PSI brings the Voices of Health Workers in Conflict Zones to the G2H2 Policy Dialogue

The discussion brought together trade union leaders from Palestinian, Ukrainian, Sudanese, and Nigerian health sector affiliates as well as the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, as lead speakers.

Background: a deadly trend

Health workers are the backbone of healthcare delivery in all settings. As Dr Tlaleng Mofokeng, the UN Special Rapporteur on the right to health noted in her report to the fifty-ninth session of the United Nations Human Rights Council last year, “Health and care workers are crucial to realise and defend the right to health”. They perform these roles in conflict zones, at great risk to their lives, safety and liberty.

Health and care workers are targeted by armed bodies of all sorts, including armies of invading countries as is the case in Ukraine and Gaza, contending factions of armed forces of the same country as we are witnessing in Sudan and even by armed non-state actors of different sorts as is the case in Nigeria with bandits and in Haiti with gangs. We also see a mix of these with non-state actor proxies of external countries being centrally involved in attacks on health workers and healthcare facilities in the Democratic Republic of Congo (DRC).

These attacks are carried out with scant, if any regard, to international humanitarian law or respect for the dignity of health workers as human beings performing essential services for the well-being of humankind.

The cost, in lives, of these attacks has been soaring in recent years, reaching an “all-time high” over the last two years, according to Médecins Sans Frontières (MSF). An important report issued last year noted that attacks on healthcare workers and health facilities reached “new levels of horror” in 2024. At least 927 health workers were verified to have been killed in 2024 alone. This was almost double the 480 killed in 2023 which itself was double the numbers of 2022.

Many more healthcare workers suffer in various ways from the horrors they face in armed conflicts. Loss of limbs, incarceration, the mental agony of watching their colleagues and patients being killed leave scars and post-traumatic stress disorder (PTSD) even years after violent conflicts.

Voices of health workers

There are PSI affiliates in almost all of the conflict zones in the world. The unions that constituted the panel were from some of the most troubling conflict zones in the global landscape of armed conflicts. A very relevant United Nations special procedures expert set the context for the discussion, underscoring the important place of multilateralism for the world to address the issues at stake, despite the barrage of attacks on the multilateral system.

Dr Mafokong, who is a medical practitioner in South Africa  set the ball rolling by putting the global situation in context. She started with reference to her reports last year to the United Nations Human Rights Council and the United Nations General Assembly. Dr T., as she is often fondly called noted that “the catastrophic failures” of international systems to safeguard health workers in the face of genocide, informed those reports. She argued that international humanitarian law is still important. Even when they are not respected, she urged health workers to document the human right violations taking place  as evidence. As we fight for the right things to be done, we must be able to put forward evidence to back our claims. She noted that even after the war on Gaza has been formally ended, many healthcare workers are still being illegally detained by the Israeli state.

While observing that the international community has let health workers down in the midst of raging conflicts in countries like Sudan, Myanmar, Haiti, Palestine and Ukraine, she urged health workers to still call on the Member States of the United Nations to live up to their responsibilities. Health workers, as she stressed, often go beyond the call of duty out of commitment to delivering healthcare. They do not deserve to be targeted on one hand or abandoned to by those who could stop the normalisation of such targetting on the other.

Mr Oleg Panasenko, the president of FUTHMW in Ukraine gave an insight into how health workers face attacks in the ongoing war in Ukraine. He informed that several health workers have been killed from attacks by Russian forces. But, what is often not mentioned is also how health workers face attacks within Ukraine. Paramedics, he informed have been increasingly facing attacks by people who have themselves been driven to the edge of anger and frustration with the war dragging on for years

Against all odds, health workers in Ukraine keep showing up. Over 2,000 health facilities have been destroyed to different extents. The health workers face attacks of different sorts. But they still do all they can to deliver health services to the population. But their efforts are also not appreciated by the management in some health facilities, such as the Poltava Regional Centre for Emergency Medical Care and Disaster Medicine. It has sacked a leading trade union activist after she raised pertinent questions about workplace safety, poor working conditions and take home pay that cannot take the health workrs home.

