Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; Global Health Initiative, American University of Beirut, Beirut, Lebanon.
Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Lancet. 2017 Dec 2;390(10111):2516-2526. doi: 10.1016/S0140-6736(17)30741-9. Epub 2017 Mar 15.
The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care-a strategy of using people's need for health care as a weapon against them by violently depriving them of it-has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.
叙利亚冲突带来了新的、前所未有的挑战，破坏了武装冲突中医学中立的原则和实践。由于医疗工作者、医疗设施和救护车直接且反复成为袭击目标，叙利亚已经成为对医疗保健提供者最危险的地方。将医疗保健武器化——通过暴力剥夺人们的医疗保健来将其作为武器的策略——已经导致数百名医疗工作者死亡，数百人被监禁或遭受酷刑，以及数百个医疗设施被蓄意和系统地袭击。有证据表明，叙利亚政府和盟军以空前的规模使用了这一策略，人权组织将其描述为战争罪策略，尽管所有各方似乎都犯有违规行为。对医疗保健的攻击引发了大批经验丰富的医疗工作者外流。留下来的医疗工作者面临着巨大的挑战，由于没有医疗保健是难民外流的一个主要因素，其影响远远超出了叙利亚。国际社会对这些违反国际人道主义和人权法的行为基本上没有回应，尽管这些行为造成了巨大的后果。虽然有谴责，但在将肇事者绳之以法方面几乎没有采取行动。这种应对不力，对在武装冲突局势中维持全球卫生和人道主义机构运作所需的医学中立基础构成了挑战。在本卫生政策中，我们分析了面临此类系统和严重违反国际人道主义法的医疗工作者的情况。我们描述了医疗工作者所面临的巨大压力，以及他们在应对这场危机时所表现出的非凡的适应力和创造力。我们提出了保护和支持在武装冲突地区工作的医疗工作者的政策要务。
