Violence Against Healthcare

About this course: At the global level, there are many countries marked by violence affecting health care. The 'Health care in danger' project aims to establish practical measures and recommendations that can be implemented on the ground by policy-makers, humanitarian organizations and health professionals. In view of the multiplicity of actors and latitudes concerned, it is essential to be able to make available the tools needed to make informed decisions, guide behaviour in high-risk areas and provide everyone the means to create and optimize the dialogue between humanitarian professionals and health on the one hand and relevant authorities or other armed actors. This course covers various topics such as ethics, rights and responsibilities of the staff of health and pre-hospital personnel, issues related to international law and humanitarian law, international human rights, caregivers and patient safety as well as the role of communities to address and reduce violence against health care.

Who is this class for: This MOOC caters to all people interested in understanding the issues of violence against healthcare. Especially all people in training or already working in the humanitarian, medical, social and military, fields, including other actors operating in situations of armed conflict or emergency, such as authorities, the armed forces, police, judicial and other bodies facing the issues of violence against healthcare.

Created by:  University of Geneva

• Taught by:  Angela Gussing, Regional Director for the Americas

  International Committee of the Red Cross

• Taught by:  Beat Stoll, Dr

  PD, Coordinator of the Master of Science in Global Health, University of Geneva

• Taught by:  Esperanza Martinez, Dr, Head of Health

  International Committee of the Red Cross

• Taught by:  Alexander Breitegger, Legal Adviser

  International Committee of the Red Cross

• Taught by:  Frederik Siem, Senior Adviser for Health Care in Danger

  Norwegian Red Cross (NorCross)

• Taught by:  Bruce Eshaya-Chauvin, Dr, Medical Advisor Health Care in Danger Project

  International Committee of the Red Cross

• Taught by:  Jamie Williamson, Head of Unit, Relations with Arms Carriers

  International Committee of the Red Cross

• Taught by:  Luigi Fratini, Head of Prevention Cell Unit, Law & Policy department

  International Committee of the Red Cross

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Syllabus


WEEK 1


General Introduction



2 videos, 5 readings expand

1. Video: General introduction
2. Video: The importance of addressing violence against Health Care together -Angela Gussing (Regional Director for the Americas, ICRC)
3. Reading: Syllabus
4. Reading: Course Summary
5. Reading: General References
6. Reading: Key terms - Glossary and Acronyms
7. Reading: Aknowledgements

Module 1: Health-care personnel: ethical principles of health care in times of armed conflict and other emergencies



The purpose of this first module on violence against health care Is to highlight and understand the situations and the constraints faced on the ground in conflicts and emergencies. These sitautions will be analysed both from the health care providers perspective as well as from the beneficiairies perspective. A special focus on Mental Health and psychosocial support, ethical dilemmas and riks analysis


12 videos, 1 reading expand

1. Video: Introduction
2. Reading: Key resource for module 1
3. Video: 1.1.1 Me, The health provider - Esperanza Martinez, (Head of the health unit, ICRC)
4. Video: 1.1.2 Human resource challenges - Esperanza Martinez, (Head of the health unit, ICRC)
5. Video: 1.1.3 The ethical issues - Robin Coupland, (former field surgeon, ICRC)
6. Video: 1.1.4 Health Care in Danger: Voices of the Community - Dr Otmar Kloiber, (Secretary General, WMA)
7. Video: 1.1.5 The perspective of the beneficiaries - Eric Bernes, (Coordinator, First Aid & Prehospital Emergency care programs, ICRC)
8. Video: 1.2.1 Quantitative data and their bias - Robin Coupland, (former field surgeon, ICRC)
9. Video: 1.3.1 Introduction to help the helpers’ strategy - Carla Uriarte, (Mental Health and Psychosocial Support Advisor, Health Unit, ICRC)
10. Video: 1.3.2 Help the Helpers program in Mexico (Excerpt from MHPSS film Healing Hidden Wounds, 2015)
11. Video: 1.3.3 MHPSS delegate interview (encapsulating presentation with Excerpt from Health care in Gaza: Mental health support for frontline workers, 2015)
12. Video: 1.4.1 Explanation of the vulnerable groups, their invisibility and early search for them - Stephane Du Mortier, (Head of the Primary Health Care Services, ICRC)
13. Discussion Prompt: Discussion on module 1
14. Video: Course summary module 1

Graded: Health-care personnel: ethical principles of health care in times of armed conflict and other emergencies