Dr Sara Gallo was president of the Sudanese Doctors Union, UK (SDU-UK) between 2017 and 2020, during which the Sudanese Revolution took place. The SDU-UK played a key role at that key moment to help entrench solid roots for independent trade unionism, once again, across Sudan. Over the last 33 months, the SDU-UK has been invaluable in coordinating the efforts of thousands of Sudanese health professionals trying to bring succour within a very dire situation, to Sudanese people within and outside the country. Fourteen million Sudanese are internally displaced or are refugees in several countries. “It is the worst humanitarian situation” in the world right now.

She added that, at “least 70% of the health facilities are not accessible” due to destruction by the insurgents. Lack of access to water and food is getting generalised. This has brought about famine in parts of the country. In other areas, so many people face acute starvation and malnutrition. Painfully she said there had earlier been several alerts, but “the international community chose to ignore these alerts” and then “stood paralysed” when the violence started. She described the health workers who have stood back to serve people within this blood-soaked conflict as heroes. Some have been arrested and detained. Some have also faced death penalties for doing their work. Many health workers who are refugees are helping in the refugee camps with health promotion as best as they can.

She wrapped up her intervention with questions about who will stand up for health workers who are putting their lives on the line for others.

Dr Ojonugwa Ayegba, education officer of the Medical and Health Workers’ Union of Nigeria stood in for Dr Kabiru Sani Minjibir, the president of the union, who as president of the Joint Health Sector Unions (JOHESU) was in the middle of tasks related to an ongoing nationwide health workers’ strike in Nigeria. And he spoke eloquently to the situation that health workers are facing in parts of Nigeria rocked by insurgency and banditry. He pointed out that health infrastructure are burnt down and health workers are targeted by the bandits and insurgents. He highlighted the gender dimensions with women being “worse-off” in what is already a terrible situation.

The discussion also brough to the fore how bandits at times kidnap health workers and take them to the bandits’ camp to treat the wounded in their ranks. “The deliberate acts of killing health workers” are condemnable and everybody should speak out against these. It is not fair, he said, for health workers to be made vulnerable while working to deliver health services to the population. The safety of health workers is essential for healthcare delivery.

Dr Jehad Attal, a former president of the doctors association in Gaza is a leading member of the General Union of Health Services Workers (GUHSW) in Gaza. He described the situation on the Gaza strip as “tragic”. At least 150 doctors, he said, were killed by Israeli forces during the war on Gaza. These included well-trained and highly skilled specialists. Medical colleges have also been destroyed. This means that for the coming ten years, minimum, it would be very difficult to train a new generation of medical doctors. He added that not less than 50 doctors are still being illegally held in jails in Israel.

The war, he added, has also resulted in sharp increases in the prices of drugs. Surgeries, including amputations are being done without anaesthesia. Thousands of patients are waiting to be allowed to go abroad for treatment. There is lack of medication for treating them in Palestine and yet they were being denied the right to travel for treatment, by the state of Israel.

The whole world is witnessing all these, he painfully stressed. He then pointed out that, at the heart of the violent conflicts which has been recuring for decades now in the Occupied Palestinian Territory, is the need for the right of Palestinians to self-determination to be duly respected.

Conclusion

There are one hundred and ten conflict zones across the world at the moment. They are of different sorts. But in all of these, health and care workers’ lives and liberty are always at risk, for providing much needed healthcare services to communities and the population.

Fifty-nine of these conflicts are state-based. That means the parties fanning the violent flames of wars are primarily governments which should be bound by international humanitarian law. Attacks on medical and health workers in violent conflicts are prohibited under provisions of the Geneva Conventions and the Rome Statute of the International Criminal Court. The targeting of health and care workers thus constitutes a war crime.

Health workers are united in saying enough is enough. These war crimes must be stopped and those responsible held to account. PSI will deepen support for our members living under the shadows of these despicable attacks. We unequivocally demand that governments and the international community take all necessary action to safeguard the lives and well-being of health and care workers in conflict zones.