Agency Coordinating Body for Afghan Relief and Development

Not a Target: 2016 Attacks on healthcare in Afghanistan

Published: 12:14 PM 05-05-2017 Updated: 04:38 PM 06-05-2017
 
 
   
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Copyright Watchlist

Not a Target: 2016 Attacks on healthcare in Afghanistan

 

By Watchlist & ACBAR, Abstract from The Safeguarding Health in Conflict Coalition report

 

In 2016, ongoing conflict in Afghanistan and continued targeting of medical facilities and personnel by parties to the conflict has further eroded the country’s already fragile health system. Between January 1 and December 31, 2016, UNAMA documented 119 conflict-related incidents targeting or impacting medical facilities and personnel.[1] According to UNAMA, these incidents directly resulted in 23 casualties (10 deaths and 13 injuries).[2] Ninety-five incidents were attributed to Armed Opposition Groups (AOGs),[3] including the Taliban and the Islamic State in the Levant-Khorasan Province (ISIS-KP), and 23 incidents were attributed to the Afghan National Security Forces (ANSF), including the Afghan Local Police, Afghan National Army, Afghan National Police, National Directorate of Security, and Afghan Special Forces.[4]


During the same reporting period, data collected from NGOs by the Agency Coordinating Body for Afghan Relief and Development (ACBAR) showed 110 conflict-related incidents that resulted in as many as 46 casualties (21deaths and 25 injuries).[5] The differences between ACBAR’s figures and those of the UN can be explained by different data collection methods. Of the 110 incidents recorded by ACBAR, only 26 occurred in urban areas (i.e., provincial capitals); the majority of incidents were carried out in rural areas.[6] The Eastern[7] and Western regions showed the greatest numbers of incidents—30 and 25, respectively.
 

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Safeguarding Health in Conflict Coalition

The Safeguarding Health in Conflict Coalition consists of more than 30 organizations working to protect health workers and services threatened by war or civil unrest. The coalition raises awareness of global attacks on health and presses governments and United Nations agencies for greater global action to protect the security of health care.

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While there are officially more than 2,200 medical facilities throughout Afghanistan’s 34 provinces,[8] according to the Ministry of Public Health, more than 30% of its population lacks access to health care.[9] Ongoing conflict in some provinces has further constrained what was already limited access due to road closures, irregular delivery of medical supplies, lack of facilities, and shortages of medical personnel.[10] Attacks on health care during the reporting period have compounded challenges to civilian health already exacerbated by months of escalating armed conflict. Reports from the UN Office for the Coordination of Humanitarian Affairs (OCHA)[11] and the World Health Organization (WHO)[12] indicate increases in 2016 in the percentage of civilians, particularly children, suffering from malnutrition, water-borne diseases, and vaccine preventable diseases. Attacks on health care have also contributed to the flight of medical personnel, particularly female staff; the temporary or indefinite  suspensions of vaccination programs, as well as humanitarian organizations’ operations; and shortages of supplies to treat high volumes of trauma cases, which has sometimes led to reduced quality of care provided to patients.

According to UNAMA, there were 74 incidents of threats and intimidation carried out in 2016.[13] Threats, intimidation, abduction, and harassment of medical personnel and civilians in need of health care comprised the majority of incidents perpetrated by AOGs.[14] For example, on August 11 in Farah province, an AOG member called the director of an NGO-run medical facility, introduced himself as the head of the Islamic Emirate of Afghanistan Health Department, and ordered the director to shut down the operation.[15] The NGO-run facility was subsequently closed.[16] ACBAR recorded 27 incidents of the abduction of medical personnel, including at least six incidents in which AOGs were seeking medical personnel to treat wounded members or extend services to areas under AOG influence. For example, on April 20 in Nangarhar province, armed men believed to be members of the Taliban abducted a doctor from a clinic and took him to a neighboring district, where a Taliban commander issued a list of demands to the doctor, including that the clinic should provide more comprehensive health services and extend its operating hours.[17] Following the meeting, the doctor was then transported back to the clinic; it is unknown whether any of the Taliban commander’s demands were met.[18] On July 13 in Ghor province, three AOG members broke into an NGO-run clinic and abducted a health worker; the health worker was released the following day, though during his detention was beaten and sustained injuries.[19]

There were at least 13 attacks on vaccination programs, including orders issued by AOGs to halt vaccination campaigns, abduction and killing of vaccinators, and destruction of stores of vaccines. For example, on January 26 in Kunar province, an improvised explosive device (IED) was detonated inside the vaccine storeroom of an NGOrun clinic, damaging the vaccine kits.[20]On the same day, in another area in Kunar province, AOG members abducted 13 vaccination campaigners, three of whom were shot and killed.[21] For all of 2016, at least 16 vaccinators were abducted and ten were killed.[22]

Several medical facilities were also damaged by rockets and mortars during fighting by parties to the conflict. For example, on April 20 in Paktya province, AOGs fired several mortar rounds that landed on or around an NGO-run medical facility. No patients or personnel were harmed by the blasts, but the building was damaged and patients were evacuated.[23]

