1. "Health Care in Danger" Protecting health care personnel and infrastructure in armed conflict and other situations of violence Robin Coupland International Committee of the Red Cross

2. The reality  Imbalance of needs and capacity  Standards / ethics  Constraints  SECURITY  Health care is not respected!

3. Rules of international humanitarian law  Care for wounded and sick  Permit access to health care  Protect health personnel and infrastructure  Respect emblems of Geneva Conventions  Discrimination (-)  Unethical practices (-)

4. Objectives of "Health Care in Danger"  Respect for international humanitarian law  "Other situations of violence"  Monitoring events  Real picture of health care in danger  Identify threats and vulnerabilities  Improved security policies  Improve security?

5. Monitoring health care in danger  Taback Coupland Model  Converts (any) reports of events into data  Definitions  Pilot – 10 countries, 119 events  65 health care, 59 humanitarian aid  Sri Lanka, ILOT, Afghanistan, Somalia - 80%  Killed 66, Wounded 73, Kidnapped 52  Patterns of violence in:  Health care in buildings  Health care not in buildings  Aid (not health care)  Who, what, to whom, how, when and where?

6. What?

7. How? +

8. Threats and vulnerabilities: health care (buildings)  Active hostilities  Military actors  Explosive weapons (buildings)  Not targeted  Not deliberate  Low lethality  Few expats

9. Threats and vulnerabilities: aid workers  Outside active hostilities  Unknown / non-state actors  Firearms  Targeted  Lethal or kidnap  Many expats  Where….?  ROAD!!!!

10. Threats and vulnerabilities: health care (not buildings)  A mixture?  On the road  Ambulances  Few kidnappings?

11. Preventive measures Health care (buildings)  Threats - IHL  Vulnerabilities – explosive force Aid workers  Threats - perception  Vulnerabilities – road

12. Thank you

13. What is Health Care?  Hospitals / clinics / first aid posts / ambulances  Personnel & health professionals  Movement staff / volunteers in health care  Military health infrastructure and personnel

14. Violence affecting health care Events which result in:  Death, injury, kidnap, arrest, rape, threat, harrassment  Material damage inc. cut off electricity and water  Prevention of access  Attacking / removing sick or wounded from health care  Use of health care for attack / defence  PLUS aid workers

15. The "Model"  Perpetrator  Victim  P – physical means (weapons)  P – motivation (intent)  V – vulnerability  V – effects  Context – Time and place  Any use of any weapons (or threat) with any effects

16. EFFECTS of armed violence Weapon Use (motivation) Number of weapons Perpetrator Victim Vulnerability

17. How does the TCM work?  Info from real events  Written reports  Details of reports – XL spreadsheet  Fields for perpetrator and victim data  Analysis  Accuracy?

18. HEADLINE: Patient shot in bed Reuters (date) Two masked men entered hospital X last night and shot dead a sleeping patient. This is the fifth such attack since… In terms of TCM: Two [number of people armed] masked men [who] entered hospital X [where] last night [when] and shot [weapon (firearms)] dead a [outcome] sleeping [vulnerability] patient. "shot dead" [intent]