More than honour, humanitarian health-care workers need life-saving protection
Authors: Etienne V Langlois, Teesta Dey, Mehr Gul Shah
Journal: The Lancet (2021)

Honouring all humanitarian workers, including health-care professionals, Aug 19, 2021, marks the second World Humanitarian Day since the start of the COVID-19 pandemic. Many humanitarian workers have given their lives to support and protect the communities they serve, including millions of the world's most vulnerable women, children, and adolescents. But humanitarian workers need more than honour: they need support and protection themselves. Settings for humanitarian health care have become increasingly complex: at the crossroads of conflict, social and economic fragility, a global pandemic, and a growing climate crisis. The climate emergency, and its impact on humanitarian contexts, is the central theme of the World Humanitarian Day 2021, calling on greater action to address the needs of the people most vulnerable to the effects of climate change and the essential workers caring for them. Even before COVID-19, humanitarian health-care workers faced considerable risks, both as inadvertent casualties of the conflicts and disasters they sought to alleviate and as deliberate victims of attacks.1Spiegel PB The humanitarian system is not just broke, but broken: recommendations for future humanitarian action.Lancet. 2017; (published online June 7.)https://doi.org/10.1016/s0140-6736(17)31278-3Summary Full Text Full Text PDF Scopus (62) Google Scholar For example, in the Central African Republic, in conflict since 2013, more than one incident against humanitarian workers is reported every day.2Devi S 2021: a year of humanitarian need.Lancet. 2021; (published online Jan 2.)https://doi.org/10.1016/s0140-6736(20)32752-5Google Scholar The situation has not improved during the pandemic, and attacks on health facilities, transport, and patients have become more frequent.3WHOAttacks on health care: three-year analysis of SSA data (2018–2020).https://www.who.int/data/stories/attacks-on-health-care-three-year-analysis-of-ssa-data-2018-2020Date accessed: August 12, 2021Google Scholar In 2020, the mortality rate among health-care professionals also increased.3WHOAttacks on health care: three-year analysis of SSA data (2018–2020).https://www.who.int/data/stories/attacks-on-health-care-three-year-analysis-of-ssa-data-2018-2020Date accessed: August 12, 2021Google Scholar From February to July, 2021, in Myanmar alone, 252 incidents of violence against health-care workers were reported: 190 were unfairly arrested, 37 were injured, and 25 were killed.4UNOCHAViolence against health care in Myanmar data 1 February 2021–31 July 2021.https://data.humdata.org/dataset/63605720-f0da-454d-89a6-552f1acc3a53/resource/40e22ce6-4f60-4ef8-806b-01094ce19555/download/violence-against-health-care-in-myanmar-data-01-february-31-july-2021.xlsxDate accessed: August 12, 2021Google Scholar In light of this trend, protecting the safety, health, and wellbeing of the humanitarian workforce should be a key global health priority. The difficulties facing humanitarian workers are exacerbated by inequitable distribution of COVID-19 vaccines and the innate challenges in delivering health services in humanitarian settings.5UN Security CouncilResolution S/RES/2565.https://undocs.org/en/S/RES/2565(2021)Date: 2021Date accessed: August 3, 2021Google Scholar People working in health care have the highest risk of infection from COVID-19, yet the global community is failing to provide them with life-saving immunisation. As of Aug 11, 2021, only 1·6% of people living in low-income countries, including health-care professionals, have received at least one dose of a COVID-19 vaccine.6UNDPGlobal Dashboard for Vaccine Equity.https://data.undp.org/vaccine-equity/Date accessed: August 12, 2021Google Scholar COVID-19 has also exacerbated the humanitarian crises that health-care workers are dealing with. In 2021, one in 33 people worldwide are predicted to need humanitarian assistance and protection—a substantial increase from one in 45, in 2020, which was already the highest figure in decades.7UNOCHAGlobal Humanitarian Overview.https://gho.unocha.org/Date: 2021Date accessed: August 5, 2021Google Scholar Over half of the countries needing humanitarian aid to deal with the pandemic were already facing another long-term humanitarian crisis in 2020.8Development InitiativesGlobal humanitarian assistance report.https://devinit.org/resources/global-humanitarian-assistance-report-2020/executive-summary/Date: 