Attacks against health care in Syria, 2015-16: results from a real-time reporting tool
Attacks against health care in Syria, 2015-16: results from a real-time reporting tool
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DOI：
10.1016/s0140-6736(17)31328-4
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发表时间：
2017-11-18
期刊：
影响因子：
168.9
通讯作者：
AbouZeid, Alaa
中科院分区：
文献类型：
--
作者：
Elamein, Mohamed;Bower, Hilary;AbouZeid, Alaa
收集战区针对卫生服务机构、卫生工作者和病人的暴力行为的可靠数据是一项巨大挑战，但对于了解违反国际人道主义法的程度至关重要。我们描述了自2015年11月以来主要在叙利亚武装反对派团体大量存在的地区使用的一种新系统，用于检测和核实对医疗服务的攻击并描述其影响。方法要求所有在叙利亚有实际存在的土耳其卫生集群组织，无论是通过部署的还是当地雇用的工作人员，参加监测暴力侵害卫生保健（MVH）警报网络。卫生集群的土耳其中心是联合国启动的人道主义卫生协调机构，通过WhatsApp和匿名在线数据输入工具收到卫生集群合作伙伴的警报。要求外地工作人员尽可能采访受害者和其他证人，以寻求进一步的资料。MVH数据小组对警报进行三角分析，以确定个别事件，并向合作伙伴、世卫组织、联合国人道主义事务协调厅和捐助者分发关键信息（地点、服务类型、攻击方式、死亡和伤亡）的初步快速更新。该小组还收到并输入了来自几个大型非卫生集群组织（称为外部合作伙伴，它们在共享信息之前进行自己的信息收集和验证过程）的警报。然后在严格的信息匹配过程中对每个事件进行评估。如果攻击由至少一个健康集群合作伙伴和一个外部合作伙伴报告，并且大多数关键数据点匹配，则视为已核实。未达到此标准的警报被视为未经验证。结果被制成表格来描述攻击的发生和影响，并在可能的情况下按年龄、性别和地点分类。2015年11月初至2016年12月31日期间，在402起针对医护人员的暴力事件中，938人直接受到伤害：677人（72%）受伤，261人（28%）死亡。大多数死者为成年男性（68%），但5岁以下儿童的病死率最高（39%）。24%的袭击受害者是卫生工作者。在主要有大量武装反对派团体存在的地区，约44%的医院和5%的初级保健诊所遭到袭击。空中轰炸是主要的攻击方式。三分之一的医疗保健服务不止一次遭到袭击。提供创伤护理的服务比其他服务更容易受到攻击。本研究中使用的数据系统解决了重复计算问题，减少了潜在的有偏见的自我报告的影响，并从匿名信息中产生了可信的数据。MVH工具可以在许多冲突地区部署。可靠的数据对于显示交战各方在多大程度上偏离了在冲突中保护医疗保健的国际法以及有效利用法律机制阻止未来的犯罪者至关重要。版权所有2017世界卫生组织。Elsevier Ltd/Inc/BV出版。版权所有。
Background Collecting credible data on violence against health services, health workers, and patients in war zones is a massive challenge, but crucial to understanding the extent to which international humanitarian law is being breached. We describe a new system used mainly in areas of Syria with a substantial presence of armed opposition groups since November, 2015, to detect and verify attacks on health-care services and describe their effect.Methods All Turkey health cluster organisations with a physical presence in Syria, either through deployed and locally employed staff, were asked to participate in the Monitoring Violence against Health Care (MVH) alert network. The Turkey hub of the health cluster, a UN-activated humanitarian health coordination body, received alerts from health cluster partners via WhatsApp and an anonymised online data-entry tool. Field staff were asked to seek further information by interviewing victims and other witnesses when possible. The MVH data team triangulated alerts to identify individual events and distributed a preliminary flash update of key information (location, type of service, modality of attack, deaths, and casualties) to partners, WHO, United Nations Office for the Coordination of Humanitarian Affairs, and donors. The team also received and entered alerts from several large non-health cluster organisations (known as external partners, who do their own information-gathering and verification processes before sharing their information). Each incident was then assessed in a stringent process of information-matching. Attacks were deemed to be verified if they were reported by a minimum of one health cluster partner and one external partner, and the majority of the key datapoints matched. Alerts that did not meet this standard were deemed to be unverified. Results were tabulated to describe attack occurrence and impact, disaggregated where possible by age, sex, and location.Findings Between early November, 2015, and Dec 31 2016, 938 people were directly harmed in 402 incidents of violence against health care: 677 (72%) were wounded and 261 (28%) were killed. Most of the dead were adult males (68%), but the highest case fatality (39%) was seen in children aged younger than 5 years. 24% of attack victims were health workers. Around 44% of hospitals and 5% of all primary care clinics in mainly areas with a substantial presence of armed opposition groups experienced attacks. Aerial bombardment was the main form of attack. A third of health-care services were hit more than once. Services providing trauma care were attacked more than other services.Interpretation The data system used in this study addressed double-counting, reduced the effect of potentially biased self-reports, and produced credible data from anonymous information. The MVH tool could be feasibly deployed in many conflict areas. Reliable data are essential to show how far warring parties have strayed from international law protecting health care in conflict and to effectively harness legal mechanisms to discourage future perpetrators. Copyright (C) 2017. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.