Choosing not to weaponize healthcare: politics and health service delivery during Nepal’s civil war, 1996-2006
Choosing not to weaponize healthcare: politics and health service delivery during Nepal’s civil war, 1996-2006
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选择不将医疗保健武器化：1996-2006 年尼泊尔内战期间的政治和医疗服务提供
DOI：
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发表时间：
2020
影响因子：
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通讯作者：
B. Devkota
中科院分区：
文献类型：
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作者：
S. Rushton;B. Devkota
摘要在武装冲突期间，医疗保健经常被“武器化”，冲突各方为了自己的战略目的干涉或暴力袭击卫生设施和人员。相反，在对尼泊尔内战（1996-2006）的探索性研究中，我们看到了一个案例，在这个案例中，双方（除了一些例外）都认为避免以卫生设施为目标或故意破坏医疗服务符合他们的利益。根据对关键线人的采访和文献分析，我们确定了四个似乎促成双方做出这一选择的因素：（一）他们对卫生系统继续运作的兴趣（具体而言，毛派需要利用政府管理的设施治疗其干部，毛派提供的医疗服务确保了至少在他们控制的地区继续提供一些服务;（二）医疗保健没有成为冲突中重要的“意识形态战场”;（三）人道主义和发展组织在影响交战双方行为方面发挥的作用;以及iv）卫生专业人员在应对他们所承受的压力和迅速动员起来抵制更持续的干预医疗保健的企图方面所发挥的作用。
ABSTRACT Healthcare has often been ‘weaponized’ during armed conflicts, with parties to the conflict interfering with or violently attacking health facilities and personnel for their own strategic ends. In this exploratory study of the civil war in Nepal (1996–2006), by contrast, we look at a case in which both sides (with some exceptions) came to see it as in their interests to avoid targeting health facilities or deliberately disrupting healthcare delivery. Drawing on key informant interviews and documentary analysis, we identify four factors that appear to have contributed to the two sides making this choice: i) their interest in the continued functioning of the health systems (specifically, the need of the Maoists to access government-run facilities for treatment of their cadres, and the fact that Maoist healthcare provision ensured that at least some service delivery continued in areas under their control; ii) the fact that healthcare did not become an important ‘ideological battleground’ in the conflict; iii) the roles played by humanitarian and development organizations in shaping the behaviour of both the warring sides; and iv) the part played by health professionals in navigating the pressures on them and quickly mobilizing to resist more sustained attempts at interference with healthcare.