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New white paper in Côte d’Ivoire helps prepare doctors to work in midst of violence

13-02-2014 Article

For over a decade, health-care personnel in Côte d'Ivoire found themselves working in a general climate of violence as the country was struck by repeated crises and outbreaks of armed conflict. Sometimes the staff fell victim to violence; sometimes they committed acts of violence themselves. Taking these experiences into account, the National Council of the Order of Physicians in Cote d'Ivoire decided to draft a white paper on the issue. It marks an excellent first step towards making sure that health-care workers are better prepared and trained to act appropriately in dangerous situations in future.

During the post-election crisis in Côte d’Ivoire in 2011, most offences that occurred were committed by armed civilian militia with little education. At times, health-care providers were prevented from reaching their workplace, leading to a disruption in health-care services. On other occasions, arms carriers forced their way into operating theatres, where surgeons were in the middle of surgery, bringing in wounded people who needed urgent care. Sometimes, doctors arrogantly refused to treat patients based on their ethnicity or political affiliation. In circumstances such as these, doctors were at a loss as to how to react appropriately and encountered serious obstacles to carrying out their work.

Now that the security situation is back to normal, the authorities no longer consider it a matter of priority to increase the safety of health-care staff in times of armed conflict; the Ministry of Health faces other challenges, such as improving public health services. But the National Council of the Order of Physicians of Cote d'Ivoire believed it was important to learn from the past in order to better prepare for the future. For that reason, it decided to draft a white paper on the rights and responsibilities of doctors confronted by violence in time of crisis and armed conflict. The white paper would also include testimonies of doctors who were arrested or who disappeared during the armed conflict, to give an insight into the harsh reality experienced by health-care personnel during the conflict.

To carry out this task, the Council approached the World Medical Association and the ICRC for advice and legal expertise in international humanitarian law (IHL, the legal framework that regulates the conduct of armed conflict).

In May 2013, the chair of the Council contacted the ICRC delegation in Abidjan. Both organizations quickly realized that there was a mutual interest in working together, within the framework of the Health Care in Danger campaign, in a way that went beyond the provision of legal advice. The chair of the Council invited the ICRC’s head of communications and IHL legal adviser to meet the group of practitioners who were drafting the white paper. Many of these practitioners had dedicated two hours of their time to the task every fortnight, for several months on end. There was some discussion about the scope of the white paper: should it only focus on situations of armed conflict or should it also address the mistreatment of doctors at work in peacetime? The Council decided to tackle both issues. In contributing to the preface of the white paper, the head of the ICRC delegation was able to introduce the ICRC-led Health Care in Danger campaign.

The white paper is intended as a set of practical recommendations primarily for doctors, but also for the authorities and arms carriers. It contains guidelines, along with the World Medical Association’s code of conduct, specifying the duties of every doctor. In particular, health-care personnel are reminded that they should uphold the worldwide medical ethical code, which states that health care should be provided to all patients without discrimination. In times of armed conflict, health-care personnel are far less at risk of being targeted by armed groups if they work with impartiality.

The Council has also established a monitoring centre to check the level of insecurity and mistreatment that doctors are exposed to even during peacetime. The centre uses a data-collection system similar to that of France’s violence-monitoring centre. The Council asks that doctors report any violence encountered in the exercise of their profession, to enable them to gauge what the situation is on the ground.

The white paper will be sent to all doctors in Cote d’Ivoire who are members of the Council. The Council also hopes to distribute it abroad, among peers working in member States of the Economic Community of West African States. With that in mind, the document will likely be translated into English and Portuguese. The white paper is already available, in French, on the Health Care in Danger online platform.

This collaboration between an ICRC delegation and a national medical body proved highly successful and is something that could certainly be replicated elsewhere in the world.