iranian red crescent

 

Health Care in Danger

Expert Workshop on Health Care in Danger

For National Red Cross and Red Crescent Societies

The role and responsibility of National Societies to deliver safe

Health care in armed conflict and other emergencies

12-14 February 2013, Tehran

Workshop co-organised and report jointly prepared by:

The International Committee of the Red Cross (ICRC)

And

Red Crescent Society of the Islamic Republic of Iran

  TABLE OF CONTENTS Background (objectives, themes) Workshop key messages  Opening Ceremony and Remarks Summary of the Presentations and issues discussed  Theme 1:   Theme 2:   Theme 3:   Recommendations ÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪ... - Clear NS mandate and role in armed conflict and other emergenciesÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪ.. ┬á - Red Cross, Red Crescent, Red Crystal Emblem and IdentificationÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪ. ┬á - Capacity and PreparednessÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪ ┬á - Security and Access (Perception and Acceptance) ÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪ ┬á - Communication and Advocacy on Health Care in DangerÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪÔǪ. ┬á Annexes: -┬á┬á┬á┬á┬á┬á┬á┬á┬á Annex 1: Agenda -┬á┬á┬á┬á┬á┬á┬á┬á┬á Annex 2: Background Document -┬á┬á┬á┬á┬á┬á┬á┬á┬á Annex 3: List of participant -┬á┬á┬á┬á┬á┬á┬á┬á┬á Annex 4: Presentations and speeches by key note speakers

• Robert Mardini, Head of Operations for the Near and Middle East, ICRC
• Mr. Ghazwan Al-Maliki, Legal Advisor, Syrian Arab Red Crescent
• Mr. Bildard Baguma, Under Secretary General, Uganda Red Cross
• Dr. Leonard Neol Zeade, Director General, Ivorian Red Cross Society

┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á Background       To address the issue of violence affecting health care, the 31st International Red Cross and Red Crescent Conference in November 2011 called upon the ICRC to initiate consultations with experts from States, the Red Cross and Red Crescent Movement and other actors in the health-care sector, with a view to making the delivery of health care safer in armed conflict and other emergencies. The ICRC was further called upon to report to the 32nd Conference in 2015 on the progress made.   As part of this process, the ICRC, along with numerous partners from a range of areas of expertise, is organizing a series of consultations during 2012 ÔÇô 2014 to identify measures for making the delivery of health-care services during armed conflict and other emergencies safer. ICRC will report on this consultation and progress made to the 32^nd International Conference in 2015.   The Red Crescent Society of the Islamic Republic of Iran and the ICRC co-hosted a workshop in Tehran in February 12-14 of 2013 to explore ÔÇ£The role and responsibilities of national societies to deliver safe health care in armed conflict and other emergenciesÔÇØ. This event followed the first workshop on the same subject organized in Oslo together with the Norwegian Red cross in December 2012.   The Tehran workshop brought together some thirty-five participants, experts in the field of emergency health, relief operations and disaster management, from thirteen National Societies, the International Federation (IFRC), the Iraqi Ministry of Health and ICRC[1]. The primary objectives of the workshop were to identify the main challenges National societies face when attempting to provide health care to the sick and wounded during armed conflict and other emergencies and to develop recommendations for dealing with them.   This workshop largely addressed the same objectives and issues as the workshop organized in Oslo. This permitted the validation of many of the outcomes emanating from the Oslo workshop by drawing on the experience from participants from other contexts. Some of the key messages resulting from the workshop in Oslo, organized under following headings, were:  

1. 1.    National Society role and relationship with Public Authorities

-┬á┬á┬á┬á┬á┬á┬á┬á┬á Authorities must have clear understanding of NSÔÇÖ mandate and role in armed conflict and other emergencies, including in cases of collective violence -┬á┬á┬á┬á┬á┬á┬á┬á┬á NS act as neutral, impartial and independent auxiliaries in the humanitarian field -┬á┬á┬á┬á┬á┬á┬á┬á┬á NS must develop and maintain strong links with authorities -┬á┬á┬á┬á┬á┬á┬á┬á┬á NS Mandate and role should be formalized within national legislation and other mechanisms

1. 2.    The «Safer Access Framework»

-┬á┬á┬á┬á┬á┬á┬á┬á┬á The Safer Access Framework is an important capacity strengthening tool for NS to use to improve acceptance and respect for their activities amongst State authorities, non-State armed groups and the local community at all times, thereby contributing to the safe access to the wounded and sick during armed conflict and other emergencies.  