There were also several documented incidents of the looting of medical facilities and destruction of medical supplies. For example, on September 28 in Badghis province, four AOG members broke into an NGO-run clinic and set fire to stocks of medicine and other supplies.[24] In another incident, on December 3 in Nangarhar province, men believed to be members of ISIL-KP forcibly entered a medical facility that had been delivering nutritional supplements, bound the facility’s guards, and set fire to the stock room containing the supplements and other medical supplies. The fire destroyed the supplies and damaged the stock room and other parts of the facility.[25] The assailants reportedly told the guards that they were opposed to male employees assessing female patients, as had been the practice at the clinic.[26]

Military use of medical facilities and threats and intimidation against medical personnel, particularly for allegedly providing medical care to AOGs, constitute the majority of the 23 incidents perpetrated by ANSF. For example, on January 11 in Wardak province, between 60 and 70 Afghan Special Forces troops entered and searched a medical facility in the capital city, Maidan Shar.[27] The troops interrogated medical personnel about persons treated the previous evening and warned them not to provide services to any insurgents.[28] On the night of February 17, Afghan Special Forces raided a clinic run by the Swedish Committee for Afghanistan (SCA), also in Wardak province. During the raid, Afghan Special forces assaulted medical staff, removed two patients, one of whom was under 18, and a 15-year-old caregiver from the facility, and summarily executed them outside the clinic. Following the incident, Afghan provincial authorities in Wardak gave statements justifying the raid on the grounds that those killed (including two children) were Taliban and that the raid was carried out because Taliban were being treated at the clinic.[29] On May 10, again in Wardak province, Afghan Special Forces entered an NGO-run clinic; following negotiations with the health shura (council), the troops vacated the facility after four days.[30] The troops reportedly did not mistreat the clinic’s staff members during the occupation;[31] however, a staff member was killed during a firefight between the troops occupying the clinic and the Taliban.[32] There were also some incidents in which medical facilities were occupied by multiple parties to the conflict. In one case, a clinic in Paktya was alternately occupied by an AOG and then by ANSF after ANSF had recaptured the area.[33] During its occupation, the facility was considerably damaged and at least 60% of its medical equipment was looted.[34]

 

[1] United Nations Assistance Mission in Afghanistan (UNAMA). February 2017. Afghanistan annual report on protection of civilians inarmed conflict: 2016. pp. 34-35 https://unama.unmissions.org/sites/default/files/protection_of_civilians_in_armed_conflict_annual_report_march_2016_final.pdf(accessed March 26, 2017).

[2] ibid

[3] Armed Opposition Groups (AOGs) include the Taliban and the Islamic State in Iraq and the Levant-Khorasa Province (ISIL-KP).

[4] United Nations Assistance Mission in Afghanistan (UNAMA). February 2017. Afghanistan annual report on protection of civilians in armed conflict: 2016. pp. 34-35 https://unama.unmissions.org/sites/default/files/protection_of_civilians_in_armed_conflict_annual_report_march_2016_final.pdf(accessed March 26, 2017).

[5] These data have not been otherwise published.

[6] Ibid

[7] For the Eastern region, ACBAR notes that its records do not include incidents from southern districts in Nangarhar province. Since 2015,this area has been heavily contested by ISIS-KP, the Taliban, and ANSF, and many medical facilities closed when the area became a front line in the conflict. As such, it has not been possible to reliably obtain and verify information on attacks.

[8] These data have not been otherwise published.

[9] Including temporary trauma posts, clinics, and district, provincial, and regional hospitals

[10] The World Bank. December 22, 2015. Afghanistan builds capacity to meet healthcare challenges. http://www.worldbank.org/en/news/feature/2015/12/22/afghanistan-builds-capacity-meet-healthcare-challenges (accessed November 30, 2016).

[11] United Nations Office for the Coordination of Humanitarian Affairs (OCHA). May 2016. Humanitarian bulletin: Afghanistan. Issue 52: p. 1.ReliefWeb. http://reliefweb.int/sites/reliefweb.int/files/resources/afg_mhb_may_2016_lr.pdf (accessed November 30, 2016).

[12] World Health Organization. n.d. Afghanistan humanitarian response plan 2016. http://www.who.int/hac/crises/afg/appeal/en/ (accessedDecember 9, 2016).

[13] United Nations Assistance Mission in Afghanistan (UNAMA). February 2017. Afghanistan annual report on protection of civilians inarmed conflict: 2016. pp. 34-35 https://unama.unmissions.org/sites/default/files/protection_of_civilians_in_armed_conflict_annual_report_march_2016_final.pdf(accessed March 26, 2017).

[14] These data have not been otherwise published.

[15] Ibid

[16] Ibid

[17] ibid

[18] ibid

[19] ibid

[20] ibid

[21] ibid

[22] ibid

[23] ibid

[24] ibid

[25] ibid

[26] ibid

[27] ibid

[28]ibis.

[29] Human Rights Watch. July 6, 2016. Letter to NATO re: civilian protection in Afghanistan. https://www.hrw.org/news/2016/07/06/letternato-re-civilian-protection-afghanistan (accessed March 19, 2017).

[30] These data have not been otherwise published..

[31] Ibid

[32] Ibid

[33] Ibid

[34] Ibid