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Violence against health care: insights from Afghanistan, Somalia, and the Democratic Republic of the Congo

  • Fiona Terry


This article explores the methodology and main findings of field studies conducted for the ICRC's Health Care in Danger project in Afghanistan, Somalia, and the Democratic Republic of the Congo between 2010 and 2013. It discusses some of the actions that the ICRC takes in its health programmes to facilitate access to health care, and its approach to promoting better respect for the laws protecting it. It then suggests what more needs to be done to curb the violence.



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1 Fiona Terry, ‘Protecting health-care in Afghanistan: IHL violations and the ICRC's response, April 2009–April 2010’, ICRC internal document, June 2010; Fiona Terry, ‘ICRC Health-Care in Danger project: Somalia case-study’, ICRC internal document, July 2012; Fiona Terry, ‘ICRC Health-Care in Danger project: Democratic Republic of Congo case-study’, ICRC internal document, March 2013.

2 See inter alia Alexandre Breitegger's article in this issue.

3 For more information, see inter alia the articles by Alexandre Breitegger, Amrei Müller, and Len Rubenstein and Katherine Footer in this issue.

4 These categories were also used in the ICRC publication Health Care in Danger: Making the Case, ICRC, Geneva, 2011, available at: (all internet references were last accessed in June 2013).

5 World Health Organization, World Health Statistics 2012, Chapter 6, available at:

6 ICRC, ‘Afghanistan: ambulance used in attack on Police Training Compound’, ICRC News Release 11/85, 7 April 2011, available at:

7 The ban itself did have some military rationale, however, with the militant Islamist group Al Shabaab concerned that the personnel of some aid agencies were spies and would report on the location of leaders, who would then be the target of drone attacks.

8 See Jonathan Whittall, ‘My enemy's doctor is my enemy’, in The Huffington Post, 10 April 2013, available at:

9 ‘Afghanistan: Taliban rue ambulance attack’, in IRIN, 12 April 2011, available at:

10 On 18 January 2010, for instance, an attack against a government building in Kabul was carried out in this way.

11 See Johnson, Thomas H. and DuPe, Matthew C., ‘Analysing the new Taliban Code of Conduct (Layeha): an assessment of changing perspectives and strategies of the Afghan Taliban’, in Central Asian Survey, Vol. 31, No. 1, March 2012, pp. 7791; and Munir, Muhammad, ‘The Layha for the Mujahideen: an analysis of the code of conduct for the Taliban fighters under Islamic law’, in International Review of the Red Cross, Vol. 93, No. 881, March 2011, pp. 81120.

12 Karim Talbi, ‘Uphill task for US Marines on Afghan healthcare’, in AFP, 24 March 2010, available at:

13 ‘DR Congo: MSF vaccination used as bait in unacceptable attack on civilians’, MSF press release, 6 November 2009, available at:

14 See Human Rights Watch (HRW), Shell-Shocked: Civilians under Siege in Mogadishu, HRW, New York, August 2007, pp. 5157.

15 Interviews with staff of the hospitals took place in Mogadishu in June 2012.

16 ‘Life and death on the streets of Somalia’, in Forgotten Diaries, 28 August 2010, available at:

17 ‘Hostilities against aid work in Jowhar put lives of Somali children and women at risk’, UNICEF press release, Nairobi, 17 June 2009, available at:

18 ‘Polio outbreak spreads in Somalia’, Polio Global Eradication Initiative, 30 May 2013, available at:

19 See Pete Jones, ‘Congo's army accused of rape and looting as M23 rebels win image war’, in The Guardian, 26 November 2012, available at:

20 ‘Afghanistan: mines prevent resumption of normal life in Marjah’, ICRC News Release 10/34, 5 March 2010, available at:

21 Interview with Mohammed Nur, Vice-Rector of Benadir University, Mogadishu, 12 June 2012.

22 M. Arte, ‘Exodus of medical professionals from Somalia’, in Somalia Report, 5 November 2011, available at:

23 See Rubenstein, Leonard and Bittle, Melanie, ‘Responsibility for protection of medical workers and facilities in armed conflict’, in The Lancet, Vol. 375, January 2010, pp. 329340.

24 See International Criminal Tribunal for the former Yugoslavia, Mrkšić et al., (‘Vukovar Hospital’ case), IT-95-13/1; and the Ovčara cases before the War Crimes Chamber of the Belgrade District Court.

25 ‘Rwanda 1994: la vraie vie est absente’, talk given by Philippe Gaillard, Head of ICRC delegation in Rwanda during the genocide, at the Red Cross and Red Crescent Museum, Geneva, 18 October 1994, available at:

26 ‘Patients killed in cluster bomb attack on Sri Lanka hospital’, in The Guardian, 4 February 2009, available at:

27 ‘Gaza: ICRC demands urgent access to wounded as Israeli army fails to assist wounded Palestinians’, ICRC News Release 09/04, 8 January 2009, available at:

28 Saeed Shah, ‘CIA's fake vaccination programme criticised by Médecins Sans Frontières’, in The Guardian, 14 July 2011, available at:

29 ‘Somalia launching new five-in-one child vaccines’, in AP, 25 April 2013. This article was picked up by newspapers the world over, including Somali ones like Hiiraan Online: ‘New push against polio and new vaccines in Somalia’, in Hiiraan Online, 26 April 2013, available at:

* Cornell University Press, Ithaca and London, 2002.


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Violence against health care: insights from Afghanistan, Somalia, and the Democratic Republic of the Congo

  • Fiona Terry


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