Yemen conference: right to health care must be respected
Daniel MacSweeney, the ICRC’s protection coordinator in Yemen, explains why the Health Care in Danger conference held in the Yemeni capital, Sana’a on 16 December is a vital step in ensuring greater respect for the protection of people’s right to health care in a country where armed conflict and other situations of violence are widespread.
What are the main problems related to safe access to health care in Yemen?
Yemen is a country where guns are often carried openly, and helping people to understand that there are places, such as hospitals, that need to remain safe and free from violence, is challenging. Lack of respect for the protected status of medical facilities, personnel and medical transport, especially ambulances, is another problem. We have seen incidents where ambulances have been attacked by various parties. We have also seen situations where ambulances have been prevented from reaching the wounded, or have been blocked at checkpoints.
There have, unfortunately, also been attacks on hospitals themselves. There has equally been the use of hospitals and clinics by armed groups for military purposes, which can lead to the facility losing its protection from attack under international humanitarian law (IHL).
Arresting, and then removing people who have been injured from hospital, against medical advice, has been known to happen. Of course the State has the responsibility to maintain security and the right to arrest people, but under IHL if a patient in need of ongoing care is arrested, he should remain in hospital or be transferred to a facility where similar treatment can be provided.
What are the humanitarian consequences of these problems?
The humanitarian consequences of such situations for the wounded and sick in Yemen can be enormous. Also, the chronically sick are affected when there is no safe and regular access to treatment. Vaccination campaigns, antenatal care and other preventive health measures at a local level may be disrupted as well. Some ambulance drivers have stopped working after having been attacked; some doctors have left their places of work after being threatened, and clinics in some areas have closed. In such circumstances, patients have had to travel longer distances to find the most basic medical services.
What is the ICRC doing to improve safe access to health care in Yemen?
The ICRC is using both a confidential and a public approach to raise awareness about these and other issues that amount to violations of IHL, human rights law and Yemeni law, with respect to the protection of health-care delivery, medical facilities, transport and personnel. The conference in Sana’a is part of that effort.
We have been working on the confidential track for some time. We first gather information relating to alleged violations, in order to find out what happened. If we are aware that violations have taken place we will talk confidentially with the authority, or group, or whomsoever is allegedly responsible for the incident. We discuss the applicable law, be it IHL, or Yemeni law, or human rights law, and about the alleged violations. We ask them to investigate what happened and to change their behaviour in the future. I think we are making progress because we are managing – through confidential dialogue – to reach many actors from different sides of the ongoing fighting and violence.
With regard to the public track, let me go back for a moment to what I said earlier about Yemen being a country where guns are carried openly and there is widespread lack of understanding that medical facilities, transport and personnel are protected under IHL. It can happen that a hospital director will not consider his premises protected unless it has armed guards and medical facilities where guns might be placed on the roof.
The conference in Sana’a is a first step aimed at raising public awareness about the issues involved. One very clear message is that hospitals, clinics, ambulances and staff are protected by IHL and must be respected.
How can the Health Care in Danger conference that took place in Sana'a on 16 December help improve the situation?
There are legal protections that exist under both IHL – which applies to the situations of armed conflict in Yemen – and human rights law and Yemeni law, which apply in all circumstances. All are important, all are helpful, and all should be respected.
Decision makers from the security, health and legal sectors of the government and the State armed forces were invited to the conference. Clear vocal and written support from the Yemeni government and other stakeholders afterwards would be the first step in creating a change in people’s attitudes and will have an impact. Of course we will need to talk to all other actors too. There are lots of different layers to Yemeni society; there’s the tribal layer, for example, which is extremely important, and there are geographical elements involved in the equation as well.
In addition, there are many different parties involved in various disputes and conflicts. We aim ultimately to get the support of all of them. If we can achieve this, then hopefully we will see over time a real change in attitude and behaviour towards ensuring respect and protection for the sick and wounded, as well as for people’s right to preventive health care.