1. 3.    The Role of National Societies in Promoting Safe Access to Health Care

-┬á┬á┬á┬á┬á┬á┬á┬á┬á NS play a critical role in ensuring safe delivery of health care, carrying out a range of assistance and protection activities. -┬á┬á┬á┬á┬á┬á┬á┬á┬á NS have a further potential for enhancing their own capacities to deliver health care more effectively and safely by enhancing preparation and training of staff and volunteers . -┬á┬á┬á┬á┬á┬á┬á┬á┬á NS can contribute to raising awareness of the problem and to engaging a wide range of concerned actors beyond the Movement in efforts to promote the safe delivery of health care.   These outcomes, as presented by the Norwegian Red Cross during the workshop, together with a background report summarizing main challenges faced by NS in providing health care in armed conflict and other emergencies, served as a basis for further discussion in Tehran. The agenda in Tehran was adapted accordingly and focused on the following three overarching themes:   -┬á┬á┬á The challenges National Societies face in delivering health care in armed conflict and other emergencies - In armed conflict and other emergencies, what are the greatest operational challenges faced by National Societies in terms of safe access to health care, and what can they do to overcome them? -┬á┬á┬á Meeting the challenges ÔÇô operational dimensions (access, security) What concrete steps can National Societies take to increase their acceptance, access to victims and operational security with respect to all relevant stakeholders in armed conflict and other emergencies? -┬á┬á┬á┬á┬á┬á┬á┬á┬á Meeting the challenges ÔÇô advocacy and communication What can National Societies do ÔÇô through advocacy and communication ÔÇô to improve the safe delivery of health care in situations of armed conflict and other emergencies?   The participants in Tehran largely confirmed these key messages from the workshop in Oslo, particularly those pertaining to the importance of NS applying the Safer Access Framework and those relating to the NS relationship with public authorities. However the Tehran workshop also further elaborated on some of the recommendations from the workshop in Oslo as well as locating these in a national context. The Tehran workshop further produced additional conclusions particularly relating to security measures, advocacy on HCiD and the role NS can play in supporting the broader health care in danger campaign beyond the Movement.   This report presents some of the key messages from the workshop, gives an overview of some of the main points raised and discussed by the various speakers addressing the workshop and summarizes the recommendations resulting from these discussions.   ┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á Key messages from the workshop: ┬á -┬á┬á┬á┬á┬á┬á┬á┬á┬á Security and Access management: Movement-components need to explore further how to balance between the need, on the one hand, to ensure the security of its health care providers (staff and volunteers) and, on the other hand, to provide critical, life-saving health care services in situations with very high risk of insecurity for the wounded, the sick and the health care providers. This exploration needs to review and compare various methods of managing security in extreme volatile security situations in which security rules and guidelines may be inadequate. Furthermore related to the security of front line responders, the Movement needs to explore further the advantages and disadvantages of equipping frontline responders with Personal Protective Equipment (PPE). Lastly, Movement components should be cautious to avoid that Movement health care provision isnÔÇÖt paralysed in situations of armed conflict and other emergencies resulting from an over-emphasis on security.   -┬á┬á┬á┬á┬á┬á┬á┬á┬á The Health Care in Danger public communication campaign should be implemented by all components of the Red Cross Red Crescent Movement. It should address the insecurity of health care services of all health care providers during armed conflict and other emergencies, including those provided by Movement components. it was stressed that the insecurity of health care goes beyond that of the Red Cross Red Crescent Movement. NS and ICRC need to work closely together in the design and implementation of the campaign, drawing on the respective componentsÔÇÖ experience, capacities and networks in order to raise awareness about the problem, promote measures to address them and engage key stakeholders at local, national, regional and global level.   -┬á┬á┬á┬á┬á┬á┬á┬á┬á Health Care in Danger coordination mechanism: NS and ICRC need to take advantage of their positions, networks and authority on humanitarian issues generally, and the issue pertaining to the security of health care in situations of armed conflict and other emergencies specifically, to explore the possibility to establish national, multi-stakeholder coordination mechanisms for Health Care in Danger. These would serve as platforms to raise attention and mobilise key stakeholders to the issue of insecurity of health care, identify measure to address the issue and coordinate efforts towards improving the security of health provision in situations of armed conflict and other emergencies. ┬á -┬á┬á┬á┬á┬á┬á┬á┬á┬á National Society auxiliary role: National Societies, as auxiliaries to their public authorities, have a duty to consider seriously any request by their public authorities to carry out humanitarian activities within their mandate. However, states must refrain from requesting National Societies to perform activities that are in conflict with the Fundamental Principles or the Statutes of the Movement or its mission. No matter what the circumstance, a National Society as a humanitarian organization is never subordinated to the public authorities: its auxiliary role (s) never transforms a National Society or its staff into an organ of the State. Within that frame, National Societies should seek to establish a permanent dialogue at all levels of public authorities contributing towards the improved security of health care provision.                   Opening Ceremony and Remarks:   The Opening Ceremony on the morning of 12^th of February was attended by senior officials from the Iranian Ministries of Foreign Affairs, Health, Defense and Justice; members of the National Committee of Humanitarian Law, Non-Governmental Organisations, media and the diplomatic community; as well as the Red Cross and Red Crescent Movement.   As co-hosts of the event, Mr. Mohammad Sh. Mohammadi-Araghi, Under Secretary General of the International Affairs and IHL of the IRCS, and ICRC Tehran Head of Mission, Mr. Pierre Ryter welcomed and opened the workshop.   Opening remarks were delivered by: -┬á┬á┬á┬á┬á┬á┬á┬á┬á Dr. Abolhassan Faghih, President of the Iranian Red Crescent Society -┬á┬á┬á┬á┬á┬á┬á┬á┬á Mr. Robert Mardini, ICRC Director of Operations for North America Middle East -┬á┬á┬á┬á┬á┬á┬á┬á┬á Dr. Shahabeddin Sadr, President of the Iranian Medical Council -┬á┬á┬á┬á┬á┬á┬á┬á┬á Representative of the legal department of the Ministry of Foreign Affairs of the Islamic Republic of Iran (MFA)   All keynote speakers underlined the gravity of attacking health care providers and as expressed by Dr Abolhassan Faghih, President of the Iranian Red Crescent Society, ÔÇ£attacking health care personnel and facilities is a sign that red lines have been crossed, ultimately preventing the wounded and sick from accessing health careÔÇØ. He continued by reminding the audience that this problem is close to the identity of the Red Cross and Red Crescent Movement and that, unfortunately, also its own health staff and volunteers are directly affected by this problem, as sadly experienced when the Secretary General of Syrian Arab Red Crescent recently was killed on his way back from a mission.   Speakers recalled that violence against healthcare facilities and personnel is clearly illegal under international law and it is unacceptable. Doctors, nurses, relief workers and health care personnel all across the world are performing their duties with a sacred goal, which is to maintain and improve public health, and to support those who suffer. This is an issue that requires urgent international attention.   The participants further emphasized that there is plenty of common ground for joint activities between the Red Cross Red Crescent Movement and other actors, and that this is a problem that needs to be solved by a range of concerned stakeholders with complementary efforts, competencies and perspectives. The secure delivery of health care in armed conflict and other emergencies is a goal that is of concern beyond the Red Cross Red Crescent Movement. As stated by the Dr. Sadr, President of the Iranian Medical Council, ÔÇ£public awareness should be raised to the extent which respect for the life of health care workers is highly integrated into the culture of each society and community.ÔÇØ   The representative from the Iranian MFA gave a warm welcome to the international participants to Iran and congratulated the Red Cross and Red Crescent Movement for launching this important effort to address the insecurity of health care provision in zones of armed conflict and other emergencies.   Highlights and key messages:   Dr. Shahabeddin Sadr, President of the Iranian Medical Council, proposed a series of measures towards improving the security in the delivery of health care, including: -┬á┬á┬á┬á┬á┬á┬á┬á┬á Training health care personnel to better face crisis situations in which there is a high risk of insecurity such as armed conflict -┬á┬á┬á┬á┬á┬á┬á┬á┬á Sensitize and mobilize policy makers at national and international level -┬á┬á┬á┬á┬á┬á┬á┬á┬á Mobilize public and civil entities in addressing the issue; -┬á┬á┬á┬á┬á┬á┬á┬á┬á Address the issue in legislation on national and international levels; -┬á┬á┬á┬á┬á┬á┬á┬á┬á Register the cases of attacks against medical personnel and engage in dialogue with concerned actors on these attacks. -┬á┬á┬á┬á┬á┬á┬á┬á┬á Cooperate closely with academic circles and researchers, as well as industries and technology owners in a bid to find mechanisms required for protection of medical personnel in times of crisis, in order to improve vehicles, communication devices and other logistical facilities. -┬á┬á┬á┬á┬á┬á┬á┬á┬á Train the public (even hostile groups) to make them familiar with relief and rescue organizations and their emblems, their humanitarian goals and their neutrality in times of hostility, taking into account the legal background appertaining thereto.   