2020Date accessed: August 4, 2021Google Scholar Yemen, for example, was already going through civil war, drought, and an outbreak of cholera. Furthermore, movement restrictions imposed on development workers have impeded their capacity to contribute to emergency responses.9Smith E Chadwick V Local professionals step in to fill delivery gap amid questions over resources.https://www.devex.com/news/local-professionals-step-in-to-fill-delivery-gap-amid-questions-over-resources-97363Date: June 2, 2021Date accessed: August 5, 2021Google Scholar These humanitarian crises disproportionately affect women, children, and adolescents. In 2020, children accounted for 42% of the 82·4 million people forcibly displaced worldwide,10UNHCRFigures at a glance.https://www.unhcr.org/uk/figures-at-a-glance.htmlDate accessed: August 4, 2021Google Scholar and nine of ten countries with the highest neonatal mortality rates are in conflict.11Wise PH Shiel A Southard N et al.The political and security dimensions of the humanitarian health response to violent conflict.Lancet. 2021; 397: 6-12Summary Full Text Full Text PDF Scopus (30) Google Scholar The health of these vulnerable women, children, and adolescents has always depended on humanitarian health-care workers, especially midwives and nurses. Midwives alone can provide 90% of essential care in sexual, reproductive, maternal, neonatal, child, and adolescent health.12UNFPAState of the world's midwifery.https://www.unfpa.org/sites/default/files/pub-pdf/21-038-UNFPA-SoWMy2021-Report-ENv4302.pdfDate: 2021Date accessed: August 4, 2021Google Scholar In short, the pandemic has given humanitarian workers a bigger task than ever, and yet made their work harder and more dangerous. We must urgently prioritise their health and wellbeing, both in global initiatives and national policies, including humanitarian response plans. In response to these challenges, the Partnership for Maternal, Newborn & Child Health has made the protection and support of essential health-care professionals a central component of its Call to Action on COVID-19.13PMNCHCall to action on COVID-19.https://pmnch.who.int/news-and-events/campaigns/pmnch-call-to-action-on-covid-19Date accessed: August 5, 2021Google Scholar At the global level, preparedness and response mechanisms for dealing with future pandemics must specifically address humanitarian settings and prioritise the protection of humanitarian health-care workers, including nurses and midwives.14IPPRCOVID-19: make it the last pandemic: a summary.https://theindependentpanel.org/wp-content/uploads/2021/05/Summary_COVID-19-Make-it-the-Last-Pandemic_final.pdfDate accessed: August 4, 2021Google Scholar Governments must further develop and enforce national policies that explicitly protect them, as urged by the UN Security Council and mandated by international humanitarian and human rights laws.15UN Security CouncilResolution S/RES/2286.http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/2286(2016)Date: 2016Date accessed: August 3, 2021Google Scholar, 16ICRCRespecting and protecting health care in armed conflicts and in situations not covered by international humanitarian law—factsheet.https://www.icrc.org/en/document/respecting-and-protecting-health-care-armed-conflicts-and-situations-not-coveredDate accessed: August 4, 2021Google Scholar Policies must prioritise quality of care and the training, recruitment, retention, safety, and security of essential workers, including nurses and midwives, and their representation in senior decision-making positions.17WHOGlobal strategic directions for nursing and midwifery 2021–2025.https://www.who.int/publications/m/item/global-strategic-directions-for-nursing-and-midwifery-2021-2025Date: April 1, 2021Date accessed: August 4, 2021Google Scholar Greater efforts are also required to support the implementation of these policies in complex humanitarian contexts. Above and beyond global agreements and celebrations, greater investments and locally led efforts are needed to strengthen systems delivering life-saving protection to humanitarian health-care professionals and the communities they serve. Only by prioritising the safety, health, and wellbeing of humanitarian workers can the goal of universal health coverage and protection of the most vulnerable be realised. EVL is employed by the Partnership for Maternal, Newborn & Child Health. TD and MGS are consultants for the Partnership for Maternal, Newborn & Child Health.