Emergency response itself is not discussed in this article; this report mostly focuses on nuances of emergency/aid worker experiences. Particularly, it centers on the sheer, inexplicable lack of information surrounding attacks, harm, obstructions, and threats experienced by health care workers.
This article was meant to highlight the gaps in data available for violence against health care/aid workers in unsecured areas. As such, a large portion of the methods segment is dedicated to discussing the difficulties in locating this data and any patterns in data gaps. The primary method of collection, it appears, was through an initial search for peer-reviewed work that transformed into an accumulation of accounts from media, documentary, and editorial reports. It should be noted that some data is available from various organizations, regarding their specific statistics; however, this mainly tends to focus on larger incidents, such as kidnappings and deaths (as mentioned in the paper). There is also some information available through Aid Workers Security Database, but shortcomings in this area are also heavily noted.
1) "On an individual level, disagreements over treatment can arise when there are competing ideas about the cause and most appropriate treatment of disease. The weak and sometimes nonfunctioning health systems that often characterize complex security environments can compound these challenges and contribute to a milieu of mistrust that sets the stage for violence against health workers, facilities and transportation"
2) "There are also often inconsistencies in the categories used to describe perpetrators e e.g. terrorist, state actors, non-state actor e and these categories have legal ramifications under both International Humanitarian Law and in national legal frameworks. Although a standardizing of terminology and scope of study would be welcome, this has proven difficult."
3) "Although violence directly affecting health service delivery in complex security environments has received a great deal of media attention, there is very little publically available research, particularly peer-reviewed, original research. Only thirty-eight articles met the original search criteria outlined in the methods section, of which only eleven contained original research; a further citation search yielded another four original research articles."
1) Definition of humanitarian crisis: This article denotes a multitude of situations, all of which seem to have a drastic effect on human health and well-being. That being said, some crisis or armed conflicts are not deemed a humanitarian crisis. According to several sources, the definition is incredibly subjective, and must be event(s) which harm the health, safety, or well-being of a community or large group of people.
2) Humanitarian worker protections: At this time, there does not seem to be a true movement to legally prosecute those who harm humanitarian or aid workers. However, within the Geneva Convention and later Protocols, there are legal protections for non-combatants during armed conflicts; this is in addition to a UN Security Council Resolution (1502) which gives greater protection to aid workers, classifying attacks on them as a war crime.
3) Non-combatants: This is where definitions of humanitarian aid workers and their protections under both the Geneva Convention and UN Resolution fall apart. The current climate and disregard for international sanctions has left many aid workers at the mercy of those who do not recognize the UN or global entities. As such, they are faced with the choice to remain non-combatants (those who do not carry or use a weapon during a conflict) and most likely be harmed; or to carry defensive arms and proclaim themselves a combatant, and thus be a target. Hence, the difficulty in being a health care worker in an age of general militarization. This is also a topic heavily discussed in the book Trauma by Dr. James Cole. As a member of the special operations, Dr. Cole was always well within danger; he discusses the choice to carry or not carry a weapon, and how discharging the weapon (even in self-defense) changes the nature of the health care provider and their position in an armed conflict.
Information provided by the AWSD (Aid Worker Security Database), there were 251 individual attacks in 2013. This, and the subsequent 460 workers involved or affected, is in no way separated according to the aid work the individuals participated in. Thus, all 251 attacks may have been aimed at health care clinics, but only 50 of those injured may have been health care workers; the rest may have been members of peacekeeping forces. Further more, which members of the health care system are being harmed is extremely useful in future aid endeavors. Knowing who is targeted or particularly vulnerable could make the difference in the next incident.
Moreover, any data that is available can be difficult or complicated to obtain. Outside of the nuances of procuring data from different corporations or foundations, many organizations have individual categories for reporting incidents. They may even have different definitions of attacks and incidents-- eerily similar to how German and US officials view sexual assault in different lenses (German officials may often be disinclined to act unless penetration occurs, while US officials have been known to prosecute or bring charges for offenses such as groping).
These definition differences may also lead to an under reporting of incidents. While most available data contains information about abductions or fatalities, very little data can be accessed pertaining to threats or obstructions. This may also color how and what aid workers report; knowing that an incident did not culminate in a kidnapping or death may lead workers to be less inclined to report these issues, for fear of not being taken seriously. Aid workers may also feel that, during some stressful circumstances, reporting something that could be constituted as "mild" would only be a waste of time and resource.
True to the article's sentiments, many of the works cited in the bibliography are entries from news agencies, such as The Lancet, UPenn Press (the university paper) & The Guardian. There is even a citation for a blog entry. There are several releases from organizations, such as MSF and WHO, but it is unclear whether these are reports, official press statements, or opinion articles produced by workers. Additionally, there are several entries for articles from PubMed, indicating that there may be some information in the form of actual research articles.
This article examines the gaps in research concerning health care workers in "complex security environments". These work areas contain some sort of conflict, poverty or environmental issues, particularly those that are humanitarian or crisis settings, and are characterized by civil unrest. This, in turn, leads to an involvement of aid personnel-- this report primarily focuses on violence towards health care workers within these settings and the lack of information on this issue. It pays particular attention to discrepancies between peer-reviewed, academic research and general media commentary or articles.
At present time, PubMed only has 1 entry for reports/articles citing this research. It is put forth by another group discussing documentation of health care worker attacks during armed conflicts.