WEEK 2


Module 2: The legal framework on the protection of health-care delivery



Today, an elaborate international legal framework exists whose aim is to guarantee protection of patients and health-care providers from violence in armed conflict or other emergencies. However, violence against patients and health-care providers remains a sad reality in such situations. Still, it is important for those who have an influence over the respect for the law, like State authorities, State armed forces, armed groups or members of communities, as well as for health-care professionals or those who will become health-care professionals themselves to identify who has to follow the law, what the rules describe and when they apply. A better understanding of the law may contribute to better behavior on the ground, if there is general willingness to comply with legal rules. For health-care professionals, the law may be a tool that can be invoked towards authorities, armed forces, armed groups and others for more effective protection. This module should contribute towards these aims by identifying international legal rules relevant to the protection of patients and health-care providers and pointing towards legal and practical challenges in their implementation.


12 videos, 2 readings expand

1. Video: Introduction Alexander Breitegger, (Legal Adviser, ICRC)
2. Reading: Key resources for module 2
3. Video: 2.1.2 The scope of application of relevant legal frameworks - Alexander Breitegger, (Legal Adviser, ICRC)
4. Video: 2.1.3 The sources of international humanitarian law and international human rights law - Alexander Breitegger, (Legal Adviser, ICRC)
5. Video: 2.2.1a Case Study Yemen 1 : Operational implementation of obligation to provide impartial health care - Benjamin Charlier, (Legal Adviser, Advisory Services for International Humanitarian Law, ICRC) and Alexander Breitegger, (Legal Adviser, ICRC)
6. Video: 2.2.1b Case Study Yemen 1 : Operational implementation of obligation to provide impartial health care - Benjamin Charlier, (Legal Adviser, Advisory Services for International Humanitarian Law, ICRC) and Alexander Breitegger, (Legal Adviser, ICRC)
7. Video: 2.2.2a Challenges under domestic law for guaranteeing impartial delivery of health care: example of Colombia. Skype interview German Parra Gallego, (Operational Legal Adviser, ICRC Bogota) and Alexander Breitegger, (Legal Adviser, ICRC)
8. Video: 2.2.2b Challenges under domestic law for guaranteeing impartial delivery of health care: example of Colombia. b) Skype interview Jorge Arturo Cubides Granados, (Interinstitutional coordinator of the programme by the Presidency of Colombia on human rights and international humanitarian law) and Alexander Breitegger, (Legal Adviser, ICRC)
9. Video: 2.2.3 Case Study Yemen 2: Legal aspects relevant to attacks against health-care facilities - Marisela Silva Chau, (Thematic Legal Adviser, ICRC and formerly Operational-Legal Adviser for ICRC Afghanistan, Colombia and Peru) and Alexander Breitegger, (Legal Adviser, ICRC)
10. Video: 2.2.4 Case study Yemen 3: Legal aspects relevant to obstructions of passage of medical transports - Marisela Silva Chau, (Thematic Legal Adviser, ICRC and formerly Operational-Legal Adviser for ICRC Afghanistan, Colombia and Peru) and Alexander Breitegger, (Legal Adviser, ICRC)
11. Discussion Prompt: Discussion on module 2
12. Video: 2.3.1 The red cross, red crescent and red crystal emblems-authorized uses, misuses and associated obligations - Alexander Breitegger, (Legal Adviser, ICRC)
13. Video: 2.3.2 Other symbols and possibilities of identification - Alexander Breitegger, (Legal Adviser, ICRC)
14. Reading: A health-care facility embroiled in military operations (please read before attempting the quiz !)
15. Video: Course Summary module 2

Graded: International Humanitarian Law and International Human Rights Law application (please read above case study text, before starting quiz!)

WEEK 3


Module 3: Ambulance and prehospital services in risk situations



This module will inform you of the the general security challenges that ambulance and prehospital services face in situations of armed conflict or other emergencies. Unfortunately, challenges also include targetted attacks or threats of violence against the ambulance and prehospital. Direct and indirect attacks may be carried out by arms carriers, but also by the local communities themselves. Through the following chapters, we will try to understand some of the reasons behind such threats and attacks, as well as present you with some solutions that the service providers can implement to reduce risks and the impact that threats and attacks may have on the service providers and the people they seek to help. It should be noted that these solutions and good practices have to be considered up against the context in which they are to be implemented. What works in one country or area, may not be as relevant in another.


