An unprecedented number of attacks happened in healthcare facilities and against health workers in 2022, according to a report published by Safeguarding Health in Conflict, Coalition and Insecurity Insight this year.

These attacks were the topic of a recent episode of the Global Health Matters podcast with Garry Aslanyan. The guests – health workers on the frontlines of the current conflict in Sudan, an independent advocate and a senior adviser at Physicians for Human Rights – discussed the circumstances and risks faced by health workers in conflict settings.

According to the Safeguarding Health in Conflict report, there were more than 700 incidents where health facilities were damaged in 2022, and almost 300 health personnel were kidnapped.

“In Sudan alone, just in the first six months of 2023, there were 93 attacks on health,” said guest and advocate Susannah Sirkin. “And so this kind of violence is devastating to health. So, of course, there are many acute and, of course, long-term impacts of this, including on the structure of the health systems themselves.”

Where do these violations and attacks occur?

She said these kinds of violations and attacks on health occur in various contexts, including civil unrest and insecure or volatile environments. She said there could also be the diversion of care and support for health workers in facilities for political reasons. In situations of full-out internal and international armed conflicts, such as in Syria, Yemen, Sudan, or most recently, Ukraine and Ethiopia, health workers are among those fleeing bombing and other attacks.

“In these conflicts, there are often military incursions or militia incursions into health facilities themselves, and they can assault patients and health workers using weapons,” Sirkin said. “We see everything from the detention, torture, and even killing of many health workers. And then, of course, the bombing of hospitals, raids on health facilities and utter damage and sometimes the destruction of hospitals.

“And in some countries, literally hundreds of health workers have been targeted, arrested, sometimes, as we’ve seen in Syria, and we know in other countries, they die after years languishing in prison,” she continued. “And it’s really a terrible, terrible environment. In almost every continent, health care can be under threat in this big range of situations.”

‘Building clinics in caves’

Samer Jabbour, a Syrian cardiologist and professor of public health, noted how often these health workers continue to provide care and set up alternative settings. At the same time, their hospitals and clinics are taken over.

The Syrian medics went as far as building clinics in caves to resist the bombings of hospitals, he said.

How do these workers build resilience?

“The inspiration and the resilience that I’ve seen has come from the health workers who are together, support each other in the time, in these grave situations and who resort to their deep understanding, based on their training, based on their ethics, based on their codes, based on their sense of themselves as professionals and based on their deep humanity, which in many cases is what drives someone to become a health professional in the first place,” Sirkin said. “Face-to-face with their patients, understanding that they are … they are looked up to as leaders, as change-makers in their community, and so in the face of that, time and time again, they rise to that occasion.

“And that is, I think, the depth of the human spirit that’s just so inspiring, as well as the satisfaction of saving lives through health care.”

Added Jabour: “The real heroes are those in conflict zones responding.”

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Image Credits: Global Health Matters Podcast.