Protecting access to and delivery of healthcare services
In response to the increasing number of attacks against healthcare services, the Red Cross and Red Crescent Movement launched an initiative known as ‘Health Care in Danger’ (HCiD). In 2011, it called on the ICRC to initiate expert consultations to formulate practical recommendations for making the delivery of health care safer in armed conflict or other emergencies. Thus, there is a considerable amount of guidance available for how states, healthcare facilities, ambulance services, militaries, armed groups and others can contribute to safer access to and delivery of healthcare services (12).
Nevertheless, the fundamental and non-derogable human right to access immediate and necessary health care, as stated in article 12 of the UN Covenant on Economic, Social and Cultural Rights (13), is constantly violated. Practical solutions may indeed have been developed, but the political will to implement them is often limited to conference halls in Geneva or New York and the political cost of attacks on healthcare services is disappointingly low. States must be held accountable for their implementation of the resolutions that they have voted for, such as the United Nations Security Council (UNSC) Resolution 2286, which demanded an end to impunity for those responsible for attacks against healthcare services and respect for international law on the part of all warring parties (14). Norway has already shown strong initiative, including by presenting a resolution for the protection of health workers at the United Nations General Assembly (UNGA) in 2014 (15), but could also envisage following this up in its bilateral dialogue with other states. For example, bilateral aid agreements could include commitments to strengthen and implement domestic legislation that reflects the state’s international obligations with regard to safeguarding the access to and delivery of health care.
Norwegian bilateral or multilateral funding for healthcare systems should ideally always include elements related to the protection of these systems against attacks. The establishment of mechanisms to record threats, obstructions and attacks against healthcare providers and patients would constitute a good starting point. Such data can in turn inform the selection of the measures taken by the state to safeguard access to and delivery of healthcare services. They will also be useful in monitoring the barriers to progress towards reaching SDG 3. Unfortunately, while the implementation of national data collection mechanisms has already been called for by the World Health Assembly in 2012 (16), in the UNGA resolution put forward by Norway in 2014, and the UNSC resolution 2286 passed in 2016 (14), there are very few examples of such initiatives being undertaken.
Other approaches to generating accountability exist that do not rely on the state. Another powerful avenue could be to pair hospitals operating in conflict situations with hospitals in countries that can influence the parties to the conflict An attack on a partner hospital can result in an effective domestic outcry from the partner hospital within the country of influence, thus raising the political cost of allowing allies to target healthcare services.