10 videos, 1 reading expand

1. Video: Introduction Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross)
2. Reading: Key resources for module 3
3. Video: 3.1.1 Aggression against ambulance personnel due to expectations exceeding capacity
4. Video: 3.1.2 Challenges and solutions: example from Lebanon - Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross) and Rodney Eid, (Assistant Director for Crisis Management, Lebanese Red Cross)
5. Discussion Prompt: Discussion on module 3
6. Video: 3.2.1 Consequences of ambulance misuse: example from Baghdad - Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross) and Sally Al-Nakshabandi, (Humanitarian Leadership and Management School - HLMS, ICRC)
7. Video: 3.2.2 Misuse of ambulances internally in the organization - Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross)
8. Video: 3.3.1 Solutions to operational dilemmas encountered in hot zones - Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross)
9. Video: 3.3.2 Importance of situational awareness in risk situations - Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross)
10. Video: 3.3.3 Reasons behind and consequences of ambulance obstruction: example of Colombia - Frederik Siem, (Senior Adviser for Health Care in Danger, Norwegian Red Cross) and Dr Francisco no Carillo, (Director of General Health, Colombian Red Cross) and Pascal Ollé Coordinator department of Salud ICRC
11. Video: 3.4.1 Adapting to violent situations in peaceful contexts: Example of Sweden - Jane Kautto, (President of the Swedish Ambulance Nurses Association)
12. Video: Course summary: module 3

Graded: Module 3: Ambulance and prehospital services in risk situations

WEEK 4


Module 4: Hospital managers: ensuring the preparedness and security of health-care facilities in armed conflict and other emergencies



This module speaks of how health services are valuable at any time, but particularly during emergencies resulting from any hazard (radio nuclear, disease, chemical, food safety, social/political, natural); during emergencies, hospitals may face the additional burden of overcrowding, infrastructure damage, loss of staff, and increased violence against health care facilities and workers becoming victims of the emergencies themselves; therefore hospitals must be strengthened to stay safe and resilient even when faced with these difficult challenges.


12 videos, 1 reading expand

1. Video: Introduction Dr Bruce Eshaya-Chauvin, (former Medical Adviser, Health Care in Danger project, ICRC)
2. Reading: Key resources for module 4
3. Video: 4.1.1 The well-being of health-care personnel - Dr Bruce Eshaya-Chauvin, (former Medical Adviser, Health Care in Danger Project, ICRC) and Amanda Baumgartner (Head Nurse, ICRC DRC)
4. Video: 4.1.2 Relations between health-care personnel and patients - Dr Bruce Eshaya-Chauvin (former Medical Adviser, Health Care in Danger Project, ICRC) and Joana De Barros (Head Nurse, ICRC DRC)
5. Video: 4.1.3 Who should be cared for first - Dr Bruce Eshaya-Chauvin (former Medical Adviser, Health Care in Danger Project, ICRC) and Felicity Machoka, (Hospital Project Manager, ICRC Pakistan).
6. Video: 4.1.4 Hospital infrastructure, risk analysis and how to prepare - Federico Sittaro, (Water & Habitat - Strategic Planner: Health and Urban Infrastructures, ICRC)
7. Video: 4.1.5 The multi-dimension approach to safeguarding medical care in armed conflict and other emergencies - François Delfosse, (Security Advisor for the Attacks on Hospitals Project at MSF)
8. Video: 4.2.1 The importance of preparation of HC facilities for emergencies - Sona Bari, (Communications Manager at the WHO)
9. Video: 4.2.2 The safe hospital index: an assessment report and action plan for resilience and safety - Jonathan Abrahams, (Technical Officer, Health Policy in Disaster Risk Management, Country Health Emergency Preparedness and International Health Regulations in WHO Asian Disaster Preparedness Center - ADPC)
10. Video: 4.2.3 The safe hospital index: field implementation example in Nepal - Hyo Jeong Kim, (Technical officer for Humanitarian Policy & Guidance in WHO’s Health Emergencies Program)
11. Video: 4.2.4 The safe hospital index: benefits and how to implement the program in your own country - Dr Rudi Coninx, (Coordinator of Humanitarian Policy and Guidance in WHO’s Health Emergencies Program)
12. Video: 4.3.1 Violence in the emergency room. , Sylviane Stotzer, (Nurse, Emergency Service, University Hospitals of Geneva HUG)
13. Discussion Prompt: Discussion of module 4
14. Video: Course Summary Module 4

Graded: Healthcare Facilities

WEEK 5


Module 5 Weapons bearers: military operational practice to ensure safer access to and delivery of health care



This module speaks of the vital role Non-State Armed Groups (NSAGs) play as recipients and providers of health care. This lesson delineates different ways armed groups can pose a threat to the safe provision of health care, but also how armed groups act as health care providers themselves. The lesson also highlights key tools to safeguard the provision of health care in conflict settings, i.a. doctrine, education, trainings, and sanctions, and critically discusses limitations to their applicability.