Mr. Robert Mardini, ICRC Head of Operations for the Near and Middle East, reminded the audience that the, ÔÇ£[ÔǪ] images we watch in the media from Syria are only small part of what is happening now in conflict-affected areas and escalating rate of casualties is warning us to take concrete action. Most incidents that in one way or another deny the right of wounded and sick to heath care go unreported. The scale of this problem is alarmingÔÇØ. -┬á┬á┬á┬á┬á┬á┬á┬á┬á ICRC data for 2012 shows that the vast majority of violent incidents ÔÇô some 90 per cent of the almost 900 recorded ÔÇô affect local healthcare workers. And of those people caught up in such incidents, around 25 per cent were killed or wounded. -┬á┬á┬á┬á┬á┬á┬á┬á┬á Beyond the impact of specific incidents, the general insecurity created by armed conflict or violence ÔÇô while hard to measure ÔÇô undoubtedly has a massive impact on the provision of healthcare. -┬á┬á┬á┬á┬á┬á┬á┬á┬á Primary responsibility for this issue lies with States and with combatants. In addition, national legislators and courts must fulfill their responsibilities of ensuring that domestic legislation recognizes the criminal responsibility of those who violate international humanitarian law, and of actually enforcing such legislations. Perpetrators of violations must be held accountable. -┬á┬á┬á┬á┬á┬á┬á┬á┬á The performance and behaviour of humanitarian organisations and health care workers themselves is also critical. Securing acceptance for their work from all communities and political and military groups is an essential prerequisite to being able to work in sensitive and volatile contexts. This requires an unequivocal demonstration of impartiality: the provision of health care based strictly on humanitarian needs, not on any other objectives. -┬á┬á┬á┬á┬á┬á┬á┬á Beyond the MovementÔÇÖs initiative to address this, the ICRC is pleased to see that others, such as Iranian Medical Council amongst many other organisations are taking steps to address this. Also, States, of their own volition, have in some cases undertaken diplomatic initiatives aimed at facilitating the delivery of healthcare in conflict-affected countries. In others ÔÇô Colombia and Yemen for example ÔÇô they have made specific pledges towards ensuring respect of healthcare structures and personnel in their own countries.                   Summary of the presentations and main issues discussed: ┬á Theme 1: The challenges for NSs credibility in delivering health care in armed conflict and other emergencies   To initiate reflections on the first theme, Mr. Ghazwan Al-Maliki, Legal Advisor of the Syrian Arab Red Crescent (SARC) shared some of SARCÔÇÖs recent experiences and challenges, reminding the audience that numerous volunteers and staff have been injured and killed while delivering health care during recent hostilities in Syria.   A key point he raised, which resonated much with all participants and which was reiterated during the following presentations, was that health care workers providing assistance during armed conflict and other emergencies need to be given special training on how to operate during these circumstances. This should include measures that contribute towards enabling access to the victims while also better protecting oneself during the operation. This would include training on how to ensure that oneÔÇÖs action is perceived as neutral and impartial; internal and external communication; use of protective gear; visual identity etc.   Furthermore, of particular interest to the audience were various points related to internal coordination and communication. Due to the volatile situation, SARC relies on various means of communication to coordinate its teams and communicate, ranging from regular landline telephones and cellular to radio communication and walky-talkies, the two latter being somewhat more reliable as land lines and cellular networks are prone to collapse. It was also stressed that there is a need to adapt to using modern technologies such as social media, news networks and GPS to inform and update decision makers, while ensuring to maintain good direct contact with communities, public authorities and others of influence on the security to triangulate and better assess the situation.   