A destroyed ambulance

©ICRC/Jeroen Carrin

Assaults on health-care workers and those in their care are forbidden under international and humanitarian law, yet still they continue.

There were at least 921 violent incidents against health-care personnel, facilities and wounded or sick people in 2012, according to the International Committee of the Red Cross (ICRC), which is campaigning to raise awareness of the issue.

The recent withdrawal of Médecins Sans Frontières, or Doctors Without Borders, from Somalia over security concerns has triggered much debate within the humanitarian world about how to approach working in hostile environments.

When preparing for deployments abroad and sometimes in the UK, the British Red Cross undertakes stringent security assessments and briefings to ensure risks are mitigated to an acceptable level.

Deterrence, protection or acceptance?

According to Nathanael Jarrett, security advisor at the Red Cross, there are three ways of approaching security management: deterrence, protection and acceptance.

A military operation may rely upon deterrence in the form of a strong armed presence to avert attacks. A commercial trip involving a celebrity may involve extra security as a form of protection. The humanitarian world relies upon acceptance, that is, acceptance of their workers and their need to be in situ.

“If you don’t have acceptance then it’s very hard to deliver a programme,” said Nathanael.

“If we are not accepted within the communities in which we work, then we have lost our purpose. And if it’s contingent on us having a very strong robust military deterrence then I think for many in the humanitarian world, they will start to say we have lost our way.

“It’s crucial to find operational approaches that reinforce the neutrality and independence of humanitarian actors as much as possible so that they’re not targeted for political objectives.

Two aid workers unload a box from a van with thick black smoke in the sky

©Ibrahim Malla/Syrian Red Crescent

“Governments and their security apparatus must also do everything they can to reinforce the purpose of humanitarian actors, while finding ways to reinforce the operating environment that permit aid to access those with the greatest need.”

International law

The nature of attacks on health-care personnel varies; some are opportunistic, others can be politically motivated.

“Unfortunately, humanitarian organisations are extremely vulnerable and could be targeted for both reasons,” said Nathanael.

“We have seen a growth in attacks, particularly on aid vehicles, or people thinking it’s acceptable to abduct aid workers. It’s a worrying trend.”

Deliberate attacks on health-care personnel, facilities and on the wounded or sick violate international law.

The Geneva Conventions and their Additional Protocols set out the right of the wounded and the sick – combatants and civilians alike – to be respected and protected during armed conflict and to receive medical treatment.

In non-conflict situations, the same protection is afforded by international human rights law. 

Security training

Before deployment overseas, Red Cross staff undergo security training. They will also be monitored when abroad to ensure there is a support network in place should they need it.

Security training is a mixture of classroom activities and simulation based scenarios. A group of adults are sat on the floor discussing

As part of his role, Nathanael advises and provides technical support to Red Cross workers to ensure they work as safely as possible within their operations.

“We try to inculcate that  security is the responsibility of all Red Cross staff,” he said.

“The training isn’t about giving staff or delegates loads of techniques in how to deal with working in an insecure environment.

“It’s about giving them the awareness of the circumstances they may find so they have some appreciation of what they might need to do to mitigate the risks.”

Poster campaign

A recent ICRC study found attacks were carried out against health-care workers in 22 countries last year. Needless to say that such attacks severely jeopardise the provision of help to people when they need it most.

To raise awareness of the issue, the ICRC has created a series of emotive posters that will be displayed in cities across Europe, including London, from this week.



“When violence is used against health-care staff, infrastructure or the wounded or sick, the ultimate losers are ordinary people requiring medical assistance,” said Pierre Gentile, head of the ICRC’s ‘Health Care in Danger’ project. [link]

“Violence against health-care workers and facilities must end. The impartial delivery of health care, which enables wounded and sick patients to obtain treatment, must be respected. This issue affects millions worldwide.”