Foghammar Ludvig, Jang Suyoun, Kyzy Gulzhan Asylbek, Weiss Nerina, Sullivan Katherine A, Gibson-Fall Fawzia, Irwin Rachel
Stockholm International Peace Research Institute, Sweden; Karolinska Institutet, Sweden.
Stockholm International Peace Research Institute, Sweden.
Soc Sci Med. 2016 Aug;162:219-26. doi: 10.1016/j.socscimed.2016.03.039. Epub 2016 Mar 31.
Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research collaboration among aid organizations, researchers and multilateral organizations, such as the WHO, is needed to address these challenges.
复杂的安全环境具有暴力（包括但不限于法律意义上的“武装冲突”）、贫困、环境灾难和治理不善等特征。在复杂安全环境中，直接影响医疗服务提供的暴力行为包括对个人的攻击（如医生、护士、管理人员、保安、救护车司机和翻译人员）、阻碍（如救护车在检查站被拦下）、歧视（如工作人员被迫优先治疗某一名患者而非另一名患者）、对医疗设施和财产的攻击及挪用（如武装组织的破坏、盗窃和救护车盗窃），以及将医护人员定罪。本文探讨了研究在这些环境中直接影响医疗服务提供的暴力行为的背景、范围和性质所面临的挑战。本文聚焦于数据收集，考虑这些挑战如何影响研究人员分析暴力驱动因素和暴力影响的能力。本文介绍了2014年和2015年举办的两次研究研讨会的主要成果，这两次研讨会召集了卫生和人道主义援助提供及政策领域的研究人员和从业人员，并借鉴了对旨在应对影响医疗服务提供的暴力行为的组织努力的分析，以及对在复杂安全环境中工作的组织代表进行的11次深度访谈。尽管影响医疗服务提供的暴力行为具有紧迫性和影响力，但总体上缺乏针对卫生领域、公众可获取且具有可比性的研究，也缺乏按性别分类的数据、关于犯罪者动机的数据以及对暴力“连锁反应”的评估。这些差距限制了分析，进而限制了在复杂安全环境中运作 的组织有效管理其工作人员和设施安全以及提供医疗服务的能力。需要援助组织、研究人员和多边组织（如世界卫生组织）之间加强研究合作，以应对这些挑战。
