The horror of the bombing of Kunduz Hospital is well documented and condemned both in Afghanistan and internationally. The loss of 24 health workers/staff of the Kunduz Hospital as well as the patients (Katherine Lackey, USA Today. October 08, 2015) is truly shocking and against all the (however tenuous) rules of engagement.
These rules have shifted over the past 20+ years greatly. In the 1990s aid organizations could travel and work in sensitive and insecure areas with respect to the organizational flags they flew. To be sure this did not 100% prevent some attacks by insurgents, however by and large this guaranteed safety. I remember a case in Cambodia where an NGO vehicle was shot at by Khmer Rouge (no one was injured). However that night the NGO team leader received a message from the Khmer Rouge local commander apologising and requesting that they made the logos on their vehicles larger so they were more easily identified! These days flying a UN or ICRC flag is almost an invitation to be attacked.
The rules of engagement have changed militarily with more sophisticated weaponry so that combat can be conducted more remotely. With this so called smart weaponry and GPS technology, (coordinates which MSF had provided), why then was the hospital targeted.? The old painting of hospital symbols on the roof of the health facility is long gone. It is sad that despite all the “smart technology” and communications that this should happen.
What then are the implications for staffing of health facilities in conflict and insecure zones both in Afghanistan and internationally?
In Afghanistan, much work has been undertaken since 2002 to increase the quantity and quality of the health workforce and their deployment. A system of contracting out health service delivery to NGOs has been supported by donor agencies including the USA. It is therefore a tragedy that what is being given with one hand is being destroyed by the other hand. Salaries are low in Afghanistan and the major preoccupation of the majority of health workers is survival for their families. There is great difficulty in getting health workers to work in remote and insecure areas and, if their safety cannot now be guaranteed, this exacerbates the problems of health service provision to communities in these areas. The majority of casualties of the conflict and insecurity are civilians and these civilians are now being deprived of what little services they had already. in addition it will be increasingly difficult to get health workers to work in health facilities in similarly insecure areas.
Internationally, There are an increasing number of countries experiencing conflict and insecurity. The international media ensures that everyone is aware of what is happening in every country within minutes or hours of its occurrence. The bombing of Kunduz Hospital has sent out a clear message to health workers internationally……..there is nowhere you are safe, or your work respected.
There will be investigations into the happening and apologies made, however, what does that matter to the health workers and their families……the writing is on the wall…….you can never be safe.
There are no winners in this situation, only losers – the heath workers and above all the communities that require their services. Whilst the prevailing approaches to Human Resources Development continues to regard the health workers as pawns on a chessboard and NOT as qualified professionals who have choices, efforts to address staffing in conflict and fragile environments will fail.
First Published in October 10, 2015
