Shehada Walaa, Bouquet Benjamin, Nassar Juliana, Briody Carolyn, Alfarra Nadia, Doctor Henry V, Daher Mahmoud, Rockenschaub Gerald, Kirkwood Graham, Pollock Allyson, Kim Hyo-Jeong
WHO, occupied Palestinian territory, Gaza.
WHO, occupied Palestinian territory, Jerusalem.
Lancet. 2021 Jul;398 Suppl 1:S19. doi: 10.1016/S0140-6736(21)01505-1.
WHO defines an attack on health care as "any act of verbal or physical violence or obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies." Gaza's Great March of Return (GMR) began on Mar 30, 2018, with 322 Palestinians killed and 33 141 injured by December, 2019, and first-response health-care teams exposed to high levels of violence. The aims of this study were threefold: to explore the vulnerabilities of health workers to attacks during the GMR; to understand the effectiveness and comprehensiveness of systems for monitoring health attacks; and to identify potential strategies and interventions to improve protection.
WHO's Surveillance System for Attacks on Healthcare (SSA) verifies and records health attacks. We analysed SSA data for the Gaza Strip from Mar 30, 2018, to Dec 31, 2019, examining the number and type of attacks, the mechanisms of injury, and the distribution of attacks by gender, time, and location. We analysed the correlation of health worker injuries and deaths with total injuries and deaths of Palestinians during the GMR. We held interviews and focus groups with individuals working for organizations defined as partners contributing to the SSA in the Gaza Strip, to understand data comprehensiveness, the nature and impact of violence, and protection gaps and strategies.
During the study period, there were 567 confirmed incidents, in which three health workers were killed, 845 health workers were injured, and 129 ambulances and vehicles and 7 health facilities were damaged, including one hospital and three medical field stations. Of the total health personnel killed and injured, 166 of 848 (20%) were in the Gaza governorate, 274 (32%) were in the Khan Yunis governorate, 119 (14%) were in the middle governorate, 192 (22%) were in North governorate, and 96 (11%) were in the Rafah governorate. Of 845 injuries, 743 (88%) were in men, 45 (5%) were live ammunition injuries, 62 (7%) were rubber bullet injuries, 151 (18%) were gas canister injuries, 41 (5%) were shrapnel injuries, and 533 (64%) were gas inhalation injuries. Injuries and deaths among health workers correlated moderately (R2=0·54) with and accounted for 2% of the total. Qualitative findings highlighted the incidental and structural nature of violence, normalisation and under-reporting of attacks, the need for improved coordination of protection for health care, and gaps in the availability of protective equipment.
Health-care workers function at great personal risk. The correlation of attacks against health care with total injuries and deaths points to the need for alignment of efforts to protect health care with strategies to safeguard civilian populations, including protection of populations living under occupation and those engaged in civil demonstrations. Health-care workers identified the need for systemic measures to improve protection through training, monitoring, and coordination, and through linking of monitoring and documentation of health attacks with stronger accountability measures for prevention.
In 2017 and 2018, WHO's Right to Health Advocacy programme received funding from the Swiss Development Cooperation and the oPt Humanitarian Fund.
世界卫生组织将对医疗保健的攻击定义为“任何言语或身体暴力行为、阻碍或暴力威胁，这些行为干扰了紧急情况下治疗性和/或预防性卫生服务的可及性、获取和提供”。加沙回归大游行（GMR）始于2018年3月30日，截至2019年12月，有322名巴勒斯坦人丧生，33141人受伤，急救医疗团队遭受了高度暴力。本研究的目的有三个：探讨加沙回归大游行期间卫生工作者遭受攻击的脆弱性；了解监测医疗攻击系统的有效性和全面性；确定改善保护的潜在策略和干预措施。
世界卫生组织的医疗保健攻击监测系统（SSA）核实并记录医疗攻击事件。我们分析了2018年3月30日至2019年12月31日加沙地带的SSA数据，研究攻击的数量和类型、伤害机制以及按性别、时间和地点划分的攻击分布情况。我们分析了卫生工作者伤亡与加沙回归大游行期间巴勒斯坦人总伤亡之间的相关性。我们与为加沙地带被定义为对SSA有贡献的合作伙伴组织工作的人员进行了访谈和焦点小组讨论，以了解数据的全面性、暴力的性质和影响以及保护方面的差距和策略。
在研究期间，共发生567起经证实的事件，其中3名卫生工作者死亡，845名卫生工作者受伤，129辆救护车和车辆以及7个卫生设施受损，包括1家医院和3个医疗分站。在伤亡的卫生人员总数中，加沙省有166人（20%），汗尤尼斯省有274人（32%），中区有119人（14%），北区有192人（22%），拉法省有96人（11%）。在845起受伤事件中，743人（88%）为男性，45人（5%）为实弹致伤，62人（7%）为橡皮子弹致伤，151人（18%）为催泪瓦斯罐致伤，41人（5%）为弹片致伤，533人（64%）为吸入催泪瓦斯致伤。卫生工作者的伤亡与总伤亡之间存在中度相关性（R2 = 0.54），占总伤亡的2%。定性研究结果突出了暴力的偶发性和结构性、攻击的常态化和报告不足、改善医疗保健保护协调的必要性以及防护设备供应方面的差距。
卫生保健工作者在极大的个人风险下工作。对医疗保健的攻击与总伤亡之间的相关性表明，需要将保护医疗保健的努力与保护平民人口的战略保持一致，包括保护被占领土上的居民和参与公民示威的人员。卫生保健工作者指出，需要采取系统性措施，通过培训、监测和协调，以及将医疗攻击的监测和记录与更强有力的预防问责措施相联系，来改善保护。
2017年和2018年，世界卫生组织的健康权宣传项目获得了瑞士发展合作署和巴勒斯坦被占领土人道主义基金的资助。