8 videos, 2 readings expand

1. Video: Introduction Jamie Williamson, (Head of Unit, Relations with Arms Carriers, ICRC)
2. Reading: Key resources for module 5
3. Video: 5.1.1 Main concerns regarding the protection of healthcare personnel and facilities - Jamie Williamson, (Head of Unit, Relations with Arms Carriers, ICRC)
4. Video: 5.2.1 Practical measures/Ensuring safe passage of medical vehicles at checkpoints - David Maizlish, (Advisor, Military and Security Forces, ICRC)
5. Video: 5.2.2 Targeting of health-care facilities: Practical measures to be set up by armed forces and Non-State Armed Groups (NSAG) - David Maizlish (Advisor, Military and Security Forces, ICRC)
6. Video: 5.3.1 Non-State Armed Groups (NSAGs) and the Provision of Health Care, Part1 - Brian Mc Quinn, (Advisor on the Sociology of Non-State Armed Groups, ICRC) and Franziska Seethaler, (Associate on Relations with Non-State Armed Groups, ICRC)
7. Video: 5.3.2 Non-State Armed Groups (NSAGs) and the Provision of Health Care, Part2 - Brian Mc Quinn, (Advisor on the Sociology of Non-State Armed Groups, ICRC) and Franziska Seethaler, (Associate on Relations with Non-State Armed Groups, ICRC)
8. Discussion Prompt: Discussion of module 5
9. Video: 5.4.1 The ICMM and the issues of ethics in military medicine - Lt Col David Winkler, MD, PhD, (Chairman of the ICMM Center of Reference for Education on IHL and Ethics)
10. Reading: Key issues regarding arms carriers in the provision of health care in conflict zones (to be read before attempting the quiz !)
11. Video: Course Summary Module 5

Graded: Measures and recommendations to improve arms carriers' respect for health care (please read the text here above before attempting this quiz !)

WEEK 6


Module 6: Members of the civil society: communities, National Societies, Religious Leaders, Health organizations and others



The purpose of this module is to highlight and understand the role civil society has in the medical mission. Civil society includes those who are actors themselves in the medical mission, as well as those who protect and promote access to health care. This module will look at how Red Cross and Red Crescent National Societies, communities, medical associations and religious circles have the ability to strengthen the provision of health care and to influence relevant parties in showing respect for the medical mission. The module will allow learners to understand the bigger picture in terms of actors involved and their role in the concept of “health care in danger”.


8 videos, 5 readings expand

1. Video: Introduction Luigi Fratini, (Head of the Prevention Cell Unit, ICRC)
2. Reading: Key resources for lesson 1: National Societies
3. Video: 6.1.1 The National Society Auxiliary role - Sylvia Khamati (Head of Health and Social Services, Kenya Red Cross - KRCS) and Luigi Fratini, (Head of the Prevention Cell Unit, ICRC)
4. Reading: Key resources for lesson 2: the Role of Communities
5. Video: 6.2.1. Building Community resilience - Marta Pawlak, (Advisor on Community Based Protection & Sexual Violence, ICRC)
6. Video: 6.2.2 Encouraging Community to advocate on the respect and the protection of health care - Marta Pawlak, (Advisor on Community Based Protection & Sexual Violence, ICRC)
7. Reading: Key resources for lesson 3: Medical Associations
8. Video: 6.3.1 World Medical Association as promoter of respect of health care during crisis - Otmar Kloiber, (Secretary General, World Medical Association) and Luigi Fratini, (Head of the Prevention Cell Unit, ICRC)
9. Video: 6.3.2 The role of medical students, HCiD: Voices of the Community - Anna-Theresia Ekman, (International Federation of Medical Students’ Associations - IFMSA)
10. Reading: Key resources for lesson 4: Religious Circles
11. Video: 6.4.1 The role of religious circles - Rafiullah Qureshi (Prevention Adviser, ICRC) and Luigi Fratini, (Head of the Prevention Cell Unit, ICRC)
12. Discussion Prompt: Discussion on module 6
13. Reading: Treeland and Sealand: Civil Society, Conflict and Health Care (please read before the quiz!)
14. Video: Course Summary Module 6

Graded: The Role of Civil Society in relation to Health Care

Global Summary Violence against Health Care



1 video expand

1. Video: Connecting one another to end violence: building resilience and influencing behavior change - Dr Bruce Eshaya-Chauvin, (former Medical Adviser, Health Care in Danger Project, ICRC)