Lastly, another point causing some discussion was how SARC coordinates closely with the public health authorityÔÇÖs emergency health care services while maintaining their independent, neutral and impartial humanitarian action and being perceived as such. Although various factors contribute to managing this balance successfully, some of which were further discussed in other sessions of this workshop, the SARC experience emphasised the importance of having a clear and distinct visual identity for health care providers, their vehicles and facilities to strengthen the safe access to and delivery of health care. This visual identity must be known to all and associated purely to the delivery of neutral, impartial and independent health care services, in such a manner that it cannot be suspect or mistaken with any other purpose. In this regard, it was interestingly noted that SARCÔÇÖs ambulance services were distinct from those of the public authorities to avoid any confusion.   Theme 2: Meeting the challenges ÔÇô Operational dimensions (access and security) The keynote speaker for the second theme was Mr. Bildard Baguma, Under Secretary General of the Ugandan Red Cross. The focus of his presentation was on its national societyÔÇÖs operational challenges, categorizing them under 6 groups: access, security, perception of NS, the use of the Red Cross emblem, capacity of NSs and the role of NSs in relation to the state and the community.   Similarly to Mr. Ghazwan Al-MalikiÔÇÖs presentation, Mr. Baguma also emphasised the importance of staff and volunteers having the appropriate capacity, skills and equipment to deliver quality health care as safely as possible. In this regard, the issue of insurance for volunteers and staff generated particular interest and discussion amongst the participants. Although various practices exist from context to context, it seems that where there is insurance coverage it is sometimes insufficient, while in many other contexts insurance is not provided to the responders, highlighting the urgency of this matter.   Another issue emanating from this presentation and which was widely discussed in the various working groups was the type of personal protective equipment (PPE) of volunteers and staff. The participants had differing experiences and opinions on this. Whereas on one end of the spectrum some would argue that a clear distinct uniform that is known and respected should suffice to protect the responders, others argued that responders would benefit greatly from being equipped with personal protective equipment such as helmets, gas masks etc. Although no conclusive position was reached on this, it was evident that the nature of contexts in which NS deliver health care would need this issue to be further explored.   Mr. Baguma furthermore stressed with regards to access the importance of a sound legal base that defines the clear roles and mandate of the NS. This should permit for the NS to be part of the national contingency plans with a clearly defined role for the NS in relation to the public authorities as well as other actors. This legal base should also permit for the NS to work with other actors of influence in the field that may influence the security of their action.   However, as Mr. Baguma also recognised, the legal base is not sufficient to ensure the safe access of healthcare during an emergency. Credible action on the ground, through a broad network of trained volunteers and staff, supported by updated and relevant standard operating procedures, is crucial to ensuring the safe access to communities in need. In this regard, Mr. Baguma shared his NSÔÇÖ experience of making sure that volunteers are locally recruited and imbedded within the community, thereby building a working relationship and trust between NS and community. Acceptance by the local community can increase by having volunteers and staff assigned to work in their own localities in which the community knows them. In some contexts this could help increase the NS acceptability. It is also important to the Uganda RC that its volunteers and staff are representative of the demographics and populations groups that make up the country in order to contribute to its credibility.   These last few points were widely discussed in some of the working groups following the presentation. It was pointed out that it may in some contexts be difficult for a red cross red crescent volunteer or staff, who is part of a community directly affected by a conflict or an emergency to maintain a neutral and impartial action. To counter this risk, some argued that it was more important for the NS to ensure that its volunteers are able to act neutrally, independently and impartially, than to ensure having a representative and diversified personnel base. It was stressed that the national society has volunteers and staff that act in accordance with the principles of Humanity, Independence, Neutrality and Impartiality. Furthermore, it was also pointed out, in accordance with Mr. BagumaÔÇÖs presentation, that volunteers need the technical training to be able to offer adequate services and thereby increasing the credibility of the NS. In this regard, comprehensive and accurate training materials and methods for staff and volunteers would contribute to reducing the risk to security.   