The protection of healthcare: what does it mean in Yemen? Sanaa, March 13th 2013
Co-organized by the Ministry of Public Health and Population of Yemen and Médecins Sans Frontières
1. Background
2. Objective of the seminar
3. Process and expected outcomes of the seminar
4. Agenda
1. Background
Attacks on and obstruction of healthcare activities in Yemen is a humanitarian concern resulting in the denial of access to healthcare to a large number of people. In a context of unrest such as Yemen, those attacks contribute to destroying the neutrality of health care facilities, thus damaging the effectiveness of the medical mission. Although healthcare personnel are often the ones the most exposed to attacks and threats, it is the patient who ultimately bears the consequences of such incidents: healthcare services are disrupted, or they are available but of poor quality, and consequently the patient does not have access to health services any more.
The need for a safe delivery of healthcare has even been more acute with the recent episodes of violence that have affected the country. Violence increases the need for health care precisely at the moment when it is most difficult to address this need – precisely because of insecurity. Inevitably, health care facilities are mirroring the tensions that shakes society and healthcare personnel are too often subject to threats or acts of violence during the performance of their medical duty.
To give few examples of attacks and threats against healthcare personnel:
• Being suspected of not providing the best care to a patient or accused of “treating the enemy”, health care personnel are threatened or arrested while fulfilling their medical duties,
• Health care infrastructures are trapped in violence and are consequently fired upon,
• Ambulances carrying the sick and wounded are unnecessarily delayed at checkpoints or are purely and simply sized
The consequences of those attacks against healthcare personnel or facilities are dramatic for the patients: the quality of care is impacted and the access to health care services is shrinking:
• A nurse who is threatened by caretakers during the fulfillment of his/her duty will be reluctant to go back to work, especially in remote areas
• A hospital that is fired at, or that experiences armed intrusions, becomes a dangerous place for patients, who will thus be reluctant to go and seek for medical assistance there
• An ambulance being carjacked at a tribal checkpoint for an indefinite period of time will not be available anymore; and patients will have to resort to using inappropriate vehicle to be transferred to the nearest hospital.
Patients themselves are also the object of threats and attacks:
• Patients are interrogated by security forces while undergoing treatment, as a common fact, and this can affect their full recovery
• Patients are arrested or captured from health care facilities and their treatment is interrupted as a consequence, putting their lives in danger
• Patients are killed for revenge inside health facilities while undergoing medical treatment.
These incidents jeopardize the continuity of care for patients in Yemen: when the safety of patient, healthcare personnel or infrastructure is at risk, the provision of healthcare is disrupted and the entire community runs the risk to be left without treatment.
2. Objective of the seminar
The objective of the seminar is to create a space of reflection and understanding between the medical community and non-medical stakeholders in order to discuss whether and how healthcare should be protected in Yemen.
The specific objectives of the seminar are:
- To shed light on the risks and fatal outcomes faced by patients in accessing unsafe and non-neutral medical care
- To raise awareness on the risks faced by healthcare professional in the fulfillment of their medical duty and the negative impact on the continuity of care for patients
- To discuss about international and national legal frameworks, as well as ethical principles, that can protect the medical mission, in a manner that is compatible with cultural notions, patients needs, and contextual aspects
- To identify whether medical mission ought to be differently protected in Yemen today, and, if so, how.
It is important to underline that the issues of the protection of the medical mission and safeguarding the continuity of care are concerning the entire healthcare community in Yemen – not only Médecins Sans Frontières. This is why recommendations should be crafted by the entire healthcare community and by the civil society members, as providers and users of healthcare in Yemen.
3. Process and expected outcomes of the seminar
In order to meet the above mentioned objectives, the seminar will be articulated around 4 main topics:
Session 1: The practice of medicine in violent settings: the MSF experience in the Middle East.
MSF has a long-standing experience of working in areas affected by violence as well as in complex settings. Lessons learnt on the difficulties to maintain the neutrality and the continuity of care for patients will be shared with the audience, with a specific emphasis on the Middle East region.
Session 2: The principles of medical ethics: international and Yemeni perspectives
Medical ethics is and always has been an essential component of medical practice as it contributes to support practitioners in dealing with difficult situations in a rational and principled manner. It is a very large and complex field of study and this session will strive to identify the main ethical principles, and discuss how they are relevant to the Yemeni context.
Session 3: The protection of the medical mission: international and Yemeni law perspectives
The protection of healthcare personnel is essential to ensure the rights of wounded and sick to access healthcare. The rights of patients and responsibilities of healthcare personnel are applicable whatever the context, being peaceful or not. A various range of legal and moral rules can be called in to protect the medical mission in Yemen, being international, positive, customary or Islamic rules.
Session 4: Panel discussion - Lessons learnt from the practitioners: how to safeguard the safety and continuity of care in Yemen
Participants to the round table will share their experience of delivering healthcare in a complex environment such as Yemen: case studies, good practices, positive solutions and unsolved dilemmas will be discussed.
The outcome of the seminar will take the form of a document detailing the discussions and recommendations made during the event. This material will be shared at a later stage with regional actors (healthcare and civil society representatives) as well as with state and non-state authorities.