Date: Apr 2, 2019 Source: The Telegraph UN urged to act as research shows nearly 1,000 attacks on health workers in 2018 Anne Gulland,The Telegraph•April 1, 2019 New figures presented to the United Nations Security Council show there were nearly 1,000 attacks on health care last year. The annual figures, produced by the Safeguarding Health in Conflict Coalition and presented to members of the Security Council on April 1, show that hospitals have been subjected to airstrikes, clinics have been torched and patients assaulted. In total there were 951 attacks on health facilities in 23 countries.  The figures show that 156 health workers were killed and more than 700 were injured. And more than 100 health facilities were forced to suspend operations or close. The data is collected from various sources including news reports, humanitarian organisations and for the first time, the World Health Organization, which began collecting data on attacks last year. This could be why the number of attacks documented was greater in 2018 than 2017, when the coalition reported 701 attacks on health care. The country that witnessed the greatest number of attacks was Syria where health facilities came under fire 250 times last year. Most of the attacks took place in the spring and summer when government forces launched a major offensive to capture opposition areas in the south of the country. Gaza also witnessed a large number of attacks with more than 100 health workers injured in 2018. In one incident on the West Bank three health workers were killed as they attended wounded demonstrators.   In Afghanistan, where levels of violence have been increasing in recent years, a bomb hidden in an ambulance killed 95 people. Researchers documented 50 attacks on healthcare in Yemen, perpetrated by both parties to the conflict. In Libya there were 47 attacks, followed by 30 in the Central African Republic – although gathering data from these two countries is difficult, said Leonard Rubenstein, chair of the coalition and report author. “In the Central African Republic there may have been more attacks. These countries don’t have good reporting – in Libya, we know that the health system has pretty much collapsed. The majority of health facilities are not functioning,” he said, adding that the total number of attacks was likely to be an underestimate. He added that it was difficult to determine whether attacks were deliberate or not  in Yemen, for example, urban areas have been targeted by both parties to the conflict so destruction of health facilities and other civil infrastructure has been inevitable. The reasons for the attacks are "context specific", said Prof Rubenstein. But the increasing number has prompted concerns that long-standing protections such as the Geneva Convention are being ignored by both nation states and militant groups. The perception of neutrality that once protected health workers is also questioned or totally ignored by militants from the Islamic State group in countries such as Afghanistan to armed groups in Democratic Republic of Congo. The data show that 17 per cent of the attacks were deliberate, 11 per cent were indiscriminate attacks on urban areas and the motivation behind the rest of the attacks was unknown, said Prof Rubenstein. The figures also show that in seven countries vaccinators were attacked – a “distressing” increase on four in the last year. In 2016 the UN adopted a resolution demanding an end to impunity for those perpetrating attacks on health care. But Prof Rubenstein said: "Three years ago the Security Council adopted a resolution of protecting health care in conflict but since then there has been a lot of rhetoric from most member states in terms of condemning attacks as unacceptable. But there has been a complete lack of follow up on the resolution which signals that these attacks have become acceptable.” He called on states to hold the perpetrators of attacks on health care to account and to support health workers and facilities in conflict settings. He also said that states should investigate any violations of the resolution and those that do not should face sanctions or prosecution. He also urged countries, such as the UK and United States, to stop selling arms to Saudi Arabia, which is bombing Yemen. Hamish de Bretton-Gordon, director of the charity Doctors Under Fire, said that in the Syrian conflict attacks on health care have been a deliberate tactic of the regime as they are seen as a way of weakening morale. “Like chemical weapons, attacks on healthcare were the great taboo and were left alone for 100 years. But the war in Syria has changed that. It’s seen as an effective tactic. There doesn’t seem to be any punishment for people who attack hospitals – all we get are platitudes from the UN,” he said.