Lastly, from this discussion and presentation emerged the question as to what actions the Red Cross Red Crescent take in the event that the NS cannot access the community. Some participants pointed out that the NS should consider supporting the community capacity to respond to situations where access to healthcare is altered or hindered due to security concerns. Responding to this question it was proposed that NSÔÇÖ could consider supporting communities in basic first aid as well as basic contingency planning in the event that no healthcare provision would be able to access the community. It was further proposed that this could be considered a community based preventive measure that the NS could facilitate.   Theme three: Meeting the challenges ÔÇô advocacy and communication ┬á The Keynote speaker of this last working session was Dr. Leonard Neol Zeade, Director General of the Red Cross of the Ivory Coast. During the eight-year conflict in his country, from 2002 to 2010, the national society had tried every possible way to assist the victims by setting up mobile clinics, offering medical assistance through VHF [ICRC1]┬áand setting up medical emergency teams for intervention and evacuation.   The NS has experienced numerous challenging situations during this period while delivering healthcare services. Based on this experience the NS committed to actively sensitise the government, public authorities (parliamentarians, political party members) armed security forces and other actors that in one way or another influence the security of health care providers. The primary messages were centred on explaining the role of the national society, particularly the nature of the auxiliary role, and on its neutral, independent and impartial humanitarian action. However, as relations evolved, the NS assembled a report together with the ICRC on security incidents that had affected them. This report was discussed bilaterally with those concerned with the intent of identifying with them, measures to address these incidents.   The NS has since broadened its attention to include all healthcare provision more broadly, and not only that of the NS, by producing radio and video clips that are broadcasted on national television and radio. It has also strengthened its dialogue on the security of health care in various platforms taking advantage of its privileged position within the IHL commission where it is vice president, within disaster management mechanisms such as civil protection as well as various governmental and parliamentary working groups such as those dealing with health issues. These platforms provide excellent means of raising awareness about the insecurity of health care, discuss measures and coordinate efforts.   However, sensitisation of key stakeholders is only valuable if it is accompanied by quality services offered by staff and volunteers that act according to the Fundamental Principles as this lends credibility to the action of the NS. Towards this end, personnel need to be properly trained to deliver quality services such as First Aid techniques, on how to face various possible scenarios of insecurity as well as their responsibility in ensuring that their action is not perceived as contrary to what has been communicated.   Furthermore, it was also pointed out during the ensuing discussion that sensitising on the role of the NS as well as on key humanitarian concerns within any given context, needs to be addressed before, during as well as after a conflict and emergency. Waiting until the emergency strikes would make it more difficult to dialogue on problematic issues.   Also, as part of this discussion, it was noted how maintaining a good dialogue with authorities is essential in facilitating a campaign. However, it was also noted how this needs to be developed over time while also ensuring that the NS maintains its independence and is perceived as such in its action by the broader public and civil society at large. To the effect of the latter, it is emphasised that a successful communication campaign also needs to rely on direct communication between the NS with members and leaders of communities.       ┬á ┬á ┬á ┬á ┬á ┬á ┬á ┬á Recommendations: ┬á The workshop concluded with the adoption of recommendations constructed on the basis of three working group discussions on the three overarching workshop themes.   The recommendations are the culmination of discussions in the plenary and also stress some essential questions raised. These were categorized according to some of the main challenges that were identified during discussions of the workshop and not according to the three main themes of the workshop. Despite the categorization, it was stressed that many of the recommendations need to be considered as a whole and they interrelate in their contribution to better ensure the safe delivery of health to the wounded and sick during armed conflict and other emergencies.

