas must be actively used and cultivated. Protect humanitarian access.

• Fourth, National Societies play an important role in broadening the ownership of humanitarian action and of fundamental humanitarian values and human rights. Humanitarianism and human rights are indeed shared values. We need to make that clear. How can we achieve broader global ownership of fundamental humanitarian values and principles? There is a need to share the responsibility for the humanitarian challenges we are facing today more evenly. 

Conclusion

• This leads me to my concluding remarks:

• The importance of meeting like we do today in order to find new approaches and exchange best practices.

• We must join forces in order to address urgent humanitarian challenges.

• Norway stands ready to continue its support for the Health Care in Danger initiative and will do an effort at the diplomatic level. 

• We hope to bring countries together across regional and political divides to enhance the protection of health care in areas of conflict.

• I wish you every possible success with this workshop.

• Thank you for the attention.

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