1. 1.    Clear NS mandate and role in armed conflict and other emergencies

 

1. NS should make sure to regularly review and, where necessary or appropriate, adapt and update its legal basis, mandate, role, strategy and work plans. This should serve the NS as guidance in its humanitarian action during armed conflict and other emergencies as well as in its dialogue with external audiences

 

1. NS staff and volunteers have adequate awareness and knowledge through continuous training on the application of the Fundamental Principles (particular attention on Humanity, Impartiality, Neutrality and Independence); the NS legal base, mission and role; and the role of the Movement as a whole within the country. All staff should be able to act and communicate clearly on this.

 

1. Movement operational coordination should be strengthened to maximise the distinct yet complementary mandates, resources and capacities of its different components to improve the humanitarian coverage and impact.

 

1. Dissemination of the NS Fundamental Principles, role and mandate, with particular attention to the auxiliary role to public authorities, should be maintained a priority and integrated into all activities and service delivery of the NS. It was stressed that this effort needs to be a permanent activity (and not forgotten during the crisis).

 

1. Raise awareness in the communities with all stakeholders concerned on the NS mandate and mission in the country and the importance of keeping health care delivery safe.

 

1. NS should explore applying various approaches and means to sensitising all relevant stakeholders about the NS health care action, including media, journalists, community of concern (network of organisations, health care providers), social media and web-sites while being cautious of the risk that using these platforms and outlets can entail.

 

1. 2.    Red Cross, Red Crescent, Red Crystal Emblem and Identification

    ┬á

1. The NS should have internal guidelines on its use of the emblem and visual identity and enforce its application to ensure a consistent visual identity and usage of the emblem throughout NS at HQ and branch level and to increase NS recognition.

 

1. All external misuse of the emblem must be systematically addressed by the government with support from the NS in accordance with the Geneva Conventions and their Additional Protocols, existing Resolutions, rules and regulation.

 

1. National legislation must be strengthened and implemented to address misuse of the emblem used by other health care providers to identify their personnel, vehicles and sites to avoid suspicion and barriers to the medical services.

   

1. If possible, a distinctly recognizable and unified identification should be sought for health care providers that separates these from other service providers as well as the NS services.

 

1. NS should disseminate to all relevant authorities and actors of influence on the proper use of the emblem. (Emblem is a 'brand' that needs to be respected)
2. 3.    Capacity and Preparedness
3. Provisions to secure health care in armed conflict and other emergencies should be included in relevant NS planning and disaster management coordination mechanism and frameworks such as standard operating procedures (SoPs).

 

1. Ensure that NS staff and volunteers are prepared to respond adequately to the most pressing health needs arising during AC/OE. First line responders should also be adequately trained on issues that would permit safe access and acceptance such as operational security risk management, reporting and communication, dealing with media in stressful situations, stress management and anger management etc.

 

1. Contingency planning is an integral part to NS preparedness activities.

• As part of such planning, due consideration must be given to how NSÔÇÖ staff and volunteers in some contexts can be expected to meet the increasing needs arising from health care personnel leaving their posts due to personal security concerns.

 

1. NS should build capacity on risk assessment amongst its decision makers and front line responders in addition to training on security practices and guidelines.

 

1. NS should build community resilience and capacity to self-protect and respond if and when others cannot reach the community, enabling them to access basic health care (i.e. Community Based Health First Aid) during the period when others cannot reach them.

 

1. Appropriate insurance to NS first responders during armed conflicts and other emergencies needs to be explored.

 

1. Explore further how to best strike a balance between the need to, on the one hand, ensure the security of NS staff and volunteers and, on the other hand, to save lives in a crisis situation. In this regard the following issues caused a great degree of discussion and would need further exploration:

• How to make qualified security assessments as to whether to respond immediately to emergency needs resulting from a bomb explosion when it has been observed in some contexts that there is a high risk of a second bomb set off to target the responders coming to assist the victims of the first?
• What are the most suitable approaches available for decision makers to managing the security of volunteers and staff during an emergency: security guidelines, security rules or flexible risk assessment tools?
• The pros and cons regarding the use of personal protective equipment in terms of offering real improved security versus a false sense of increased security?

1. 4.    Security and Access (Perception and Acceptance)
2. Maintain a visual identity/identification (uniforms, vehicle colours, sites, etc.) and avoid changing this in times of crisis. Develop a visual distinctive identity from government and other health and humanitarian actors, while bearing in mind existing rules and regulations on the Emblem. (i.e. PRCS, MDA, other NS experiences)

 

1. Communication activities raise acceptance and increase access by building on NS action and operational priorities and what it realistically can deliver. Tell the "good stories"

 

1. NS reputation should focus on the NS as an institution and not the individual persons within it, as individuals may to a greater degree be associated to one side or another during in politically sensitive situations and issues than a principled neutral, independent and impartial action of the NS.

 

1. All health care workers are expected to offer health care services impartially even if they are not neutral in a conflict. This might be difficult as lacking in neutrality may raise suspicion and create a perception that the healthcare provider wonÔÇÖt act impartially.

 

1. NS identify key media spokes-persons who can actively engage the media in promoting the NS activities and telling the good stories.

 

1. Enable and facilitate first responders with the necessary context specific communication tools and strategies to build trust and credibility with communities and key stakeholders with influence on the security of health care provision.

 

1. NS volunteers and staff should reach out to community leaders, opinion leaders, persons of influence to raise awareness about NS activities and meet personally with opinion leaders, politicians, and community leaders.

 

1. Assess the pros and cons about building NS acceptance by pursuing a policy of community diversity and representation amongst personnel.
2. 5.    Communication and Advocacy on Health Care in Danger

Federation and Movement wide:

1. The HCiD campaign should develop into a truly Movement approach:
   1.                   i.    The HCiD communication campaign should tap into existing IFRC experiences and tools developed to support NS communication, campaigning and advocacy. (An example of this is the behavioural change communication framework designed specifically for health care.)
   2.                  ii.    The campaign should explore opportunities to learn from previous campaigns such as the H1N1 sample kit which NS expressed were very adaptable to their purposes.
   3.                 iii.    NS should be engaged in the design of communication kit and not have it imposed from Geneva. The ICRC must take into consideration existing tools used by NS to communicate/campaign as well as their broader experience, means and networks of communication in the HCiD campaign.
   4.                iv.    The campaign effort at NS level should build on the credibility of NS health activities such as recruitment of voluntary blood donors, first aid activities and work with other vulnerable groups.

 

1. The HCiD project should strengthen coordination with the IFRC networks with the health community amongst others, to mobilise a global community of concern.

 

1. Strengthen sharing of information, reporting and documentation as well as challenges and case studies from NS to be used beyond Movement components.

  Other:  

1. NS and ICRC should explore the possibility to establish a HCiD national multi-stakeholder coordination and communication mechanism that is inclusive of the main relevant stakeholders:
   1.                   i.    This could include MoH, potentially political actors, armed forces, international agencies, ministries, health related NGOs, national medical associations, private doctors and medical staff. The roles of each actor should be clear.
   2.                  ii.    Issues to be considered raised in such a mechanism are:
      1. Ensure the safe treatment of patients according to medical ethics
      2. Security of health care providers
      3. Confidentiality of patients data

 

1. NS should promote and use the publication ÔÇ£Health Care in Danger: the responsibilities of health health-care personnel working in armed conflict and other emergenciesÔÇØ when in dialogue with MoH and their health care organisations.

 

1. The advocacy strategy should be guided by evidence of the humanitarian problem, the core problem clearly identified, detailed plans formulated with a clearly stated goal, targeting specific audiences with specific messages and various approaches.
   1.                   i.    Tips: keep messages simple and goal focussed; Coordinated approach at global and national level with external organisations; Maximise movement fora; Draw attention to the campaign by connecting it to relevant local context such as the increase in attacks against health care personnel in western countries even if they are not experiencing armed conflict or other emergencies. Another example is from Norway during the terrorist attack of 22^nd of July 2011 when police prevented health personnel from accessing site due to security concerns.

   

1. It is important to note that the Health Care in Danger project goes beyond the activities of the Movement and looks at all health activities in Armed Conflict and other emergencies. The Movement components must therefore not focus only on its own activities but consider how it can support the health care delivery of other health care providers in armed conflicts and other emergencies and include their concerns.

 

1. Mainstreaming of Health Care in Danger key messages into all NS programmes and activities to maximise the outreach.

 

1. NS should aim to have a centralised coordination structure for communication that could include a focal point for operational communication and IHL dissemination.